WORKSHEET ON RESPIRATORY SYSTEM

OBSTRUCTION & ASTHMA

DIRECTION: Underline the correct answer and write the rationale of the chosen answer.

1. An elderly client with pneumonia may appear with which of the following symptoms first?
1. Altered mental status and dehydration
2. fever and chills
3. Hemoptysis and dyspnea
4. Pleuretic chest pain and cough

2. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma
allows pneumonia to develop?
1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation

3. A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory
rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history,
the client may have which of the following?
1. Acute asthma
2. Bronchial pneumonia
3. Chronic obstructive pulmonary disease (COPD)
4. Emphysema

4. Which of the following assessment findings would help confirm a diagnosis of asthma in a
client suspected of having the disorder?
1. Circumoral cyanosis
2. Increased forced expiratory volume
3. Inspiratory and expiratory wheezing
4. Normal breath sounds

5. Which of the following types of asthma involves an acute asthma attack brought on by an
upper respiratory infection?
1. Emotional
2. Extrinsic
3. Intrinsic
4. Mediated

6. A client with acute asthma showing inspiratory and expiratory wheezes and a decreased
expiratory volume should be treated with which of the following classes of medication right
away?
1. Beta-adrenergic blockers
2. Bronchodilators
3. Inhaled steroids
4. Oral steroids

7. A 19-year-old comes into the emergency department with acute asthma. His respiratory rate
is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following
actions should be taken first?
1. Take a full medication history
2. Give a bronchodilator by neubulizer
3. Apply a cardiac monitor to the client
4. Provide emotional support to the client.
 8. A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day
has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on
this information, he most likely has which of the following conditions?
1. Adult respiratory distress syndrome (ARDS)
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

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

1. Adult respiratory distress syndrome (ARDS)
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

10. The term “pink puffer” refers to the client with which of the following conditions?
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

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

12. It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have
Pneumovax and flu vaccinations for which of the following reasons?
1. All clients are recommended to have these vaccines
2. These vaccines produce bronchodilation and improve oxygenation.
3. These vaccines help reduce the tachypnea these clients experience.
4. Respiratory infections can cause severe hypoxia and possibly death in these clients.

13. Exercise has which of the following effects on clients with asthma, chronic bronchitis, and
emphysema?
1. It enhances cardiovascular fitness.
2. It improves respiratory muscle strength.
3. It reduces the number of acute attacks.
4. It worsens respiratory function and is discouraged.

14. Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following
reasons best explains why?
1. Reducing fluid volume reduces oxygen demand.
2. Reducing fluid volume improves clients’ mobility.
3. Restricting fluid volume reduces sputum production.
4. Reducing fluid volume improves respiratory function.

15. A 69-year-old client appears thin and cachectic. He’s short of breath at rest and his dyspnea
increases with the slightest exertion. His breath sounds are diminished even with deep
inspiration. These signs and symptoms fit which of the following conditions?
1. ARDS
2. Asthma
3. Chronic obstructive bronchitis
4. Emphysema

16. A client with emphysema should receive only 1 to 3 L/minute of oxygen, if needed, or he
may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?
1. The client doesn’t notice he needs to breathe.
2. The client breathes only when his oxygen levels climb above a certain point.
3. The client breathes only when his oxygen levels dip below a certain point.
4. The client breathes only when his carbon dioxide level dips below a certain point.

17. Teaching for a client with chronic obstructive pulmonary disease (COPD) should include
which of the following topics?
1. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.
2. How to increase his oxygen therapy.
3. How to treat respiratory infections without going to the physician.
4. How to recognize the signs of an impending respiratory infection.

