1.

An elderly client with pneumonia may appear with

which of the following symptoms first?

1. Altered mental status and dehydration

2. fever and chills
3. Hemoptysis and dyspnea
4. Pleuritic chest pain and cough

2. Which of the following pathophysiological

mechanisms that occur in the lung parenchyma allows
pneumonia to develop?

1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation

3. A 7-year-old client is brought to the E.R. He’s

tachypneic and afebrile and has a respiratory rate of 36
breaths/minute and a nonproductive cough. He recently
had a cold. From his history, the client may have which
of the following?
1. Acute asthma
2. Bronchial pneumonia
3. Chronic obstructive pulmonary disease (COPD)
4. Emphysema

4. Which of the following assessment findings would

help confirm a diagnosis of asthma in a client suspected
of having the disorder?

1. Circumoral cyanosis
2. Increased forced expiratory volume
3. Inspiratory and expiratory wheezing
4. Normal breath sounds

5. Which of the following types of asthma involves an

acute asthma attack brought on by an upper
respiratory infection?

1. Emotional
2. Extrinsic
3. Intrinsic
4. Mediated
6. A client with acute asthma showing inspiratory and
expiratory wheezes and a decreased expiratory volume
should be treated with which of the following classes
of medication right away?

1. Beta-adrenergic blockers
2. Bronchodilators
3. Inhaled steroids
4. Oral steroids

7. A 19-year-old comes into the emergency department

with acute asthma. His respiratory rate is 44
breaths/minute, and he appears to be in acute
respiratory distress. Which of the following actions
should be taken first?

1. Take a full medication history

2. Give a bronchodilator by nebulizer
3. Apply a cardiac monitor to the client
4. Provide emotional support to the client.

8. A 58-year-old client with a 40-year history

of smoking one to two packs of cigarettes a day has a
chronic cough producing thick sputum, peripheral
edema, and cyanotic nail beds. Based on this
information, he most likely has which of the following
conditions?

1. Adult respiratory distress syndrome (ARDS)

2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

9. The term “blue bloater” refers to which of the

following conditions?

1. Adult respiratory distress syndrome (ARDS)

2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

10. The term “pink puffer” refers to the client with which
of the following conditions?

1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema
11. A 66-year-old client has marked dyspnea at rest, is
thin, and uses accessory muscles to breathe. He’s
tachypneic, with a prolonged expiratory phase. He has
no cough. He leans forward with his arms braced on his
knees to support his chest and shoulders for breathing.
This client has symptoms of which of the following
respiratory disorders?

1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

12. It’s highly recommended that clients with asthma,

chronic bronchitis, and emphysema have Pneumovax
and flu vaccinations for which of the following reasons?

1. All clients are recommended to have these vaccines

2. These vaccines produce bronchodilation and improve
oxygenation.
3. These vaccines help reduce the tachypnea these clients
experience.
4. Respiratory infections can cause severe hypoxia and
possibly death in these clients.
13. Exercise has which of the following effects on clients
with asthma, chronic bronchitis, and emphysema?

1. It enhances cardiovascular fitness.

2. It improves respiratory muscle strength.
3. It reduces the number of acute attacks.
4. It worsens respiratory function and is discouraged.

14. Clients with chronic obstructive bronchitis are given

diuretic therapy. Which of the following reasons best
explains why?

1. Reducing fluid volume reduces oxygen demand.

2. Reducing fluid volume improves clients’ mobility.
3. Restricting fluid volume reduces sputum production.
4. Reducing fluid volume improves respiratory function.

15. A 69-year-old client appears thin and cachectic. He’s

short of breath at rest and his dyspnea increases with
the slightest exertion. His breath sounds are diminished
even with deep inspiration. These signs and symptoms
fit which of the following conditions?
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

16. A client with emphysema should receive only 1 to 3

L/minute of oxygen, if needed, or he may lose his
hypoxic drive. Which of the following statements is
correct about hypoxic drive?

1. The client doesn’t notice he needs to breathe.

2. The client breathes only when his oxygen levels climb
above a certain point.
3. The client breathes only when his oxygen levels dip below
a certain point.
4. The client breathes only when his carbon dioxide level
dips below a certain point.

17. Teaching for a client with chronic obstructive

pulmonary disease (COPD) should include which of the
following topics?

