1. **A patient states that he has smoked a half a pack of cigarettes per day for 30 years.

This
should be documented as:**

**Answer:** C. 30 pack years

**Explanation:** Pack years = 0.5 packs/day × 30 years = 15 pack years.

2. **When assessing Ms. EA, the nurse would expect to auscultate:**

**Answer:** C. Distant breath sounds and expiratory wheezes

**Explanation:** Asthma commonly presents with wheezing and may have distant breath
sounds due to bronchoconstriction.

3. **A severe inflammatory response triggered Ms. EA’s asthma attack. Which of the following
drugs would the nurse expect to give to combat the inflammatory response?**

**Answer:** B. Prednisone (Sterapred)

**Explanation:** Prednisone is a corticosteroid that reduces inflammation in asthma.

4. **Ms. EA’s condition worsens, requiring endotracheal intubation and mechanical ventilation.
Her ventilator is set to respond with a positive pressure breath at a preset tidal volume every time
she attempts to take a breath. If she fails to breathe, the machine automatically takes over
ventilation at a preset rate and tidal volume. This ventilator mode is called the:**

**Answer:** D. Assist control mode

**Explanation:** Assist control mode provides full mechanical ventilation and assists with
breathing if the patient fails to initiate breaths.

5. **Which of the following diagnostic tests would confirm the diagnosis of tuberculosis (TB)?
**
 **Answer:** D. Sputum stains and cultures
**Explanation:** Sputum stains and cultures confirm TB by detecting Mycobacterium
tuberculosis.

6. **Before giving the patient rifampin as prescribed, the nurse should warn the patient about
which of the following possible adverse urinary reactions?**

**Answer:** B. Reddish orange urine

**Explanation:** Rifampin can cause urine to become reddish orange.

7. **Mr. DA is restless and cyanotic. Based on this finding, the nurse should first:**

**Answer:** A. Perform nasotracheal suctioning

**Explanation:** Restlessness and cyanosis may indicate a need for airway clearance.

8. **While inspecting the patient’s chest, the nurse notes that the wall caves in on inspiration and
bulges on expiration. From this assessment, she suspects:**

**Answer:** D. Tension pneumothorax

**Explanation:** The described movement is indicative of tension pneumothorax, where air
trapped in the pleural space causes this effect.

9. **Mr. DA's arterial blood gas (ABG) analysis reveals a pH of 7.20, a PaCO2 of 65 mm Hg, a
PaO2 of 45 mm Hg, and an HCO3- of 22 mEq/L. These laboratory values indicate:**

**Answer:** A. Respiratory acidosis

**Explanation:** Low pH and elevated PaCO2 indicate respiratory acidosis.
10. **Mr. DA’s respiratory status continues to deteriorate. The nurse should prepare to assist
with:**

**Answer:** D. Endotracheal intubation

**Explanation:** Progressive deterioration in respiratory status often necessitates intubation.

11. **Mr. DA requires vecuronium bromide (Norcuron) to support mechanical ventilation. The
patient’s wife understands the nurse’s teaching about the drug when she states:**

**Answer:** A. “I know he appears unconscious, but he’s awake and can hear me.”
**Explanation:** Vecuronium bromide paralyzes but does not affect consciousness or
awareness.

12. **Which of the following interventions would help prevent complications of immobility?**

**Answer:** A. Performing passive range-of-motion exercises

**Explanation:** Passive range-of-motion exercises help prevent complications related to
immobility.

13. **To assess Ms. AB for possible Homan’s sign, the nurse should:**

**Answer:** C. Dorsiflex the foot with the leg elevated, noting any calf pain
**Explanation:** Homan’s sign is assessed by dorsiflexing the foot and checking for calf
pain, which may indicate deep vein thrombosis.

14. **Ms. AB suddenly develops chest pain, shortness of breath, and air hunger. The nurse
knows she must further assess Ms. AB’s chest pain to determine its origin. When determining
whether the chest pain is cardiac or pleuritic in nature, the nurse knows that pleuritic chest pain
typically:**
 **Answer:** B. Worsens with inspiration
**Explanation:** Pleuritic chest pain typically worsens with deep breathing or inspiration.