18. Which of the following respiratory disorders is most common in the first 24 to 48 hours after
surgery?
1. Atelectasis
2. Bronchitis
3. Pneumonia
4. Pneumothorax

19. Which of the following measures can reduce or prevent the incidence of atelectasis in a post-
operative client?
1. Chest physiotherapy
2. Mechanical ventilation
3. Reducing oxygen requirements
4. Use of an incentive spirometer

20. Emergency treatment of a client in status asthmaticus includes which of the following
medications?
1. Inhaled beta-adrenergic agents
2. Inhaled corticosteroids
3. I.V. beta-adrenergic agents
4. Oral corticosteroids

21. Which of the following treatment goals is best for the client with status asthmaticus?
1. Avoiding intubation
2. Determining the cause of the attack
3. Improving exercise tolerance
4. Reducing secretions

22. Dani was given dilaudid for pain. She’s sleeping and her respiratory rate is 4 breaths/minute.
If action isn’t taken quickly, she might have which of the following reactions?
1. Asthma attack
2. Respiratory arrest
3. Be pissed about receiving Narcan
4. Wake up on her own

23. Which of the following additional assessment data should immediately be gathered to
determine the status of a client with a respiratory rate of 4 breaths/minute?
1. Arterial blood gas (ABG) and breath sounds
2. Level of consciousness and a pulse oximetry value.
3. Breath sounds and reflexes
4. Pulse oximetry value and heart sounds
 24. A client is in danger of respiratory arrest following the administration of a narcotic analgesic.
An arterial blood gas value is obtained. The nurse would expect to Pa CO2 to be which of the
following values?
1. 15 mm Hg
2. 30 mm Hg
3. 40 mm Hg
4. 80 mm Hg

25. A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he
develops chest tightness and becomes short of breath and tachypneic. He has a decreased level
of consciousness. These signs indicate which of the following conditions?
1. Asthma attack
2. Pulmonary embolism
3. respiratory failure
4. Rheumatoid arthritis

26. Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity
to a drug should include which of the following actions first?
1. Administering oxygen
2. Inserting an I.V. catheter
3. Obtaining a complete blood count (CBC)
4. Taking vital signs

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

28. A client’s ABG results are as follows: pH: 7.16; Pa CO2 80 mm Hg; PaO2 46 mm Hg; HCO3– 24
mEq/L; SaO2 81%. This ABG result represents which of the following conditions?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis

29. A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the
client is most likely to experience what type of acid-base imbalance?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

30. A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a
pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing
respiratory alkalosis. Which laboratory value would most likely be noted in this condition?
1. Sodium level of 145 mEq/L
2. Potassium level of 3.0 mEq/L
3. Magnesium level of 2.0 mg/L
4. Phosphorus level of 4.0 mg/dl

31. A nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45;
PCO2 30 mm Hg; and bicarbonate concentration of 22 mEq/L. The nurse analyzes these results as
indicating:
1. Metabolic acidosis, compensated.
2. Metabolic alkalosis, uncompensated.
3. Respiratory alkalosis, compensated.
4. Respiratory acidosis, compensated.

32. A client is scheduled for blood to be drawn from the radial artery for an ABG determination.
Before the blood is drawn, an Allen’s test is performed to determine the adequacy of the:
1. Popliteal circulation
2. Ulnar circulation
3. Femoral circulation
4. Carotid circulation

33. A nurse is caring for a client with a nasogastric tube that is attached to low suction. The
nurse monitors the client, knowing that the client is at risk for which acid-base disorder?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

34. A nurse is caring for a client with an ileostomy understands that the client is most at risk for
developing which acid-base disorder?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

35. A nurse is caring for a client with diabetic ketoacidosis and documents that the client is
experiencing Kussmaul’s respirations. Based on this documentation, which of the following did
the nurse observe?
1. Respirations that are abnormally deep, regular, and increased in rate.
2. Respirations that are regular but abnormally slow.
3. Respirations that are labored and increased in depth and rate
4. Respirations that cease for several seconds.

36. A nurse understands that the excessive use of oral antacids containing bicarbonate can
result in which acid-base disturbance?
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis
4. Metabolic alkalosis

37. A nurse is caring for a client with renal failure. Blood gas results indicate a pH of 7.30; a
PCO2 of 32 mm Hg, and a bicarbonate concentration of 20 mEq/L. The nurse has determined that
the client is experiencing metabolic acidosis. Which of the following laboratory values would the
nurse expect to note?
1. Sodium level of 145 mEq/L
2. Magnesium level of 2.0 mg/dL
3. Potassium level of 5.2 mEq/L
4. Phosphorus level of 4.0 mg/dL

38. A nurse is preparing to obtain an arterial blood gas specimen from a client and plans to
perform the Allen’s test on the client. Number in order of priority the steps for performing the
Allen’s test (#1 is first step).
1. Ask the client to open and close the hand repeatedly.
2. Apply pressure over the ulnar and radial arteries.
3. Assess the color of the extremity distal to the pressure point
4. Release pressure from the ulnar artery
5. Explain the procedure to the client.