1. How to have his wife learn to listen to his lungs with a

stethoscope from Wal-Mart.
2. How to increase his oxygen therapy.
3. How to treat respiratory infections without going to the
physician.
4. How to recognize the signs of an impending respiratory
infection.

18. Which of the following respiratory disorders is most

common in the first 24 to 48 hours after surgery?

1. Atelectasis
2. Bronchitis
3. Pneumonia
4. Pneumothorax

19. Which of the following measures can reduce or

prevent the incidence of atelectasis in a post-operative
client?

1. Chest physiotherapy
2. Mechanical ventilation
3. Reducing oxygen requirements
4. Use of an incentive spirometer
20. Emergency treatment of a client in status
asthmaticus includes which of the following
medications?

1. Inhaled beta-adrenergic agents

2. Inhaled corticosteroids
3. I.V. beta-adrenergic agents
4. Oral corticosteroids

21. Which of the following treatment goals is best for the

client with status asthmaticus?

1. Avoiding intubation
2. Determining the cause of the attack
3. Improving exercise tolerance
4. Reducing secretions

22. Dani was given Dilaudid for pain. She’s sleeping and
her respiratory rate is 4 breaths/minute. If action isn’t
taken quickly, she might have which of the following
reactions?

1. Asthma attack
2. Respiratory arrest
3. Improve cardiac output
4. Constipation

23. Which of the following additional assessment data

should immediately be gathered to determine the status
of a client with a respiratory rate of 4 breaths/minute?

1. Arterial blood gas (ABG) and breath sounds

2. Level of consciousness and a pulse oximetry value.
3. Breath sounds and reflexes
4. Pulse oximetry value and heart sounds

24. A client is in danger of respiratory arrest following

the administration of a narcotic analgesic. An arterial
blood gas value is obtained. The nurse would expect to
PaCO2 to be which of the following values?

1. 15 mm Hg
2. 30 mm Hg
3. 40 mm Hg
4. 80 mm Hg

25. A client has started a new drug for hypertension.

Thirty minutes after he takes the drug, he develops
chest tightness and becomes short of breath and
tachypneic. He has a decreased level of consciousness.
These signs indicate which of the following conditions?

1. Asthma attack
2. Pulmonary embolism
3. respiratory failure
4. Rheumatoid arthritis

26. Emergency treatment for a client with

impending anaphylaxis secondary to hypersensitivity to
a drug should include which of the following actions
first?

1. Administering oxygen
2. Inserting an I.V. catheter
3. Obtaining a complete blood count (CBC)
4. Taking vital signs

27. Following the initial care of a client with asthma and

impending anaphylaxis from hypersensitivity to a drug,
the nurse should take which of the following steps next?
1. Administer beta-adrenergic blockers
2. Administer bronchodilators
3. Obtain serum electrolyte levels
4. Have the client lie flat in the bed.

28. A client’s ABG results are as follows: pH: 7.16;

PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L;
SaO2 81%. This ABG result represents which of the
following conditions?

1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis

29. A nurse plans care for a client with chronic

obstructive pulmonary disease, knowing that the client
is most likely to experience what type of acid-base
imbalance?

1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
30. A nurse is caring for a client who is on a mechanical
ventilator. Blood gas results indicate a pH of 7.50 and a
PCO2 of 30 mm Hg. The nurse has determined that the
client is experiencing respiratory alkalosis. Which
laboratory value would most likely be noted in this
condition?

1. Sodium level of 145 mEq/L

2. Potassium level of 3.0 mEq/L
3. Magnesium level of 2.0 mg/L
4. Phosphorus level of 4.0 mg/dl

31. A nurse reviews the arterial blood gas results of a

patient and notes the following: pH 7.45; PCO2 30 mm
Hg; and bicarbonate concentration of 22 mEq/L. The
nurse analyzes these results as indicating:

1. Metabolic acidosis, compensated.

2. Metabolic alkalosis, uncompensated.
3. Respiratory alkalosis, compensated.
4. Respiratory acidosis, compensated.

32. A client is scheduled for blood to be drawn from the

radial artery for an ABG determination. Before the blood
is drawn, an Allen’s test is performed to determine the
adequacy of the:

1. Popliteal circulation
2. Ulnar circulation
3. Femoral circulation
4. Carotid circulation

33. A nurse is caring for a client with a nasogastric

tube that is attached to low suction. The nurse monitors
the client, knowing that the client is at risk for which
acid-base disorder?

