KABC – RESPI Q&A

1. The emergency department nurse is assessing a client who has a. Continue to suction.
sustained a blunt injury to the chest wall. Which finding indicates b. Notify the health care provider immediately.
the presence of a pneumothorax in this client? c. Stop the procedure and re-oxygenate the client.
a. A low respiratory rate d. Ensure that the suction is limited to 15 seconds.
b. Diminished breath sounds
c. The presence of a barrel chest 8. The nurse is assessing the respiratory status of a client who has
d. A sucking sound at the site of injury suffered a fractured rib. The nurse should expect to note which
finding?
2. The nurse is caring for a client hospitalized with acute exacerbation a. Slow, deep respirations
of chronic obstructive pulmonary disease. Which findings would the b. Rapid, deep respirations
nurse expect to note on assessment of this client? Select all that c. Paradoxical respirations
apply. d. Pain, especially with inspiration
a. A low arterial PCo2 level
b. A hyperinflated chest noted on the chest x -ray 9. A client with a chest injury has suffered flail chest. The nurse
c. Decreased oxygen saturation with mild exercise assesses the client for which most distinctive sign of flail chest?
d. A widened diaphragm noted on the chest x-ray a. Cyanosis
e. Pulmonary function tests that demonstrate b. Hypotension
f. increased vital capacity c. Paradoxical chest movement
d. Dyspnea, especially on exhalation
3. The nurse instructs a client to use the pursed-lip method of
breathing and evaluates the teaching by asking the client about the 10. A client has been admitted with chest trauma after a motor vehicle
purpose of this type of breathing. The nurse determines that the crash and has undergone subsequent intubation. The nurse checks
client understands if the client states that the primary purpose of the client when the high-pressure alarm on the ventilator sounds,
pursed-lip breathing is to promote which outcome? and notes that the client has absence of breath sounds in the right
a. Promote oxygen intake upper lobe of the lung. The nurse immediately assesses for other
b. Strengthen the diaphragm signs of which condition?
c. Strengthen the intercostal muscles a. Right pneumothorax
d. Promote carbon dioxide elimination b. Pulmonary embolism
c. Displaced endotracheal tube
4. The nurse is preparing a list of home care instructions for a client d. Acute respiratory distress syndrome
who has been hospitalized and treated for tuberculosis. Which
instructions should the nurse include on the list? Select all that 11. The nurse is assessing a client with multiple trauma who is at risk
apply. for developing acute respiratory distress syndrome. The nurse should
a. Activities should be resumed gradually. assess for which earliest sign of acute respiratory distress syndrome?
b. Avoid contact with other individuals, except family a. Bilateral wheezing
members, for at least 6 months. b. Inspiratory crackles
c. A sputum culture is needed every 2 to 4 weeks once c. Intercostal retractions
medication therapy is initiated. d. Increased respiratory rate
d. Respiratory isolation is not necessary because family
members already have been exposed. 12. The nurse is discussing the techniques of chest physiotherapy and
e. Cover the mouth and nose when coughing or sneezing and postural drainage (respiratory treatments) to a client having
put used tissues in plastic bags. expectoration problems because of chronic thick, tena cious mucus
f. When 1 sputum culture is negative, the client is no longer production in the lower airway. The nurse explains that after the
considered infectious and usually can return to former client is positioned for postural drainage the nurse will perform
employment. which action to help loosen secretions?
a. Palpation and clubbing
5. The nurse is caring for a client after a bronchoscopy and biopsy. b. Percussion and vibration
Which finding, if noted in the client, should be reported immediately c. Hyperoxygenation and suctioning
to the health care provider? d. Administer a bronchodilator and monitor peak flow
a. Dry cough
b. Hematuria 13. The nurse has conducted discharge teaching with a client diagnosed
c. Bronchospasm with tuberculosis who has been receiving medication for 2 weeks.
d. Blood-streaked sputum The nurse determines that the client has understood the inform ation
if the client makes which statement?
6. The nurse is preparing to suction a client via a tracheostomy tube. a. “I need to continue medication therapy for 1 month.”
The nurse should plan to limit the suctioning time to a maximum of b. “I can’t shop at the mall for the next 6 months.”
which time period? c. “I can return to work if a sputum culture comes back
a. 5 seconds negative.”
b. 10 seconds d. “I should not be contagious after 2 to 3 weeks of
c. 30 seconds e. medication therapy.”
d. 60 seconds
14. The nurse is preparing to give a bed bath to an immobilized client
7. The nurse is suctioning a client via an endotracheal tube. During the with tuberculosis. The nurse should wear which items when
suctioning procedure, the nurse notes on the monitor that the heart performing this care?
rate is decreasing. Which nursing intervention is appropriate? a. Surgical mask and gloves

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b. Particulate respirator, gown, and gloves associated with tuberculosis. The nurse informs the participants tha t
c. Particulate respirator and protective eyewear tuberculosis is considered as a diagnosis if which signs and
d. Surgical mask, gown, and protective eyewear symptoms are present? Select all that apply.
a. Dyspnea
15. A client has experienced pulmonary embolism. The nurse should b. Headache
assess for which symptom, which is most commonly reported? c. Night sweats
a. Hot, flushed feeling d. A bloody, productive cough
b. Sudden chills and fever e. A cough with the expectoration of mucoid sputum
c. Chest pain that occurs suddenly
d. Dyspnea when deep breaths are taken 23. The nurse performs an admission assessment on a client with a
diagnosis of tuberculosis. The nurse should check the results of
16. A client who is human immunodeficiency virus (HIV)–positive has had which diagnostic test that will confirm this diagnosis?
a tuberculin skin test (TST). The nurse notes a 7-mm area of a. Chest x-ray
induration at the site of the skin test and interprets the result as b. Bronchoscopy
which finding? c. Sputum culture
a. Positive d. Tuberculin skin test
b. Negative
c. Inconclusive 24. The low-pressure alarm sounds on a ventilator. The nurse assesses
d. Need for repeat testing the client and then attempts to determine the cause of the alarm. If
unsuccessful in determining the cause of the alarm, the nurse should
17. A client with acquired immunodeficiency syndrome (AIDS) has take what initial action?
histoplasmosis. The nurse should assess the client for which a. Administer oxygen
expected finding? b. Check the client’s vital signs
a. Dyspnea c. Ventilate the client manuall y
b. Headache d. Start cardiopulmonary resuscitation
c. Weight gain
d. Hypothermia 25. A client has a prescription to take guaifenesin. The nurse determines
that the client understands the proper administration of this
18. The nurse is giving discharge instructions to a client with pulmonary medication if the client states that he or she will perform which
sarcoidosis. The nurse concludes that the client understands the action?
information if the client indicates to report which early sign of a. Take an extra dose if fever develops
exacerbation? b. Take the medication with meals only
a. Fever c. Take the tablet with a full glass of water
b. Fatigue d. Decrease the amount of daily fluid intake
c. Weight loss
d. Shortness of breath 26. The nurse is preparing to administer a dose of naloxone
intravenously to a client with an opioid overdose. Which supportive
19. The nurse is taking the history of a client with occupational lung medical equipment should the nurse plan to have at the client’s
disease (silicosis). The nurse should assess whether the client wears bedside if needed?
which item during periods of exposure to silica particles? a. Nasogastric tube
a. Mask b. Paracentesis tray
b. Gown c. Resuscitation equipment
c. Gloves d. Central line insertion tray
d. Eye protection
27. The nurse teaches a client about the effects of diphenhydramine,
20. An oxygen delivery system is p rescribed for a client with chronic which has been prescribed as a cough suppressant. The nurse
obstructive pulmonary disease to deliver a precise oxygen determines that the client needs further instruction if the client
concentration. Which oxygen delivery system would the nurse makes which statement?
prepare for the client? a. “I will take the medication on an empty stomach.”
a. Face tent b. “I won’t drink alcohol while taking this medication.”
b. Venturi mask c. “I won’t do activities that require mental alertness while
c. Aerosol mask taking this medication.”
d. Tracheostomy collar d. “I will use sugarless gum, candy, or oral rinses to decrease
dryness in my mouth.”
21. The nurse is instructing a hospitalized client with a diagnosis of
emphysema about measures that will enhance the effectiveness of 28. Acromolyn sodium inhaler is prescribed for a client with allergic
breathing during dyspneic periods. Which position should the nurse asthma. The nurse provides instructions regarding the adverse
instruct the client to assume? effects of this medication and should tell the client that which
a. Sitting up in bed undesirable effect is associated with this medication?
b. Side-lying in bed a. Insomnia
c. Sitting in a recliner chair b. Constipation
d. Sitting up and leaning on an overbed table c. Hypotension
d. Bronchospasm
22. The community health nurse is conducting an educational session
with community members regarding the signs and symptoms