39. A nurse is preparing to obtain a sputum specimen from a client. Which of the following
nursing actions will facilitate obtaining the specimen?
1. Limiting fluids
2. Having the client take 3 deep breaths.
3. Asking the client to spit into the collection container.
4. Asking the client to obtain the specimen after eating.

40. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if
noted in the client should be reported immediately to the physician?
1. Blood-streaked sputum
2. Dry cough
3. Hematuria
4. Bronchospasm

41. A nurse is suctioning fluids from a client via a tracheostomy tube. When suctioning, the
nurse must limit the suctioning to a maximum of:
1. 5 seconds
2. 10 seconds
3. 30 seconds
4. 1 minute

42. A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning
procedure, the nurse notes on the monitor that the heart rate decreases. Which of the following
is the most appropriate nursing intervention?
1. Continue to suction
2. Ensure that the suction is limited to 15 seconds
3. Stop the procedure and reoxyenate the client
4. Notify the physician immediately.

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

44. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the
following would the nurse expect to note on assessment of this client?
1. Increased oxygen saturation with exercise
2. Hypocapnia
3. A hyperinflated chest on x-ray film
4. A widened diaphragm noted on chest x-ray film

45. An oxygenated delivery system is prescribed for a client with COPD to deliver a precise
oxygen concentration. Which of the following types of oxygen delivery systems would the nurse
anticipate to be prescribed?
1. Venturi mask
2. Aerosol mask
3. Face tent
4. Tracheostomy collar
 46. Theophylline (Theo-Dur) tablets are prescribed for a client with chronic airflow limitation, and
the nurse instructs the client about the medication. Which statement by the client indicates a
need for further teaching?
1. “I will take the medication on an empty stomach.”
2. “I will take the medication with food.”
3. “I will continue to take the medication even if I am feeling better.”
4. “Periodic blood levels will need to be obtained.”

47. A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse
assesses the oxygen flow rate to ensure that it does not exceed
1. 1 L/min
2. 2 L/min
3. 6 L/min
4. 10 L/min

48. The nurse reviews the ABG values of a client. The results indicate respiratory acidosis. Which
of the following values would indicate that this acid-base imbalance exists?
1. pH of 7.48
2. PCO2 of 32 mm Hg
3. pH of 7.30
4. HCO3– of 20 mEq/L

49. A nurse instructs a client to use the pursed lip method of breathing. The client asks the
nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary
purpose of pursed lip breathing is:
1. Promote oxygen intake
2. Strengthen the diaphragm
3. Strengthen the intercostal muscles
4. Promote carbon dioxide elimination

50. A nurse reviews the ABG values and notes a pH of 7.50, a P CO2of 30 mm Hg, and an HCO3 of
25 mEq/L. The nurse interprets these values as indicating:
1. Respiratory acidosis uncompensated
2. Respiratory alkalosis uncompensated
3. Metabolic acidosis uncompensated
4. Metabolic acidosis partially compensated.

51. Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse
administers the medication, knowing that the primary action of this medication is to:
1. Promote expectoration
2. Suppress the cough
3. Relax smooth muscles of the bronchial airway
4. Prevent infection

52. A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors
the client for which side effect of this medication?
1. Constipation
2. Diarrhea
3. Bradycardia
4. Tachycardia

53. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client
indicated a need for further teaching?
1. Removes the cap and shakes the inhaler well before use.
2. Presses the canister down with finger as he breathes in.
3. Inhales the mist and quickly exhales.
4. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

54. A female client is scheduled to have a chest radiograph. Which of the following questions is
of most importance to the nurse assessing this client?
1. “Is there any possibility that you could be pregnant?”
2. “Are you wearing any metal chains or jewelry?”
3. “Can you hold your breath easily?”
4. “Are you able to hold your arms above your head?”