1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

34. A nurse is caring for a client with an ileostomy

understands that the client is most at risk for
developing which acid-base disorder?

1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

35. A nurse is caring for a client with diabetic

ketoacidosis and documents that the client is
experiencing Kussmaul’s respirations. Based on this
documentation, which of the following did the nurse
observe?

1. Respirations that are abnormally deep, regular, and

increased in rate.
2. Respirations that are regular but abnormally slow.
3. Respirations that are labored and increased in depth and
rate
4. Respirations that cease for several seconds.

36. A nurse understands that the excessive use of oral

antacids containing bicarbonate can result in which
acid-base disturbance?

1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis
4. Metabolic alkalosis
37. A nurse is caring for a client with renal failure. Blood
gas results indicate a pH of 7.30; a PCO2 of 32 mm Hg,
and a bicarbonate concentration of 20 mEq/L. The nurse
has determined that the client is experiencing metabolic
acidosis. Which of the following laboratory values would
the nurse expect to note?

1. Sodium level of 145 mEq/L

2. Magnesium level of 2.0 mg/dL
3. Potassium level of 5.2 mEq/L
4. Phosphorus level of 4.0 mg/dL

38. A nurse is preparing to obtain an arterial blood gas

specimen from a client and plans to perform the Allen’s
test on the client. Number in order of priority the steps
for performing the Allen’s test (#1 is first step).

1. Ask the client to open and close the hand repeatedly.

2. Apply pressure over the ulnar and radial arteries.
3. Assess the color of the extremity distal to the pressure
point
4. Release pressure from the ulnar artery
5. Explain the procedure to the client.
39. A nurse is preparing to obtain a sputum specimen
from a client. Which of the following nursing actions will
facilitate obtaining the specimen?

1. Limiting fluids
2. Having the client take 3 deep breaths.
3. Asking the client to spit into the collection container.
4. Asking the client to obtain the specimen after eating.

40. A nurse is caring for a client after

a bronchoscopy and biopsy. Which of the following signs
if noted in the client should be reported immediately to
the physician?

1. Blood-streaked sputum
2. Dry cough
3. Hematuria
4. Bronchospasm

41. A nurse is suctioning fluids from a client via

a tracheostomy tube. When suctioning, the nurse must
limit the suctioning to a maximum of:
1. 5 seconds
2. 10 seconds
3. 30 seconds
4. 1 minute

42. A nurse is suctioning fluids from a client through an

endotracheal tube. During the suctioning procedure, the
nurse notes on the monitor that the heart rate
decreases. Which of the following is the most
appropriate nursing intervention?

1. Continue to suction
2. Ensure that the suction is limited to 15 seconds
3. Stop the procedure and reoxygenated the client
4. Notify the physician immediately.

43. An unconscious client is admitted to an emergency

room. Arterial blood gas measurements reveal a pH of
7.30, a low bicarbonate level, a normal carbon dioxide
level, and a normal oxygen level. An elevated potassium
level is also present. These results indicate the presence
of:
1. Metabolic acidosis
2. Respiratory acidosis
3. Combined respiratory and metabolic acidosis
4. over compensated respiratory acidosis

44. A nurse is caring for a client hospitalized with acute

exacerbation of COPD. Which of the following would the
nurse expect to note on assessment of this client?

1. Increased oxygen saturation with exercise

2. Hypocapnia
3. A hyperinflated chest on x-ray film
4. A widened diaphragm noted on chest x-ray film

45. An oxygenated delivery system is prescribed for a

client with COPD to deliver a precise oxygen
concentration. Which of the following types of oxygen
delivery systems would the nurse anticipate to be
prescribed?

1. Venturi mask
2. Aerosol mask
3. Face tent
4. Tracheostomy collar
46. Theophylline (Theo-Dur) tablets are prescribed for a
client with chronic airflow limitation, and the nurse
instructs the client about the medication. Which
statement by the client indicates a need for further
teaching?

1. “I will take the medication on an empty stomach.”

2. “I will take the medication with food.”
3. “I will continue to take the medication even if I am feeling
better.”
4. “Periodic blood levels will need to be obtained.”