15. **Ms. AB diagnosed with a pulmonary embolus. Which of the following is the most
appropriate nursing diagnosis for this patient?**

**Answer:** C. Impaired gas exchange

**Explanation:** Pulmonary embolism impairs gas exchange due to obstruction in the
pulmonary arteries.

16. **Mr. TW’s chest X-ray reveals a right pneumothorax. With this in mind, the nurse should
first:**

**Answer:** B. Prepare a chest drainage system

**Explanation:** A pneumothorax typically requires a chest drainage system to remove air
from the pleural space.

17. **As the nurse helps Mr. TW out of bed, his chest tube becomes dislodged and falls to the
floor. Which of the following must be done first?**

**Answer:** C. Sealing off the insertion site

**Explanation:** To prevent air from entering the pleural space, sealing the insertion site is
critical.

18. **Assessment of Mr. TW after chest insertion should include:**

**Answer:** C. Auscultating breath sounds every 4 hours and as needed

**Explanation:** Regular assessment of breath sounds is important to monitor for proper lung
re-expansion and complications.
19. **The nurse is performing Mr. JC’s admission assessment. She should obtain subjective data
by:**

**Answer:** C. Asking the patient to describe his symptoms

**Explanation:** Subjective data comes from the patient’s own description of symptoms and
experiences.

20. **During assessment, Mr. JC is having difficulty breathing. When interviewing him about his
health history, the nurse should:**

**Answer:** B. Quickly ask as many questions as possible

**Explanation:** In a state of respiratory distress, it is important to gather information rapidly
but efficiently.

21. **The doctor orders pulmonary function tests for Mr. JC. Which of the following instructions
should be given to him before testing?**

**Answer:** A. “Don’t take bronchodilators for 4 hours before testing.”

**Explanation:** Bronchodilators can affect test results, so they should be withheld as
instructed.

22. **Mr. JC returns to his room after pulmonary function testing and develops an acute episode
of respiratory distress. How is oxygen most accurately administered for this condition?**

**Answer:** C. Venturi mask

**Explanation:** A Venturi mask provides precise oxygen concentrations, important for
accurate management of respiratory distress.
23. **Mr. JC refuses to participate in his self-care. Every time the nurse approaches him he
states, “I just want to die. I’m no good to anyone anymore.” The nurse realizes that he’s
experiencing:**

**Answer:** D. Grief
**Explanation:** Expressions of worthlessness and a desire to die can be indicative of grief or
depression.

24. **While preparing Ms. BE for a diagnostic test, the nurse explains, “The doctor will insert a
tube down your throat to visualize your trachea and lung passages.” The nurse has explained
which of the following diagnostic tests?**

**Answer:** A. Bronchoscopy
**Explanation:** A bronchoscopy involves inserting a tube to visualize the trachea and
bronchial tree.
25. The nurse is caring for Ms. Evans immediately following her bronchoscopy. Which of the
following nursing diagnoses should receive priority?
Answer: Risks for aspiration related to gag reflex suppression
Explanation: After a bronchoscopy, gag reflex suppression increases the risk of aspiration, which
is a critical concern.

26. Ms. BE undergoes a right pneumonectomy for lung cancer. Which of the following positions
shouldn’t be used when repositioning her immediately following the procedure?
Answer: Right side-lying position
Explanation: Following a right pneumonectomy, the right side-lying position should be avoided
to prevent pressure on the surgical site and facilitate lung expansion on the left side.

27. Ms. BE should be assessed closely for which of the following complications of a
pneumonectomy?
Answer: Pulmonary edema
Explanation: Pulmonary edema can occur as a complication of pneumonectomy due to changes
in fluid dynamics and lung function.

28. Following the tonic-clonic seizure, Mr. WD has snoring respirations. The doctor orders a
nasopharyngeal airway inserted to protect Mr. WD’s airway. The nurse is inserting the airway
correctly when she:
Answer: Gently pushes the airway along the floor of the nostril.
Explanation: The nasopharyngeal airway should be inserted gently along the floor of the nostril,
not upward or with excessive force.

29. Mr. WD experiences additional seizure activity after admission to the medical-surgical floor
and is given lorazepam (Ativan). Later, his respirations become shallow and drop to a rate of 6
breaths/minute. What is the most appropriate oxygen delivery system for this patient?
Answer: Bag-valve mask
Explanation: Given Mr. WD’s shallow respirations and low respiratory rate, a bag-valve mask is
necessary for adequate ventilation.

30. Mr. WD requires endotracheal intubation and mechanical ventilation. Disconnecting the
ventilator and vigorously suctioning Mr. WD for a prolonged period could lead to which of the
following complications?
Answer: Hypoxemia
Explanation: Prolonged suctioning can lead to hypoxemia due to reduced oxygen levels in the
blood from inadequate ventilation.

31. When collecting a sputum specimen, the nurse should:

Answer: Tell the patient to cough deeply and expectorate into the specimen container.
Explanation: Sputum collection requires deep coughing to ensure that the specimen is from the
lower respiratory tract.