55. A client has just returned to a nursing unit following bronchoscopy. A nurse would implement
which of the following nursing interventions for this client?
1. Encouraging additional fluids for the next 24 hours
2. Ensuring the return of the gag reflex before offering foods or fluids
3. Administering atropine intravenously
4. Administering small doses of midazolam (Versed).

56. A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes
the:
1. Brachial and radial arteries, and then releases them and observes the circulation of the
hand.
2. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the
process with the other artery.
3. Radial artery and observes for color changes in the affected hand.
4. Ulnar artery and observes for color changes in the affected hand.

57. A nurse is assessing a client with chronic airflow limitation and notes that the client has a
“barrel chest.” The nurse interprets that this client has which of the following forms of chronic
airflow limitation?
1. Chronic obstructive bronchitis
2. Emphysema
3. Bronchial asthma
4. Bronchial asthma and bronchitis

58. A client has been taking benzonatate (Tessalin Perles) as prescribed. A nurse concludes that
the medication is having the intended effect if the client experiences:
1. Decreased anxiety level
2. Increased comfort level
3. Reduction of N/V
4. Decreased frequency and intensity of cough

59. Which of the following would be an expected outcome for a client recovering from an upper
respiratory tract infection? The client will:
1. Maintain a fluid intake of 800ml every 24 hours.
2. Experience chills only once a day
3. Cough productively without chest discomfort.
4. Experience less nasal obstruction and discharge.

60. Which of the following individuals would the nurse consider to have the highest priority for
receiving an influenza vaccination?
1. A 60-year-old man with a hiatal hernia
2. A 36-year-old woman with 3 children
3. A 50-year-old woman caring for a spouse with cancer
4. a 60-year-old woman with osteoarthritis

61. A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms.
Which of the following instructions would be appropriate for the nurse to give the client?
1. “Use your nasal decongestant spray regularly to help clear your nasal passages.”
2. “Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.”
3. “It is important to increase your activity. A daily brisk walk will help promote drainage.”
4. “Keep a diary if when your symptoms occur. This can help you identify what precipitates
your attacks.”

62. An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3
days, she develops a cough productive of yellow sputum. The nurse auscultates her lungs and
hears diffuse crackles. How would the nurse best interpret these assessment findings?
1. It is likely that the client is developing a secondary bacterial pneumonia.
2. The assessment findings are consistent with influenza and are to be expected.
3. The client is getting dehydrated and needs to increase her fluid intake to decrease
secretions.
4. The client has not been taking her decongestants and bronchodilators as prescribed.

63. Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage
strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose?
1. 5.0 ml
2. 7.5 ml
3. 9.5 ml
4. 10 ml

64. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the
following is a possible side effect of this drug?
1. Constipation
2. Bradycardia
3. Diplopia
4. Restlessness

65. A client with COPD reports steady weight loss and being “too tired from just breathing to
eat.” Which of the following nursing diagnoses would be most appropriate when planning
nutritional interventions for this client?
1. Altered nutrition: Less than body requirements related to fatigue.
2. Activity intolerance related to dyspnea.
3. Weight loss related to COPD.
4. Ineffective breathing pattern related to alveolar hypoventilation.

66. When developing a discharge plan to manage the care of a client with COPD, the nurse
should anticipate that the client will do which of the following?
1. Develop infections easily
2. Maintain current status
3. Require less supplemental oxygen
4. Show permanent improvement.

67. Which of the following outcomes would be appropriate for a client with COPD who has been
discharged to home? The client:
1. Promises to do pursed lip breathing at home.
2. States actions to reduce pain.
3. States that he will use oxygen via a nasal cannula at 5 L/minute.
4. Agrees to call the physician if dyspnea on exertion increases.