47. A nurse is caring for a client with emphysema. The

client is receiving oxygen. The nurse assesses the oxygen
flow rate to ensure that it does not exceed

1. 1 L/min
2. 2 L/min
3. 6 L/min
4. 10 L/min

48. The nurse reviews the ABG values of a client. The

results indicate respiratory acidosis. Which of the
following values would indicate that this acid-base
imbalance exists?

1. pH of 7.48
2. PCO2 of 32 mm Hg
3. pH of 7.30
4. HCO3- of 20 mEq/L

49. A nurse instructs a client to use the pursed lip

method of breathing. The client asks the nurse about
the purpose of this type of breathing. The nurse
responds, knowing that the primary purpose of pursed
lip breathing is:

1. Promote oxygen intake

2. Strengthen the diaphragm
3. Strengthen the intercostal muscles
4. Promote carbon dioxide elimination

50. A nurse reviews the ABG values and notes a pH of

7.50, a PCO2 of 30 mm Hg, and an HCO3 of 25 mEq/L. The
nurse interprets these values as indicating:
1. Respiratory acidosis uncompensated
2. Respiratory alkalosis uncompensated
3. Metabolic acidosis uncompensated
4. Metabolic acidosis partially compensated.

Answers and Rationale

1. Answer: 1. Altered mental status and dehydration

Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest

pain are the common symptoms of pneumonia, but elderly
clients may first appear with only an altered mental status
and dehydration due to a blunted immune response.

2. Answer: 4. Inflammation

ADVERTISEMENTS

The most common feature of all types of pneumonia is an

inflammatory pulmonary response to the offending
organism or agent. Atelectasis and bronchiectasis indicate a
collapse of a portion of the airway that doesn’t occur with
pneumonia. An effusion is an accumulation of excess pleural
fluid in the pleural space, which may be a secondary
response to pneumonia.
3. Answer: 1. Acute asthma

Based on the client’s history and symptoms, acute asthma is

the most likely diagnosis. He’s unlikely to have bronchial
pneumonia without a productive cough and fever and he’s
too young to have developed COPD or emphysema.

4. Answer: 3. Inspiratory and expiratory wheezing

Inspiratory and expiratory wheezes are typical findings in

asthma. Circumoral cyanosis may be present in extreme
cases of respiratory distress. The nurse would expect the
client to have a decreased forced expiratory volume because
asthma is an obstructive pulmonary disease. Breath sounds
will be “tight” sounding or markedly decreased; they won’t
be normal.

5. Answer: 3. Intrinsic

Intrinsic asthma doesn’t have an easily

identifiable allergen and can be triggered by the common
cold. Asthma caused be emotional reasons is considered to
be in the extrinsic category. Extrinsic asthma is caused by
dust, molds, and pets; easily identifiable allergens. Mediated
asthma doesn’t exist.

6. Answer: 2. Bronchodilators

Bronchodilators are the first line of treatment for asthma

because bronchoconstriction is the cause of reduced airflow.
Beta-adrenergic blockers aren’t used to treat asthma and
can cause bronchoconstriction. Inhaled or oral steroids may
be given to reduce the inflammation but aren’t used for
emergency relief.

7. Answer: 2. Give a bronchodilator by nebulizer

The client is having an acute asthma attack and needs to

increase oxygen delivery to the lung and body. Nebulized
bronchodilators open airways and increase the amount of
oxygen delivered. First, resolve the acute phase of the attack
ad how to prevent attacks in the future. It may not be
necessary to place the client on a cardiac monitor because
he’s only 19-years-old, unless he has a past medical history
of cardiac problems.

8. Answer: 3. Chronic obstructive bronchitis

Because of his extensive smoking history and symptoms, the
client most likely has chronic obstructive bronchitis. Clients
with ARDS have acute symptoms of and typically need large
amounts of oxygen. Clients with asthma and emphysema
tend not to have a chronic cough or peripheral edema.

9. Answer: 3. Chronic obstructive bronchitis

Clients with chronic obstructive bronchitis appear bloated;

they have large barrel chests and peripheral edema, cyanotic
nail beds and, at times, circumoral cyanosis. Clients with
ARDS are acutely short of breath and frequently need
intubation for mechanical ventilation and large amounts of
oxygen. Clients with asthma don’t exhibit characteristics of
chronic disease, and clients with emphysema appear pink
and cachectic (a state of ill health, malnutrition, and
wasting).