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29. Terbutaline is prescribed for a client with bronch itis. The nurse c. Alternating a single puff of each, beginning with the
checks the client’s medical history for which disorder in which the beclomethasone
medication should be used with caution?
a. Osteoarthritis 37. Rifabutin is prescribed for a client with active Mycobacterium avium
b. Hypothyroidism complex (MAC) disease and tuberculosis. For which side and adverse
c. Diabetes mellitus effects of the medication should the nurse monitor? Select all that
d. Polycystic disease apply.
a. Signs of hepatitis
30. Zafirlukast is prescribed for a client with bronchial asthma. Which b. Flulike syndrome
laboratory test does the nurse expect to be prescribed before the c. Low neutrophil count
administration of this medication? d. Vitamin B6 deficiency
a. Platelet count e. Ocular pain or blurred vision
b. Neutrophil count f. Tingling and numbness of the fingers
c. Liver function tests
d. Complete blood count 38. A client has begun therapy with theophylline. The nurse should plan
to teach the client to limit the intake of which items while taking
31. A client has been taking isoniazid for 2 months. The client complains this medication?
to the nurse about numbness, paresthesias, and tingling in the a. Coffee, cola, and chocolate
extremities. The nurse interprets that the client is experiencing b. Oysters, lobster, and shrimp
which problem? c. Melons, oranges, and pineapple
a. Hypercalcemia d. Cottage cheese, cream cheese, and dairy creamers
b. Peripheral neuritis
c. Small blood vessel spasm 39. The nurse has just administered the first dose of omalizumab to a
d. Impaired peripheral circulation client. Which statement by the client would alert the nurse that the
client may be experiencing a life-threatening effect?
32. A client is to begin a 6-month course of therapy with isoniazid. The a. “I have a severe headache.”
nurse should plan to teach the client to take which action? b. “My feet are quite swollen.”
a. Use alcohol in small amounts only. c. “I am nauseated and may vomit.”
b. Report yellow eyes or skin immediately. d. “My lips and tongue are swollen.”
c. Increase intake of Swiss or aged cheeses.
d. Avoid vitamin supplements during the rapy. 40. The nurse is caring for a client with a diagnosis of influenza who first
began to experience symptoms yesterday. Antiviral the rapy is
33. A client has been started on long -term therapy with rifampin. The prescribed and the nurse provides instructions to the client about
nurse should provide which information to the client about the the therapy. Which statement by the client indicates an
medication? understanding of the instructions?
a. Should always be taken with food or antacids a. “I must take the medication exactly as prescribed.”
b. Should be double-dosed if 1 dose is forgotten b. “Once I start the medication, I will no longer be
c. Causes orange discoloration of sweat, tears, urine, and contagious.”
feces c. “I will not get any colds or infections while taking this
d. May be discontinued independently if symptoms are gone medication.”
in 3 months d. “This medication has minimal side effects and I can return
to normal activities.”
34. The nurse has given a client taking ethambutol information about
the medication. The nurse determines that the client understands
the instructions if the client states that he or she will immediately
report which finding ?
a. Impaired sense of hearing
b. Gastrointestinal side effects
c. Orange-red discoloration of body secretions
d. Difficulty in discriminating the color red from green

35. A client with tuberculosis is being started on anti -tuberculosis

therapy with isoniazid. Before giving the client the first dose, the
nurse should ensure that which baseline study has been completed?
a. Electrolyte levels
b. Coagulation times
c. Liver enzyme levels
d. Serum creatinine level

36. The nurse has a prescription to give a client salmeterol, 2 puffs, and
beclomethasone di propionate, 2 puffs, by metered-dose inhaler. The
nurse should administer the medication using which procedure?
a. Beclomethasone first and then the sal meterol
b. Salmeterol first and then the beclomethasone Alternating
a single puff of each, beginning with the salmeterol

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 KABC – RESPI Q&A

1. B 8. D
This client has sustained a blunt or closed -chest injury. Basic Rib fractures result from a blunt injury or a fall. Typical
symptoms of a closed pneumothorax are shortness of breath and signs and symptoms include pain and tenderness localized at the
chest pain. A larger pneumothorax may cause tachypnea, cyanosis, fracture site that is exacerbated by inspiration and palpation,
diminished breath sounds, and subcutaneous emphysema. shallow respirations, splinting or guarding the chest protectively to
Hyperresonance also may occur on the affected side. A sucking sound minimize chest movement, and possible bruising at the fracture site.
at the site of injury would be noted with an open chest injury. Paradoxical respirations are seen with flail chest.

2. B, C 9. C
Clinical manifestations of chronic obstructive pulmonary disease Flail chest results from multiple rib fractures. This results in a
(COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at “floating” section of ribs. Because this section is unattached to the
rest, oxygen desaturation with exercise, and the use of accessory rest of the bony rib cage, this segment results in paradoxical chest
muscles of respiration. Chest x -rays reveal a hyperinflated chest and movement. This means that the force of inspiration pulls the
a flattened diaphragm if the disease is advanc ed. Pulmonary function fractured segment inward, while the rest of the chest expands.
tests will demonstrate decreased vital capacity. Similarly, during exhalation, the segment balloons outward while the
rest of the chest moves inw ard. This is a characteristic sign of flail
3. D chest.
Pursed-lip breathing facilitates maximal expiration for clients with
obstructive lung disease. This type of breathing allows better 10. A.
expiration by increasing airway pressure that keeps air passages Pneumothorax is characterized by restlessness, tachycardia,
open during exhalation. Options A, B, and C are not the purposes of dyspnea, pain with respiration, asymmetrical chest expansion, and
this type of breathing. diminished or absent breath sounds on the affected side.
Pneumothorax can cause increased airway pressure because of
4. A, C, D, E resistance to lung inflation. Acute respiratory distress syndrome and
The nurse should provide the client and family with information pulmonary embolism are not characterized by absent breath sounds.
about tuberculosis and allay concerns about the contagious aspect An endotracheal tube that is inserted too far can cause absent breath
of the infection. The client needs to follow the medication regimen sounds, but the lack of breath sounds most likely would be on the
exactly as prescribed and always have a supply of the medication on left side because of the degree of curvature of the right and left
hand. Side and adverse effects of the medication and ways of mainstem bronchi.
minimizing them to ensure compliance should be explained. After 2
to 3 weeks of medication therapy, it is unlikely that the client will 11. D
infect anyone. Activities should be resumed gradually and a well - The earliest detectable sign of acute respiratory distress syndrome
balanced diet that is rich in iron, protein, and vitamin C to promote is an increased respiratory rate, which c an begin from 1 to 96 hours
healing and prevent recurrence of infection should be consumed. after the initial insult to the body. This is followed by increasing
Respiratory isolation is not necessary because family members dyspnea, air hunger, retraction of accessory muscles, and cyanosis.
already have been exposed. Instruct the client about thorough hand Breath sounds may be clear or consist of fine inspiratory crackles or
washing, to cover the mouth and nose when coughing or sneezing, diffuse coarse crackles.
and to put used tissues into plastic bags. A sput um culture is needed
every 2 to 4 weeks once medication therapy is initiated. When the 12. B.
results of 3 sputum cultures are negative, the client is no longer Chest physiotherapy of percussion and vibration helps to loosen
considered infectious and can usually return to former employment. secretions in the smaller lower airways. Postural drainage positions
the client so that gravity can help mucus move from smaller airways
5. C to larger ones to support expectoration of the mucus. Options A, C,
If a biopsy was performed during a bronchoscopy, blood-streaked and D are not actions that will loosen secretions.
sputum is expected for several hours. Frank blood indicates
hemorrhage. A dry cough may be expected. The client should be 13. D
assessed for signs of complications, which would include cyanosis, The client is continued on medication therapy for up to 12 months,
dyspnea, stridor, bronchospasm, hemoptysis, hypotension, depending on the situation. The client generally is considered
tachycardia, and dysrhythmias. Hematuria is unrelated to this noncontagious after 2 to 3 weeks of medication therapy. The client
procedure. is instructed to wear a mask if there will be exposure to crowds until
the medication is effective in preventing transmission. The client is
6. B allowed to return to work when the results of 3 sputum cultures are
Hypoxemia can be caused by prolonged suctioning, which stimulates negative.
the pacemaker cells in the heart. A vasovagal response may occur,
causing bradycardia. The nurse must preoxygenate the client before 14. B
suctioning and limit the suctioning pass to 10 seconds. The nurse who is in contact with a client with tuberculosis should
wear an individually fitted particulate respirator. The nurse also
7. C would wear gloves as per standard precautions. The nurse wears a
During suctioning, the nurse should monitor the client closely for gown when the possibility exists that the clothing could become
adverse effects, including hypoxemia, cardiac irregularities such as contami nated, such as when giving a bed bath.
a decrease in heart rate resulting from vagal stimulation, mucosal
trauma, hypotension, and paroxysmal coughing. If adverse effects 15. C
develop, especially cardiac irregularities, the procedure is stopped The most common initial symptom in pulmonary embolism is chest
and the client is reoxygenated. pain that is sudden in onset. The next most commonly reported
symptom is dyspnea, which is accompanied by an increased