32. The most common causative organism of bacterial pneumonia is:

Answer: Streptococcus pneumoniae
Explanation: Streptococcus pneumoniae is the most common pathogen causing bacterial
pneumonia.

33. Aggressive chest physiotherapy is instituted but isn’t successful in removing Mrs. PG’s
secretions. Which type of drug would the nurse expect the doctor to prescribe following
physiotherapy?
Answer: Mucolytic
Explanation: Mucolytics help break down and loosen mucus, making it easier to expectorate
after physiotherapy.

34. Which is the most appropriate nursing diagnosis for the patient with pneumonia?
Answer: Impaired gas exchange
Explanation: Pneumonia commonly results in impaired gas exchange due to inflammation and
fluid accumulation in the lungs.

35. Which of the following factors places Ms. KK at risk for developing adult respiratory distress
syndrome (ARDS)?
Answer: Traumatic injury
Explanation: Traumatic injury is a significant risk factor for developing ARDS due to its
potential to cause severe lung damage and inflammation.

36. A classic finding in the patient with acute respiratory distress syndrome (ARDS) is:
Answer: Hypoxia resistant to oxygen therapy
Explanation: ARDS is characterized by hypoxia that does not improve with supplemental oxygen
due to severe pulmonary damage.

37. What pathologic change is responsible for the development of pulmonary edema in the
patient with acute respiratory distress syndrome (ARDS)?
Answer: Alveolocapillary membrane damage
Explanation: Damage to the alveolocapillary membrane leads to increased permeability and
pulmonary edema in ARDS.

38. Ms. KK continues to show signs of hypoxemia. The nurse knows that the patient’s treatment
plan is appropriate when the doctor:
Answer: Prescribes mechanical ventilation
Explanation: Mechanical ventilation is often required for ARDS patients to ensure adequate
oxygenation and ventilation.

39. The doctor prescribes an arterial blood gas analysis, which reveals pH of 7.64, PaCO2 of 26
mmHg, a PaO2 of 100 mmHg, and an HCO3- of 28 mEq/L. After analyzing the results, the nurse
determines that the patient is experiencing:
Answer: Respiratory alkalosis
Explanation: The elevated pH and low PaCO2 indicate respiratory alkalosis, often due to
hyperventilation.

40. The nurse should tell Ms. DJ to do which of the following to arrest the hyperventilation?
Answer: Breathe into a paper bag
Explanation: Breathing into a paper bag helps to rebreathe carbon dioxide, which can correct the
alkalosis caused by hyperventilation.

41. Ms. LJ has abnormally deep, grasping respirations. This breathing pattern is known as:
Answer: Kussmaul’s respirations
Explanation: Kussmaul’s respirations are characterized by deep, labored breaths and are
commonly associated with metabolic acidosis, such as diabetic ketoacidosis.

42. Ms. LJ’s arterial blood gas analysis reveals a pH of 7.25, a PaCO2 of 33 mmHg, a PaO2 of
102 mmHg, and an HCO3- of 19 mEq/L. After analyzing these values, the nurse determines that
the patient is experiencing:
Answer: Metabolic acidosis
Explanation: The low pH and low HCO3- indicate metabolic acidosis. The normal PaCO2
suggests that respiratory compensation is occurring.

43. During the immediate postoperative period, the priority nursing diagnosis for Mr. RE would
be:
Answer: Ineffective airway clearance related to bronchial secretions.
Explanation: Ensuring effective airway clearance is essential immediately after tracheostomy to
avoid airway obstruction and potential respiratory complications.

44. Mr. RE requires tracheostomy care at each shift. When providing tracheostomy care the nurse
should:
Answer: Replace the disposable inner cannula daily
Explanation: Replacing the inner cannula helps to maintain airway patency and prevent
infection.

45. The next day Mr. RE has coughing episodes while taking clear liquids by mouth. The nurse
should immediately:
Answer: Check to see if the tracheostomy cuff is inflated
Explanation: Checking the cuff inflation is important to prevent aspiration and ensure effective
ventilation.

46. The nurse should describe sarcoidosis to Mr. TR as:

Answer: A disease characterized by multiple body organ masses.
Explanation: Sarcoidosis is a systemic granulomatous disease that can affect multiple organs,
primarily the lungs.

47. The doctor prescribes a corticosteroid for Mr. TR. To assess him for adverse effects of the
corticosteroid the nurse should do which of the following?
Answer: Observe for signs of hyperglycemia
Explanation: Corticosteroids can increase blood glucose levels, so monitoring for signs of
hyperglycemia is important.

48. Mr. TR shows that he understands the discharge instructions he received about corticosteroid
administration when he states:
Answer: “I know I shouldn’t suddenly stop taking the drug.”
Explanation: Corticosteroids should not be abruptly discontinued to avoid withdrawal symptoms
and potential adrenal insufficiency.

49. Which initial clinical manifestation would the nurse expect JM to exhibit?
Answer: Shallow, painful breathing
Explanation: Shallow and painful breathing is often the initial response to rib fractures due to
pain and the need to minimize chest movement.

50. JM becomes increasingly irritable and short of breath. A chest X-ray shows 30% of his right
lung has collapsed. He’s given oxygen via nasal cannula while awaiting chest tube insertion. At
this point, the nurse should assess for which early sign of hypoxia?
Answer: Restlessness
Explanation: Restlessness is an early indicator of hypoxia, especially when oxygenation is
compromised.

51. JM asks the nurse, “What if I stop breathing when the doctor inserts the chest tube?” The
most appropriate response would be to:
Answer: Assure him that the nurse and doctor will be present
Explanation: Providing reassurance about the presence of the medical team helps alleviate
anxiety about the procedure.

52. The doctor orders diazepam (Valium) I.V. before chest tube insertion primarily to:
Answer: Relieve anxiety and tension
Explanation: Diazepam is used to reduce anxiety and muscle tension before invasive procedures.
53. While JM is connected to the chest drainage device, the nurse should immediately report:
Answer: Excessive bubbling in the water-seal chamber
Explanation: Excessive bubbling in the water-seal chamber may indicate an air leak, which needs
to be addressed promptly.

54. Which observation would most likely indicate that JM’s chest tube should be removed?
Answer: Lung reexpansion on chest x-ray
**Explanation:
Lung reexpansion as confirmed by chest x-ray is a key indicator that the chest tube may be
removed.

55. Which method would best prevent air:

Answer: Breathing through pursed lips
Explanation: Pursed-lip breathing helps to maintain open airways and improve ventilation,
reducing air trapping and hyperinflation.

56. Which of the following statements is TRUE about securing the artificial airway?
Answer: Artificial airways must be secured directly to the patient
Explanation: Proper securing of artificial airways ensures they remain in place and function
effectively.

57. Endotracheal tube size indicated on the tube reflects what measurements:
Answer: The internal diameter of the tube
Explanation: The size of an endotracheal tube refers to its internal diameter, which affects
airflow and ventilation.

58. The mother of the patient asked what is the purpose of the tube, the following responses of
the nurse are accurate except:
Answer: Helps in feeding the patient
Explanation: The endotracheal tube is used for ventilation and suctioning, not for feeding.

59. After ET tube insertion, correct placement of the tube is verified most accurately by the
following means:
Answer: Chest x-ray
Explanation: A chest x-ray provides the most accurate confirmation of correct endotracheal tube
placement.

60. In adults, an inflated E-T tube cuff is necessary for mechanical ventilation primarily because:
Answer: It seals off the lower airway from the upper airway
Explanation: The cuff on an endotracheal tube prevents air from escaping and ensures proper
ventilation by sealing the lower airway.

61. Marie listens to Rica’s bilateral sound & finds that congestion is in the upper lobes of the
lungs. The appropriate position to drain the anterior & posterior apical segment of the lungs
when Marie does percussion would be:
Answer: Client lying flat on his back & then flat on his abdomen
Explanation: Positioning the client flat on their back and then their abdomen helps to drain the
anterior and posterior apical segments of the lungs.

62. When documenting outcome of Rica’s treatment Marie should include the following in his
recording EXCEPT:
Answer: Amount of fluid intake of client before & after procedure
Explanation: The amount of fluid intake is not directly relevant to the immediate outcome of
chest percussion or postural drainage.

63. When assessing Rica for chest percussion or chest vibration & postural drainage, Marie
would focus on the following EXCEPT:
Answer: Amount of food & fluid taken during the last meal before the treatment
Explanation: The amount of food and fluid intake is less relevant to the effectiveness of chest
percussion or postural drainage compared to respiratory and procedural factors.

64. Marie prepares Rica for postural drainage & percussion. Which of the following is a special
consideration when doing the procedure?
Answer: Time of last food & fluid intake of the client
Explanation: The time of last food and fluid intake is important to avoid discomfort and potential
aspiration during the procedure.

65. The purpose of chest percussion & vibration is to loosen secretions in the lungs. The
difference between the procedure is:
Answer: Percussion delivers cushioned blows to the chest with cupped palms while vibration
gently shakes secretion loose on the exhalation cycle
Explanation: Percussion involves striking the chest to loosen secretions, while vibration uses a
shaking motion to move secretions toward the central airways.