10. Answer: 4. Emphysema

Because of the large amount of energy it takes to breathe,

clients with emphysema are usually cachectic. They’re pink
and usually breathe through pursed lips, hence the term
“puffer”. Clients with ARDS are usually acutely short of
breath. Clients with asthma don’t have any particular
characteristics, and clients with chronic obstructive
bronchitis are bloated and cyanotic in appearance.

11. Answer: 4. Emphysema

These are classic signs and symptoms of a client with

emphysema. Clients with ARDS are acutely short of breath
and require emergency care; those with asthma are also
acutely short of breath during an attack and appear very
frightened. Clients with chronic obstructive bronchitis are
bloated and cyanotic in appearance.

12. Answer: 4. Respiratory infections can cause severe

hypoxia and possibly death in these clients.

It’s highly recommended that clients with respiratory

disorders be given vaccines to protect against respiratory
infection. Infections can cause these clients to need
intubation and mechanical ventilation, and it may be difficult
to wean these clients from the ventilator. The vaccines have
no effect on bronchodilation or respiratory care.

13. Answer: 1. It enhances cardiovascular fitness.

Exercise can improve cardiovascular fitness and help the
client tolerate periods of hypoxia better, perhaps reducing
the risk of heart attack. Most exercise has little effect on
respiratory muscle strength, and these clients can’t tolerate
the type of exercise necessary to do this. Exercise won’t
reduce the number of acute attacks. In some instances,
exercise may be contraindicated, and the client should check
with his physician before starting any exercise program.

14. Answer: 1. Reducing fluid volume reduces oxygen

demand.

Reducing fluid volume reduces the workload of the heart,

which reduces oxygen demand and, in turn, reduces the
respiratory rate. It may also reduce edema and improve
mobility a little, but exercise tolerance will still be harder to
clear airways. Reducing fluid volume won’t improve
respiratory function, but may improve oxygenation.

15. Answer: 4. Emphysema

In emphysema, the wall integrity of the individual air sacs is

damaged, reducing the surface area available for gas
exchange. Very little air movement occurs in the lungs
because of bronchial collapse, as well. In ARDS, the client’s
condition is more acute and typically requires mechanical
ventilation. In asthma and bronchitis, wheezing is prevalent.

16. Answer: 3. The client breathes only when his oxygen

levels dip below a certain point.

Clients with emphysema breathe when their oxygen levels

drop to a certain level; this is known as the hypoxic drive.
They don’t take a breath when their levels of carbon dioxide
are higher than normal, as do those with healthy respiratory
physiology. If too much oxygen is given, the client has little
stimulus to take another breath. In the meantime, his
carbon dioxide levels continue to climb, and the client will
pass out, leading to a respiratory arrest.

17. Answer: 4. How to recognize the signs of an

impending respiratory infection.

Respiratory infection in clients with a respiratory disorder

can be fatal. It’s important that the client understands how
to recognize the signs and symptoms of an impending
respiratory infection. It isn’t appropriate for the wife to listen
to his lung sounds, besides, you can’t purchase stethoscopes
from Wal-Mart. If the client has signs and symptoms of an
infection, he should contact his physician at once.

18. Answer: 1. Atelectasis

Atelectasis develops when there’s interference with the

normal negative pressure that promotes lung expansion.
Clients in the postoperative phase often splint their
breathing because of pain and positioning, which causes
hypoxia. It’s uncommon for any of the other respiratory
disorders to develop.

19. Answer: 4. Use of an incentive spirometer

Using an incentive spirometer requires the client to take

deep breaths and promotes lung expansion. Chest
physiotherapy helps mobilize secretions but won’t prevent
atelectasis. Reducing oxygen requirements or placing
someone on mechanical ventilation doesn’t affect the
development of atelectasis.

20. Answer: 1. Inhaled beta-adrenergic agents

Inhaled beta-adrenergic agents help promote
bronchodilation, which improves oxygenation. I.V. beta-
adrenergic agents can be used but have to be monitored
because of their greater systemic effects. They’re typically
used when the inhaled beta-adrenergic agents don’t work.
Corticosteroids are slow-acting, so their use won’t reduce
hypoxia in the acute phase.