68. Which of the following physical assessment findings would the nurse expect to find in a
client with advanced COPD?
1. Increased anteroposterior chest diameter
2. Underdeveloped neck muscles
3. Collapsed neck veins
4. Increased chest excursions with respiration

69. Which of the following is the primary reason to teach pursed-lip breathing to clients with
emphysema?
1. To promote oxygen intake
2. To strengthen the diaphragm
3. To strengthen the intercostal muscles
4. To promote carbon dioxide elimination

70. Which of the following is a priority goal for the client with COPD?
1. Maintaining functional ability
2. Minimizing chest pain
3. Increasing carbon dioxide levels in the blood
4. Treating infectious agents

71. A client’s arterial blood gas levels are as follows: pH 7.31; Pa O280 mm Hg, PaCO2 65 mm Hg;
HCO3– 36 mEq/L. Which of the following signs or symptoms would the nurse expect?
1. Cyanosis
2. Flushed skin
3. Irritability
4. Anxiety

72. When teaching a client with COPD to conserve energy, the nurse should teach the client to
lift objects:
1. While inhaling through an open mouth.
2. While exhaling through pursed lips
3. After exhaling but before inhaling.
4. While taking a deep breath and holding it.

73. The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of
the following s/s would be included in the teaching plan?
1. Clubbing of nail beds
2. Hypertension
3. Peripheral edema
4. Increased appetite

74. The nurse assesses the respiratory status of a client who is experiencing an exacerbation of
COPD secondary to an upper respiratory tract infection. Which of the following findings would be
expected?
1. Normal breath sounds
2. Prolonged inspiration
3. Normal chest movement
4. Coarse crackles and rhonchi

75. Which of the following ABG abnormalities should the nurse anticipate in a client with
advanced COPD?
1. Increased PaCO2
2. Increased PaO2
3. Increased pH.
4. Increased oxygen saturation

76. Which of the following diets would be most appropriate for a client with COPD?
1. Low fat, low cholesterol
2. Bland, soft diet
3. Low-Sodium diet
4. High calorie, high-protein diet
 77. The nurse is planning to teach a client with COPD how to cough effectively. Which of the
following instructions should be included?
1. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.
2. Lie flat on back, splint the thorax, take two deep breaths and cough.
3. Take several rapid, shallow breaths and then cough forcefully.
4. Assume a side-lying position, extend the arm over the head, and alternate deep breathing
with coughing.

78. A 34-year-old woman with a history of asthma is admitted to the emergency department.
The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal
flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished
breath sounds. Based on these findings, what action should the nurse take to initiate care of the
client?
1. Initiate oxygen therapy and reassess the client in 10 minutes.
2. Draw blood for an ABG analysis and send the client for a chest x-ray.
3. Encourage the client to relax and breathe slowly through the mouth
4. Administer bronchodilators

79. The nurse would anticipate which of the following ABG results in a client experiencing a
prolonged, severe asthma attack?
1. Decreased PaCO2, increased PaO2, and decreased pH.
2. Increased PaCO2, decreased PaO2, and decreased pH.
3. Increased PaCO2, increased PaO2, and increased pH.
4. Decreased PaCO2, decreased PaO2, and increased pH.

80. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the
rationale for the use of steroids in clients with asthma?
1. Corticosteroids promote bronchodilation
2. Corticosteroids act as an expectorant
3. Corticosteroids have an anti-inflammatory effect
4. Corticosteroids prevent development of respiratory infections.

81. The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a
Corticosteroid drug. Which of the following client actions indicates that he us using the MDI
correctly? Select all that apply.
1. The inhaler is held upright.
2. Head is tilted down while inhaling the medication
3. Client waits 5 minutes between puffs.
4. Mouth is rinsed with water following administration
5. Client lies supine for 15 minutes following administration.

82. A client is prescribed metaproterenol (Alupent) via a metered dose inhaler (MDI), two puffs
every 4 hours. The nurse instructs the client to report side effects. Which of the following are
potential side effects of metaproterenol?
1. Irregular heartbeat
2. Constipation
3. Petal edema
4. Decreased heart rate.

83. A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma.
He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse
would be the most appropriate?
1. “This is an anticipated side-effect of your medication. It should go away in a couple of
weeks.”
2. “You are using your inhaler too much and it has irritated your mouth.”
3. “You have developed a fungal infection from your medication. It will need to be treated
with an antibiotic.”
4. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”

84. Which of the following health promotion activities should the nurse include in the discharge
teaching plan for a client with asthma?
1. Incorporate physical exercise as tolerated into the treatment plan.
2. Monitor peak flow numbers after meals and at bedtime.
3. Eliminate stressors in the work and home environment
4. Use sedatives to ensure uninterrupted sleep at night.

