Mock Board Exam: Upper & Lower Respiratory Problems

(1–100)

QUESTIONS (1–100)

1. A patient with pneumonia is most likely to exhibit which finding on auscultation?

a. Crackles
b. Wheezes
c. Pleural friction rub
d. Absent breath sounds
2. The most reliable method for confirming the diagnosis of tuberculosis is:
a. Chest x-ray
b. Sputum culture for acid-fast bacilli
c. Mantoux skin test
d. Clinical symptoms
3. A nurse admitting a client with suspected influenza should implement which precaution?
a. Contact precautions
b. Airborne precautions
c. Droplet precautions
d. Standard precautions only
4. When teaching a patient how to control an anterior epistaxis at home, the nurse should instruct the client to:
a. Tilt the head back and lie down
b. Lean forward and pinch the nares for 10 minutes
c. Insert tissues into the nostril to stop bleeding
d. Apply a warm compress to the back of the neck
5. RSV (respiratory syncytial virus) in an infant commonly presents with which early sign?
a. Bradycardia
b. Apnea and poor feeding
c. Hypertension
d. Hemoptysis
6. A postoperative tonsillectomy client who repeatedly swallows or vomits bright red blood most likely has:
a. Dehydration
b. Delayed hemorrhage
c. Respiratory infection
d. Allergic reaction
7. After a total laryngectomy, which statement by the client indicates correct understanding?
a. I will breathe through my mouth as before
b. I will have a permanent stoma in my neck for breathing
c. My voice will return to normal after a month
d. I can use a standard hearing aid to help speech
8. When suctioning a tracheostomy tube, the nurse should do which of the following?
a. Apply suction while inserting the catheter
b. Limit each suction pass to 10 seconds or less
c. Use a clean nonsterile technique
d. Instill normal saline routinely before suctioning
9. Continuous bubbling in the water-seal chamber of a chest drainage system most likely indicates:
a. Normal functioning
b. An air leak
c. A blocked tube
d. Excessive drainage
10. A patient with a chest tube develops subcutaneous emphysema around the insertion site. The nurse should:
a. Immediately clamp the chest tube
b. Notify the physician and continue to monitor
c. Strip the chest tube to remove air
d. Remove the chest tube
11. A sudden onset of unilateral chest pain and absent breath sounds on one side suggests:
a. Pulmonary edema
b. Tension pneumothorax
c. Spontaneous pneumothorax
d. Pleural effusion
12. The most immediate nursing action for suspected tension pneumothorax is:
a. Prepare for chest x-ray
b. Needle decompression of the affected side
c. Increase oxygen to 100% via nonrebreather
d. Initiate chest physiotherapy
13. An arterial blood gas shows pH 7.28, PaCO2 60 mm Hg, HCO3- 26 mEq/L. This indicates:
a. Metabolic acidosis
b. Respiratory acidosis without compensation
c. Respiratory alkalosis
d. Metabolic alkalosis
14. A COPD client is receiving oxygen therapy. The nurse should be most concerned if the family states:
a. They can adjust the flow if the client is short of breath
b. Oxygen will help the client's activity tolerance
c. The client will use oxygen while sleeping
d. They will keep oxygen cylinders upright
15. A peak expiratory flow measurement at 45% of personal best indicates:
a. Green zone (good control)
b. Yellow zone (caution)
c. Red zone (medical alert)
d. Blue zone (maintenance)
16. Which finding in a patient with asthma indicates impending respiratory failure?
a. Audible wheezes throughout inspiration and expiration
b. Absence of wheeze with decreased breath sounds
c. Peak flow at 85% of predicted
d. Respiratory rate of 18/min
17. Side effects of beta-2 agonist nebulization may include:
a. Bradycardia and hypotension
b. Tachycardia and tremors
c. Constipation
d. Urinary retention
18. The highest priority nursing action for a patient experiencing an acute COPD exacerbation is:
a. Administer broad-spectrum antibiotics
b. Improve oxygenation and airway clearance
c. Start physical therapy
d. Encourage high-fat meals
19. Pursed-lip breathing helps the COPD client primarily by:
a. Increasing inspiratory volume
b. Preventing airway collapse during exhalation
c. Strengthening diaphragmatic muscles
d. Promoting faster respiratory rate
20. A correct home oxygen safety teaching statement is:
a. I can smoke while using a small oxygen tank
b. I will keep flammable materials away from the oxygen source
c. I can use petroleum jelly around my nostrils
d. I can adjust the prescribed oxygen flow
21. The best time to collect a sputum specimen for culture is:
a. Immediately after the first oral intake
b. First morning deep cough before antibiotics
c. Any time during the day
d. After respiratory therapy with nebulizer
22. Prior to bronchoscopy, the nurse should:
a. Encourage a full meal 2 hours prior
b. Obtain informed consent and NPO status until gag reflex returns
c. Administer oral anticoagulants to prevent clots
d. Schedule the procedure without sedation
23. After bronchoscopy, the nurse must monitor the client for:
a. Hypertension and bradycardia
b. Hemoptysis and pneumothorax
c. Urinary retention
d. Constipation
24. Classic signs of pulmonary embolism include:
a. Gradual onset cough and low-grade fever
b. Sudden dyspnea, pleuritic chest pain, and possible hemoptysis
c. Chronic productive cough over months
d. Recurrent epistaxis
25. The immediate medical management for a large pulmonary embolus includes:
a. Immediate antibiotics
b. Anticoagulation and oxygen therapy
c. Bronchodilators and steroids
d. Oral aspirin only
26. For DVT prevention in an immobile postoperative client, the nurse should implement:
a. Strict bed rest for 72 hours
b. Sequential compression devices and prophylactic heparin as ordered
c. Massage of the lower extremities
d. High-calorie diet
27. Acute respiratory distress syndrome (ARDS) is characterized by:
a. Left-sided heart failure signs
b. Noncardiogenic pulmonary edema with refractory hypoxemia
c. Slowly progressive hypoxia over months
d. Isolated upper airway obstruction
28. A ventilator high-pressure alarm is most commonly caused by:
a. Low tidal volume setting
b. Excessive secretions, coughing, or a kinked tube
c. Disconnection from the ventilator
d. Power failure
29. Criteria that may support readiness for weaning from mechanical ventilation include:
a. FiO2 > 70%
b. Hemodynamic instability
c. Adequate oxygenation, alertness, and effective cough
d. High PEEP requirement
30. During endotracheal suctioning, the nurse should:
a. Apply suction while inserting the catheter
b. Preoxygenate and limit suction passes to 10 seconds
c. Routinely instill saline before each suction pass
d. Use the largest catheter possible
31. A key ventilator strategy for ARDS management is:
a. High tidal volumes to improve oxygenation
b. Low tidal volumes and adequate PEEP to prevent alveolar collapse
c. Zero PEEP with high respiratory rate
d. Minimal monitoring once stabilized
32. Pulmonary hypertension commonly leads to which cardiac complication?
a. Left-sided heart failure
b. Coronary artery disease
c. Right ventricular hypertrophy and cor pulmonale
d. Mitral valve prolapse
33. Cor pulmonale is best described as:
a. Heart failure caused by primary myocardial disease
b. Right-sided heart failure caused by pulmonary disease
c. Left-sided heart failure due to hypertension
d. Valvular disease of the tricuspid valve
34. Which symptom is most suspicious for lung cancer?
a. Intermittent clear nasal drainage
b. Cough that changes character and persists
c. Sudden high fever and chills
d. Seasonal sneezing
35. Chest physiotherapy is contraindicated in which situation?
a. Copious secretions
b. Recent rib fracture or unstable hemodynamics
c. Cystic fibrosis with retained sputum
d. Postural drainage ordered by physician
36. Cystic fibrosis in adults commonly presents with:
a. Thin, watery sputum
b. Thick, sticky secretions and chronic productive cough
c. Isolated nasal congestion only
d. Primarily cardiac symptoms
37. Bronchiectasis is characterized by:
a. Reversible airway constriction only
b. Irreversible bronchial dilation with copious foul-smelling sputum
c. Acute viral upper respiratory infection
d. Allergic nasal symptoms
38. For a patient suspected of having tuberculosis, the nurse should:
a. Place the client in droplet precautions
b. Use airborne precautions and a negative-pressure room
c. No special precautions are needed
d. Use contact precautions only
39. Isoniazid therapy teaching should include which instruction?
a. Avoid vitamin B6 (pyridoxine)
b. Take pyridoxine to prevent peripheral neuropathy
c. Increase alcohol to speed metabolism
d. Stop therapy when symptoms improve
40. A known effect of rifampin therapy is:
a. Decreased liver enzymes
b. Orange-red discoloration of body fluids and drug interactions
c. Severe hypokalemia
d. Increased sedation
41. Directly Observed Therapy (DOT) for TB is important because:
a. It is less effective than self-administered therapy
b. It ensures adherence to the long treatment course and reduces resistance
c. It is more costly and should be avoided
d. It eliminates the need for follow-up
42. Antiviral therapy for influenza (oseltamivir) is most effective when started:
a. Within 48 hours of symptom onset
b. After one week of symptoms
c. Only for hospitalized patients
d. When symptoms resolve
43. The most effective nursing intervention to prevent postoperative atelectasis is:
a. Prolonged bed rest
b. Incentive spirometry and early ambulation
c. Restricting oral fluids
d. Giving only light meals
44. Proper use of an incentive spirometer includes:
a. Exhale forcefully into the device
b. Inhale slowly and deeply, hold breath briefly, then exhale
c. Use only once a day
d. Take quick shallow breaths repeatedly
45. A pleural effusion is most likely to produce which finding on percussion?
a. Hyperresonance
b. Dullness
c. Tympany
d. Normal resonance
46. Before thoracentesis, the nurse should instruct the client to:
a. Lie flat on the back
b. Sit upright, leaning forward with arms supported
c. Exercise vigorously
d. Eat a large meal
47. The Mantoux (PPD) skin test is interpreted as positive based on induration size. Which is true?
a. 5 mm is positive for all persons
b. 15 mm is positive only for high-risk people
c. 10 mm is considered positive for recent immigrants and high-risk groups
d. Induration is not used for interpretation
48. A false-negative Mantoux test may occur in:
a. Immunocompromised individuals
b. Healthy young adults
c. People vaccinated with BCG years ago
d. Those with prior TB infection
49. After using an inhaled corticosteroid, the client should be taught to:
a. Rinse mouth to prevent oral thrush
b. Take an extra dose if symptoms persist
c. Avoid using a spacer
d. Stop using once feeling better
50. Peak expiratory flow zones commonly indicate: green, yellow, red. The red zone requires:
a. Continue current medications
b. Call healthcare provider or use rescue medications immediately
c. No change in therapy
d. Begin long-term controller therapy only
51. Antihistamines used for allergic rhinitis commonly cause which side effect?
a. Diarrhea
b. Sedation and dry mouth
c. Hypotension
d. Bradycardia
52. In a child with suspected epiglottitis, the nurse should:
a. Examine the throat with a tongue depressor
b. Keep the child calm and prepare for possible airway intervention
c. Encourage the child to lie supine
d. Give oral antibiotics immediately
53. Stridor indicates which type of problem?
a. Lower airway obstruction
b. Upper airway obstruction
c. Cardiac arrhythmia
d. Abdominal distress
54. A persistent hoarseness in an adult is a red flag for:
a. Allergic rhinitis
b. Laryngeal cancer
c. Asthma
d. Sinusitis
55. Pulmonary function tests that show a reduced FEV1/FVC ratio indicate:
a. Obstructive lung disease
b. Restrictive lung disease
c. Normal pulmonary function
d. Neuromuscular disease
56. An ABG with pH 7.50, PaCO2 30 mm Hg suggests:
a. Respiratory alkalosis
b. Respiratory acidosis
c. Metabolic acidosis
d. Metabolic alkalosis
57. Aspiration pneumonia is most likely in a client who has:
a. Chronic hypertension
b. Decreased level of consciousness and impaired swallowing
c. Controlled diabetes
d. Mild seasonal allergies
58. Before allowing oral intake for a stroke patient, the nurse should:
a. Offer thin liquids first
b. Perform a formal swallow evaluation
c. Give solid food to test chewing
d. Encourage the patient to eat quickly
59. A tracheostomy cuff leak may lead to:
a. Improved speech without intervention
b. Aspiration and decreased ventilation effectiveness
c. Lower risk of infection
d. Increased oxygen saturation
60. Decannulation of a tracheostomy is appropriate when the client:
a. Is ventilator-dependent
b. Demonstrates effective cough, airway protection, and adequate oxygenation
c. Has persistent airway swelling
d. Is unable to clear secretions
61. Spirometry that shows decreased total lung capacity suggests:
a. Obstructive disease
b. Restrictive disease
c. Normal aging only
d. Cardiac disease
62. Which oxygen delivery device delivers the most precise FiO2?
a. Nasal cannula
b. Simple face mask
c. Venturi mask
d. Nonrebreather mask
63. High-flow nasal cannula therapy is beneficial because it:
a. Delivers dry cold oxygen at low flows
b. Provides humidified oxygen at high flows and can reduce work of breathing
c. Is only used for hyperbaric treatments
d. Replaces the need for mechanical ventilation in all patients
64. Chest physiotherapy is contraindicated in which condition?
a. Cystic fibrosis
b. Recent head injury or increased intracranial pressure
c. Retained secretions
d. Atelectasis
65. Proper technique for using a metered-dose inhaler includes:
a. Shaking the inhaler, using a spacer if available, and inhaling slowly
b. Exhaling forcefully into the inhaler before actuation
c. Closing the mouth tightly around the inhaler and exhaling immediately
d. Using it only once a week
66. Using a spacer with an MDI is beneficial because it:
a. Increases oropharyngeal deposition
b. Decreases coordination requirement and improves lung deposition
c. Eliminates the need for a rescue inhaler
d. Increases systemic side effects
67. An oscillating PEP device (e.g., Flutter valve) helps by:
a. Delivering antibiotics directly to the lungs
b. Loosening and mobilizing secretions for expectoration
c. Increasing cardiac output
d. Preventing pneumonia entirely
68. Pulmonary edema often presents with:
a. Pink frothy sputum and bilateral crackles
b. Massive hemoptysis and unilateral wheeze
c. Dry cough only
d. Peripheral cyanosis only
69. A patient receiving inhaled albuterol complains of tremors and palpitations. The nurse should:
a. Stop the medication and never give again
b. Recognize these as common side effects and monitor closely
c. Assume signs of myocardial infarction
d. Give a beta blocker immediately
70. Ipratropium (anticholinergic) is useful in COPD but should be used cautiously in patients with:
a. Diabetes
b. Glaucoma and urinary retention
c. Hypothyroidism
d. Renal failure
71. Acetylcysteine (mucolytic) is indicated for:
a. Thin secretions that need to be dried
b. Thick tenacious secretions to help liquefy them
c. Treating viral infections directly
d. Reducing bronchospasm
72. Systemic corticosteroid therapy can cause which adverse effect requiring monitoring?
a. Hypoglycemia
b. Hyperglycemia and immune suppression
c. Decreased appetite
d. Increased wound healing
73. If a chest tube becomes disconnected from the drainage system, the nurse should:
a. Clamp the tube permanently
b. Place the end of the tubing in a sterile water container to maintain the water seal
c. Strip the tubing vigorously
d. Remove the tube from the patient
74. The maximum recommended time for each tracheal suction pass is:
a. 5-10 seconds
b. 30-45 seconds
c. 60 seconds
d. 2 minutes
75. In infants, an early sign of hypoxia may be:
a. Cyanosis only
b. Tachypnea and retractions before cyanosis
c. Bradycardia only
d. Hypertension