21. Answer: 1. Avoiding intubation

Inhaled beta-adrenergic agents, I.V. corticosteroids, and

supplemental oxygen are used to reduce bronchospasm,
improve oxygenation, and avoid intubation. Determining the
trigger for the client’s attack and improving exercise
tolerance are later goals. Typically, secretions aren’t a
problem in status asthmaticus.

22. Answer: 2. Respiratory arrest

Narcotics can cause respiratory arrest if given in large

quantities.

23. Answer: 2. Level of consciousness and a pulse

oximetry value.
First, the nurse should attempt to rouse the client because
this should increase the client’s respiratory rate. If available,
a spot pulse oximetry check should be done and breath
sounds should be checked. The physician should be notified
immediately if of the findings. He’ll probably order ABG
analysis to determine specific carbon dioxide and oxygen
levels, which will indicate the effectiveness of ventilation.
Reflexes and heart sounds will be part of the more extensive
examination done after these initial actions are completed.

24. Answer: 4. 80 mm Hg

A client about to go into respiratory arrest will have

inefficient ventilation and will be retaining carbon dioxide.
The value expected would be around 80 mm Hg. All other
values are lower than expected.

25. Answer: 3. Respiratory Failure

The client was reacting to the drug with respiratory signs of

impending anaphylaxis, which could lead to eventual
respiratory failure. Although the signs are also related to an
asthma attack or a pulmonary embolism, consider the new
drug first. Rheumatoid arthritis doesn’t manifest these signs.
26. Answer: 1. Administering oxygen

Giving oxygen would be the best first action in this case. Vital
signs then should be checked and the physician immediately
notified. If the client doesn’t already have an I.V. catheter,
one may be inserted now if anaphylactic shock is developing.
Obtaining a CBC wouldn’t help the emergency situation.

27. Answer: 2. Administer bronchodilators

Bronchodilators would help open the client’s airway and

improve his oxygenation status. Beta-adrenergic blockers
aren’t indicated in the management of asthma because they
may cause bronchospasm. Obtaining laboratory values
wouldn’t be done on an emergency basis, and having the
client lie flat in bed could worsen his ability to breathe.

28. Answer: 3. Respiratory acidosis

You all should know this. Practice some problems if you got
this wrong.

29. Answer: 1. Respiratory acidosis

Respiratory acidosis is most often due to hypoventilation.
Chronic respiratory acidosis is most commonly caused by
COPD. In end-stage disease, pathological changes lead to
airway collapse, air trapping, and disturbance of ventilation-
perfusion relationships.

30. Answer: 2. Potassium level of 3.0 mEq/L

 Clinical manifestations of respiratory alkalosis

include headache, tachypnea, paresthesias, tetany,
vertigo, convulsions, hypokalemia, and hypocalcemia.
Options 1, 3, and 4 identify normal laboratory values.
Option 2 identifies the presence of hypokalemia.

31. Answer: 3. Respiratory alkalosis, compensated.

The normal pH is 7.35 to 7.45. In a respiratory condition, an

opposite (see-saw) will be seen between the pH and the
PCO2. In this situation, the pH is at the high end of the
normal value and the PCO2 is low. In an alkalotic condition,
the pH is up. Therefore, the values identified in the question
indicate a respiratory alkalosis. Compensation occurs when
the pH returns to a normal value. Because the pH is in the
normal range at the high end, compensation has occurred.
32. Answer: 2. Ulnar circulation

Before radial puncture for obtaining an ABG, you should

perform an Allen’s test to determine adequate ulnar
circulation. Failure to determine the presence of adequate
collateral circulation could result in severe ischemic injury o
the hand if damage to the radial artery occurs with arterial
puncture.

33. Answer: 4. Metabolic alkalosis

Loss of gastric fluid via nasogastric suction

or vomiting causes metabolic alkalosis as a result of the loss
of hydrochloric acid.

34. Answer: 3. Metabolic acidosis

Intestinal secretions are high in bicarbonate and may be lost

through enteric drainage tubes or an ileostomy or
with diarrhea. These conditions result in metabolic acidosis.

35. Answer: 1. Respirations that are abnormally deep,

regular, and increased in rate.
Kussmaul’s respirations are abnormally deep, regular, and
increased in rate.

36. Answer: 4. Metabolic alkalosis

Increases in base components occur as a result of oral or

parenteral intake of bicarbonates, carbonates, acetates,
citrates, or lactates. Excessive use of oral antacids containing
bicarbonate can cause metabolic alkalosis.

37. Answer: 3. Potassium level of 5.2 mEq/L

Clinical manifestations of metabolic acidosis include

hyperpnea with Kussmaul’s respirations; headache; N/V,
and diarrhea; fruity-smelling breath resulting from improper
fat metabolism; CNS depression, including mental dullness,
drowsiness, stupor, and coma; twitching, and coma.
Hyperkalemia will occur.

38. Answer: 5, 2, 1, 4, and then 3.

39. Answer: 2. Having the client take 3 deep breaths.

To obtain a sputum specimen, the client should rinse
the mouth to prevent contamination, breathe deeply, and
then cough unto a sputum specimen container. The client
should be encouraged to cough and not spit so as to obtain
sputum. Sputum can be thinned by fluids or by a respiratory
treatment such as inhalation of nebulized saline or water.
The optimal time to obtain a specimen is on arising in the
morning.

40. Answer: 4. Bronchospasm

If a biopsy was performed during a bronchoscopy, blood-

streaked sputum is expected for several hours. Frank blood
indicates hemorrhage. A dry cough may be expected. The
client should be assessed for signs of complications, which
would include cyanosis, dyspnea, stridor, bronchospasm,
hemoptysis, hypotension, tachycardia, and arrhythmias.
Hematuria is unrelated to this procedure.

41. Answer: 2. 10 seconds

ADVERTISEMENTS

Hypoxemia can be caused by prolonged suctioning, which

stimulates the pacemaker cells within the heart. A vasovagal
response may occur causing bradycardia. The nurse must
preoxygenate the client before suctioning and limit the
suctioning pass to 10 seconds.

42. Answer: 3. Stop the procedure and reoxygenated the

client

During suctioning, the nurse should monitor the client

closely for side effects, including hypoxemia, cardiac
irregularities such as a decrease in HR resulting from vagal
stimulation, mucosal trauma, hypotension, and paroxysmal
coughing. If side effects develop, especially cardiac
irregularities, this procedure is stopped and the client is
reoxygenated.

43. Answer: 1. Metabolic acidosis

In an acidotic condition, the pH would be low, indicating the

acidosis. In addition, a low bicarbonate level along with the
pH would indicate a metabolic state.

44. Answer: 3. A hyperinflated chest on x-ray film

Clinical manifestations of COPD include hypoxemia,

hypercapnia, dyspnea on exertion and at rest, oxygen
desaturation with exercise, and the use of accessory muscles
of respiration. Chest x-ray films reveal a hyperinflated chest
and a flattened diaphragm is the disease is advanced.

45. Answer: 1. Venturi mask

The venture mask delivers the most accurate oxygen

concentration. The Venturi mask is the best oxygen delivery
system for the client with chronic airflow limitation because
it delivers a precise oxygen concentration. The face tent, the
aerosol mask, and the tracheostomy collar are also high-flow
oxygen delivery systems but most often are used to
administer high humidity.

46. Answer: 1. “I will take the medication on an empty

stomach.”

Theo-Dur is a bronchodilator. The medication should be

administered with food such as milk and crackers to prevent
GI irritation.

47. Answer: 2. 2 L/min

One to 3 L/min of oxygen by nasal cannula may be required
to raise to PaO2 to 60 to 80 mm Hg. However, oxygen is
used cautiously and should not exceed 2 L/min. Because of
the long-standing hypercapnia, the respiratory drive is
triggered by low oxygen levels rather than increased carbon
dioxide levels, as is the case in normal respiratory system.

48. Answer: 3. pH of 7.30

49. Answer: 4. Promote carbon dioxide elimination

Pursed lip breathing facilitates maximum expiration for

clients with obstructive lung disease. This type of breathing
allows better expiration by increasing airway pressure that
keeps air passages open during exhalation.

50. Answer: 2. Respiratory alkalosis uncompensated

In respiratory alkalosis, the pH will be higher than normal

and the PCO2 will be low.