85. The client with asthma should be taught that which of the following is one of the most
common precipitating factors of an acute asthma attack?
1. Occupational exposure to toxins
2. Viral respiratory infections
3. Exposure to cigarette smoke
4. Exercising in cold temperatures

86. A female client comes into the emergency room complaining of SOB and pain in the lung
area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her
VS are: 140/80, P 110, R 40. The physician orders ABG’s, results are as follows: pH: 7.50; Pa CO2 29
mm Hg; PaO2 60 mm Hg; HCO3– 24 mEq/L; SaO2 86%. Considering these results, the first
intervention is to:
1. Begin mechanical ventilation
2. Place the client on oxygen
3. Give the client sodium bicarbonate
4. Monitor for pulmonary embolism.

87. Basilar crackles are present in a client’s lungs on auscultation. The nurse knows that these
are discrete, noncontinuous sounds that are:
1. Caused by the sudden opening of alveoli
2. Usually more prominent during expiration
3. Produced by airflow across passages narrowed by secretions
4. Found primarily in the pleura.

88. A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the
first nursing action would be to:
1. Wait until the client’s lab work is done.
2. Not administer oxygen unless ordered by the physician.
3. Administer oxygen at 2 L flow per minute.
4. Administer oxygen at 10 L flow per minute and check the client’s nailbeds.

89. Immediately following a thoeacentesis, which clinical manifestations indicate that a

complication has occurred and the physician should be notified?
1. Serosanguineous drainage from the puncture site
2. Increased temperature and blood pressure
3. Increased pulse and pallor
4. Hypotension and hypothermia

90. If a client continues to hypoventilate, the nurse will continually assess for a complication of:
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
 91. A client is admitted to the hospital with acute bronchitis. While taking the client’s VS, the
nurse notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in
chronic respiratory distress are usually the result of:
1. Respiratory acidosis
2. A build-up of carbon dioxide
3. A build-up of oxygen without adequate expelling of carbon dioxide.
4. An acute respiratory infection.

92. Auscultation of a client’s lungs reveals crackles in the left posterior base. The nursing
intervention is to:
1. Repeat auscultation after asking the client to deep breathe and cough.
2. Instruct the client to limit fluid intake to less than 2000 ml/day.
3. Inspect the client’s ankles and sacrum for the presence of edema
4. Place the client on bedrest in a semi-Fowlers position.

93. The most reliable index to determine the respiratory status of a client is to:
1. Observe the chest rising and falling
2. Observe the skin and mucous membrane color.
3. Listen and feel the air movement.
4. Determine the presence of a femoral pulse.

94. A client with COPD has developed secondary polycythemia. Which nursing diagnosis would
be included in the plan of care because of the polycythemia?
1. Fluid volume deficit related to blood loss.
2. Impaired tissue perfusion related to thrombosis
3. Activity intolerance related to dyspnea
4. Risk for infection related to suppressed immune response.

95. The physician has scheduled a client for a left pneumonectomy. The position that will most
likely be ordered postoperatively for his is the:
1. Unoperative side or back
2. Operative side or back
3. Back only
4. Back or either side.

96. Assessing a client who has developed atelectasis postoperatively, the nurse will most likely
find:
1. A flushed face
2. Dyspnea and pain
3. Decreased temperature
4. Severe cough and no pain.

97. A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first
intervention in completing this procedure would be to:
1. Change the tracheostomy dressing
2. Provide humidity with a trach mask
3. Apply oral or nasal suction
4. Deflate the tracheal cuff

98. A client states that the physician said the tidal volume is slightly diminished and asks the
nurse what this means. The nurse explains that the tidal volume is the amount of air:
1. Exhaled forcibly after a normal expiration
2. Exhaled after there is a normal inspiration
3. Trapped in the alveoli that cannot be exhaled
4. Forcibly inspired over and above a normal respiration.
 99. An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the
tissues, is caused by:
1. A decreasing oxygen pressure in the blood
2. An increasing carbon dioxide pressure in the blood
3. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.
4. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood.