Exam 2: Oxygenation (NCLEX)

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An RN from the orthopedic unit has been floated to the medical
unit. Which client assignment for the floated RN is best?

A. The client with a resolving pulmonary embolus who is receiving

oxygen at 6 L/min through a nasal cannula A
B. The client with chronic lung disease who is being evaluated for Orthopedic nurses are familiar with pulmonary emboli and with
possible home oxygen use administration of oxygen through nasal cannulas.
C. The client with a newly placed tracheostomy who is receiving
oxygen through a tracheostomy collar
D. The client with chronic bronchitis who is receiving oxygen at
60% through a Venturi mask
Which value indicates clinical hypoxemia and the need to increase
oxygen delivery?
C
A. Hemoglobin of 22 g/dL PaO2 of 65 mm Hg indicates low levels of oxygen in the arterial
B. PaCO2 of 30 mm Hg blood; this is termed hypoxemia.
C. PaO2 of 65 mm Hg
D. Oxygen saturation of 88%
A client with COPD has a physician's prescription stating, "Adjust
oxygen to SpO2 at 90% to 92%." Which nursing action can be
delegated to a nursing assistant working under the supervision of
an RN? A
The scope of a nursing assistant's work includes positioning of
A. Adjust the position of the oxygen tubing oxygen tubing for client comfort.
B. Assess for signs and symptoms of hypoventilation
C. Change the O2 flow rate to keep SpO2 as prescribed
D. Choose which O2 delivery device should be used for the client
A client who smokes is being discharged home on oxygen. The
client states, "My lungs are already damaged, so I'm not going to
quit smoking." What is the discharge nurse's best response?
D
This is a great opening for the nurse to educate the client about
A. "You can quit when you are ready."
the dangers of smoking in the presence of oxygen, as well as the
B. "It's never too late to quit."
benefits of quitting.
C. "Just turn off your oxygen when you smoke."
D. "You are right, the damage has been done. But let's talk about
why smoking around oxygen is dangerous."
Which client has the most urgent need for frequent nursing as-
sessment?

A. An older client who was admitted 2 hours ago with emphysema

and dyspnea and has a 45-year 2-pack-per-day smoking history,
A
and is receiving 50% oxygen through a Venturi mask
An older adult client with a long history of smoking and chronic
B. A young client who has had a tracheostomy for 1 week, who is
lung disease who is receiving high-flow oxygen delivery is at
on room air with SpO2 in the upper 90's, who has been receiving
elevated risk for respiratory depression owing to the hypoxic drive
antibiotic therapy for 16 hours, and who has foul-smelling drainage
of respirations countered by high levels of oxygen. This client must
on the tracheostomy ties
be assessed frequently while receiving high-flow oxygen.
C. An older adult client who is anxious to go home with her
new tank of oxygen and supply of nasal cannulas and is being
discharged with a new prescription for home oxygen therapy
D. A middle-aged client who was admitted yesterday with pneu-
monia and is receiving oxygen at 2 L/min through a nasal cannula
A client has just been admitted to the emergency department and
requires high-flow oxygen therapy after suffering facial burns and
smoke inhalation. Which oxygen delivery device should the nurse A
use initially? A client with smoke inhalation and facial burns who requires
high-flow oxygen should initially be placed on a face tent because
A. Face tent this is the only noninvasive high-flow device that will minimize
B. Venturi mask painful and contaminating contact with burned facial tissue.
C. Nasal cannula
D. Non-rebreather mask

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 Exam 2: Oxygenation (NCLEX)
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A (DNR) client has a non-rebreather oxygen mask and breathing
appears to be labored. What does the nurse do first?
A
A. Ensures that the tubing is patent and that oxygen flow is high Labored breathing and ultimately suffocation can occur if the
B. Notifies the chaplain and the family member of record reservoir bag kinks, or if the oxygen source disconnects or is not
C. Calls the Rapid Response Team and prepares to intubate set to high flow levels.
D. Comforts the client and confirms that signed DNR orders are
in the chart
The client is admitted to the hospital for COPD, and the physician
requests a nasal cannula at 2 L/min. Within 30 minutes, the client's B
color improves. What does the nurse continue to monitor that may Respiratory rate and depth should be monitored closely while the
require immediate attention? client receives oxygen, because hypoventilation is seen during the
first 30 minutes of oxygen therapy in clients with hypoxic drive
A. Increasing carbon dioxide levels for respiration. The client's color will improve (from ashen or gray
B. Decreasing respiratory rate to pink) because of an increase in PaO2 level before apnea or
C. Increasing adventitious breath sounds respiratory arrest occurs from loss of the hypoxic drive.
D. Increased coughing
A client who has experienced a panic attack is being transferred
to the medical-surgical ward. The transfer nurse reports that the
client is doing much better after receiving bronchodilators via
nebulizer and a small dose of oral Valium 4 hours ago in the emer-
gency department. Vital signs are stable with oxygen delivered at D
4 L/min via simple facemask. Why is this client at high risk for A simple facemask must receive oxygen at a rate of at least 5
subsequent respiratory distress? L/min to prevent inhalation of exhaled breath, which has low levels
of oxygen and can eventually suffocate the client.
A. The client is not being treated for asthma
B. The client has a mental disorder
C. The client received a dose of Valium
D. The client is receiving oxygen at 4 L/min
A patient has been diagnosed with severe iron deficiency anemia.
During physical assessment for which of the following symptoms
would the nurse assess to determine the patient's oxygen status?
D
A: Increased breathlessness but increased activity tolerance
B: Decreased breathlessness and decreased activity tolerance
C: Increased activity tolerance and decreased breathlessness
D: Decreased activity tolerance and increased breathlessness
A 6-year-old boy is admitted to the pediatric unit with chills and a
fever of 104°F (40°C). What physiological process explains why
the child is at risk for developing dyspnea?