76. The presence of intercostal retractions indicates:
a. Decreased work of breathing
b. Increased work of breathing and respiratory distress
c. Normal respiration in infants
d. Improved lung compliance
77. The most common cause of bronchiolitis in infants is:
a. Influenza virus
b. Respiratory syncytial virus (RSV)
c. Streptococcus pneumoniae
d. Mycoplasma pneumoniae
78. When caring for a patient with confirmed pulmonary tuberculosis, staff should wear:
a. Surgical mask only
b. N95 respirator (or equivalent) for airborne precautions
c. No special mask when in the room
d. Gloves only
79. A patient with a recent ischemic stroke is found to have a DVT. Anticoagulation is contraindicated if the patient also
has:
a. History of deep venous thrombosis
b. Active intracranial hemorrhage
c. Controlled hypertension
d. Recent myocardial infarction
80. Kussmaul respirations are commonly associated with:
a. Respiratory alkalosis
b. Metabolic acidosis (e.g., diabetic ketoacidosis)
c. Normal sleep
d. Obstructive sleep apnea
81. A client with pneumonia has a productive cough with rust-colored sputum. This is most commonly associated with:
a. Mycoplasma pneumonia
b. Pneumococcal pneumonia
c. Viral pneumonia
d. Fungal pneumonia
82. Which finding best indicates effective therapy in a patient with TB on isoniazid and rifampin?
a. Weight loss
b. Negative sputum culture
c. Night sweats
d. Decreased cough
83. A patient with asthma presents with wheezing and shortness of breath unrelieved by bronchodilators. The nurse
suspects:
a. Status asthmaticus
b. Pleural effusion
c. Pneumothorax
d. Pulmonary embolism
84. A nurse teaches a COPD client about pursed-lip breathing. The primary purpose of this technique is to:
a. Increase oxygen intake
b. Strengthen respiratory muscles
c. Promote CO■ elimination
d. Prevent airway infection
85. Which position will best promote oxygenation in a client with right lower lobe pneumonia?
a. Supine with arms at side
b. Left lateral with head elevated
c. Right lateral with head flat
d. High Fowler’s position
86. A client with a chest tube accidentally disconnects the tubing from the drainage system. The nurse’s best immediate
action is to:
a. Reconnect the tubing under sterile technique
b. Place the tube in sterile water
c. Clamp the tube
d. Call the physician
87. The most reliable method for confirming endotracheal tube placement immediately after intubation is:
a. Chest X-ray
b. Bilateral breath sounds
c. End-tidal CO■ detector
d. Symmetric chest expansion
88. Which is the earliest clinical sign of hypoxemia?
a. Cyanosis
b. Confusion
c. Restlessness
d. Hypotension
89. A patient with COPD has been prescribed home oxygen therapy. Which statement by the client indicates correct
understanding?
a. “I can adjust the flow rate if I feel short of breath.”
b. “I will use oxygen while exercising and sleeping.”
c. “I should smoke outside, not near the oxygen tank.”
d. “I will use petroleum jelly around my nose for dryness.”
90. A nurse is caring for a patient with pulmonary embolism. Which nursing intervention is priority?
a. Encourage coughing and deep breathing
b. Administer anticoagulants as prescribed
c. Place the client on bed rest in high Fowler’s position
d. Provide emotional support
91. A patient is prescribed streptomycin for TB. Which finding must be reported immediately?
a. Tinnitus
b. Nausea
c. Diarrhea
d. Flushing
92. A nurse provides teaching to a client with laryngectomy. Which statement indicates understanding?
a. “I will need to use a permanent tracheostomy for breathing.”
b. “I can still speak normally after the surgery.”
c. “The opening will close naturally in a few months.”
d. “I should avoid wearing a scarf near my neck.”
93. Which diagnostic test is most specific for confirming pulmonary tuberculosis?
a. Chest X-ray
b. Mantoux test
c. Sputum culture for acid-fast bacilli
d. Erythrocyte sedimentation rate
94. A nurse notes continuous bubbling in the water-seal chamber of a chest drainage system. This indicates:
a. Normal function
b. Air leak
c. System blockage
d. Drainage collection
95. A client with asthma reports increasing shortness of breath. Which assessment finding requires immediate action?
a. Increased wheezing
b. Peak flow reading of 75% predicted
c. Absence of wheezing with decreased breath sounds
d. Prolonged expiratory phase
96. The priority nursing diagnosis for a client with advanced COPD is:
a. Risk for infection
b. Ineffective airway clearance
c. Impaired gas exchange
d. Activity intolerance
97. During suctioning of a tracheostomy, the nurse observes the client becomes bradycardic. The best action is to:
a. Stop suctioning immediately
b. Increase suction pressure
c. Continue and finish quickly
d. Give atropine IV
98. Which symptom most strongly suggests lung cancer?
a. Productive cough with purulent sputum
b. Cough that changes character and persists
c. Sudden onset of dyspnea with wheezing
d. High-grade fever with chills
99. Which client is the nurse most concerned about receiving contrast dye for a CT scan?
a. 55-year-old with type 2 diabetes on metformin
b. 40-year-old with controlled hypertension
c. 70-year-old with mild osteoarthritis
d. 25-year-old with seasonal allergies
100. Which assessment best reflects adequate tissue perfusion in a postoperative client?
a. Warm skin and capillary refill < 3 seconds
b. HR 110/min and BP 90/60 mmHg
c. Urine output 20 mL/hr
d. SpO■ 88% on room air
ANSWER KEY WITH RATIONALE (1–100)

1. a – Crackles: Pneumonia fills alveoli with fluid or exudate, producing crackles on auscultation.
2. b – Sputum culture for acid-fast bacilli: Gold standard for confirming active TB infection.
3. c – Droplet precautions: Influenza is transmitted by droplets; implement droplet and standard precautions.
4. b – Lean forward and pinch the nares for 10 minutes: Prevents aspiration and allows clot formation.
5. b – Apnea and poor feeding: RSV in infants often presents with apnea, feeding difficulty, and respiratory distress.
6. b – Delayed hemorrhage: Frequent swallowing post-tonsillectomy suggests bleeding from the surgical site.
7. b – I will have a permanent stoma in my neck for breathing: Laryngectomy removes the larynx; breathing is via a
permanent stoma.
8. b – Limit each suction pass to 10 seconds or less: Reduces hypoxia and vagal stimulation during suctioning.
9. b – An air leak: Continuous bubbling in the water-seal chamber indicates an air leak that needs investigation.
10. b – Notify the physician and continue to monitor: Subcutaneous emphysema indicates air leak; assess but do not
clamp routinely.
11. c – Spontaneous pneumothorax: Sudden unilateral pleuritic pain with absent breath sounds suggests
pneumothorax.
12. b – Needle decompression of the affected side: Tension pneumothorax is an emergency requiring immediate
decompression.
13. b – Respiratory acidosis without compensation: Elevated PaCO2 with low pH indicates acute respiratory acidosis.
14. a – They can adjust the flow if short of breath: Family should not adjust prescribed oxygen—this is concerning and
requires correction.
15. c – Red zone (medical alert): <50% personal best indicates severe obstruction requiring immediate action.
16. b – Absence of wheeze with decreased breath sounds: May indicate poor air movement and impending respiratory
failure.
17. b – Tachycardia and tremors: Beta-2 agonists commonly cause these sympathetic side effects.
18. b – Improve oxygenation and airway clearance: Priority is maintaining adequate oxygenation and ventilatory status.
19. b – Preventing airway collapse during exhalation: Pursed-lip breathing prolongs exhalation and reduces air trapping.
20. b – Keep flammable materials away from the oxygen source: Oxygen supports combustion; safety is critical.
21. b – First morning deep cough before antibiotics: Best sputum sample is early morning prior to antibiotics.
22. b – Obtain informed consent and NPO status until gag reflex returns: Standard pre-bronchoscopy preparation.
23. b – Hemoptysis and pneumothorax: Watch for bleeding and signs of pneumothorax after the procedure.
24. b – Sudden dyspnea, pleuritic chest pain, and possible hemoptysis: Classic presentation of PE.
25. b – Anticoagulation and oxygen therapy: Immediate management includes stabilizing oxygenation and preventing
clot extension.
26. b – Sequential compression devices and prophylactic heparin as ordered: Standard DVT prevention in immobile
clients.
27. b – Noncardiogenic pulmonary edema with refractory hypoxemia: ARDS is due to increased alveolar-capillary
permeability.
28. b – Excessive secretions, coughing, or a kinked tube: These factors commonly trigger high-pressure alarms.
29. c – Adequate oxygenation, alertness, and effective cough: Indicators the patient may tolerate weaning trials.
30. b – Preoxygenate and limit suction passes to 10 seconds: Prevents hypoxia during suctioning.
31. b – Low tidal volumes and adequate PEEP to prevent alveolar collapse: Lung-protective ventilation strategy for
ARDS.
32. c – Right ventricular hypertrophy and cor pulmonale: Pulmonary hypertension strains the right heart.
33. b – Right-sided heart failure caused by pulmonary disease: Cor pulmonale results from chronic lung disease.
34. b – Cough that changes character and persists: Persistent changing cough is concerning for malignancy.
35. b – Recent rib fracture or unstable hemodynamics: Chest physiotherapy can worsen these conditions.
36. b – Thick, sticky secretions and chronic productive cough: Classic CF presentation in adults.
37. b – Irreversible bronchial dilation with copious foul-smelling sputum: Hallmark of bronchiectasis.
38. b – Use airborne precautions and a negative-pressure room: TB requires airborne infection control measures.
39. b – Take pyridoxine to prevent peripheral neuropathy: Isoniazid can cause B6 deficiency leading to neuropathy.
40. b – Orange-red discoloration of body fluids and drug interactions: Rifampin causes harmless orange discoloration
and induces hepatic enzymes.
41. b – It ensures adherence to the long treatment course and reduces resistance: DOT improves completion rates and
reduces resistance.
42. a – Within 48 hours of symptom onset: Antivirals are most effective when started early.
43. b – Incentive spirometry and early ambulation: Prevents postoperative atelectasis and promotes lung expansion.
44. b – Inhale slowly and deeply, hold breath briefly, then exhale: Correct technique for incentive spirometry.
45. b – Dullness: Fluid in the pleural space produces dullness to percussion over the effusion.
46. b – Sit upright, leaning forward with arms supported: Optimal position for thoracentesis to access pleural space
safely.
47. c – 10 mm is considered positive for recent immigrants and high-risk groups: Interpretation depends on risk factors;
10 mm threshold for certain groups.
48. a – Immunocompromised individuals: Can have anergy and false-negative PPD reactions.
49. a – Rinse mouth to prevent oral thrush: Reduces risk of candidiasis after inhaled steroids.
50. b – Call healthcare provider or use rescue medications immediately: Red zone requires urgent treatment.
51. b – Sedation and dry mouth: Common antihistamine side effects (especially first-generation).
52. b – Keep the child calm and prepare for possible airway intervention: Do not examine throat vigorously; risk of
complete obstruction.
53. b – Upper airway obstruction: Stridor indicates obstruction at or above the larynx.
54. b – Laryngeal cancer: Persistent hoarseness is a red flag warranting evaluation.
55. a – Obstructive lung disease: Reduced FEV1/FVC suggests obstruction like COPD or asthma.
56. a – Respiratory alkalosis: High pH and low PaCO2 indicate respiratory alkalosis, often from hyperventilation.
57. b – Decreased level of consciousness and impaired swallowing: These increase risk for aspiration.
58. b – Perform a formal swallow evaluation: Confirms safety before oral intake to reduce aspiration risk.
59. b – Aspiration and decreased ventilation effectiveness: Cuff leak can allow aspiration and reduce ventilation
efficiency.
60. b – Demonstrates effective cough, airway protection, and adequate oxygenation: Criteria for safe decannulation.
61. b – Restrictive disease: Reduced TLC suggests a restrictive pattern (e.g., pulmonary fibrosis).
62. c – Venturi mask: Provides precise FiO2 delivery by designating entrainment ports.
63. b – Provides humidified oxygen at high flows and can reduce work of breathing: High-flow nasal cannula provides
heated, humidified oxygen at high flows.
64. b – Recent head injury or increased intracranial pressure: CPT may increase intracranial pressure and be
contraindicated.
65. a – Shaking the inhaler, using a spacer if available, and inhaling slowly: Proper MDI technique improves delivery.
66. b – Decreases coordination requirement and improves lung deposition: Spacer allows more medication to reach
lungs.
67. b – Loosening and mobilizing secretions for expectoration: Oscillating PEP devices help clear mucus.
68. a – Pink frothy sputum and bilateral crackles: Classic pulmonary edema presentation.
69. b – Recognize these as common side effects and monitor closely: Albuterol commonly causes tremors and
palpitations; monitor for severe effects.
70. b – Glaucoma and urinary retention: Anticholinergics can exacerbate these conditions; use cautiously.
71. b – Thick tenacious secretions to help liquefy them: Acetylcysteine helps break down mucus.
72. b – Hyperglycemia and immune suppression: Watch blood glucose and infection risk with systemic steroids.
73. b – Place the end of the tubing in a sterile water container to maintain the water seal: This maintains the water seal
until reconnection or new system.
74. a – 5-10 seconds: Limit suction passes to reduce hypoxia and vagal stimulation.
75. b – Tachypnea and retractions before cyanosis: Infants often show increased work of breathing before cyanosis
appears.
76. b – Increased work of breathing and respiratory distress: Retractions indicate respiratory compromise.
77. b – Respiratory syncytial virus (RSV): Most common cause of bronchiolitis in infants.
78. b – N95 respirator (or equivalent) for airborne precautions: Staff should use N95 for TB to prevent inhalation of
droplet nuclei.
79. b – Active intracranial hemorrhage: Anticoagulation is contraindicated in active bleeding in critical sites such as the
brain.
80. b – Metabolic acidosis (e.g., diabetic ketoacidosis): Kussmaul respirations are deep, rapid respirations seen in
metabolic acidosis.
81. b – Pneumococcal pneumonia: Rust-colored sputum is classically associated with Streptococcus pneumoniae.
82. b – Negative sputum culture: Demonstrates eradication of active TB infection and effective therapy.
83. a – Status asthmaticus: Life-threatening asthma not relieved by bronchodilators requires immediate intervention.
84. c – Promote CO■ elimination: Pursed-lip breathing prolongs exhalation and helps remove CO■ and prevent air
trapping.
85. d – High Fowler’s position: Promotes lung expansion and improves oxygenation in clients with lower lobe
pneumonia.
86. b – Place the tube in sterile water: Maintains the water-seal until proper reconnection can be made; do not clamp
routinely.
87. c – End-tidal CO■ detector: Rapidly confirms correct endotracheal tube placement at bedside before CXR.
88. c – Restlessness: Early indicator of hypoxemia; cyanosis is a late sign.
89. b – “I will use oxygen while exercising and sleeping.”: Correct use; patients should not self-adjust prescribed flow or
smoke near oxygen.
90. b – Administer anticoagulants as prescribed: Priority intervention to prevent clot extension and stabilize PE.
91. a – Tinnitus: Early sign of ototoxicity from aminoglycosides like streptomycin; report immediately.
92. a – “I will need to use a permanent tracheostomy for breathing.”: Laryngectomy requires a permanent stoma for
breathing.
93. c – Sputum culture for acid-fast bacilli: The most specific diagnostic test for active TB.
94. b – Air leak: Continuous bubbling in the water-seal chamber indicates an air leak in the system.
95. c – Absence of wheezing with decreased breath sounds: Sign of minimal air movement and impending respiratory
failure; requires immediate action.
96. c – Impaired gas exchange: Priority nursing diagnosis in advanced COPD due to hypoxemia and hypercapnia risk.
97. a – Stop suctioning immediately: Bradycardia indicates vagal stimulation—stop suctioning and oxygenate.
98. b – Cough that changes character and persists: Suggests malignancy and warrants evaluation.
99. a – 55-year-old with type 2 diabetes on metformin: Metformin and contrast dye increase risk of lactic acidosis;
caution and protocols required.
100. a – Warm skin and capillary refill < 3 seconds: Indicates adequate peripheral perfusion and tissue perfusion
postoperatively.