TEST

4 The Client with Respiratory Health Problems

■ The Client with an Upper Respiratory Tract Infection
■ The Client Undergoing Nasal Surgery
■ The Client with Cancer of the Larynx
■ The Client with Pneumonia
■ The Client with Tuberculosis
■ The Client with Chronic Obstructive Pulmonary Disease
■ The Client with Asthma
■ The Client with Lung Cancer
■ The Client with Chest Trauma
■ The Client with Acute Respiratory Distress Syndrome
■ Managing Care Quality and Safety
■ Answers, Rationales, and Test Taking Strategies

The Client with an Upper Respiratory 3. A client with allergic rhinitis is instructed on
Tract Infection the correct technique for using an intranasal inhaler.
Which of the following statements would demon-
1. A nurse is completing the health history for strate to the nurse that the client understands the
a client who has been taking echinacea for a head instructions?
cold. The client asks, “Why isn’t this helping me ■ 1. “I should limit the use of the inhaler to early
feel better?” Which of the following responses by morning and bedtime use.”
the nurse would be the most accurate? ■ 2. “It is important to not shake the canister
■ 1. “There is limited information as to the effec- because that can damage the spray device.”
tiveness of herbal products.” ■ 3. “I should hold one nostril closed while I
■ 2. “Antibiotics are the agents needed to treat a insert the spray into the other nostril.”
head cold.” ■ 4. “The inhaler tip is inserted into the nostril
■ 3. “The head cold should be gone within the and pointed toward the inside nostril wall.”
month.” 4. Which of the following would be an expected
■ 4. “Combining herbal products with prescrip- outcome for a client recovering from an upper respi-
tion antiviral medications is sure to help ratory tract infection? The client will:
you.” ■ 1. Maintain a fluid intake of 800 mL every
2. A nurse is teaching a client about taking 24 hours.
antihistamines. Which of the following instruc- ■ 2. Experience chills only once a day.
tions should the nurse include in the teaching plan? ■ 3. Cough productively without chest discomfort.
Select all that apply. ■ 4. Experience less nasal obstruction and discharge.
■ 1. Operating machinery and driving may be 5. The nurse teaches the client how to instill
dangerous while taking antihistamines. nose drops. Which of the following techniques is
■ 2. Continue taking antihistamines even if nasal correct?
infection develops. ■ 1. The client uses sterile technique when han-
■ 3. The effect of antihistamines is not felt until a dling the dropper.
day later. ■ 2. The client blows the nose gently before
■ 4. Do not use alcohol with antihistamines. instilling drops.
■ 5. Increase fluid intake to 2,000 mL/day. ■ 3. The client uses a new dropper for each instil-
lation.
■ 4. The client sits in a semi-Fowler’s position
with the head tilted forward after administra-
tion of the drops.

396
 The Client with Respiratory Health Problems 397

6. The nurse should include which of the fol- 12. A client who has undergone outpatient nasal
lowing instructions in the teaching plan for a client surgery is ready for discharge and has nasal packing
with chronic sinusitis? in place. Which of the following discharge instruc-
■ 1. Avoid the use of caffeinated beverages. tions would be appropriate for the client?
■ 2. Perform postural drainage every day. ■ 1. Avoid activities that elicit the Valsalva
■ 3. Take hot showers twice daily. maneuver.
■ 4. Report a temperature of 102° F (38.9° C) or ■ 2. Take aspirin to control nasal discomfort.
higher. ■ 3. Avoid brushing the teeth until the nasal pack-
ing is removed.
7. A client with allergic rhinitis asks the nurse ■ 4. Apply heat to the nasal area to control swelling.
what he should do to decrease his symptoms. Which
of the following instructions would be appropriate 13. Which of the following statements should indi-
for the nurse to give the client? cate to the nurse that a client has understood the dis-
■ 1. “Use your nasal decongestant spray regularly charge instructions provided after her nasal surgery?
to help clear your nasal passages.” ■ 1. “I should not shower until my packing is
■ 2. “Ask the doctor for antibiotics. Antibiotics removed.”
will help decrease the secretion.” ■ 2. “I will take stool softeners and modify my
■ 3. “It is important to increase your activity. A diet to prevent constipation.”
daily brisk walk will help promote drainage.” ■ 3. “Coughing every 2 hours is important to pre-
■ 4. “Keep a diary of when your symptoms occur. vent respiratory complications.”
This can help you identify what precipitates ■ 4. “It is important to blow my nose each day to
your attacks.” remove the dried secretions.”
8. Guaifenesin (Robitussin) 300 mg four times a 14. The nurse is planning to give preoperative
day has been ordered as an expectorant. The dosage instructions to a client who will be undergoing
strength of the liquid is 200 mg/5 mL. How many rhinoplasty. Which of the following instructions
milliliters should the nurse administer for each should be included?
dose? ■ 1. After surgery, nasal packing will be in place
for 7 to 10 days.
_____________________ mL. ■ 2. Normal saline nose drops will need to be
9. Pseudoephedrine (Sudafed) has been ordered administered preoperatively.
as a nasal decongestant. Which of the following is a ■ 3. The results of the surgery will be immediately
possible adverse effect of this drug? obvious postoperatively.
■ 1. Constipation. ■ 4. Aspirin-containing medications should not be
■ 2. Bradycardia. taken for 2 weeks before surgery.
■ 3. Diplopia.
■ 4. Restlessness.
15. Which of the following assessments should
be a priority immediately after nasal surgery?
■ 1. Assessing the client’s pain.
■ 2. Inspecting for periorbital ecchymosis.
The Client Undergoing Nasal Surgery ■ 3. Assessing respiratory status.
■ 4. Measuring intake and output.
10. A health care provider has just inserted nasal
packing for a client with epistaxis. The client is tak- 16. After nasal surgery, the client expresses con-
ing ramipril (Altace) for hypertension. What should cern about how to decrease facial pain and swelling
the nurse instruct the client to do? while recovering at home. Which of the following
■ 1. Use 81 mg of aspirin daily for relief of dis- discharge instructions would be most effective for
comfort. decreasing pain and edema?
■ 2. Omit the next dose of ramipril (Altace). ■ 1. Take analgesics every 4 hours around the
■ 3. Remove the packing if there is difficulty swal- clock.
lowing. ■ 2. Use corticosteroid nasal spray as needed to
■ 4. Avoid rigorous aerobic exercise. control symptoms.
■ 3. Use a bedside humidifier while sleeping.
11. A 27-year-old female has had elective nasal ■ 4. Apply cold compresses to the area.
surgery for a deviated septum. Which of the follow-
ing would indicate thaat bleeding was occurring 17. A client is being discharged with nasal pack-
even if the nasal drip pad remained dry and intact? ing in place. The nurse should instruct the client to:
■ 1. Nausea. ■ 1. Perform frequent mouth care.
■ 2. Repeated swallowing. ■ 2. Use normal saline nose drops daily.
■ 3. Increased respiratory rate. ■ 3. Sneeze and cough with mouth closed.
■ 4. Increased pain. ■ 4. Gargle every 4 hours with salt water.