A: Fever increases metabolic demands, requiring increased oxy-

gen need.
A
B: Blood glucose stores are depleted, and the cells do not have
energy to use oxygen.
C: Carbon dioxide production increases as result of hyperventila-
tion.
D: Carbon dioxide production decreases as a result of hypoven-
tilation.
The nurse is caring for a patient who has decreased mobility.
Which intervention is a simple and cost-effective method for re-
ducing the risks of stasis of pulmonary secretions and decreased
chest wall expansion?
B
A: Antibiotics
B: Frequent change of position
C: Oxygen humidification
D: Chest physiotherapy

A patient is admitted with severe lobar pneumonia. Which of

the following assessment findings would indicate that the patient
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 Exam 2: Oxygenation (NCLEX)
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needs airway suctioning?

A: Coughing up thick sputum only occasionally

C
B: Coughing up thin, watery sputum easily after nebulization
C: Decreased independent ability to cough
D: Lung sounds clear only after coughing
A patient has been newly diagnosed with emphysema. In dis-
cussing his condition with the nurse, which of his statements
would indicate a need for further education?

A: "I'll make sure that I rest between activities so I don't get so

D
short of breath."
B: "I'll rest for 30 minutes before I eat my meal."
C: "If I have trouble breathing at night, I'll use two to three pillows
to prop up."
D: "If I get short of breath, I'll turn up my oxygen level to 6 L/min."
The nurse goes to assess a new patient and finds him lying supine
in bed. The patient tells the nurse that he feels short of breath.
Which nursing action should the nurse perform first?
A
A: Raise the head of the bed to 45 degrees.
B: Take his oxygen saturation with a pulse oximeter.
C: Take his blood pressure and respiratory rate.
D: Notify the health care provider of his shortness of breath
The nurse is caring for a patient who exhibits labored breathing
and uses accessory muscles. The patient has crackles in both
lung bases and diminished breath sounds. Which would be priority
assessments for the nurse to perform? (Select all that apply.)
ABC
A: SpO2 levels
B: Amount of sputum production
C: Change in respiratory rate and pattern
D: Pain in lower calf area
Which nursing intervention is appropriate for preventing atelecta-
sis in the postoperative patient?

A: Postural drainage C
B: Chest percussion
C: Incentive spirometer
D: Suctioning
The nurse needs to apply oxygen to a patient who has a precise
oxygen level prescribed. Which of the following oxygen-delivery
systems should the nurse select to administer the oxygen to the
patient?
A
A: Nasal cannula
B: Venturi mask
C: Simple face mask without inflated reservoir bag
D: Plastic face mask with inflated reservoir bag
For a male client with chronic obstructive pulmonary disease,
which nursing intervention would help maintain a patent airway?

A. Restricting fluid intake to 1,000 ml/day

C
B. Enforcing absolute bed rest
C. Teaching the client how to perform controlled coughing
D. Administering prescribed sedatives regularly and in large
amounts
For a client who is having respiratory symptoms of unknown
etiology, the diagnostic test that is most invasive is:

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 Exam 2: Oxygenation (NCLEX)
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A. Pulse oximetry to determine oxygen saturation levels
B. Throat cultures with sterile swabs
C
C. Bronchoscopy of the bronchial trees
D. Computed tomography of the lung fields
The nurse identifies that the client is unable to cough to produce a
sputum specimen and must be suctioned. Which suctioning route
is preferred?
B
A. Nasopharyngeal
B. Nasotracheal
C. Oropharyngeal
D. Orotracheal
The nurse is reviewing the results of the patient's diagnostic test-
ing. Of the following results, the finding that falls within expected
or normal limits is:

A. Palpable, elevated hardened area around a tuberculosis skin

D
testing site.
B. Sputum for culture and sensitivity identifies mycobacterium
tuberculosis
C. Presence of acid fast bacilli in sputum
D. Arterial oxygen tension (PaO2) of 95 mmHg
What is the correct sequence for suctioning a patient?

1. Open kit and basin.

2. Apply gloves.
3. Lubricate catheter.
4. Verify functioning of suction device and pressure.
5. Connect suctioning tubing to suction catheter.
6. Increase supplemental oxygen. C
7. Reapply oxygen.
8. Suction airway.

A. 6, 4, 3, 1, 2, 5, 8, 7
B. 4, 6, 1, 2, 3, 8, 5, 7
C. 4, 6, 1, 3, 2, 5, 8, 7
D. 6, 4, 1, 3, 2, 5, 7, 8
Which of the following skills can be delegated to the LPN? (Select
all that apply.)

A. Nasotracheal suctioning
BDE
B. Oropharyngeal suctioning of a stable patient
C. Suctioning a new artificial airway
D. Permanent tracheostomy tube suctioning
E. Care of an endotracheal tube (ETT)
The nurse is caring for a client after a bronchoscopy and biopsy.
Which finding, if noted in the client, should be reported immedi-
ately to the health care provider?
C
a. Dry cough
b. Hematuria
c. Bronchospasm
d. Blood-streaked sputum

The nurse is assessing the respiratory status of a client who has

suffered a fractured rib. The nurse should expect to note which
finding?
D
a. Slow, deep respirations
b. Rapid, deep respirations

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c. Paradoxical respirations
d. Pain, especially with inspiration
The nurse is discussing the techniques of chest physiotherapy
and postural drainage (respiratory treatments) to a client having
expectoration problems because of chronic thick, tenacious mu-
cus production in the lower airway. The nurse explains that after
the client is positioned for postural drainage the nurse will perform
which action to help loosen secretions? B

a. Palpation and clubbing

b. Percussion and vibration
c. Hyperoxygenation and suctioning
d. Administer a bronchodilator and monitor peak flow
A nurse is suctioning the nasopharyngeal airway of a patient to
maintain a patent airway. For which condition would the nurse
anticipate the need for a nasal trumpet?
D
a) The patient vomits during suctioning.
b) The secretions appear to be stomach contents.
c) The catheter touches an unsterile surface.
d) Epistaxis is noted with continued suctioning.
A nurse working in a long-term care facility is providing teaching to
BDE
patients with altered oxygenation due to conditions such as asth-
When caring for patients with COPD, it is important to create an
ma and COPD. Which measures would the nurse recommend?
environment that is likely to reduce anxiety and ensure that they
Select all that apply.
eat a high-protein/high-calorie diet. People with dyspnea and or-
thopnea are most comfortable in a high Fowler's position because
a) Refrain from exercise.
accessory muscles can easily be used to promote respiration.
b) Reduce anxiety.
Patients with COPD should pace physical activities and schedule
c) Eat meals 1 to 2 hours prior to breathing treatments.
frequent rest periods to conserve energy. Meals should be eaten 1
d) Eat a high-protein/high-calorie diet.
to 2 hours after breathing treatments and exercises, and drinking
e) Maintain a high-Fowler's position when possible.
2 to 3 quarts (1.9-2.9 L) of clear fluids daily is recommended.
f) Drink 2 to 3 pints of clear fluids daily.
A nurse is providing postural drainage for a patient with cystic
fibrosis. In which position should the nurse place the patient to
drain the right lobe of the lung?
B
a) High Fowler's position
b) Left side with pillow under chest wall
c) Lying position/half on abdomen and half on side
d) Trendelenberg position
When planning care for a patient with chronic lung disease who
is receiving oxygen through a nasal cannula, what does the nurse
B
expect?
A rate higher than 3 L/min may destroy the hypoxic drive that
stimulates respirations in the medulla in a patient with chronic
a) The oxygen must be humidified.
lung disease. Oxygen delivered at low rates does not necessarily
b) The rate will be no more than 2 to 3 L/min or less.
have to be humidified, and arterial blood gases are not required
c) Arterial blood gases will be drawn every 4 hours to assess flow
at regular intervals to determine the flow rate.
rate.
d) The rate will be 6 L/min or more.
What action does the nurse perform to follow safe technique when
using a portable oxygen cylinder?

a) Checking the amount of oxygen in the cylinder before using it

b) Using a cylinder for a patient transfer that indicates available A
oxygen is 500 psi
c) Placing the oxygen cylinder on the stretcher next to the patient
d) Discontinuing oxygen flow by turning cylinder key counterclock-
wise until tight
An emergency department nurse is using a manual resuscitation
bag (Ambu bag) to assist ventilation in a patient with lung cancer
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 Exam 2: Oxygenation (NCLEX)
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who has stopped breathing on his own. What is an appropriate
step in this procedure?

a) Tilt the patient's head forward.

B
b) Hold the mask tightly over the patient's nose and mouth.
c) Pull the patient's jaw backward.
d) Compress the bag twice the normal respiratory rate for the
patient.
A patient with a diagnosis of advanced Alzheimer disease who
is unable to follow directions requires an inhaled bronchodilator.
Which of the following medication delivery systems is most ap-
propriate for this patient?
B
a) metered-dose inhaler with spacer
b) nebulizer
c) metered-dose inhaler without spacer
d) dry powder inhaler
The nurse is caring for a client who is diagnosed with impaired gas
exchange. While performing a physical assessment of the client,
which data is the nurse likely to find, keeping in mind the client's
diagnosis?
A
a) high respiratory rate
b) low pulse rate
c) high temperature
d) low blood pressure
A nurse assessing a patient's respiratory effort notes that the
client's breaths are shallow and 8 per minute. Shortly after, the
client's respirations cease. Which of the following should the nurse D
use for this patient? If the patient is not breathing with an adequate rate and depth, or
if the patient has lost the respiratory drive, a manual rescucitation
a) Oxygen tent bag (Ambu bag)may be used to deliver oxygen until the patient is
b) Oxygen mask resuscitated or can be intubated with an endotracheal tube.
c) Nasal cannula
d) Ambu bag
Which dietary guideline would be appropriate for the older adult
homebound client with advanced respiratory disease who informs
the nurse that she has no energy to eat?
C
a) Eat one large meal at noon.
b) Snack on high-carbohydrate foods frequently.
c) Eat smaller meals that are high in protein.
d) Contact the physician for nutrition shake.
The nurse is informed while receiving a nursing report that the
client has been hypoxic during the evening shift. Which assess-
ment finding is consistent with hypoxia?
A
a) Confusion
b) Decreased blood pressure
c) Decreased respiratory rate
d) Hyperactivity
A physician has ordered an arterial blood gas test for a client with
a respiratory disorder. What is the most common role of the nurse
in performing the arterial blood gas test?

a) Implement measures to prevent complications after arterial A

puncture.
b) Measure the partial pressure of oxygen dissolved in plasma.
c) Measure the percentage of hemoglobin saturated with oxygen.
d) Perform the arterial puncture to obtain the specimen.

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 Exam 2: Oxygenation (NCLEX)
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The nurse is caring for a postoperative client who has a prescrip-
tion for meperidine (Demerol) 7 5mg intramuscularly (IM) every 4
hours as needed for pain. Before and after administering Demerol,
the nurse would assess which most important sign?
A
a) Respiratory rate and depth
b) Urinary intake and output
c) Orthostatic blood pressure
d) Apical pulse
Which diagnostic procedure measures lung size and airway pa-
tency, producing graphic representations of lung volumes and
flows?
A
a) Pulmonary function tests
b) Chest x-ray
c) Skin tests
d) Bronchoscopy
A newly hired nurse is performing a focused respiratory assess-
ment. The nurse mentor will intervene if which action by the newly
hired nurse is noted?