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 398 The Nursing Care of Adults with Medical and Surgical Health Problems

18. Which of the following activities should 23. The nurse is suctioning a client who had a
the nurse teach the client to implement after the laryngectomy. What is the maximum amount of time
removal of nasal packing on the second postopera- the nurse should suction the client?
tive day? ■ 1. 10 seconds.
■ 1. Avoid cleaning the nares until swelling has ■ 2. 15 seconds.
subsided. ■ 3. 25 seconds.
■ 2. Apply water-soluble jelly to lubricate the ■ 4. 30 seconds.
nares.
■ 3. Keep a nasal drip pad in place to absorb
24. When suctioning a tracheostomy or larynge-
ctomy tube, the nurse should follow which of the
secretions.
following procedures?
■ 4. Use a bulb syringe to gently irrigate nares.
■ 1. Use a sterile catheter each time the client is
19. The nurse is teaching a client how to manage suctioned.
a nosebleed. Which of the following instructions ■ 2. Clean the catheter in sterile water after each
would be appropriate to give the client? use and reuse for no longer than 8 hours.
■ 1. “Tilt your head backward and pinch your ■ 3. Protect the catheter in sterile packaging
nose.” between suctioning episodes.
■ 2. “Lie down flat and place an ice compress over ■ 4. Use a clean catheter with each suctioning, and
the bridge of the nose.” disinfect it in hydrogen peroxide between uses.
■ 3. “Blow your nose gently with your neck
flexed.”
25. The client with a laryngectomy communi-
cates to the nurse that he does not want his family
■ 4. “Sit down, lean forward, and pinch the soft
to see him. He indicates that he thinks the opening
portion of your nose.”
in his throat is disgusting. Which of the following
20. An elderly client had posterior packing nursing diagnoses would be most appropriate?
inserted to control a severe nosebleed. After inser- ■ 1. Deficient knowledge about the care of a stoma.
tion of the packing, the client should be closely ■ 2. Disturbed personal identity related to change
monitored for which of the following complica- in appearance.
tions? ■ 3. Disturbed body image related to neck surgery.
■ 1. Vertigo. ■ 4. Hopelessness related to irreversible changes
■ 2. Bell’s palsy. in body functioning.
■ 3. Hypoventilation.
■ 4. Loss of gag reflex.
26. What areas of education should the nurse
provide employees in a factory making products
that cause respiratory irritation to reduce the risk of
laryngeal cancer? Select all that apply.
The Client with Cancer ■ 1. Smoking cessation concurrent with counsel-
of the Larynx ing.
■ 2. HEPA filter use in the home.
21. Postoperative nursing management of the cli- ■ 3. Limiting alcohol use.
ent following a radical neck dissection for laryngeal ■ 4. Brushing teeth after every meal.
cancer requires: ■ 5. Raising the voice to be heard over the noise in
■ 1. Complete bed rest minimizing head the factory.
movement.
■ 2. Vital signs once a shift.
27. A client has had hoarseness for more than
2 weeks. The nurse should:
■ 3. Clear liquid diet started at 48 hours.
■ 1. Refer to a health care provider for a prescrip-
■ 4. Frequent suctioning of the laryngectomy tube.
tion for an antibiotic.
22. A client who has had a total laryngectomy ■ 2. Instruct the client to gargle with salt water at
appears withdrawn and depressed. He keeps the home.
curtain drawn, refuses visitors, and indicates a ■ 3. Assess the client for dysphagia.
desire to be left alone. Which nursing intervention ■ 4. Instruct the client to take a throat analgesic.
would most likely be therapeutic for the client?
■ 1. Discussing his behavior with his wife to
28. A client has just returned from the postan-
esthesia care unit after undergoing a laryngectomy.
determine the cause.
Which of the following interventions should the
■ 2. Exploring his future plans.
nurse include in the plan of care?
■ 3. Respecting his need for privacy.
■ 1. Maintain the head of the bed at 30 to 40 degrees.
■ 4. Encouraging him to express his feelings non-
■ 2. Teach the client how to use esophageal speech.
verbally and in writing.
■ 3. Initiate small feedings of soft foods.
■ 4. Irrigate drainage tubes as needed.

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 The Client with Respiratory Health Problems 399

29. Which of the following is an appropriate The Client with Pneumonia

expected outcome for a client recovering from a
total laryngectomy? The client will: 32. A nurse notes that a client has kyphosis and
■ 1. Regain the ability to taste and smell food. generalized muscle atrophy. Which of the following
■ 2. Demonstrate appropriate care of the gastros- problems is a priority when the nurse develops a
tomy tube. nursing plan of care?
■ 3. Communicate feelings about body image ■ 1. Infection.
changes. ■ 2. Confusion.
■ 4. Demonstrate sterile suctioning technique for ■ 3. Ineffective coughing and deep breathing.
stoma care. ■ 4. Difficulty chewing solid foods.
30. Which of the following home care instruc- 33. A client with deep vein thrombosis suddenly
tions would be appropriate for a client with a laryn- develops dyspnea, tachypnea, and chest discomfort.
gectomy? What should the nurse do first?
■ 1. Perform mouth care every morning and eve- ■ 1. Elevate the head of the bed 30 to 45 degrees.
ning. ■ 2. Encourage the client to cough and deep
■ 2. Provide adequate humidity in the home. breathe.
■ 3. Maintain a soft, bland diet. ■ 3. Auscultate the lungs to detect abnormal
■ 4. Limit physical activity to shoulder and neck breath sounds.
exercises. ■ 4. Contact the physician.
31. The nurse has reported to the hospital to 34. A 79-year-old female client is admitted to the
work the evening shift on a respiratory unit. The hospital with a diagnosis of bacterial pneumonia.
nurse’s assignment consists of four clients. Priori- While obtaining the client’s health history, the nurse
tize in order from highest to lowest priority how the learns that the client has osteoarthritis, follows a
nurse would assess the clients after receiving report. vegetarian diet, and is very concerned with cleanli-
ness. Which of the following would most likely be a
1. An 85-year-old client with bacterial pneumo- predisposing factor for the diagnosis of pneumonia?
nia, temperature of 102.2° F (42° C), and short- ■ 1. Age.
ness of breath. ■ 2. Osteoarthritis.
■ 3. Vegetarian diet.
2. A 60-year-old client with chest tubes who is ■ 4. Daily bathing.
2 days postoperative following a thoracotomy 35. Which of the following is significant data to
for lung cancer and is requesting something gather from a client who has been diagnosed with
for pain. pneumonia? Select all that apply.
■ 1. Quality of breath sounds.
3. A 35-year-old client with suspected tuberculo- ■ 2. Presence of bowel sounds.
sis who is complaining of a cough. ■ 3. Occurence of chest pain.
■ 4. Amount of peripheral edema.
4. A 56-year-old client with emphysema who has ■ 5. Color of nail beds.
a scheduled dose of a bronchodilator due to be 36. A client with bacterial pneumonia is to be
administered, with no report of acute respira- started on I.V. antibiotics. Which of the following
tory distress. diagnostic tests must be completed before antibiotic
therapy begins?
■ 1. Urinalysis.
■ 2. Sputum culture.
■ 3. Chest radiograph.
■ 4. Red blood cell count.
37. When caring for the client who is receiv-
ing an aminoglycoside antibiotic, the nurse should
monitor which of the following laboratory values?
■ 1. Serum sodium.
■ 2. Serum potassium.
■ 3. Serum creatinine.
■ 4. Serum calcium.

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 400 The Nursing Care of Adults with Medical and Surgical Health Problems

38. A client with pneumonia has a temperature 45. The client with pneumonia develops mild
of 102.6° F (39.2° C), is diaphoretic, and has a pro- constipation, and the nurse administers docusate
ductive cough. The nurse should include which of sodium (Colace) as ordered. This drug works by:
the following measures in the plan of care? ■ 1. Softening the stool.
■ 1. Position changes every 4 hours. ■ 2. Lubricating the stool.
■ 2. Nasotracheal suctioning to clear secretions. ■ 3. Increasing stool bulk.
■ 3. Frequent linen changes. ■ 4. Stimulating peristalsis.
■ 4. Frequent offering of a bedpan.
46. The unliscensed assistive personnel (UAP)
39. Bed rest is prescribed for a client with pneu- reports to the registered nurse that a client admit-
monia during the acute phase of the illness. The ted with pneumonia is very diaphoretic. The
nurse should determine the effectiveness of bed rest nurse reviews the following vital signs in the chart
by assessing the client’s: obtained by the UAP. The nurse should:
■ 1. Decreased cellular demand for oxygen.
■ 2. Reduced episodes of coughing.
■ 3. Diminished pain when breathing deeply. Vital Signs
■ 4. Ability to expectorate secretions more easily.
Time 8 AM 10 AM 12 PM
40. The cyanosis that accompanies bacterial
pneumonia is primarily caused by which of the fol- Temperature 38.3° C 38.8° C
lowing? Pulse 90 104 118
■ 1. Decreased cardiac output. Respirations 16 18 24
■ 2. Pleural effusion.
Blood 112/74 110/68 116/78
■ 3. Inadequate peripheral circulation. Pressure
■ 4. Decreased oxygenation of the blood.
Spo2 93% 92% 92%
41. A client with pneumonia is experiencing
pleuritic chest pain. The nurse should assess the cli-
ent for:
■ 1. A mild but constant aching in the chest. ■ 1. Maintain complete bed rest.
■ 2. Severe midsternal pain. ■ 2. Check the urine output.
■ 3. Moderate pain that worsens on inspiration. ■ 3. Ask the UAP to change the linens.
■ 4. Muscle spasm pain that accompanies cough- ■ 4. Administer a beta blocker.
ing.
47. Which of the following is an expected out-
42. Which of the following measures would most come for an elderly client following treatment for
likely be successful in reducing pleuritic chest pain bacterial pneumonia?
in a client with pneumonia? ■ 1. A respiratory rate of 25 to 30 breaths/minute.
■ 1. Encourage the client to breathe shallowly. ■ 2. The ability to perform activities of daily liv-
■ 2. Have the client practice abdominal breathing. ing without dyspnea.
■ 3. Offer the client incentive spirometry. ■ 3. A maximum loss of 5 to 10 lb of body weight.
■ 4. Teach the client to splint the rib cage when ■ 4. Chest pain that is minimized by splinting the
coughing. rib cage.
43. The nurse administers two 325 mg aspirin
every 4 hours to a client with pneumonia. The nurse
should evaluate the outcome of administering the The Client with Tuberculosis
drug by assessing which of the following? Select all
that apply. 48. Which of the following symptoms is common
■ 1. Decreased pain when breathing. in clients with active tuberculosis?
■ 2. Prolonged clotting time. ■ 1. Weight loss.
■ 3. Decreased temperature. ■ 2. Increased appetite.
■ 4. Decreased respiratory rate. ■ 3. Dyspnea on exertion.
■ 5. Increased ability to expectorate secretions. ■ 4. Mental status changes.

44. Which of the following mental status changes 49. A client is receiving streptomycin in the
may occur when a client with pneumonia is first treatment regimen of tuberculosis. The nurse should
experiencing hypoxia? assess for:
■ 1. Coma. ■ 1. Decreased serum creatinine.
■ 2. Apathy. ■ 2. Difficulty swallowing.
■ 3. Irritability. ■ 3. Hearing loss.
■ 4. Depression. ■ 4. I.V. infiltration.

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 The Client with Respiratory Health Problems 401

50. A client is receiving streptomycin for the 55. Which of the following techniques for admin-
treatment of tuberculosis. The nurse should assess istering the Mantoux test is correct?
the client for eighth cranial nerve damage by observ- ■ 1. Hold the needle and syringe almost parallel
ing the client for: to the client’s skin.
■ 1. Vertigo. ■ 2. Pinch the skin when inserting the needle.
■ 2. Facial paralysis. ■ 3. Aspirate before injecting the medication.
■ 3. Impaired vision. ■ 4. Massage the site after injecting the medica-
■ 4. Difficulty swallowing. tion.
51. The nurse should teach clients that the most 56. Which of the following family members
common route of transmitting tubercle bacilli from exposed to tuberculosis would be at highest risk for
person to person is through contaminated: contracting the disease?
■ 1. Dust particles. ■ 1. 45-year-old mother.
■ 2. Droplet nuclei. ■ 2. 17-year-old daughter.
■ 3. Water. ■ 3. 8-year-old son.
■ 4. Eating utensils. ■ 4. 76-year-old grandmother.
52. What is the rationale that supports multidrug 57. The nurse is teaching a client who has been
treatment for clients with tuberculosis? diagnosed with tuberculosis how to avoid spreading
■ 1. Multiple drugs potentiate the drugs’ actions. the disease to family members. Which statement(s)
■ 2. Multiple drugs reduce undesirable drug by the client indicate(s) that he has understood the
adverse effects. nurse’s instructions? Select all that apply.
■ 3. Multiple drugs allow reduced drug dosages to ■ 1. “I will need to dispose of my old clothing
be given. when I return home.”
■ 4. Multiple drugs reduce development of resis- ■ 2. “I should always cover my mouth and nose
tant strains of the bacteria. when sneezing.”
■ 3. “It is important that I isolate myself from fam-
53. The client with tuberculosis is to be dis- ily when possible.”
charged home with community health nursing
■ 4. “I should use paper tissues to cough in and
follow-up. Of the following nursing interventions,
dispose of them promptly.”
which should have the highest priority?
■ 5. “I can use regular plates and utensils when-
■ 1. Offering the client emotional support.
ever I eat.”
■ 2. Teaching the client about the disease and its
treatment. 58. A client has a positive reaction to the Man-
■ 3. Coordinating various agency services. toux test. The nurse correctly interprets this reaction
■ 4. Assessing the client’s environment for sanita- to mean that the client has:
tion. ■ 1. Active tuberculosis.
■ 2. Had contact with Mycobacterium tuberculo-
54. The nurse is reading the results of a tubercu- sis.
lin skin test (see figure). The nurse should interpret
■ 3. Developed a resistance to tubercle bacilli.
the results as:
■ 4. Developed passive immunity to tuberculosis.
■ 1. Negative.
■ 2. Needing to be repeated. 59. A client with tuberculosis is taking Isoniazid
■ 3. Positive. (INH). To help prevent development of peripheral
■ 4. False. neuropathies, the nurse should instruct the client to:
■ 1. Adhere to a low-cholesterol diet.
■ 2. Supplement the diet with pyridoxine
(vitamin B6).
■ 3. Get extra rest.
■ 4. Avoid excessive sun exposure.
60. The nurse should caution sexually active
female clients taking isoniazid (INH) that the drug
has which of the following effects?
■ 1. Increases the risk of vaginal infection.
■ 2. Has mutagenic effects on ova.
■ 3. Decreases the effectiveness of hormonal con-
traceptives.
■ 4. Inhibits ovulation.

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 402 The Nursing Care of Adults with Medical and Surgical Health Problems

61. Clients who have had active tuberculosis are The Client with Chronic Obstructive
at risk for recurrence. Which of the following condi- Pulmonary Disease
tions increases that risk?
■ 1. Cool and damp weather. 66. The nurse is instructing a client with COPD
■ 2. Active exercise and exertion. how to do pursed-lip breathing. In which order
■ 3. Physical and emotional stress. should the nurse explain the steps to the client?
■ 4. Rest and inactivity. ■ 1. “Breathe in normally through your nose for
62. In which areas of the United States is the 2 counts (while counting to yourself, one,
incidence of tuberculosis highest? two).”
■ 1. Rural farming areas. ■ 2. “Relax your neck and shoulder muscles.”
■ 2. Inner-city areas. ■ 3. “Pucker your lips as if you were going to
■ 3. Areas where clean water standards are low. whistle.”
■ 4. Suburban areas with significant industrial ■ 4. “Breathe out slowly through pursed lips for
pollution. 4 counts (while counting to yourself, one,
two, three, four).”
63. The nurse should include which of the
following instructions when developing a teaching 67. The nurse reviews an arterial blood gas
plan for a client who is receiving isoniazid report for a client with chronic obstructive pulmo-
and rifampin (Rifamate) for treatment of nary disease (COPD).
tuberculosis? pH 7.35; PC02 62; PO2 70; HCO3 34
■ 1. Take the medication with antacids. The nurse should:
■ 2. Double the dosage if a drug dose is missed. ■ 1. Apply a 100% non-rebreather mask.
■ 3. Increase intake of dairy products. ■ 2. Assess the vital signs.
■ 4. Limit alcohol intake. ■ 3. Reposition the client.
■ 4. Prepare for intubation.
64. A client who has been diagnosed with
tuberculosis has been placed on drug therapy. The 68. When developing a discharge plan to manage
medication regimen includes rifampin (Rifadin). the care of a client with chronic obstructive pulmo-
Which of the following instructions should the nary disease (COPD), the nurse should advise the
nurse include in the client’s teaching plan related to the client to expect to:
the potential adverse effects of rifampin? Select all ■ 1. Develop respiratory infections easily.
that apply. ■ 2. Maintain current status.
■ 1. Having eye examinations every 6 months. ■ 3. Require less supplemental oxygen.
■ 2. Maintaining follow-up monitoring of liver ■ 4. Show permanent improvement.
enzymes. 69. Which of the following indicates that the
■ 3. Decreasing protein intake in the diet. client with chronic obstructive pulmonary disease
■ 4. Avoiding alcohol intake. (COPD) who has been discharged to home under-
■ 5. The urine may have an orange color. stands his care plan?
65. The nurse is providing follow-up care to a ■ 1. The client promises to do pursed-lip breath-
client with tuberculosis who does not regularly take ing at home.
his medication. Which nursing action would be ■ 2. The client states actions to reduce pain.
most appropriate for this client? ■ 3. The client says that he will use oxygen via a
■ 1. Ask the client’s spouse to supervise the daily nasal cannula at 5 L/minute.
administration of the medications. ■ 4. The client agrees to call the physician if dysp-
■ 2. Visit the client weekly to ask him whether he nea on exertion increases.
is taking his medications regularly. 70. Which of the following physical assessment
■ 3. Notify the physician of the client’s findings are normal for a client with advanced
noncompliance and request a different chronic obstructive pulmonary disease (COPD)?
prescription. ■ 1. Increased anteroposterior chest diameter.
■ 4. Remind the client that tuberculosis can be ■ 2. Underdeveloped neck muscles.
fatal if it is not treated promptly. ■ 3. Collapsed neck veins.
■ 4. Increased chest excursions with respiration.

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 The Client with Respiratory Health Problems 403

71. When instructing clients on how to decrease 78. The nurse assesses the respiratory status
the risk of chronic obstructive pulmonary disease of a client who is experiencing an exacerbation
(COPD), the nurse should emphasize which of the of chronic obstructive pulmonary disease (COPD)
following? secondary to an upper respiratory tract infection.
■ 1. Participate regularly in aerobic exercises. Which of the following findings would be expected?
■ 2. Maintain a high-protein diet. ■ 1. Normal breath sounds.
■ 3. Avoid exposure to people with known respi- ■ 2. Prolonged inspiration.
ratory infections. ■ 3. Normal chest movement.
■ 4. Abstain from cigarette smoking. ■ 4. Coarse crackles and rhonchi.
72. Which of the following is an expected 79. A client with chronic obstructive pulmonary
outcome of pursed-lip breathing for clients with disease (COPD) is experiencing dyspnea and has a
emphysema? low PaO2 level. The nurse plans to administer oxy-
■ 1. To promote oxygen intake. gen as ordered. Which of the following statements
■ 2. To strengthen the diaphragm. is true concerning oxygen administration to a client
■ 3. To strengthen the intercostal muscles. with COPD?
■ 4. To promote carbon dioxide elimination. ■ 1. High oxygen concentrations will cause cough-
ing and dyspnea.
73. Which of the following is a priority goal for ■ 2. High oxygen concentrations may inhibit the
the client with chronic obstructive pulmonary dis-
hypoxic stimulus to breathe.
ease (COPD)?
■ 3. Increased oxygen use will cause the client to
■ 1. Maintaining functional ability.
become dependent on the oxygen.
■ 2. Minimizing chest pain.
■ 4. Administration of oxygen is contraindicated
■ 3. Increasing carbon dioxide levels in the blood.
in clients who are using bronchodilators.
■ 4. Treating infectious agents.
74. A client’s arterial blood gas values are as fol- 80. Which of the following diets would be most
appropriate for a client with chronic obstructive
lows: pH, 7.31; PaO2, 80 mm Hg; PaCO2, 65 mm Hg;
pulmonary disease (COPD)?
HCO3−, 36 mEq/L. The nurse should assess the client
■ 1. Low-fat, low-cholesterol diet.
for?
■ 2. Bland, soft diet.
■ 1. Cyanosis.
■ 3. Low-sodium diet.
■ 2. Flushed skin.
■ 4. High-calorie, high-protein diet.
■ 3. Irritability.
■ 4. Anxiety. 81. The nurse administers theophylline (Theo-
Dur) to a client. To evaluate the effectiveness of this
75. When performing postural drainage, which medication, which of the following drug actions
of the following factors promotes the movement of
should the nurse anticipate?
secretions from the lower to the upper respiratory
■ 1. Suppression of the client’s respiratory infec-
tract?
tion.
■ 1. Friction between the cilia.
■ 2. Decrease in bronchial secretions.
■ 2. Force of gravity.
■ 3. Relaxation of bronchial smooth muscle.
■ 3. Sweeping motion of cilia.
■ 4. Thinning of tenacious, purulent sputum.
■ 4. Involuntary muscle contractions.
76. When teaching a client with chronic obstruc- 82. The nurse is planning to teach a client with
chronic obstructive pulmonary disease how to
tive pulmonary disease to conserve energy, the
cough effectively. Which of the following instruc-
nurse should teach the client to lift objects:
tions should be included?
■ 1. While inhaling through an open mouth.
■ 1. Take a deep abdominal breath, bend forward,
■ 2. While exhaling through pursed lips.
and cough three or four times on exhalation.
■ 3. After exhaling but before inhaling.
■ 2. Lie flat on the back, splint the thorax, take
■ 4. While taking a deep breath and holding it.
two deep breaths, and cough.
77. The nurse teaches a client with chronic ■ 3. Take several rapid, shallow breaths and then
obstructive pulmonary disease (COPD) to assess cough forcefully.
for signs and symptoms of right-sided heart failure. ■ 4. Assume a side-lying position, extend the arm
Which of the following signs and symptoms should over the head, and alternate deep breathing
be included in the teaching plan? with coughing.
■ 1. Clubbing of nail beds.
■ 2. Hypertension.
■ 3. Peripheral edema.
■ 4. Increased appetite.

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 404 The Nursing Care of Adults with Medical and Surgical Health Problems

The Client with Asthma 88. A client is prescribed metaproterenol (Alu-

pent) via a metered-dose inhaler, two puffs every
83. A client uses a metered-dose inhaler (MDI) to 4 hours. The nurse instructs the client to report
aid in management of his asthma. Which action by adverse effects. Which of the following are potential
the client indicates to the nurse that he needs further adverse effects of metaproterenol?
instruction regarding its use? Select all that apply. ■ 1. Irregular heartbeat.
■ 1. Activation of the MDI is not coordinated with ■ 2. Constipation.
inspiration. ■ 3. Pedal edema.
■ 2. The client inspires rapidly when using the ■ 4. Decreased pulse rate.
MDI.
■ 3. The client holds his breath for 3 seconds after
89. A client who has been taking flunisolide (Aer-
oBid), two inhalations a day, for treatment of asthma.
inhaling with the MDI.
has painful, white patches in his mouth. Which
■ 4. The client shakes the MDI after use.
response by the nurse would be most appropriate?
■ 5. The client performs puffs in rapid succession.
■ 1. “This is an anticipated adverse effect of your
84. A 34-year-old female with a history of asthma medication. It should go away in a couple of
is admitted to the emergency department. The nurse weeks.”
notes that the client is dyspneic, with a respiratory ■ 2. “You are using your inhaler too much and it
rate of 35 breaths/minute, nasal flaring, and use of has irritated your mouth.”
accessory muscles. Auscultation of the lung fields ■ 3. “You have developed a fungal infection from
reveals greatly diminished breath sounds. Based on your medication. It will need to be treated
these findings, which action should the nurse take with an antifungal agent.”
to initiate care of the client? ■ 4. “Be sure to brush your teeth and floss daily.
■ 1. Initiate oxygen therapy and reassess the client Good oral hygiene will treat this problem.”
in 10 minutes.
■ 2. Draw blood for an arterial blood gas analysis
90. A nurse is teaching a client to use a metered-
dose inhaler (MDI) to administer his bronchodilator
and send the client for a chest X-ray.
medication. Indicate the correct order of the steps
■ 3. Encourage the client to relax and breathe
the client should take to use the MDI appropriately.
slowly through the mouth.
■ 4. Administer bronchodilators.
85. A client experiencing a severe asthma attack 1. Shake the inhaler immediately before use.
has the following arterial blood gas:
pH 7.33; PCO2 48; PO2 58; HCO3 26. Which of the fol- 2. Hold breath for 5 to 10 seconds and then
lowing orders should the nurse perform first? exhale.
■ 1. Albuterol (Proventil) nebulizer.
■ 2. Chest x-ray. 3. Activate the MDI on inhalation.
■ 3. Ipratropium (Atrovent) inhaler.
■ 4. Sputum culture. 4. Breathe out through the mouth.
86. A client with acute asthma is prescribed
short-term corticosteroid therapy. Which is the
expected outcome for the use of steroids in clients
with asthma?
■ 1. Promote bronchodilation.
■ 2. Act as an expectorant.
■ 3. Have an anti-inflammatory effect.
■ 4. Prevent development of respiratory infections.
87. The nurse is teaching the client how to use a
metered-dose inhaler (MDI) to administer a corticos-
teroid. Which of the following client actions indi-
cates that he is using the MDI correctly? Select all
91. Which of the following is an appropriate
expected outcome for an adult client with well-
that apply.
controlled asthma?
■ 1. The inhaler is held upright.
■ 1. Chest X-ray demonstrates minimal
■ 2. The head is tilted down while inhaling the
hyperinflation.
medicine.
■ 2. Temperature remains lower than 100° F
■ 3. The client waits 5 minutes between puffs.
(37.8° C).
■ 4. The mouth is rinsed with water following
■ 3. Arterial blood gas analysis demonstrates a
administration.
decrease in PaO2.
■ 5. The client lies supine for 15 minutes follow-
■ 4. Breath sounds are clear.
ing administration.

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 The Client with Respiratory Health Problems 405

92. Which of the following health promotion 97. The nurse in the perioperative area is
activities should the nurse include in the discharge preparing a client for surgery and notices that the
teaching plan for a client with asthma? client looks sad. The client says, “I’m scared of hav-
■ 1. Incorporate physical exercise as tolerated into ing cancer. It’s so horrible and I brought it on myself.
the daily routine. I should have quit smoking years ago.” What would
■ 2. Monitor peak flow numbers after meals and at be the nurse’s best response to the client?
bedtime. ■ 1. “It’s okay to be scared. What is it about cancer
■ 3. Eliminate stressors in the work and home that you’re afraid of?”
environment. ■ 2. “It’s normal to be scared. I would be, too.
■ 4. Use sedatives to ensure uninterrupted sleep We’ll help you through it.”
at night. ■ 3. “Don’t be so hard on yourself. You don’t
know if your smoking caused the cancer.”
93. The nurse should teach the client with ■ 4. “Do you feel guilty because you smoked?”
asthma that which of the following is one of the
most common precipitating factors of an acute 98. A client who underwent a left lower lobec-
asthma attack? tomy has been out of surgery for 48 hours. She is
■ 1. Occupational exposure to toxins. receiving morphine sulfate via a patient-controlled
■ 2. Viral respiratory infections. analgesia (PCA) system. She tells the nurse that she
■ 3. Exposure to cigarette smoke. has some pain in her left thorax that worsens when
■ 4. Exercising in cold temperatures. she coughs. The nurse should:
■ 1. Let the client rest, so that she is not stimu-
94. Which of the following findings would most lated to cough.
likely indicate the presence of a respiratory infec-
■ 2. Encourage the client to take deep breaths to
tion in a client with asthma?
help control the pain.
■ 1. Cough productive of yellow sputum.
■ 3. Check that the PCA device is functioning
■ 2. Bilateral expiratory wheezing.
properly, and then reassure the client that the
■ 3. Chest tightness.
machine is working and will relieve her pain.
■ 4. Respiratory rate of 30 breaths/minute.
■ 4. Obtain a more detailed assessment of the cli-
ent’s pain using a pain scale.
The Client with Lung Cancer 99. Which of the following areas is a priority to
evaluate when completing discharge planning for
95. The nurse has assisted the physician at the a client who has had a lobectomy for treatment of
bedside with insertion of a left subclavian, triple lung cancer?
lumen catheter in a client admitted with lung ■ 1. The support available to assist the client at
cancer. Suddenly, the client becomes restless and home.
tachypneic. The nurse should: ■ 2. The distance the client lives from the hospi-
■ 1. Assess breath sounds. tal.
■ 2. Remove the catheter. ■ 3. The client’s ability to do home blood pressure
■ 3. Insert a peripheral I.V. monitoring.
■ 4. Reposition the client. ■ 4. The client’s knowledge of the causes of lung
cancer.
96. A female client diagnosed with lung can-
cer is to have a left lower lobectomy. Which of the 100. Which of the following would be a significant
following increase the client’s risk of developing intervention to help prevent lung cancer?
postoperative pulmonary complications? ■ 1. Encourage cigarette smokers to have yearly
■ 1. Height is 5 feet, 7 inches and weight is 110 lb. chest radiographs.
■ 2. The client tends to keep her real feelings to ■ 2. Instruct people about techniques for smoking
herself. cessation.
■ 3. She ambulates and can climb one flight of ■ 3. Recommend that people have their houses
stairs without dyspnea. and apartments checked for asbestos leakage.
■ 4. The client is 58 years of age. ■ 4. Encourage people to install central air clean-
ers in their homes.

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 406 The Nursing Care of Adults with Medical and Surgical Health Problems

101. After a thoracotomy, the nurse instructs the 105. Which of the following rehabilitative mea-
client to perform deep-breathing exercises. Which sures should the nurse teach the client who has
of the following is an expected outcome of these undergone chest surgery to prevent shoulder anky-
exercises? losis?
■ 1. Deep breathing elevates the diaphragm, ■ 1. Turn from side to side.
which enlarges the thorax and increases the ■ 2. Raise and lower the head.
lung surface available for gas exchange. ■ 3. Raise the arm on the affected side over the
■ 2. Deep breathing increases blood flow to the head.
lungs to allow them to recover from the ■ 4. Flex and extend the elbow on the affected
trauma of surgery. side.
■ 3. Deep breathing controls the rate of air flow to
the remaining lobe so that it will not become
106. When caring for a client with a chest tube
and water-seal drainage system, the nurse should:
hyperinflated.
■ 1. Verify that the air vent on the water-seal
■ 4. Deep breathing expands the alveoli and
drainage system is capped when the suction
increases the lung surface available for
is off.
ventilation.
■ 2. Strip the chest drainage tubes at least every
102. Following a thoracotomy, the client has 4 hours if excessive bleeding occurs.
severe pain. Which of the following strategies for ■ 3. Ensure that the chest tube is clamped when
pain management will be most effective for this moving the client out of the bed.
client? ■ 4. Make sure that the drainage apparatus is
■ 1. Repositioning the client immediately after always below the client’s chest level.
administering pain medication.
■ 2. Reassessing the client 30 minutes after
107. A client has a chest tube attached to a water-
seal drainage system and the nurse notes that the
administering pain medication.
fluid in the chest tube and in the water-seal column
■ 3. Verbally reassuring the client after adminis-
has stopped fluctuating. The nurse should deter-
tering pain medication.
mine that:
■ 4. Readjusting the pain medication dosage as
■ 1. The lung has fully expanded.
needed according to the client’s condition.
■ 2. The lung has collapsed.
103. While assessing a thoracotomy incisional ■ 3. The chest tube is in the pleural space.
area from which a chest tube exits, the nurse feels ■ 4. The mediastinal space has decreased.
a crackling sensation under the fingertips along the
entire incision. Which of the following should be
108. The nurse observes a constant gentle bubbling
in the water-seal column of a water-seal chest drain-
the nurse’s first action?
age system. This observation should prompt the
■ 1. Lower the head of the bed and call the physi-
nurse to do which of the following?
cian.
■ 1. Continue monitoring as usual; this is
■ 2. Prepare an aspiration tray.
expected.
■ 3. Mark the area with a skin pencil at the outer
■ 2. Check the connectors between the chest and
periphery of the crackling.
drainage tubes and where the drainage tube
■ 4. Turn off the suction of the chest drainage
enters the collection bottle.
system.
■ 3. Decrease the suction to –15 cm H2O and
104. When teaching a client to deep breathe effec- continue observing the system for changes in
tively after a lobectomy, the nurse should instruct bubbling during the next several hours.
the client to do which of the following? ■ 4. Drain half of the water from the water-seal
■ 1. Contract the abdominal muscles, take a slow chamber.
deep breath through the nose and hold it for
3 to 5 seconds, then exhale.
109. A client who underwent a lobectomy and has
a water-seal chest drainage system is breathing with
■ 2. Contract the abdominal muscles, take a deep
a little more effort and at a faster rate than 1 hour
breath through the mouth, and exhale slowly
ago. The client’s pulse rate is also increased. The
as if trying to blow out a candle.
nurse should:
■ 3. Relax the abdominal muscles, take a slow
■ 1. Check the tubing to ensure that the client is
deep breath through the nose, and hold it for
not lying on it or kinking it.
3 to 5 seconds.
■ 2. Increase the suction.
■ 4. Relax the abdominal muscles, take a deep
■ 3. Lower the drainage bottles 2 to 3 feet below
breath through the mouth, and exhale slowly
the level of the client’s chest.
over 10 seconds.
■ 4. Ensure that the chest tube has two clamps on
it to prevent air leaks.

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 The Client with Respiratory Health Problems 407

110. The nurse is assessing a client who has 114. A 21-year-old male client is transported by
a chest tube connected to a water-seal chest tube ambulance to the emergency department after a
drainage system. According to the illustration serious automobile accident. He complains of severe
shown, which should the nurse do? pain in his right chest where he struck the steering
■ 1. Clamp the chest tube near the insertion site to wheel. Which is the primary client goal at this time?
prevent air from entering the pleural cavity. ■ 1. Reduce the client’s anxiety.
■ 2. Notify the physician of the amount of chest ■ 2. Maintain adequate oxygenation.
tube drainage. ■ 3. Decrease chest pain.
■ 3. Add water to maintain the water seal. ■ 4. Maintain adequate circulating volume.
■ 4. Lower the drainage system to maintain
gravity flow.
115. A client with rib fractures and a pneumotho-
rax has a chest tube inserted that is connected to a
water-seal chest tube drainage system. The nurse
notes that the fluid in the water-seal column is fluc-
tuating with each breath that the client takes. What
is the significance of this fluctuation?
■ 1. An obstruction is present in the chest tube.
■ 2. The client is developing subcutaneous
emphysema.
■ 3. The chest tube system is functioning
properly.
■ 4. There is a leak in the chest tube system.
116. A client who is recovering from chest
trauma is to be discharged home with a chest tube
drainage system intact. The nurse should instruct
the client to call the physician for which of the
following?
■ 1. Respiratory rate greater than 16 breaths/
minute.
■ 2. Continuous bubbling in the water-seal
111. Which of the following should be readily chamber.
available at the bedside of a client with a chest tube ■ 3. Fluid in the chest tube.
in place? ■ 4. Fluctuation of fluid in the water-seal
■ 1. A tracheostomy tray. chamber.
■ 2. Another sterile chest tube.
■ 3. A bottle of sterile water. 117. Which of the following findings would
■ 4. A spirometer. suggest pneumothorax in a trauma victim?
■ 1. Pronounced crackles.
■ 2. Inspiratory wheezing.
The Client with Chest Trauma ■ 3. Dullness on percussion.
■ 4. Absent breath sounds.
112. A nurse should interpret which of the follow- 118. For a client with rib fractures and a pneu-
ing as an early sign of a tension pneumothorax in a
mothorax, the physician prescribes morphine
client with chest trauma?
sulfate, 1 to 2 mg/hour, given I.V. as needed for pain.
■ 1. Diminished bilateral breath sounds.
The nursing care goal is to provide adequate pain
■ 2. Muffled heart sounds.
control so that the client can breathe effectively.
■ 3. Respiratory distress.
Which of the following outcomes would indicate
■ 4. Tracheal deviation.
successful achievement of this goal?
113. A nurse is to administer 10 mg of morphine ■ 1. Pain rating of 0 on a scale of 0 to 10 by the
sulfate to a client with three fractured ribs. The client.
available concentration for this drug is 15 mg/mL. ■ 2. Decreased client anxiety.
How many milliliters should the nurse administer? ■ 3. Respiratory rate of 26 breaths/minute.
Round to one decimal point. ■ 4. PaO2 of 70 mm Hg.
__________________ mL.

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 408 The Nursing Care of Adults with Medical and Surgical Health Problems

119. A client undergoes surgery to repair lung inju- 125. The nurse has calculated a low PaO2/FIO2
ries. Postoperative orders include the transfusion of (P/F) ratio < 150 for a client with acute respiratory
one unit of packed red blood cells at a rate of 60 mL/ distress syndrome (ARDS). The nurse should place
hour. How long would this transfusion take to infuse? the client in which position to improve oxygenation,
■ 1. 2 hours. ventilation distribution, and drainage of secretions?
■ 2. 4 hours. ■ 1. Supine.
■ 3. 6 hours. ■ 2. Semi-fowlers.
■ 4. 8 hours. ■ 3. Lateral side.
■ 4. Prone.
120. The primary reason for infusing blood at a
rate of 60 mL/hour is to help prevent which of the 126. A client with acute respiratory distress syn-
following complications? drome (ARDS) has fine crackles at lung bases and the
■ 1. Emboli formation. respirations are shallow at a rate of 28 breaths/minute.
■ 2. Fluid volume overload. The client is restless and anxious. In addition to moni-
■ 3. Red blood cell hemolysis. toring the arterial blood gas results, the nurse should
■ 4. Allergic reaction. do which of the following? Select all that apply.
■ 1. Monitor serum creatinine and blood urea
121. A client’s chest tube is to be removed by the nitrogen levels.
physician. Which of the following items should ■ 2. Administer a sedative.
the nurse have ready to be placed directly over the ■ 3. Keep the head of the bed flat.
wound when the chest tube is removed? ■ 4. Administer humidified oxygen.
■ 1. Butterfly dressing. ■ 5. Auscultate the lungs.
■ 2. Montgomery strap.
■ 3. Fine-mesh gauze dressing. 127. Which of the following interventions would
■ 4. Petroleum gauze dressing. be most likely to prevent the development of acute
respiratory distress syndrome (ARDS)?
122. A client has been in an automobile accident ■ 1. Teaching cigarette smoking cessation.
and the nurse is assessing the client for possible ■ 2. Maintaining adequate serum potassium levels.
pneumothorax. The nurse should assess the client for: ■ 3. Monitoring clients for signs of hypercapnia.
■ 1. Sudden, sharp chest pain. ■ 4. Replacing fluids adequately during hypov-
■ 2. Wheezing breath sounds over affected side. olemic states.
■ 3. Hemoptysis.
■ 4. Cyanosis. 128. The nurse interprets which of the following
as an early sign of acute respiratory distress syn-
123. The physician has inserted a chest tube in drome (ARDS) in a client at risk?
a client with a pneumothorax. The nurse should ■ 1. Elevated carbon dioxide level.
evaluate the effectiveness of the chest tube: ■ 2. Hypoxia not responsive to oxygen therapy.
■ 1. For administration of oxygen. ■ 3. Metabolic acidosis.
■ 2. To promote formation of lung scar tissue. ■ 4. Severe, unexplained electrolyte imbalance.
■ 3. To insert antibiotics into the pleural space.
■ 4. To remove air and fluid. 129. A client with acute respiratory distress syn-
drome (ARDS) is showing signs of increased dysp-
nea. The nurse reviews a report of blood gas values
that recently arrived, shown below.
The Client with Acute Respiratory
Distress Syndrome
Laboratory Results
124. The nurse has placed the intubated client
with acute respiratory distress syndrome (ARDS) in Blood chemistry Result
prone position for 30 minutes. Which of the follow- pH 7.35
ing would require the nurse to discontinue prone
positioning and return the client to the supine posi- PaCO2 25 mm Hg
tion? Select all that apply. Hco3– 22 mEq/L
■ 1. The family is coming in to visit. PaO2 95 mm Hg
■ 2. The client has increased secretions requiring
frequent suctioning.
■ 3. The SpO2 and PO2 have decreased.
■ 4. The client is tachycardic with drop in blood Which finding should the nurse report to the
pressure. physician?
■ 5. The face has increased skin breakdown and ■ 1. pH.
edema. ■ 2. PaCO2.
■ 3. HCO3–.
■ 4. PaO2.

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 The Client with Respiratory Health Problems 409

130. A client with acute respiratory distress 136. Which of the following nursing interventions
syndrome (ARDS) is on a ventilator. The client’s peak would promote effective airway clearance in a client
inspiratory pressures and spontaneous respiratory with acute respiratory distress?
rate are increasing, and the PO2 is not improving. ■ 1. Administering oxygen every 2 hours.
Using the SBAR (Situation-Background-Assessment- ■ 2. Turning the client every 4 hours.
Recommendation) technique for communication, ■ 3. Administering sedatives to promote rest.
the nurse calls the physician with the recommenda- ■ 4. Suctioning if cough is ineffective.
tion for:
■ 1. Initiating I.V. sedation.
137. Which of the following complications is asso-
ciated with mechanical ventilation?
■ 2. Starting a high-protein diet.
■ 1. Gastrointestinal hemorrhage.
■ 3. Providing pain medication.
■ 2. Immunosuppression.
■ 4. Increasing the ventilator rate.
■ 3. Increased cardiac output.
131. A client has the following arterial blood gas ■ 4. Pulmonary emboli.
values: pH, 7.52; PaO2, 50 mm Hg; PaCO2, 28 mm
Hg; HCO3–, 24 mEq/L. Based upon the client’s PaO2,
138. A client is admitted to the emergency depart-
ment with a headache, weakness, and slight confu-
which of the following conclusions would be accu-
sion. The physician diagnoses carbon monoxide
rate?
poisoning. What should the nurse do first?
■ 1. The client is severely hypoxic.
■ 1. Initiate gastric lavage.
■ 2. The oxygen level is low but poses no risk for
■ 2. Maintain body temperature.
the client.
■ 3. Administer 100% oxygen by mask.
■ 3. The client’s PaO2 level is within normal
■ 4. Obtain a psychiatric referral.
range.
■ 4. The client requires oxygen therapy with very 139. A confused client with carbon monoxide
low oxygen concentrations. poisoning experiences dizziness when ambulating
to the bathroom. The nurse should:
132. A client has the following arterial blood gas ■ 1. Put all four side rails up on the bed.
values: pH, 7.52; PaO2, 50 mm Hg; PaCO2, 28 mm Hg;
■ 2. Ask the unlicensed personnel to place
HCO3–, 24 mEq/L. The nurse determines that which
restraints on the client’s upper extremities.
of the following is a possible cause for these findings?
■ 3. Request that the client’s roommate put the
■ 1. Chronic obstructive pulmonary disease
call light on when the client is attempting to
(COPD).
get out of bed.
■ 2. Diabetic ketoacidosis with Kussmaul’s
■ 4. Check on the client at regular intervals to
respirations.
ascertain the need to use the bathroom.
■ 3. Myocardial infarction.
■ 4. Pulmonary embolus. 140. Which of the following are expected out-
comes for a client with pulmonary disease?
133. Which of the following interventions should ■ 1. A relatively matched ventilation-to-perfusion
the nurse anticipate in a client who has been diag-
ratio.
nosed with acute respiratory distress syndrome
■ 2. A low ventilation-to-perfusion ratio.
(ARDS)?
■ 3. A high ventilation-to-perfusion ratio.
■ 1. Tracheostomy.
■ 4. An equal PaO2 and PaCO2 ratio.
■ 2. Use of a nasal cannula.
■ 3. Mechanical ventilation.
■ 4. Insertion of a chest tube.
Managing Care Quality
134. Which of the following conditions can place a and Safety
client at risk for acute respiratory distress syndrome
(ARDS)?
■ 1. Septic shock.
141. The nurse should place a client being admit-
ted to the hospital with suspected tuberculosis on
■ 2. Chronic obstructive pulmonary disease. what type of isolation?
■ 3. Asthma. ■ 1. Standard precautions.
■ 4. Heart failure. ■ 2. Contact precautions.
135. Which one of the following assessments is ■ 3. Droplet precautions.
most appropriate for determining the correct place- ■ 4. Airborne precautions.
ment of an endotracheal tube in a mechanically
ventilated client?
■ 1. Assessing the client’s skin color.
■ 2. Monitoring the respiratory rate.
■ 3. Verifying the amount of cuff inflation.
■ 4. Auscultating breath sounds bilaterally.

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