a) The newly hired nurse palpates the point of maximal impulse

(PMI).
B
b) The newly hired nurse auscultates breath sounds as the client
breathes through the nose.
c) The newly hired nurse attaches a pulse oximetry to the client's
index finger.
d) The newly hired nurse explains the assessment procedure
before performing it.
B
The nurse is caring for a client with emphysema. A review of
The client with chronic lung disease, such as emphysema, be-
the client's chart reveals pH 7.36, paO2 73 mm Hg, PaCO2 64
comes insensitive to carbon dioxide and responds to hypoxia to
mm Hg, and HCO3 35 mEq/L. The nurse would question which
stimulate breathing. If given excessive oxygen (4 L/minute), the
prescription, if prescribed by the health care practitioner?
stimulus to breathe is removed. Clients with emphysema are most
comfortable in high-Fowler's position because it aids in the use
a) Pulse oximetry
of the accessory muscles to promote respirations. Increasing fluid
b) 4 L/minute O2 nasal cannula
intake helps keep the client's secretions thin. Pulse oximetry mon-
c) High-Fowler's position
itors the client's arterial oxyhemoglobin saturation while receiving
d) Increase fluid intake to 3 L/day
oxygen therapy.
The nurse is caring for a client who has a compromised car-
diopulmonary system and needs to assess the client's tissue
oxygenation. The nurse would use which appropriate method to A
assess this client's oxygenation? Arterial blood gases include the levels of oxygen, carbon dioxide,
bicarbonate, and pH. Blood gases determine the adequacy of
a) Arterial blood gas alveolar gas exchange and the ability of the lungs and kidneys to
b) Hemoglobin levels maintain the acid-base balance of body fluids.
c) Hematocrit values
d) Pulmonary function
A nurse is delivering 3 L/min oxygen to a patient via nasal cannula.
What percentage of delivered oxygen is the patient receiving?
A
A nasal cannula is used to deliver from 1 L/minute to 6 L/minute of
a) 32%
oxygen. 1 L/minute = 24%, 2 L/minute = 28%, 3 L/minute = 32%,
b) 28%
4 L/minute = 36%, 5 L/minute = 40%, and 6 L/minute = 44%
c) 47%
d) 23%

B
What structural changes to the respiratory system should a nurse One of the structural changes affecting the respiratory system that
observe when caring for older adults? a nurse should observe in an older adult is respiratory muscles
becoming weaker. The nurse should also observe other structural
changes: the chest wall becomes stiffer as a result of calcification
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 Exam 2: Oxygenation (NCLEX)
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of the intercostals cartilage, kyphoscoliosis, and arthritic changes
to costovertebral joints; the ribs and vertebrae lose calcium; the
a) increased use of accessory muscles for breathing
lungs become smaller and less elastic; alveoli enlarge; and alve-
b) respiratory muscles become weaker
olar walls become thinner. Diminished coughing and gag reflexes,
c) increased mouth breathing and snoring
increased use of accessory muscles for breathing, and increased
d) diminished coughing and gag reflexes
mouth breathing and snoring are functional changes to the respi-
ratory system in older adults.
A client has been placed on 6 L of humidified oxygen via nasal D
cannula. Which action by the nurse is most appropriate? Condensation often forms in the tubing when a client receives
humidified high-flow oxygen. Remove this condensation as it col-
a. Drain condensation back into the humidifier, maintaining a lects by disconnecting the tubing and emptying the water. Some
closed system. humidifiers and nebulizers have a water trap that hangs from the
b. Keep the water sterile by draining it from the water trap back into tubing so the condensation can be drained without disconnecting.
the humidifier. To prevent bacterial contamination, never drain the fluid back into
c. Turn down the humidity when condensation begins to collect in the humidifier or the nebulizer. Do not turn down the humidity
the tubing. because the physician has ordered it and the client needs it.
d. Remove condensation in the tubing by disconnecting and emp- Minimize how long the tubing is disconnected because the client
tying it appropriately. does not receive oxygen during this period.
A
A client is receiving oxygen via Venturi mask at 40%. On assess- The Venturi mask works by drawing in a specific amount of air
ment the nurse finds the client cyanotic with labored respirations. to mix with the oxygen through holes in an adaptor fitted at
Which action does the nurse perform first? the bottom of the mask. Holes of different sizes allow different
amounts of room air to be entrained, changing the amount of
a. Remove bedding from around the adaptor opening. oxygen delivered. Bedding (or clothing) wrapped around those
b. Listen to lung sounds and obtain a respiratory rate. holes would effectively change the FiO2. The nurse should ensure
c. Call respiratory therapy to check oxygen saturation. that the holes remain unobstructed. Other options are appropriate
d. Notify the provider or Rapid Response Team immediately. but are not the first choice, because this simple step may be what
solves the problem.
A client requires oxygen received via a face mask but wants
to remain as mobile as possible once discharged home. Which
intervention by the home health nurse best provides the client with
maximal mobility?

a. Arrange a consultation with pulmonary rehabilitation to de-

crease oxygen needs. C
b. Encourage the client to remove the mask occasionally to assess
tolerance.
c. Add extra connecting pieces of tubing to the client's existing
oxygen setup.
d. Change the face mask to a nasal cannula occasionally, such as
at mealtimes.
A client has been brought in by the rescue squad to the emer-
gency department. The client is having an acute exacerbation of B
chronic obstructive pulmonary disease (COPD) and is severely Oxygen-induced hypoventilation can occur in clients with chron-
short of breath. On arrival, the client is on 15 L/min of oxygen via
ically elevated PCO2 levels, such as those seen in COPD. Giv-
rebreather mask. Which action by the nurse takes priority? ing oxygen can eliminate their hypoxic drive to breathe and can
cause respiratory arrest. However, hypoxemia is a greater threat
a. Immediately reduce the oxygen flow to 2 to 4 L/min via nasal to an acutely ill client than is the potential for oxygen-induced
cannula. hypoventilation, and clients should be given the amount of oxygen
b. Perform a thorough respiratory assessment and attach pulse they require. The nurse should perform a thorough respiratory
oximetry. assessment and should monitor the client for signs of this problem,
c. Call the laboratory to obtain arterial blood gases as soon as rather than automatically reducing oxygen delivery. Blood gases
possible. and a chest x-ray will also be obtained, but they do not take priority
d. Obtain a stat chest x-ray, then slowly wean the client's oxygen over assessing and monitoring the client.
down.

The nurse is caring for a client with orders for oxygen at 5 L/min.
Approximately how much FiO2 is the client receiving?
D
a. 24%
b. 28%

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 Exam 2: Oxygenation (NCLEX)
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c. 36%
d. 40%
A client who is receiving continuous oxygen therapy by nasal B
cannula for an acute respiratory problem is becoming increasingly Cerebral hypoxia is a cause of confusion and is a sensitive indi-
confused. What does the nurse do first? cator that the client needs more oxygen. Although you would want
to notify the provider of the change in the client's condition, the
a. Notify the health care provider. best action is first to assess pulse oximetry and then to increase
b. Assess the client's pulse oximetry. the oxygen. You would not just document the assessment finding
c. Document the observation. without intervening. Raising the head of the bed would not help
d. Raise the head of the bed. the client oxygenate better.
The nurse assesses a client who is receiving oxygen via a partial
rebreather mask. Which assessment finding does the nurse inter-
C
vene to correct?
Flow rate should be 6 to 11 L/min. A flow rate of 2 L/min will
not adequately inflate the bag. A bag that is two thirds inflated is
a. The bag is two thirds inflated during inhalation.
desired. A pulse oximetry reading of 93% and higher is adequate,
b. The client's pulse oximetry reading is 93%.
as is an arterial oxygenation of 90%.
c. The oxygen flow rate is 2 L/min.
d. The arterial oxygen level is 90%.
The nurse is caring for a patient with chronic obstructive
pulmonary disease (COPD). The patient has been receiving
high-flow oxygen therapy for an extended time. What symptoms
should the nurse anticipate if the patient were experiencing oxy-
gen toxicity?
B
A) Bradycardia and frontal headache
B) Dyspnea and substernal pain
C) Peripheral cyanosis and restlessness
D) Hypotension and tachycardia
The nurse is caring for a patient who is scheduled to have a tho-
racotomy. When planning preoperative teaching, what information
should the nurse communicate to the patient?
B
A) How to milk the chest tubing
B) How to splint the incision when coughing
C) How to take prophylactic antibiotics correctly
D) How to manage the need for fluid restriction
The nurse is discussing activity management with a patient who is
postoperative following thoracotomy. What instructions should the
nurse give to the patient regarding activity immediately following
discharge?
D
A) Walk 1 mile 3 to 4 times a week.
B) Use weights daily to increase arm strength.
C) Walk on a treadmill 30 minutes daily.
D) Perform shoulder exercises five times daily.
The home care nurse is visiting a patient newly discharged home
after a lobectomy. What would be most important for the home
care nurse to assess?
D
A) Resumption of the patients ADLs
B) The familys willingness to care for the patient
C) Nutritional status and fluid balance
D) Signs and symptoms of respiratory complications
A patient has been discharged home after thoracic surgery. The
home care nurse performs the initial visit and finds the patient
discouraged and saddened. The client states, I am recovering so
slowly. I really thought I would be better by now. What nursing A
action should the nurse prioritize?

A) Provide emotional support to the patient and family.

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B) Schedule a visit to the patients primary physician within 24
hours.
C) Notify the physician that the patient needs a referral to a
psychiatrist.
D) Place a referral for a social worker to visit the patient.
The nurse is performing nasotracheal suctioning on a medical pa-
tient and obtains copious amounts of secretions from the patients
airway, even after inserting and withdrawing the catheter several
times. How should the nurse proceed?

A) Continue suctioning the patient until no more secretions are C

obtained.
B) Perform chest physiotherapy rather than nasotracheal suction-
ing.
C) Wait several minutes and then repeat suctioning.
D) Perform postural drainage and then repeat suctioning.
The charge nurse is making assignments for the next shift. Which
patient should be assigned to the fairly new nurse (6 months of C
experience) floated from the surgical unit to the medical unit? Many surgical patients are taught about coughing, deep breathing,
and the use of incentive spirometry preoperatively. Also, a fairly
A.) A 58-year-old patient on airborne precautions for tuberculosis new nurse should be assigned more stable and less complicated
(TB) patients. To care for the patient with TB in isolation, the nurse
B.) A 65-year-old patient who just returned from bronchoscopy must be fitted for a high-efficiency particulate air (HEPA) respirator
and biopsy mask. The bronchoscopy patient needs specialized and careful
C.) A 72-year-old patient who needs teaching about the use of assessment and monitoring after the procedure, and the ventila-
incentive spirometry tor-dependent patient needs a nurse who is familiar with ventilator
D.)A 69-year-old patient with chronic obstructive pulmonary dis- care. Both of these patients need experienced nurses.
ease (COPD) who is ventilator dependent
The unlicensed assistive personnel (UAP) is assisting with feeding
for a patient with severe end-stage chronic obstructive pulmonary
disease (COPD). Which instruction will the nurse provide the
UAP?
A
A.) Encourage the patient to eat foods that are high in calories and
protein.
B.) Feed the patient as quickly as possible to prevent early satiety.
C.) Offer lots of fluids between bites of food.
D.) Try to get the patient to eat everything on the tray
An experienced LPN/LVN, under the supervision of the team
leader RN, is assigned to provide nursing care for a patient with a 124
respiratory problem. Which actions are appropriate to the scope The experienced LPN/LVN is capable of gathering data and mak-
of practice of an experienced LPN/LVN? Select all that apply. ing observations, including noting breath sounds and performing
pulse oximetry. Administering medications, such as those deliv-
1.) Auscultating breath sounds ered via MDIs, is within the scope of practice of the LPN/LVN.
2.) Administering medications via metered-dose inhaler (MDI) Independently completing the admission assessment, developing
3.) Completing in-depth admission assessment the nursing care plan, and evaluating a patient's abilities require
4.) Checking oxygen saturation using pulse oximetry additional education and skills within the scope of practice of the
5.)Developing the nursing care plan professional RN.
6.) Evaluating the patient's technique for using MDIs
The nurse is evaluating and assessing a patient with a diagnosis
of chronic emphysema. The patient is receiving oxygen at a flow
rate of 5 L/min by nasal cannula. Which finding concerns the nurse
immediately?
B
A.) Fine bibasilar crackles
B.) Respiratory rate of 8 breaths/min
C.) The patient sitting up and leaning over the nightstand
D.) A large barrel chest

The unlicensed assistive personnel (UAP) tells the nurse that a

patient who is receiving oxygen at a flow rate of 6 L/min by nasal
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 Exam 2: Oxygenation (NCLEX)
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cannula is reporting nasal passage discomfort. What intervention
should the nurse suggest to the UAP to improve the patient's A
comfort for this problem? When the oxygen flow rate is higher than 4 L/min, the mucous
membranes can be dried out. The best treatment is to add hu-
A.) Humidify the patient's oxygen. midification to the oxygen delivery system. Applying water-soluble
B.) Use a simple face mask instead of a nasal cannula. jelly to the nares can also help decrease mucosal irritation. None
C.) Provide the patient with an extra pillow. of the other options will treat the problem.
D.) Have the patient sit up in a chair at the bedside.
The RN is teaching an unlicensed assistive personnel (UAP) to
check oxygen saturation by pulse oximetry. What will the nurse be
sure to tell the UAP about patients with darker skin?

A.) "Be aware that patients with darker skin usually show a 3%
to 5% higher oxygen saturation compared with light-skinned pa-
tients."
B
B.) "Usually dark-skinned patients show a 3% to 5% lower oxygen
saturation by pulse oximetry than light-skinned patients."
C.) "With a dark-skinned patient, you may get more accurate
results by measuring pulse oximetry on the patient's toes."
D.) "More accurate results may result from continuous pulse
oximetry monitoring than spot checking when a patient has darker
skin."
After the respiratory therapist performs suctioning on a patient
who is intubated, the unlicensed assistive personnel (UAP) mea-
sures vital signs for the patient. Which vital sign value should the
UAP be instructed to report to the RN immediately?
D
a. Heart rate of 98 beats/min
b. Respiratory rate of 24 breaths/min
c. Blood pressure of 168/90 mm Hg
d. Tympanic temperature of 101.4°F (38.6°C)
The critical care charge nurse is responsible for the care of four
patients receiving mechanical ventilation. Which patient is most at
risk for failure to wean and ventilator dependence?
A
a. A 68-year-old patient with a history of smoking and emphysema
b. A 57-year-old patient who experienced a cardiac arrest
c. A 49-year-old postoperative patient who had a colectomy
d. A 29-year-old patient who is recovering from flail chest
Which of the following nursing diagnoses would be the most
important yet relevant nursing diagnosis for the patient diagnosed
A
with having a pulmonary contusion?
Fluid volume overload would be appropriate for this client be-
cause of the fluid build-up occurring in the lungs (AEB: Crackles,
A) Fluid Volume Overload
decreased breath sounds, etc.). This build-up is caused by the
B) Imbalanced Nutrition: Less than body requirements
bruising and edema pulling fluid from the vascular spaces.
C) Acute Pain
D) Risk for Infection
The nurse enters the patient's room at the beginning of her shift.
The patient is 3 days post-op right-sided pneumonectomy. Which
of the following findings requires most immediate intervention by
3
the nurse?
The post-op pneumonectomy patient should be positioned on the
OPERATIVE (bad) side OR on the back. Sipping iced water in
1) The patient is slowly sipping iced water.
itself isn't harmful to this patient. Urinary output is sufficient. Pain
2) The CNA reports that urinary output for the last 6 hours is 200
is expected, although this would be the nurse's second concern.
mL.
3) The patient is positioned on her left side with SCDs in place.
4) The patient reports pain at 9/10.

A patient admits to the E.D. with fractures of 3 lower ribs. Which

of the following is the priority concern of the nurse caring for this
patient?
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 Exam 2: Oxygenation (NCLEX)
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1) infection risk
2) pain 3
3) hemorrhage risk
4) airway maintenance
ABCD
Which of the following would the nurse anticipate being ordered
IV fluids would be necessary to prevent hypovolemia because of
for the patient with pulmonary contusion? SATA:
the fluid that is leaving the vascular spaces into the lungs/pleural
spaces. This must be administered judiciously to prevent fluid
A) IV fluids
volume overload or worsening lung function. Intubation or me-
B) Intubation/mechanical ventilation
chanical ventilation may be ordered, if pulmonary contusion is
C) Opioids
severe. Opioids are often used for pain relief. Antibiotics would
D) Antibiotics
be administered prophylactically to prevent infection from arising.
E) Albumin
Albumin would not be given in this disorder.
The patient arrives to the ED and you are told by the reporting
C
nurse that the patient is suspected of having flail chest. Which of
In order to look for s/s of flail chest, the most important assessment
the following would the nurse assess for first?
sign to watch for is paradoxical chest movement, which could be
found by monitoring respirations. Palpating the thorax could cause
A) Palpate the thorax for a crackling, grating sound
further damage to the ribs. It would be very important to assess
B) Ask pt. pain level and location
pain and bp and hr (bleeding) but these will not help confirm the
C) Monitor respirations
suspected diagnosis.
D) Assess blood pressure and heart rate
A nurse is caring for a 29 year-old patient on a med-surg unit with
3 lower rib fractures. Which of the following findings, if noted by
3
the nurse, is most concerning?
This patient has spiked a fever which, even though it is slight,
could be indicative of pneumonia or atelectasis. This needs to be
1) Patient rates pain 8/10.
further investigated. Crepitus and muscle spasms over the area
2) Patient reports feeling muscle spasms over the fracture area
are expected. Extreme pain is also expected, and would be the
when he coughs.
nurse's immediate concern after addressing the patient's elevated
3) Patient's temperature is 99.8F.
temperature.
4) The nurse feels a crackling, grating sensation over the lower
ribs.
A male client has been admitted with chest trauma after a motor B
vehicle accident and has undergone subsequent intubation. A Pneumothorax is characterized by restlessness, tachycardia, dys-
nurse checks the client when the high-pressure alarm on the pnea, pain with respiration, asymmetrical chest expansion, and
ventilator sounds, and notes that the client has absence of breathe diminished or absent breath sounds on the affected side. Pneu-
sounds in right upper lobe of the lung. The nurse immediately mothorax can cause increased airway pressure because of re-
assesses for other signs of: sistance to lung inflation. Acute respiratory distress syndrome
and pulmonary embolism are not characterized by absent breath
A. Pulmonary Embolism sounds. An endotracheal tube that is inserted too far can cause
B. Right pneumothorax absent breath sounds, but the lack of breath sounds most likely
C. Displaced endotracheal tube would be on the left side because of the degree of curvature of
D. Acute respiratory distress syndrome the right and left main stem bronchi.
A patient with a possible pulmonary embolism complains of chest
pain and difficulty breathing. The nurse finds a heart rate of 142
beats/minute, blood pressure of 100/60 mmHg, and respirations
of 42 breaths/minute. Which action should the nurse take first?
D
a. Administer anticoagulant drug therapy.
b. Notify the patient's health care provider.
c. Prepare patient for a spiral computed tomography (CT).
d. Elevate the head of the bed to a semi-Fowler's position.

The nurse receives change-of-shift report on the following four

patients. Which patient should the nurse assess first?

a. A 23-year-old patient with cystic fibrosis who has pulmonary

B
function testing scheduled
b. A 46-year-old patient on bed rest who is complaining of sudden
onset of shortness of breath
c. A 77-year-old patient with tuberculosis (TB) who has four anti-
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 Exam 2: Oxygenation (NCLEX)
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tubercular medications due in 15 minutes
d. A 35-year-old patient who was admitted the previous day with
pneumonia and has a temperature of 100.2° F (37.8° C)
A patient is admitted to the emergency department with an open
stab wound to the left chest. What is the first action that the nurse
should take?

a. Position the patient so that the left chest is dependent.

b. Tape a nonporous dressing on three sides over the chest B
wound.
c. Cover the sucking chest wound firmly with an occlusive dress-
ing.
d. Keep the head of the patient's bed at no more than 30 degrees
elevation.
The nurse notes that a patient has incisional pain, a poor cough
effort, and scattered rhonchi after a thoracotomy. Which action
should the nurse take first?
C
a. Assist the patient to sit upright in a chair.
b. Splint the patient's chest during coughing.
c. Medicate the patient with prescribed morphine.
d. Observe the patient use the incentive spirometer.
The nurse provides discharge teaching for a patient who has
two fractured ribs from an automobile accident. Which statement,
if made by the patient, would indicate that teaching has been
effective?

a. "I am going to buy a rib binder to wear during the day." D

b. "I can take shallow breaths to prevent my chest from hurting."
c. "I should plan on taking the pain pills only at bedtime so I can
sleep."
d. "I will use the incentive spirometer every hour or two during the
day."
After change-of-shift report, which patient should the nurse as-
sess first?

a. 72-year-old with cor pulmonale who has 4+ bilateral edema in

his legs and feet
b. 28-year-old with a history of a lung transplant and a temperature D
of 101° F (38.3° C)
c. 40-year-old with a pleural effusion who is complaining of severe
stabbing chest pain
d. 64-year-old with lung cancer and tracheal deviation after sub-
clavian catheter insertion
Gina, a home health nurse is visiting a home care client with
advanced lung cancer. Upon assessing the client, the nurse
discovers wheezing, bradycardia, and a respiratory rate of 10
breaths/minute. These signs are associated with which condition?
A
a. Hypoxia
b. Delirium
c. Hyperventilation
d. Semiconsciousness

A male client with Guillain-Barré syndrome develops respiratory

acidosis as a result of reduced alveolar ventilation. Which com-
bination of arterial blood gas (ABG) values confirms respiratory
acidosis? D

a. pH, 5.0; PaCO2 30 mm Hg

b. pH, 7.40; PaCO2 35 mm Hg
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 Exam 2: Oxygenation (NCLEX)
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c. pH, 7.35; PaCO2 40 mm Hg
d. pH, 7.25; PaCO2 50 mm Hg
A female client with interstitial lung disease is prescribed pred-
nisone (Deltasone) to control inflammation. During client teaching,
the nurse stresses the importance of taking prednisone exactly as
prescribed and cautions against discontinuing the drug abruptly.
A client who discontinues prednisone abruptly may experience:
B
a. hyperglycemia and glycosuria.
b. acute adrenocortical insufficiency.
c. GI bleeding.
d. restlessness and seizures.
A male adult client with cystic fibrosis is admitted to an acute care
facility with an acute respiratory infection. Prescribed respiratory
treatment includes chest physiotherapy. When should the nurse
perform this procedure?
B
a. Immediately before a meal
b. At least 2 hours after a meal
c. When bronchospasms occur
d. When secretions have mobilized
The amount of air inspired and expired with each breath is called:

a. tidal volume.
A
b. residual volume.
c. vital capacity.
d. dead-space volume.
Which of the following would be most appropriate for a male client
with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2
saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?
B
a. Administer a prescribed decongestant.
b. Instruct the client to breathe into a paper bag.
c. Offer the client fluids frequently.
d. Administer prescribed supplemental oxygen.
A black male client with asthma seeks emergency care for acute
respiratory distress. Because of this client's dark skin, the nurse
should assess for cyanosis by inspecting the:
B
a. lips.
b. mucous membranes.
c. nail beds.
d. earlobes
A female client with asthma is receiving a theophylline preparation
to promote bronchodilation. Because of the risk of drug toxicity, the
nurse must monitor the client's serum theophylline level closely.
The nurse knows that the therapeutic theophylline concentration
falls within which range?
D
a. 1 to 2 mcg/ml
b. 2 to 5 mcg/ml
c. 5 to 10 mcg/ml
d. 10 to 20 mcg/ml

Before seeing a newly assigned female client with respiratory

alkalosis, the nurse quickly reviews the client's medical history.
Which condition is a predisposing factor for respiratory alkalosis?
C
a. Myasthenia gravis
b. Type 1 diabetes mellitus

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 Exam 2: Oxygenation (NCLEX)
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c. Extreme anxiety
d. Narcotic overdose
At 11 p.m., a male client is admitted to the emergency department.
He has a respiratory rate of 44 breaths/minute. He's anxious, and
wheezes are audible. The client is immediately given oxygen by
face mask and methylprednisolone (Depo-medrol) I.V. At 11:30
p.m., the client's arterial blood oxygen saturation is 86% and he's
still wheezing. The nurse should plan to administer: D

a. alprazolam (Xanax).
b. propranolol (Inderal)
c. morphine.
d. albuterol (Proventil).
The charge nurse is making client assignments on a medical floor.
Which client should the charge nurse assign to the LPN?

1. The client with pneumonia who has a pulse oximeter reading of

91%.
4
2. The client with a hemothorax who has Hgb of 9 mg/dL and Hct
of 20%.
3. The client with chest tubes who has jugular vein distention and
BP of 96/60.
4. The client who is two (2) hours post-bronchoscopy procedure.
Which of the following statements is true about intrapleural (the
space between the parietal and visceral or pulmonary pleurae)
pressure under normal conditions?
D
A. It is always positive
B. It is negative during inhalation; positive during exhalation
C. It is positive during inhalation; negative during exhalation
D. It is always negative
When the nurse is caring for an obese patient with left lower
lobe pneumonia, gas exchange will be best when the patient is
B
positioned
The patient should be positioned with the "good" lung in the
dependent position to improve the match between ventilation and
a. on the left side.
perfusion. The obese patient's abdomen will limit respiratory ex-
b. on the right side.
cursion when sitting in the high-Fowler's or tripod positions.
c. in the tripod position.
d. in the high-Fowler's position.
The nurse obtains the vital signs for a patient admitted 2 days ago C
with gram-negative sepsis: temperature 101.2° F, blood pressure The patient's increased respiratory rate in combination with the
90/56 mm Hg, pulse 92, respirations 34. Which action should the admission diagnosis of gram-negative sepsis indicates that acute
nurse take next? respiratory distress syndrome (ARDS) may be developing. The
nurse should check for hypoxemia, a hallmark of ARDS. The health
a. Administer the scheduled IV antibiotic. care provider should be notified after further assessment of the
b. Give the PRN acetaminophen (Tylenol) 650 mg. patient. Administration of the scheduled antibiotic and adminis-
c. Obtain oxygen saturation using pulse oximetry. tration of Tylenol also will be done, but they are not the highest
d. Notify the health care provider of the patient's vital signs. priority for a patient who may be developing ARDS.
After receiving change-of-shift report, which patient will the nurse
assess first?

a. A patient with cystic fibrosis who has thick, green-colored

sputum
b. A patient with pneumonia who has coarse crackles in both lung D
bases
c. A patient with emphysema who has an oxygen saturation of
91% to 92%
d. A patient with septicemia who has intercostal and suprasternal
retractions

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 Exam 2: Oxygenation (NCLEX)
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When assessing a patient with chronic lung disease, the nurse
finds a sudden onset of agitation and confusion. Which action
should the nurse take first?
D
a. Check pupil reaction to light.
b. Notify the health care provider.
c. Attempt to calm and reassure the patient.
d. Assess oxygenation using pulse oximetry.
The nurse is caring for a 22-year-old patient who came to the
emergency department with acute respiratory distress. Which in-
formation about the patient requires the most rapid action by the
nurse?
C
a. Respiratory rate is 32 breaths/min.
b. Pattern of breathing is shallow.
c. The patient's PaO2 is 45 mm Hg.
d. The patient's PaCO2 is 34 mm Hg.
A client who has undergone radical neck dissection for a tumor
has a potential problem of obstruction related to postoperative
edema, drainage, and secretions. To promote adequate respi-
ratory function in this client, the nurse should implement which
activities? Select all that apply.
1245
1.Suctioning the client as needed
2.Encouraging coughing every 2 hours
3.Placing the bed in low Fowler's position
4.Supporting the neck incision when the client coughs
5.Monitoring the respiratory status frequently as prescribed
The nurse will monitor for clinical manifestations of hypercapnia
when a patient in the emergency department has

a. chest trauma and multiple rib fractures. A

b. carbon monoxide poisoning after a house fire.
c. left-sided ventricular failure and acute pulmonary edema.
d. tachypnea and acute respiratory distress syndrome (ARDS).
A patient is brought to the emergency department unconscious
following a barbiturate overdose. Which potential complication will
the nurse include when developing the plan of care?

a. Hypercapnic respiratory failure related to decreased ventilatory A

effort
b. Hypoxemic respiratory failure related to diffusion limitations
c. Hypoxemic respiratory failure related to shunting of blood
d. Hypercapnic respiratory failure related to inc
A patient with hypercapnic respiratory failure has a respiratory rate
of 8 and an SpO2 of 89%. The patient is increasingly lethargic.
Which collaborative intervention will the nurse anticipate?
B
a. Administration of 100% oxygen by non-rebreather mask
b. Endotracheal intubation and positive pressure ventilation
c. Insertion of a mini-tracheostomy with frequent suctioning
d. Initiation of bilevel positive pressure ventilation (BiPAP)

Mr. D, a 28-year-old man, has been admitted to the intensive

care unit for monitoring after a motor vehicle accident (MVA).
Your physical assessment reveals multiple abrasions and bruising
across the chest but an otherwise healthy young man. Suddenly,
C
Mr. D complains of difficulty breathing. You quickly perform an
assessment of his respiratory status and observe that his O2
saturation has dropped dramatically, there are decreased breath
sounds on the left, and it appears that there is some tracheal
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 Exam 2: Oxygenation (NCLEX)
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deviation. What would be your next logical action?

A) Notify Mr. D's physician and prepare for a stat V/Q scan.
B) Start Mr. D on O2 at 4 L/min nasal cannula and prepare an
aminophylline drip.
C) Call the rapid response team and prepare for emergency
insertion of a chest tube.
D) Notify Mr. D's physician of these changes.
A patient has been on a non-rebreathing mask at 10 L/min for
4 days and is complaining of a dry cough, a stuffy nose, and
substernal chest pain (pain score, 6 of 10) that increases with
deep breathing. The chest radiograph shows no changes, and
the 12-lead electrocardiography (ECG) findings are normal. The
nurse suspects the patient is experiencing: B

A) hypercapnia.
B) oxygen toxicity.
C) unstable angina.
D) absorption atelectasis.
Which of the following statements is true regarding oxygen toxic-
ity?

A) It can occur in patients who inhale greater than 50% oxygen for
more than 24 hours. A
B) It causes destruction of oxygen-free radicals.
C) The most common presenting symptom is respiratory depres-
sion.
D) Chest radiography is a useful tool for early diagnosis.
Mr. J, a 26-year-old patient with diabetes, is admitted to the unit
in severe diabetic ketoacidosis. His pH is 7.29. Understanding
the principles of the oxyhemoglobin dissociation curve, you would
expect which finding when you measure his SaO2?

A) The SaO2 may be higher than normal. B

B) The SaO2 may be lower than normal.
C) The SaO2 is not affected because he does not have pulmonary
disease.
D) You must know the HCO3- before you can predict changes in
the SaO2.

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