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 KABC – RESPI Q&A

respiratory rate. Other typical symptoms of pulmonary embolism 24. C

include apprehension and restlessness, tachycardia, cough, and If at any time an alarm is sounding and the nurs e cannot quickly
cyanosis. ascertain the problem, the client is disconnected from the ventilator
and manual resuscitation is used to support respirations until the
16. A problem can be corrected. No reason is given to begin
The client with HIV infection is considered to have positive results cardiopulmonary resuscitation. Checking vital signs is not the initial
on tuberculin skin testing with an area of induration larger than 5 action. Although oxygen is helpful, it will not provide ventilation to
mm. The client without HIV is positive with an induration larger than the client.
10 mm. The client with HIV is immunosuppressed, making a smaller
area of induration positive for this type of client. It is possible for
the client infected with HIV to have false -negative readings because
of the immunosuppression factor. Options B, C, and D are incorrect 25. C
interpretations. Guaifenesin is an expectorant and should be taken with a full glass
of water to decrease the viscosity of secretions. Extra doses should
17. A not be taken. The client should contact the health care provider if
Histoplasmosis is an opportunistic fungal infection that can occur in the cough lasts longer than 1 week or is accompanied by fever, rash,
the client with AIDS. The infection begins as a respiratory infection sore throat, or persistent headache. Fluids are needed to decrease
and can progress to disseminated infection. Typical signs and the viscosity of secretions. The medication does not have to be taken
symptoms include fever, dyspnea, cough, and weight loss. with meals.
Enlargement of the client’s lymph nodes, liver, and spleen may occur
as well. 26. C
The nurse administering naloxone for suspected opioid overdose
should have resuscitation equipment readily available to support
18. D naloxone therapy if it is needed. Other adjuncts that may be needed
Dry cough and dyspnea are typical early manifestations of pulmonary include oxygen, a mechanical ventil ator, and vasopressors.
sarcoidosis. Later manifestations include night sweats, fever, weight
loss, and skin nodules. 27. A
Diphenhydramine has several uses, including as an antihistamine,
19. A. antitussive, antidyskinetic, and sedativehypnotic. Instructions for
Silicosis results from chronic, excessive inhalation of particles of use include taking with food or milk to decrease gastrointestinal
free crystalline silica dust. The client should wear a mask to limit upset and using oral rinses, sugarless gum, or hard candy to minimize
inhalation of this substance, which can cause restrictive lung disease dry mouth. Because the medication causes drowsiness, the client
after years of exposure. Options B, C, and D are not necessary. should avoid use of alcohol or central nervous system depressants,
operating a car, or engaging in other activities requiring mental
20. B awareness during use.
The Venturi mask delivers the most accurate oxygen concentration.
It is the best oxygen delivery system for the client with chronic 28. D
airflow limitation such as chronic obstructive pulmonary disease, Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a
because it delivers a precise oxygen concentration. The face tent, mast cell stabilizer. Undesirable effects associated with inhalation
aerosol mask, and tracheostomy collar are also high-flow oxygen therapy of cromolyn sodium are bronchospasm, cough, nasal
delivery systems but most often are used to administer high congestion, throat irritation, and wheezing. Clients receiving this
humidity. medication orally may experience pruritus, nausea, diarrhea, and
myalgia.
21. D
Positions that will assist the client with emphysema with breathing 29. C
include sitting up and leaning on an overbed table, sitting up and Terbutaline is a bronchodilator and is contraindicated in clients with
resting the elbows on the knees, and standing and leaning against hypersensitivity to sympathomimetics. It should be used with
the wall. caution in clients with impaired c ardiac function, diabetes mellitus,
hypertension, hyperthyroidism, or a history of seizures. The
22. A, C, D, E medication may increase blood glucose levels.
Tuberculosis should be considered for any clients with a persistent
cough, weight loss, anorexia, night sweats, hemoptysis, shortness of 30. C
breath, fever, or chills. The client’s previous exposure to Zafirlukast is a leukotriene receptor antagonist used in the
tuberculosis should also be assessed and correlated with the clinical prophylaxis and long-term treatment of bronchial asthma.
manifestations. Zafirlukast is used with caution in clients with impaired hepatic
function. Liver function laboratory tests should be performed to
23. C obtain a baseline, and the levels should be monitored during
Tuberculosis is definitively diagnosed through culture administration of the medication. It is not necessary to perform the
and isolation of Mycobacterium tuberculosis. A presumptive other laboratory tests before administration of the medication.
diagnosis is made based on a tuberculin skin test, a sputum smear
that is positive for acid-fast bacteria, a chest x-ray, and histological
evidence of granulomatous disease on biopsy. Test-Taking Strategy:
Focus on the subject, confirming the diagnosis of tuberculosis. 31. B
Confirmation is made by identifying the bacteria, M. tuberculosis. Isoniazid is an antitubercular medication. A common side effect of
isoniazid is peripheral neuritis, manifested by numbness, tingling,

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 KABC – RESPI Q&A

and paresthesias in the extremities. Th is can be minimized with numbness and tingling in the extremities are associated with the use
pyridoxine (vitamin B6) intake. Options A, C, and D are not of isoniazid.
associated with the information in the question.
38. A
32. B Theophylline is a methylxanthine bronchodilator. The nurse teaches
Isoniazid is hepatotoxic, and therefore the client is taught to report the client to limit the intake of xanthine containing foods while
signs and symptoms of hepatitis immediately, which include yellow taking this medication. These foods include coffee, cola, and
skin and sclera. For the same reason, alcohol should be avoided chocolate.
during therapy. The client should avoid intake of Swiss cheese, fish
such as tuna, and foods containing tyramine because they may cause 39. D
a reaction characterized by redness and itching of the skin, flushing, Omalizumab is an antiinflammatory used for longterm control of
sweating, tachycardia, headache, or lightheadedness. The client can asthma. Anaphylactic reactions can occur with the administration of
avoid developing peripheral neuritis by increasing the intake of omalizumab. The nurse administering the medication should monitor
pyridoxine (vitamin B6) during the course of isoniazid for adverse reactions of the medication. Swelling of the lips and
therapy. tongue are an indication of an anaphylaxis. The client statements in
options A, B, and C are not indicative of an adverse reaction.
33. C
Rifampin causes orange-red discoloration of body secretions and will 40. A
stain soft contact lenses permanently. Rifampin should be taken Antiviral medications for influenza must be taken exactly as
exactly as directed. Doses should not be doubled or skipped. The prescribed. These medications do not prevent the spread of influenza
client should not stop therapy until directed to do so by a health care and clients are usually contagious for up to 2 days after the initiation
provider. It is best to administer the medication on an empty of antiviral medications. Secondary bacterial infections may occur
stomach unless it causes gastrointestinal upset, and then it may be despite antiviral treatment. Side effects occur with these
taken with food. Antacids, if prescribed, should be taken at least 1 medications and may necessitate a change in activities, especially
hour before the medication. when driving or operating machinery if dizziness occurs.

34. D
Ethambutol causes optic neur itis, which decreases visual acuity and
the ability to discriminate between the colors red and green. This
poses a potential safety hazard when a client is driving a motor
vehicle. The client is taught to report this symptom immediately.
The client also is taught to take the medication with food if
gastrointestinal upset occurs. Impaired hearing results from
antitubercular therapy with streptomycin. Orange-red discoloration
of secretions occurs with rifampin.

35. C
Isoniazid therapy can cause an elevation of h epatic enzyme levels
and hepatitis. Therefore, liver enzyme levels are monitored when
therapy is initiated and during the first 3 months of therapy. They
may be monitored longer in the client who is older than 50 years or
abuses alcohol. The laboratory tests in options A, B, and D are not
necessary.

36. B
Salmeterol is an adrenergic type of bronchodilator and
beclomethasone dipropionate is a glucocorticoid. Bronchodilators
are always administered before glucocorticoids when both are to be
given on the same time schedule. This allows for widening of the air
passages by the bronchodilator, which then makes the glucocorticoid
more effective.

37. A, B, C, E
Rifabutin may be prescribed for a client with active MAC disease and
tuberculosis. It inhibits mycobacterial DNA-dependent RNA
polymerase and suppresses protein synthesis. Side and adverse
effects include rash, gastrointestinal disturbances, neutropenia (low
neutrophil count), redorange – colored body secretions, uveitis
(blurred vision and eye pain), myositis, arthralgia, hepatitis, chest
pain with dyspnea, and flulike syndrome. Vitamin B6 deficiency and

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 KABC – RESPI Q&A

1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with sees many abbreviations. What does a lowercase “a” in ABG value
newly diagnose asthma. When teaching the patient about this drug, present?
the nurse should explain that it may cause: a. Acid-base balance
a. Nasal congestion b. Arterial Blood
b. Nervousness c. Arterial oxygen saturation
c. Lethargy d. Alveoli
d. Hyperkalemia
9. A male patient is admitted to the healthcare facility for treatment
2. Miriam, a college student with acute rhinitis sees the campus nurse of chronic obstructive pulmonary disease. Which nursing diagnosis
because of excessive nasal drainage. The nurse asks the patient is most important for this patient?
about the color of the drainage. In acute rhinitis, nasal drainage a. Activity intolerance related to fatigue
normally is: b. Anxiety related to actual threat to health status
a. Yellow c. Risk for infection related to retained secretions
b. Green d. Impaired gas exchange related to airflow obstruction
c. Clear
d. Gray 10. Nurse Ruth assessing a patient for tracheal displacement should
know that the trachea will deviate toward the:
3. A male adult patient hospitalized for treatment of a pulmonary a. Contralateral side in a simple pneumothorax
embolism develops respiratory alkalosis. Which clinical findings b. Affected side in a hemothorax
commonly accompany respiratory alkalosis? c. Affected side in a tension pneumothorax
a. Nausea or vomiting d. Contralateral side in hemothorax
b. Abdominal pain or diarrhea
c. Hallucinations or tinnitus 11. After undergoing a left pneumonectomy, a female patient has a chest
d. Lightheadedness or paresthesia tube in place for drainage. When caring for this patient, the nurse
must:
4. 4. Before administering ephedri ne, Nurse Tony assesses the patient’s a. Monitor fluctuations in the water -seal chamber
history. Because of ephedrine’s central nervous system (CNS) b. Clamp the chest tube once every shift
effects, it is not recommended for: c. Encourage coughing and deep breathing
a. Patients with an acute asthma attack d. Milk the chest tube every 2 hours
b. Patients with narcolepsy
c. Patients under age 6 12. When caring for a male patient who has just had a total
d. Elderly patients laryngectomy, the nurse should plan to:
a. Encourage oral feeding as soon as possible
5. A female patient suffers adult respiratory distress syndrome as a b. Develop an alternative communication method
consequence of shock. The patient’s condition deteriorates rapidly, c. Keep the tracheostomy cuff fully inflated
and endotracheal intubation and mechanical ventilation are d. Keep the patient flat in bed
initiated. When the high-pressure alarm on the mechanical
ventilator, alarm sounds, the nurse starts to check for the cause. 13. A male patient has a sucking stab wound to the chest. Which action
Which condition triggers the high -pressure alarm? should the nurse take first?
a. Kinking of the ventilator tubing
b. A disconnected ventilator tube a. Drawing blood for a hematocrit and hemoglobin level
c. An endotracheal cuff leak b. Applying a dressing over the wound and taping it on three
d. A change in the oxygen concentration without resetting sides
the oxygen level alarm c. Preparing a chest tube insertion tray
d. Preparing to start an I.V. line
6. A male adult patient on mechanical ventilation is receiving
pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which 14. For a patient with advanced chronic obstructive pulmonary disease
assessment finding indicates that the patient needs another (COPD), which nursing action best promotes adequate gas exchange?
pancuronium dose? a. Encouraging the patient to drink three glasses of fluid
a. Leg movement daily
b. Finger movement b. Keeping the patient in semi -Fowler’s position
c. Lip movement c. Using a high-flow venture mask to deliver oxygen as
d. Fighting the ventilator prescribe
d. Administering a sedative, as prescribe
7. On auscultation, which finding suggests a right pneumothorax?
a. Bilateral inspiratory and expiratory crackles 15. A male patient’s X-ray result reveals bilateral white-outs, indicating
b. Absence of breaths sound in the right thorax adult respiratory distress syndrome (ARDS). This syndrome results
c. Inspiratory wheezes in the right thorax from:
d. Bilateral pleural friction rub. a. Cardiogenic pulmonary edema
b. Respiratory alkalosis
8. Rhea, conf used and short breath, is brought to the emergency c. Increased pulmonary capillary permeability
department by a family member. The medical history reveals chronic d. Renal failure
bronchitis and hypertension. To learn more about the current
respiratory problem, the doctor orders a chest x -ray and arterial 16. For a female patient with chronic obstru ctive pulmonary disease,
blood gas (ABG) analysis. When reviewing the ABG report, the nurses which nursing intervention would help maintain a patent airway?

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a. Restricting fluid intake to 1,000 ml per day 24. Nurse Reese is caring for a client hospitalized with acute
b. Enforcing absolute bed rest exacerbation of chronic obstructive pulmonary disease. Which of the
c. Teaching the patient how to perform controlled coughing following would the nurse expect to note on assessment of this
d. Administering prescribe sedatives regularly and in large client?
amounts a. Hypocapnia
b. A hyperinflated chest noted on the chest x-ray
17. Nurse Lei caring for a client with a pneumothorax and who has had a c. Increased oxygen saturation with exercise
chest tube inserted notes continues gentle bubbling in the suction d. A widened diaphragm noted on the chest x -ray
control chamber. What action is appropriate?
a. Do nothing, because this is an expected find ing 25. An oxygen delivery system is prescribed for a male client with
b. Immediately clamp the chest tube and notify the physician chronic obstructive pulmonary disease to deliver a precise oxygen
c. Check for an air leak because the bubbling should be concentration. Which of the follo wing types of oxygen delivery
intermittent systems would the nurse anticipate to be prescribed?
d. Increase the suction pressure so that the bubbling a. Face tent
becomes vigorous b. Venturi mask
c. Aerosol mask
18. Nurse Maureen has assisted a physician with the insertion o f a chest d. Tracheostomy collar
tube. The nurse monitors the client and notes fluctuation of the fluid
level in the water seal chamber after the tube is inserted. Based on 26. Blessy, a community health nurse is conducting an educational
this assessment, which action would be appropriate? session with community members regarding tuberculosis. The nurse
a. Inform the physician tells the group that one of the first symptoms associated with
b. Continue to monitor the client tuberculosis is:
c. Reinforce the occlusive dressing a. Dyspnea
d. Encourage the client to deep breathe b. Chest pain
c. A bloody, productive cough
19. Nurse Reynolds caring for a client with a chest tube turns the client d. A cough with the expectoration of mucoid sputum
to the side, and the chest tube accidentally disconnects. The initial
nursing action is to: 27. A nurse performs an admission assessment on a female client with a
a. Call the physician diagnosis of tuberculosis. The nurse reviews the result of which
b. Place the tube in bottle of sterile water diagnosis test that will confirm this diagnosis?
c. Immediately replace the chest tube system a. Bronchoscopy
d. Place a sterile dressing over the disconnection site b. Sputum culture
c. Chest x-ray
20. A nurse is assisting a physician with the removal of a chest tube. The d. Tuberculin skin test
nurse should instruct the client to:
a. Exhale slowly 28. A nurse is caring for a male client with emphysema who is receiving
b. Stay very still oxygen. The nurse assesses the oxygen flow rate to ensure that it
c. Inhale and exhale quickly does not exceed:
d. Perform the Valsalva maneuver a. 1 L/min
b. 2 L/min
21. While changing the tapes on a tracheostomy tube, the male client c. 6 L/min
coughs and tube is dislodged. The initial nursing action is to: d. 10 L/min
a. Call the physician to reinsert the tube
b. Grasp the rete ntion sutures to spread the opening 29. A nurse instructs a female client to use the pursed -lip method of
c. Call the respiratory therapy department to reinsert the breathing and the client asks the nurse about the purpose of this
tracheotomy type of breathing. The nurse responds, knowing that the primary
d. Cover the tracheostomy site with a sterile dressing to purpose of pursed-lip breathing is to:
prevent infection a. Promote oxygen intake
b. Strengthen the diaphragm
22. Nurse Oliver is caring for a client immediately after removal of the c. Strengthen the intercostal muscles
endotracheal tube. The nurse reports which of the following signs d. Promote carbon dioxide elimination
immediately if experienced by the client?
a. Stridor 30. A nurse is caring for a male client with acute respira tory distress
b. Occasional pink-tinged sputum syndrome. Which of the following would the nurse expect to note in
c. A few basilar lung crackles on the right the client?
d. Respiratory rate 24 breaths/min a. Pallor
b. Low arterial PaO2
23. An emergency room nurse is assessing a male c lient who has c. Elevated arterial PaO2
sustained a blunt injury to the chest wall. Which of these signs would d. Decreased respiratory rate
indicate the presence of a pneumothorax in this client?
a. A low respiratory rate 31. A nurse is preparing to obtain a sputum specimen from a male client.
b. Diminished breath sounds Which of the following nursing actions will facilitate obtaining the
c. The presence of a barrel chest specimen?
d. A sucking sound at the site of injur y a. Limiting fluid
b. Having the client take deep breaths

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c. Asking the client to spit into the collection container 39. Which phrase is used to describe the volume of air inspired and
d. Asking the client to obtain the specimen after eating expired with a normal breath?
32. Nurse Joy is caring for a client after a bronchoscopy and biopsy. a. Total lung capacity
Which of the following signs, if noticed in the client, should be b. Forced vital capacity
reported immediately to the physician? c. Tidal volume
a. Dry cough d. Residual volume
b. Hematuria
c. Bronchospasm 40. A male client abruptly sits up in bed, reports having difficulty
d. Blood-streaked sputum breathing and has an arterial oxygen saturation of 88%. Which mode
of oxygen delivery would most likely reverse the manifestations?
33. A nurse is suctioning fluids from a male client via a tracheos tomy a. Simple mask
tube. When suctioning, the nurse must limit the suctioning time to a b. Non-rebreather mask
maximum of: c. Face tent
a. 1 minute d. Nasal cannula
b. 5 seconds
c. 10 seconds 41. A female client must take streptomycin for tuberculosis. Before
d. 30 seconds therapy begins, the nurse should instruct the client to notify the
physician if which health concern occurs?
34. A nurse is suctioning fluids from a female client through an a. Impaired color discrimination
endotracheal tube. During the suctioning procedure, the nurse notes b. Increased urinary frequency
on the monitor that the heart rate is decreasing. Which if the c. Decreased hearing acuity
following is the appropriate nursing intervention? d. Increased appetite
a. Continue to suction
b. Notify the physician immediately 42. A male client is asking the nurse a question regarding the Mantoux
c. Stop the procedure and reoxygenate the client test for tuberculosis. The nurse should base her response on the fact
d. Ensure that the suction is limited to 15 s econds that the:
a. Area of redness is measured in 3 days and determines
35. A male adult client is suspected of having a pulmonary embolus. A whether tuberculosis is present.
nurse assesses the client, knowing that which of the following is a b. Skin test doesn’t differentiate between active and
common clinical manifestation of pulmonary embolism? dormant tuberculosis infection.
a. Dyspnea c. Presence of a wheal at the injection site in 2 days
b. Bradypnea indicates active tuberculosis.
c. Bradycardia d. Test stimulates a reddened response in some clients and
d. Decreased respirations requires a second test in 3 months.

36. A slightly obese female client with a history of allergy -induced 43. A female adult client has a tracheostomy but doesn’t require
asthma, hypertension, and mitral valve prolapse is admitted to an continuous mechanical ventilation. When weaning the client from
acute care facility for elective surgery. The nurse obtains a complete the tracheostomy tube, the nurse initially should plug the opening
history and performs a thorough physical examination, pa ying in the tube for:
special attention to the cardiovascular and respiratory systems. a. 15 to 60 seconds.
When percussing the client’s chest wall, the nurse expects to elicit: b. 5 to 20 minutes.
a. Resonant sounds. c. 30 to 40 minutes.
b. Hyperresonant sounds. d. 45 to 60 minutes.
c. Dull sounds.
d. Flat sounds. 44. Nurse Oliver observes constant bubbling in the water -seal chamber
of a closed chest drainage system. What should the nurse conclude?
37. A male client who weighs 175 lb (79.4 kg) is recei ving aminophylline a. The system is functioning normally
(Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline b. The client has a pneumothorax.
level is reported as 6 mcg/ml. The nurse calls the physician who c. The system has an air leak.
instructs the nurse to change the dosage to 0.45 mg/kg/hour. The d. The chest tube is obstructed.
nurse should:
a. Question the order because it’s too low. 45. A black client with asthma seeks emergency care for acute
b. Question the order because it’s too high. respiratory distress. Because of this client’s dark skin, the nurse
c. Set the pump at 45 ml/hour. should assess for cyanosis by inspecting the:
d. Stop the infusion and have the laboratory repeat the a. Lips.
theophylline measurement. b. Mucous membranes.
38. The nurse is teaching a male client with chronic bronchitis about c. Nail beds.
breathing exercises. Which of the following should the nurse include d. Earlobes.
in the teaching?
a. Make inhalation longer than exhalation. 46. For a male client with an endotracheal (ET) tube, which nursing
b. Exhale through an open mouth. action is most essential?
c. Use diaphragmatic breathing. a. Auscultating the lungs for bilateral breath sounds
d. Use chest breathing. b. Turning the client from side to side every 2 hours
c. Monitoring serial blood gas values every 4 hours
d. Providing frequent oral hygiene

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d. A change in the oxygen concentration without resetting

47. The nurse assesses a male client’s respiratory status. Which the oxygen level alarm
observation indicates that the client is experiencing difficulty
breathing? 54. A female client with chronic obstructive pulmonary disease (COPD)
a. Diaphragmatic breathing takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a
b. Use of accessory muscles routine clinic visit, the client asks the nurse how the drug works.
c. Pursed-lip breathing What is the mechanism of action of anhydrous theophylline in
d. Controlled breathing treating a nonre versible obstructive airway disease such as COPD?
a. It makes the central respiratory center more sensitive to
48. A female client is undergoing a complete physical examination as a carbon dioxide and stimulates the respiratory drive.
requirement for college. When checking the client’s respiratory b. It inhibits the enzyme phosphodiesterase, decreasing
status, the nurse observes respiratory excursion to help assess: degradation of cyclic adenosine monophosph ate, a
a. Lung vibrations. bronchodilator.
b. Vocal sounds. c. It stimulates adenosine receptors, causing
c. Breath sounds. bronchodilation.
d. Chest movements. d. It alters diaphragm movement, increasing chest expansion
and enhancing the lung’s capacity for gas exchange.
49. A male client comes to the emergency department complaining of
sudden onset of diarrhea, anorexia, malaise, cough, headache, and 55. A male client with pneumococcal pneumonia is admitted to an acute
recurrent chills. Based on the client’s history a nd physical findings, care facility. The client in the next room is being treated for
the physician suspects legionnaires’ disease. While awaiting mycoplasmal pneumonia. Despite the different causes of the various
diagnostic test results, the client is admitted to the facility and types of pneumonia, all of them share which feature?
started on antibiotic therapy. What is the drug of choice for treating a. Inflamed lung tissue
legionnaires’ disease? b. Sudden onset
a. Erythromyci n (Erythrocin) c. Responsiveness to penicillin.
b. Rifampin (Rifadin) d. Elevated white blood cell (WBC) count
c. Amantadine (Symmetrel)
d. Amphotericin B (Fungizone) 56. A client with Guillain-Barré syndrome develops respiratory acidosis
as a result of reduced alveolar ventilation. Which combination of
50. A male client with chronic obstructive pulmonary disease (COPD) is arterial blood gas (ABG) values confirms respiratory acidosis?
recovering from a myocardial infarction. Because the client is a. pH, 5.0; PaCO2 30 mm Hg
extremely weak and can’t produce an effec tive cough, the nurse b. pH, 7.40; PaCO2 35 mm Hg
should monitor closely for: c. pH, 7.35; PaCO2 40 mm Hg
a. Pleural effusion. d. pH, 7.25; PaCO2 50 mm Hg
b. Pulmonary edema.
c. Atelectasis. 57. A male client admitted to an acute care facility with pneumonia is
d. Oxygen toxicity. receiving supplemental oxygen, 2 L/minute via nasal cannula. The
client’s history includes chronic obstructive pulmonary disease
51. The nurse in charge is teaching a client with emphysema how to (COPD) and coronary artery disease. Because of these history
perform pursed-lip breathing. The client asks the nurse to explain findings, the nurse closely monitors the oxygen flow and the client’s
the purpose of this breathing technique. Which explanation should respiratory status. Which complication may aris e if the client
the nurse provide? receives a high oxygen concentration?
a. It helps prevent early airway collapse. a. Apnea
b. It increases inspiratory muscle strength. b. Anginal pain
c. It decreases use of accessory breathing muscles. c. Respiratory alkalosis
d. It prolongs the inspiratory phase of respiration. d. Metabolic acidosis

52. After receiving an oral dose of codeine for an intractable cough, the 58. At 11 p.m., a male client is admitted to the emergency department.
male client asks the nurse, “How long will it take for this drug to He has a respiratory rate of 44 breaths/minute. He’s anxious, and
work?” How should the nurse respond? wheezes are audible. The client is immediately given oxygen by face
a. In 30 minutes mask and methylprednisolone (Depo -medrol) I.V. At 11:30 p.m., the
b. In 1 hour client’s arterial blood oxygen saturation is 86% and he’s still
c. In 2.5 hours wheezing. The nurse should plan to administer:
d. In 4 hours a. Alprazolam (Xanax).
b. Propranolol (Inderal)
53. A male client suffers adult respiratory distress syndrome as a c. Morphine.
consequence of shock. The client’s condition deteriorates rapidly, d. Albuterol (Proventil).
and endotracheal (ET) intubation and mechanical ventilation are
initiated. When the high -pressure alarm on the mechanical ventilator 59. After undergoing a thoracotomy, a male client is receiving epidural
sounds, the nurse starts to check for the cause. Which condition analgesia. Which assessment finding indicates that the client has
triggers the high-pressure alarm? developed the most serious complication of epidural analgesia?
a. Kinking of the ventilator tubing a. Heightened alertness
b. A disconnected ventilator tube b. Increased heart rate
c. An ET cuff leak c. Numbness and tingling of the extremities
d. Respiratory depression

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60. The nurse in charge formulates a nursing diagnosis of Activity

intolerance related to inadequate oxygenation and dyspnea for a
client with chronic bronchitis. To minimize this problem, the nurse
instructs the client to avoid conditions that increase oxygen
demands. Such conditions include:
a. Drinking more than 1,500 ml of fluid daily.
b. Being overweight.
c. Eating a high-protein snack at bedtime.
d. Eating more than three large meals a day.

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 KABC – RESPI Q&A

1. Answer: B. Nervousness 9. Answer: D. Impaired gas exchange related to airflow obstruction

Albuterol may cause nervousness. The inhaled form of the drug may A patient airway and an adequate breathing pattern are the top
cause dryness and irritation of the nose and throat, not nasal priority for any patient, making “impaired gas exchange related to
congestion; insomnia, not lethargy; and h ypokalemia (with high airflow obstruction” the most important nursing diagnosis. The other
doses), not hyperkalemia. Other adverse effects of albuterol include options also may apply to this patient but less important.
tremor, dizziness, headache, tachycardia, palpitations,
hypertension, heartburn, nausea, vomiting and muscle cramps. 10. Answer: D. Contralateral side in hemothorax
The trachea will shift according to the pressure gradients within the
2. Answer: C. Clear thoracic cavity. In tension pneumothorax and hemothorax,
Normally, nasal drainage in ac ute rhinitis is clear. Yellow or green accumulation of air or fluid causes a shift away from the injured side.
drainage indicates spread of the infection to the sinuses. Gray If there is no significant air or fluid accumulation, the trachea will
drainage may indicate a secondary infection. not shift. Tracheal deviation toward the contralateral side in simple
pneumothorax is seen when the thoracic contents shift in response
3. Answer: D. Lightheadedness or paresthesia to the release of normal thoracic pressure gradients on the injured
The patient with respiratory alkalosis may complain of side.
lightheadedness or paresthesia (numbness and tingling in the arms
and legs). Nausea, vomiting, abdominal pain, and diarrhea may 11. Answer: C. Encourage coughing and deep breathing
accompany respiratory acidosis. Hallucinations and tinnitus rare are When caring for a patient who is recovering from a pneumonectomy,
associated with respiratory alkalosis or any other acid -base the nurse should encourage coughing and deep breathing to prevent
imbalance. pneumonia in the unaffected lung. Because the lung has been
removed, the water-seal chamber should display no fluctuations.
4. Answer: D. Elderly patients Reinflation is not the purpose of chest tube. Chest tube milking is
Ephedrine is not recommended for elderly patients, who are controversial and should be done only to remove blood clots that
particularly susceptible to CNS reactions (such as confusion and obstruct the flow of drainage.
anxiety) and to cardiovascular reactions (such as increased systolic
blood pressure, coldness in the extremities, and anginal pain). 12. Answer: B. Develop an alternative communication method
Ephedrine is used for its bronchodilator effects with acute and A patient with a laryngectomy cannot speak, yet sti ll needs to
chronic asthma and occasionally for its CNS stimulant actions for communicate. Therefore, the nurse should plan to develop an
narcolepsy. It can be administered to children age 2 and older. alternative communication method. After a laryngectomy, edema
interferes with the ability to swallow and necessitates tube (enteral)
5. Answer: A. Kinking of the ventilator tubing feedings. To prevent injury to the tracheal mucosa, the nurse should
Conditions that trigger the high -pressure alarm include kinking of deflate the tracheostomy cuff or use the minimal leak technique. To
the ventilator tubing, bronchospasm or pulmonary embolus, mucus decrease edema, the nurse should place the patient in semi -Fowler’s
plugging, water in the tube, coughing or biting on endotracheal tube, position.
and the patient’s being out of breathing rhythm with the ventilator.
A disconnected ventilator tube or an endotracheal cuff leak would 13. Answer: B. Applying a dressing over the wound and taping it on
trigger the low pressure alarm. Changing the oxygen concentration three sides
without resetting the oxygen level alarm would trigger the oxygen The nurse immediately should apply a dressing over the stab wound
alarm. and tape it on three sides to allow air to escape and to prevent
tension pneumothorax (which is more life -threatening than an open
6. Answer: D. Fighting the ventilator chest wound). Only after covering and taping the wound should the
Pancuronium, a nondepolarizing blocking agent, is used for muscle nurse draw blood for laboratory tests, assist with chest tube
relaxation and paralysis. It assists mechanical ventilation by insertion, and start an I.V. line.
promoting endotracheal intubation and paralyzing the patient so
that the mechanical ventilator can do its work. Fighting the 14. Answer: C. Using a high-flow venture mask to deliver oxygen as
ventilator is a sign that the patient needs another pancuronium dose. prescribed
The nurse should administer 0.01 to 0.02 mg/kg I.V. every 20 to 60 The patient with COPD retains carbon dioxide, which inhibits
minutes. Movement of the legs, or lips has no effect on the ventilator stimulation of breathing by the medullary center in the brain. As a
and therefore is not used to determine the need for another dose. result, low oxygen levels in the blood stimulate respiration, and
7. Answer: B. Absence of breaths sound in the right thorax administering unspecified, unmonitored amounts of oxygen may
In pneumothorax, the alveoli are deflated and no air exchange occurs depress ventilation. To promote adequate gas exchange, the nurse
in the lungs. Therefore, breath sounds in the affected lung field are should use a Venturi mask to deliver a specified, controlled amount
absent. None of the other options are associated with pneumothorax. of oxygen consistently and accurately. Drinking three glasses of fluid
Bilateral crackles may result from pulmonary congestion, inspiratory daily would not affect gas exchange or be sufficient to liquefy
wheezes may signal asthma, and a pleural friction rub may indicate secretions, which are common in COPD. Patients with COPD and
pleural inflammation. respiratory distress should be places in high -Fowler’s position and
should not receive sedatives or other drugs that may further depress
8. Answer: B. Arterial Blood the respiratory center.
A lowercase “a” in an ABG value represents arterial blood. For
instance, the abbreviation PaO2 refers to the partial pressure of 15. Answer: C. Increased pulmonary capillary permeability
oxygen in arterial blood. The pH value reflects the acid -base balance ARDS results from increased pulmonary capillary permeability , which
in arterial blood. Sa02 indicates arterial oxygen saturation. An leads to noncardiogenic pulmonary edema. In cardiogenic pulmonary
uppercase “A” represents alveolar conditions: for example, PA02 edema, pulmonary congestion occurs secondary to heart failure. In
indicates the partial pressure of oxygen in the alveoli. the initial stage of ARDS, respiratory alkalosis may arise secondary

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to hyperventilation; however, it does not cause ARDS. Renal failure Hyperresonance also may occur on the affected side. A sucking sound
does not cause ARDS, either . at the site of injury would be noted with an open chest injury.

16. Answer: C. Teaching the patient how to perform controlled 24. Answer: B. A hyperinflated chest noted on the chest x -ray
coughing Clinical manifestations of chronic obstructive pulmonary disease
Controlled coughing helps maintain a patent airway by helping to (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at
mobilize and remove secretions. A moderate fluid intake (usually 2 L rest, oxygen desaturation with exercise, and the use of accessory
or more daily) and moderate activity help liquefy and mobilize muscles of respiration. Chest x -rays reveal a hyperinflated chest and
secretions. Bed rest and sedatives may limit the patient’s ability to a flattened diaphragm if the disease is advanced.
maintain a patent airway, causing a high risk for infection from
pooled secretions. 25. Answer: B. Venturi mask
The Venturi mask delivers the most accurate oxygen concentration.
17. Answer: A. Do nothing, because this is an expected finding It is the best oxygen delivery system for the client with chronic
Continuous gentle bubbling should be noted in the suction control airflow limitation because it delivers a precise oxygen
chamber. Option b is incorrect. Chest tubes should only be clamped concentration. The face tent, aerosol mask, and tracheostomy collar
to check for an air leak or when changing drainage devices (according are also high-flow oxygen delivery systems but most often are used
to agency policy). Option c is incor rect. Bubbling should be to administer high humidity.
continuous and not intermittent. Option d is incorrect because
bubbling should be gentle. Increasing the suction pressure only 26. Answer: D. A cough with the expectoration of mucoid sputum
increases the rate of evaporation of water in the drainage system. One of the first pulmonary symptoms is a slight cough with the
expectoration of mucoid sputum. Options A, B, and C are late
18. Answer: B. Continue to monitor the c lient symptoms and signify cavitation and extensive lung involvement.
The presence of fluctuation of the fluid level in the water seal
chamber indicates a patent drainage system. With normal breathing, 27. Answer: B. Sputum culture
the water level rises with inspiration and falls with expiration. Tuberculosis is definitively diagnosed through cultu re and isolation
Fluctuation stops if the tube is obstructed, if a dependen t loop of Mycobacterium tuberculosis. A presumptive diagnosis is made
exists, if the suction is not working properly, or if the lung has based on a tuberculin skin test, a sputum smear that is positive for
reexpanded. Options A, C, and D are incorrect. acid-fast bacteria, a chest x-ray, and histological evidence of
granulomatous disease on biopsy.
19. Answer: B. Place the tube in bottle of sterile water
If the chest drainage system is disconnected, the end of the tube is 28. Answer: B. 2 L/min
placed in a bottle of sterile water held below the level of the chest. Oxygen is used cautiously and should not exceed 2 L/min. Because of
The system is replaced if it breaks or cracks or if the collection the long-standing hypercapnia that occurs in emphysema, the
chamber is full. Placing a sterile dressing over the disconnection site respiratory drive is triggered by low oxygen levels rather than
will not prevent complications resulting from the disconne ction. The increased carbon dioxide levels, as is the case in a normal respiratory
physician may need to be notified, but this is not the initial action. system.

20. Answer: D. Perform the Valsalva maneuver 29. Answer: D. Promote carbon dioxide elimination
When the chest tube is removed, the client is asked to perform the Pursed-lip breathing facilitates maximal expiration for clients with
Valsalva maneuver (take a deep breath, exhale, and bear down). Th e obstructive lung disease. This type of breathing allows better
tube is quickly withdrawn, and an airtight dressing is taped in place. expiration by increasing airway pressure that keep s air passages
An alternative instruction is to ask the client to take a deep breath open during exhalation. Options A, B, and C are not the purposes of
and hold the breath while the tube is removed. Options A, B, and C this type of breathing.
are incorrect client instructions.
30. Answer: B. Low arterial PaO2
21. Answer: B. Grasp the retention sutures to spread the opening The earliest clinical sign of acute respiratory distress syndrome is an
If the tube is dislodged accidentally, the initial nursing action is to increased respiratory rate. Breathing becomes l abored, and the
grasp the retention sutures and spread the opening. If agency policy client may exhibit air hunger, retractions, and cyanosis. Arterial
permits, the nurse then attempts immediately to replace the tube . blood gas analysis reveals increasing hypoxemia, with a PaO2 lower
Covering the tracheostomy site will block the airway. Options A and than 60 mm Hg.
C will delay treatment in this emergency situation.
31. Answer: B. Having the client take deep breaths
22. Answer: A. Stridor To obtain a sputum specimen, the client sho uld rinse the mouth to
The nurse reports stridor to the physician immediately. This is a reduce contamination, breathe deeply, and then cough into a sputum
high-pitched, coarse sound that is heard with th e stethoscope over specimen container. The client should be encouraged to cough and
the trachea. Stridor indicates airway edema and places the client at not spit so as to obtain sputum. Sputum can be thinned by fluids or
risk for airway obstruction. Options B, C, and D are not signs that by a respiratory treatment such as inhalation of nebulized saline or
require immediate notification of the physician. water. The optimal time to obtain a specimen is on arising in the
morning.
23. Answer: B. Diminished breath sounds
This client has sustained a blunt or a closed chest injury. Basic 32. Answer: C. Bronchospasm
symptoms of a closed pneumothorax are shortness of breath and If a biopsy was performed during a bronchoscopy, blood -streaked
chest pain. A larger pneumothorax may cause tachypnea, cyanosis, sputum is expected for several hours. Frank blood indica tes
diminished breath sounds, and subcutaneous emphysema. hemorrhage. A dry cough may be expected. The client should be
assessed for signs of complications, which would include cyanosis,

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 KABC – RESPI Q&A

dyspnea, stridor, bronchospasm, hemoptysis, hypotension, 41. Answer: C. Decreased hearing acuity
tachycardia, and dysrhythmias. Hematuria is unrelated to this Decreased hearing acuity indicates ototoxicity, a serious adverse
procedure. effect of streptomycin therapy. The client should notify the
physician immediately if it occurs so that streptomycin can be
33. Answer: C. 10 seconds discontinued and an alternative drug can be prescribed. The other
Hypoxemia can be caused by prolonged suctioning, which stimulates options aren’t associated with streptomycin. Imp aired color
the pacemaker cells in the heart. A vasovagal response may occur, discrimination indicates color blindness; increased urinary frequency
causing bradycardia. The nurse must preoxygenate the client before and increased appetite accompany diabetes mellitus.
suctioning and limit the suctioning pass to 10 seconds.
42. Answer: B. Skin test doesn’t differentiate between active and
34. Answer: C. Stop the procedure and reoxygenate the client dormant tuberculosis infection.
During suctioning, the nurse should monitor the client closely for The Mantoux test doesn’t differentiate between active and dormant
side effects, including hypoxemia, cardiac irregularities such as a infections. If a positive reaction occurs, a sputum smear and culture
decrease in heart rate resulting from vagal stimulation, mucosal as well as a chest X-ray are necessary to provide more information.
trauma, hypotension, and paroxysmal coughing. If side ef fects Although the area of redness is measured in 3 days, a second test
develop, especially cardiac irregularities, the procedure is stopped may be needed; neither test indicates that tuberculosis is active. In
and the client is reoxygenated. the Mantoux test, an induration 5 to 9 mm in diameter indicates a
borderline reaction; a larger induration indicates a positive reaction.
35. Answer: A. Dyspnea The presence of a wheal within 2 days doesn’t indicate acti ve
The common clinical manifestations of pulmonary embolism are tuberculosis.
tachypnea, tachycardia, dyspnea, and chest pain.
43. Answer: B. 5 to 20 minutes.
36. Answer: A. Resonan t sounds. Initially, the nurse should plug the opening in the tracheostomy tube
When percussing the chest wall, the nurse expects to elicit resonant for 5 to 20 minutes, then gradually lengthen this interval according
sounds — low-pitched, hollow sounds heard over normal lung tissue. to the client’s respiratory status. A client who doesn’t require
Hyperresonant sounds indicate increased air in the lungs or pleural continuous mechanical ventilation already is breathi ng without
space; they’re louder and lower pitched th an resonant sounds. assistance, at least for short periods; therefore, plugging the
Although hyperresonant sounds occur in such disorders as opening of the tube for only 15 to 60 seconds wouldn’t be long
emphysema and pneumothorax, they may be normal in children and enough to reveal the client’s true tolerance to the procedure.
very thin adults. Dull sounds, normally heard only over the liver and Plugging the opening for more than 20 minutes would inc rease the
heart, may occur over dense lung tissue, such as from consolidation risk of acute respiratory distress because the client requires an
or a tumor. Dull sounds are thudlike and of medium pitch. Flat adjustment period to start breathing normally.
sounds, soft and high-pitched, are heard over airless tissue and can
be replicated by percussing the thigh or a bony structure. 44. Answer: C. The system has an air leak.
Constant bubbling in the chamber indicates an air leak and requires
37. Answer: A. Question the order because it’s too low. immediate intervention. The client with a pneumothorax will have
A therapeutic theophylline level is 10 to 20 mcg/ml. The client is intermittent bubbling in the water -seal chamber. Clients without a
currently receiving 0.5 mg/kg/hour of aminophylline. Because the pneumothorax should have no evidence of bubbling in the chamber.
client’s theophylline level is sub -therapeutic, reducing the dose If the tube is obstructed, the nurse should notice that the fluid has
(which is what the physician’s order would do) w ould be stopped fluctu ating in the water-seal chamber.
inappropriate. Therefore, the nurse should question the order.
45. Answer: B. Mucous membranes.
38. Answer: C. Use diaphragmatic breathing. Skin color doesn’t affect the mucous membranes. The lips, nail beds,
In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic and earlobes are less reliable indicators of cyanosis because they’re
breathing helps to strengthen the diaphragm and maximizes affected by skin color.
ventilation. Exhal ation should be longer than inhalation to prevent
collapse of the bronchioles. The client with chronic bronchitis should 46. Answer: A. Auscultating the l ungs for bilateral breath sounds
exhale through pursed lips to prolong exhalation, keep the For a client with an ET tube, the most important nursing action is
bronchioles from collapsing, and prevent air trapping. auscultating the lungs regularly for bilateral breath sounds to ensure
Diaphragmatic breathi ng — not chest breathing — increases lung proper tube placement and effective oxygen delivery. Although the
expansion. other options are appropriate for this client, they’re secondary to
ensuring adequate oxygenation.
39. Answer: C. Tidal volume
Tidal volume refers to the volume of air inspired and expired with a 47. Answer: B. Use of accessory muscles
normal breath. Total lung capacity is the maximal amount of air the The use of accessory muscles for respiration indicates the client is
lungs and respiratory passages can hold a fter a forced inspiration. having difficulty breathing. Diaphragmatic and pursed -lip breathing
Forced vital capacity is the vital capacity performed with a are two controlled breathing techniques that help the client
maximally forced expiration. Residual volume is the maximal amount conserve energy.
of air left in the lung after a maximal expiration.
48. Answer: D. Chest movements.
40. Answer: B. Non-rebreather mask The nurse observes respiratory excursion to help assess chest
A non-rebreather mask can deliver levels of the fraction of inspired movements. Normally, thoracic expansion is symmetrical; unequal
oxygen (FIO2) as high as 100%. Other modes — simple mask, face expansion may indicate pleural effusion, atelectasis, pulmonary
tent, and nasal cannula — deliver lower levels of FIO2. embolus, or a rib or sternum fracture. The nurse assesses vocal
sounds to evaluate air flow when checking for tactile fremitus; after

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 KABC – RESPI Q&A

asking the client to say “99,” the nurse palpates the vibrations most types of pneumonia have a sudden onset, a few (such as
transmitted from the bronchopulmonary system along the solid anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an
surfaces of the chest wall to the nurse’s palms. The nurse assesses insidious onset. Antibiotic therapy is the primary treatment for most
breath sounds during auscultation. types of pneumonia; however, the antibiotic must be specifi c for the
causative agent, which may not be responsive to penicillin. A few
49. Answer: A. Erythromycin (Erythrocin) types of pneumonia, such as viral pneumonia, aren’t treated with
Erythromycin is the drug of choice for treating legionnaires’ disease. antibiotics. Although pneumonia usually causes an elevated WBC
Rifampin may be added to the regimen if erythromycin alone is count, some types, such as mycoplasmal pneumonia, do n’t.
ineffective; however, it isn’t administered first. Amantadine, an
antiviral agent, and amphotericin B, an antifungal agent, are 56. Answer: D. pH, 7.25; PaCO2 50 mm Hg
ineffective against legionnaires’ disease, which is caused by In respiratory acidosis, ABG analysis reveals an arterial pH below
bacterial infection. 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45
mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2
50. Answer: C. Atelectasis. value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0
In a client with COPD, an ineffective cough impedes secretion with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis.
removal. This, in turn, causes mucus plugging, which leads to Options B and C represent normal ABG values, reflecting normal gas
localized airway obstruction — a known cause of atelectasis. An exchange in the lungs.
ineffective cough doesn’t cause pleural effusion (fluid accumulation
in the pleural space). Pulmonary edema usually results from left - 57. Answer: A. Apnea
sided heart failure, not an ineffective cough. Although many Hypoxia is the main breathing stimulus for a client with COPD.
noncardiac conditions may cause pulmonary edema, an ineffective Excessive oxygen administration may lead to apnea by removing that
cough isn’t one of them. Oxygen toxicity results from prolonged stimulus. Anginal pain results from a reduced myocardial oxygen
administration of high oxygen concentrations, not an ineffective supply. A client with COPD may have anginal pain from generalized
cough. vasoconstriction secondary to hypoxia; however, administering
oxygen at any concentration dilates blood vessels, easing anginal
51. Answer: A. It helps prevent early airway collapse. pain. Respiratory alkalosis results from alveolar hyperventilation,
Pursed-lip breathing helps prevent early airway collapse. Learning not excessive oxygen administration. In a client with COPD, high
this technique helps the client control respiration during periods of oxygen concentrations decrease the ventilatory drive, leading to
excitement, anxiety, exercise, and respiratory distress. To increase respiratory acidosis, not alkalosis. High oxygen concentrations don’t
inspiratory muscle strength and endurance, the client may need to cause metabolic acidosis.
learn inspiratory resistive breathing. To decrease accessory muscle
use and thus reduce the work of breathing, the client may need to 58. Answer: D. Albuterol (Proventil).
learn diaphragmatic (abdominal) breathing. In pursed -lip breathing, The client is hypoxemic because of bronchoconstriction as evidenced
the client mimics a normal inspiratory -expiratory (I:E) ratio of 1:2. by wheezes and a subnormal arterial oxygen saturation level. The
(A client with emphysema may have an I:E ratio as high as 1 :4.) client’s greatest need is bronchodilation, which can be accomplished
by administering bronchodilators. Albuterol is a beta2 adrenergic
52. Answer: A. In 30 minutes agonist, which causes dilation of the bronchioles. It’s giv en by
Codeine’s onset of action is 30 minutes. Its peak concentration nebulization or metered-dose inhalation and may be given as often
occurs in about 1 hour; its half -life, in 2.5 hours; and its duration of as every 30 to 60 minutes until relief is accomplished. Alprazolam is
action is 4 to 6 hours. an anxiolytic and central nervous system depressant, which could
suppress the client’s breathing. Propranolol is c ontraindicated in a
53. Answer: A. Kinking of the ventilator tubing client who’s wheezing because it’s a beta2 adrenergic antagonist.
Conditions that trigger the high-pressure alarm include kinking of Morphine is a respiratory center depressant and is contraindicated
the ventilator tubing, bronchospasm or pulmonary embolus, mucus in this situation.
plugging, water in the tube, coughing or biting on the ET tube, and 59. Answer: D. Respiratory depression
the client’s being out of breathing rhythm with the ventilator. A Respiratory depression is the most serious complic ation of epidural
disconnected ventilator tube or an ET cuff leak would trigger the analgesia. Other potential complications include hypotension,
low-pressure alarm. Changing the oxygen concentration without decreased sensation and movement of the extremities, allergic
resetting the oxygen level alarm would trigger the oxygen alarm. reactions, and urine retention. Typically, epidural analgesia causes
central nervous system depression (indicated by drowsiness) as well
54. Answer: A. It makes the central respiratory center more sensitive as a decreased heart rate and blood pressure.
to carbon dioxide and stimulates the respiratory drive.
Anhydrous theophylline and other methylxanthine agents make the 60. Answer: B. Being overweight.
central respiratory center more sensitive to CO2 and stimulate the Conditions that increase oxygen demands include obesity, smoking,
respiratory drive. Inhibition of phosphodiesterase is the drug’s exposure to temperature extremes, and stress. A client with chronic
mechanism of action in treating asthma and other reversible bronchitis should drink at least 2,000 ml of fluid daily to thin mucus
obstructive airway diseases — not COPD. Methylxanthine agents secretions; restricting fluid intake may be harmful. The nurse should
inhibit rather than stimulate adenosine receptors. Although these encourage the client to eat a high -protein snack at bedtime because
agents reduce diaphragmatic fatigue in clients with chronic protein digestion produces an amino acid with s edating effects that
bronchitis or emphysema, they don’t alter diaphragm movement to may ease the insomnia associated with chronic bronchitis. Eating
increase chest expansion and enhance gas exchange. more than three large meals a day may cause fullness, making
breathing uncomfortable and difficult; however, it doesn’t increase
55. Answer: A. Inflamed lung tissue oxygen demands. To help maintain adequate nutritional intake, the
The common feature of all types of pneumonia is an inflammatory client with chronic bronchitis should eat small, frequent meals (up
pulmonary response to the offending organism or agent. Althoug h to six a day).

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 KABC – RESPI Q&A

1. An elderly client with pneumonia may appear with which of the c. Chronic obstructive bronchitis
following symptoms first? d. Emphysema
a. Altered mental status and dehydration
b. fever and chills 10. The term “pink puffer” refers to the client with which of the
c. Hemoptysis and dyspnea following conditions?
d. Pleuritic chest pain and cough a. ARDS
b. Asthma
2. Which of the following pathophysiological mechanisms that occur in c. Chronic obstructive bronchitis
the lung parenchyma allows pneumonia to develop? d. Emphysema
a. Atelectasis
b. Bronchiectasis 11. A 66-year-old client has marked dyspnea at rest, is thin, and uses
c. Effusion accessory muscles to breathe. He’s tachypneic, with a prolonged
d. Inflammation expiratory phase. He has no cough. He leans forward with his arms
braced on his knees to support his chest and shoulders for breathing.
3. A 7-year-old client is brought to the E.R. He’s tachypneic and This client has symptoms of which of the following respiratory
afebrile and has a respiratory rate of 36 breaths/minute and a disorders?
nonproductive cough. He recently had a cold. From his history, the a. ARDS
client may have which of the following? b. Asthma
a. Acute asthma c. Chronic obstructive bronchitis
b. Bronchial pneumonia d. Emphysema
c. Chronic obstructive pulmonar y disease (COPD)
d. Emphysema 12. It’s highly recommended that clients with asthma, chronic
bronchitis, and emphysema have Pneumovax and flu vaccinations for
4. Which of the following assessment findings would help confirm a which of the following reasons?
diagnosis of asthma in a client suspected of having the disorder? a. All clients are recommended to have these vacc ines
a. Circumoral cyanosis b. These vaccines produce bronchodilation and improve
b. Increased forced expiratory volume oxygenation.
c. Inspiratory and expiratory wheezing c. These vaccines help reduce the tachypnea these clients
d. Normal breath sounds experience.
d. Respiratory infections can cause severe hypoxia and
5. Which of the following types of asthma involves an acute asthma possibly death in these clients.
attack brought on by an upper respiratory infection?
a. Emotional 13. Exercise has which of the following effects on clients with asthma,
b. Extrinsic chronic bronchitis, and emphysema?
c. Intrinsic a. It enhances cardiovascular fitness.
d. Mediated b. It improves respiratory muscle strength.
c. It reduces the number of acute attacks.
6. A client with acute asthma showing inspiratory and expiratory d. It worsens respiratory function and is discouraged.
wheezes and a decreased expiratory volume should be treated with
which of the following classes of medication right away? 14. Clients with chronic obstructive bronchitis are given diuretic
a. Beta-adrenergic blockers therapy. Which of the following reasons best explains why?
b. Bronchodilators a. Reducing fluid volume reduces oxygen demand.
c. Inhaled steroids b. Reducing fluid volume improves clients’ mobility.
d. Oral steroids c. Restricting fluid volume reduces sputum product ion.
d. Reducing fluid volume improves respiratory function.
7. A 19-year-old comes into the emergency department with acute
asthma. His re spiratory rate is 44 breaths/minute, and he appears to 15. A 69-year-old client appears thin and cachectic. He’s short of breath
be in acute respiratory distress. Which of the following actions at rest and his dyspnea increases with the slightest exertion. His
should be taken first? breath sounds are diminished even with deep inspiration. The se signs
a. Take a full medication history and symptoms fit which of the following conditions?
b. Give a bronchodilator by nebulizer a. ARDS
c. Apply a cardiac monitor to the client b. Asthma
d. Provide emotional support to the client. c. Chronic obstructive bronchitis
8. A 58-year-old client with a 40-year history of smoking one to two d. Emphysema
packs of cigarettes a day has a chronic cough producing thick
sputum, peripheral edema, and cyanotic nail beds. Based on this 16. A client with emphysema should receive only 1 to 3 L/minute of
information, he most likely has which of the following conditions? oxygen, if needed, or he may lose his hypoxic drive. Which of the
a. Adult respiratory distress syndrome (ARDS) following statements is correct about hypoxic drive?
b. Asthma a. The client doesn’t notice he needs to breathe.
c. Chronic obstructive bronchitis b. The client breathes only when his oxygen levels climb
d. Emphysema above a certain point.
c. The client breathes only when his oxygen levels dip below
9. The term “blue bloater” refers to which of the following conditions? a certain point.
a. Adult respiratory distress syndrome (ARDS) d. The client breathes only when his carbon dioxide level
b. Asthma dips below a certain point.

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 KABC – RESPI Q&A

25. A client has started a new drug for hypertension. Thirty minutes
17. Teaching for a client with chronic obstructive pulmonary disease after he takes the drug, he develops chest tightness and becomes
(COPD) should include which of the following topics? short of breath and tachypneic. He has a decreased level of
a. How to have his wife learn to listen to his lungs with a consciousness. These signs indicate which of the following
stethoscope from Wal-Mart. conditions?
b. How to increase his oxygen therapy. a. Asthma attack
c. How to treat respiratory infections without going to the b. Pulmonary embolism
physician. c. respiratory failure
d. How to recognize the signs of an impending respiratory d. Rheumatoid arthritis
infection.
26. Emergency treatment for a client with impending anaphylaxis
18. Which of the following respiratory disorders is most common in the secondary to hypersensitivity to a drug should include which of the
first 24 to 48 hours after surgery? following actions first?
a. Atelectasis a. Administering oxygen
b. Bronchitis b. Inserting an I.V. catheter
c. Pneumonia c. Obtaini ng a complete blood count (CBC)
d. Pneumothorax d. Taking vital signs

19. Which of the following measures can reduce or prevent the incidence 27. Following the initial care of a client with asthma and impending
of atelectasis in a post-operative client? anaphylaxis from hypersensitivity to a drug, the nurse should take
a. Chest physiotherapy which of the following steps next?
b. Mechanical ventilation a. Administer beta-adrenergic blockers
c. Reducing oxygen requirements b. Administer bronchodilators
d. Use of an incentive spirometer c. Obtain serum electrolyte levels
d. Have the client lie flat in the bed.
20. Emergency treatment of a client in status asthmaticus includes which
of the following medications? 28. A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg;
a. Inhaled beta-adrenergic agents PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result
b. Inhaled corticosteroids represents which of the following conditions?
c. I.V. beta-adrenergic agents a. Metabolic acidosis
d. Oral corticosteroids b. Metabolic alkalosis
c. Respiratory acidosis
21. Which of the following treatment goals is best for the client with d. Respiratory alkalosis
status asthmaticus?
a. Avoiding intubation 29. A nurse plans care for a client with chronic obstructive pulmonary
b. Determining the cause of the attack disease, knowing that the client is most likely to experience what
c. Improving exercise tolerance type of acid-base imbalance?
d. Reducing secretions a. Respiratory acidosis
b. Respiratory alkalosis
22. Dani was given Dilaudid for pain. She’s sleeping and her respiratory c. Metabolic acidosis
rate is 4 breaths/minute. If action isn’t taken quickly, she might have d. Metabolic alkalosis
which of the following reactions?
a. Asthma attack 30. A nurse is caring for a client who is on a mechanical ventilator. Blood
b. Respiratory arrest gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse
c. Improve cardiac output has determined that the client is experiencing respiratory alkalosis.
d. Constipation Which laboratory value would most likely be noted in this condition?
a. Sodium level of 145 mEq/L
23. Which of the following additional assessment data should b. Potassium level of 3.0 mEq/L
immediately be gathered to determine the status of a client with a c. Magnesium level of 2.0 mg/L
respiratory rate of 4 breaths/minute? d. Phosphorus level of 4.0 mg/dl
a. Arterial blood gas (ABG) and breath sounds
b. Level of consciousness and a pulse oximetry value. 31. A nurse reviews the arterial blood gas results of a patient and notes
c. Breath sounds and reflexes the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate
d. Pulse oximetry value and heart sounds concentration of 22 mEq/L. The nurse analyzes these results as
indicating:
24. A client is in danger of respiratory arrest following the a. Metabolic acidosis, compensated.
administration of a narcotic analgesic. An arterial blood gas value is b. Metabolic alkalosis, uncompensated.
obtained. The nurse would expect to PaCO2 to be which of the c. Respiratory alkalosis , compensated.
following values? d. Respiratory acidosis, compensated.
a. 15 mm Hg
b. 30 mm Hg 32. A client is scheduled for blood to be drawn from the radial artery for
c. 40 mm Hg an ABG determination. Before the blood is drawn, an Allen’s test is
d. 80 mm Hg performed to determine the adequacy of the:
a. Popliteal circulation
b. Ulnar circulation

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 KABC – RESPI Q&A

c. Femoral circulation 40. A nurse is caring for a client after a bronchoscopy and biopsy. Which
d. Carotid circulation of the following signs if noted in the client should be reported
immediately to the physician?
33. A nurse is caring for a client with a nasogastric tube that is attached a. Blood-streaked sputum
to low suction. The nurse monitors the client, knowing that the client b. Dry cough
is at risk for which acid-base disorder? c. Hematuria
a. Respiratory acidosis d. Bronchospasm
b. Respiratory alkalosis
c. Metabolic acidosis 41. A nurse is suctioning fluids from a client via a tracheostomy tube.
d. Metabolic alkalosis When suctioning, the nurse must limit the suctioning to a maximum
of:
34. A nurse is caring for a client with an ileostomy understands that the a. 5 seconds
client is most at risk for developing which acid -base disorder? b. 10 seconds
a. Respiratory acidosis c. 30 seconds
b. Respiratory alkalosis d. 1 minute
c. Metabolic acidosis
d. Metabolic alkalosis 42. A nurse is suctioning fluids from a client through an endotracheal
tube. During the suctioning procedure, the nurse notes on the
35. A nurse is caring for a client with diabetic ketoacidosis and monitor that the heart rate decreases. Which of the following is the
documents that the client is experiencing Kussmaul’s respirations. most appropriate nursing intervention?
Based on this documentation, which of the following did the nurse a. Continue to suction
observe? b. Ensure that the suction is l imited to 15 seconds
a. Respirations that are abnormally deep, regular, and c. Stop the procedure and reoxygenated the client
increased in rate. d. Notify the physician immediately.
b. Respirations that are regular but abnormally slow.
c. Respirations that are labored and increased in depth and 43. An unconscious client is admitted to an emergency room. Arterial
rate blood gas measurements reveal a pH of 7.30, a low bicarbonate level,
d. Respirations that cease for several seconds. a normal carbon dioxide level, and a normal oxygen level. An
elevated potassium level is also present. These results indicate the
36. A nurse understands that the excessive use of oral antacids presence of:
containing bicarbonate can result in which acid -base disturbance? a. Metabolic acidosis
a. Respiratory alkalosis b. Respiratory acidosis
b. Respiratory acidosis c. Combined respiratory and metabolic acidosis
c. Metabolic acidosis d. over compensated respiratory acidosis
d. Metabolic alkalosis
44. A nurse is caring for a client hospitalized with acute exacerbation of
37. A nurse is caring for a client with renal failure. Blood gas results COPD. Which of the following would the nurse expect to note on
indicate a pH of 7.30; a PCO2 of 32 mm Hg, and a bicarbonate assessment of this client?
concentration of 20 mEq/L. The nurse has determined that the client a. Increased oxygen saturation with exercise
is experiencing metabolic acidosis. Which of the following laboratory b. Hypocapnia
values would the nurse expect to note? c. A hyperinflated chest on x -ray film
a. Sodium level of 145 mEq/L d. A widened diaphragm noted on chest x-ray film
b. Magnesium level of 2.0 mg/dL
c. Potassium level of 5.2 mEq/L 45. An oxygenated delivery system is prescribed for a client with COPD
d. Phosphorus level of 4.0 mg/dL to deliver a precise oxygen concentration. Which of the following
types of oxygen delivery systems would the nurse anticipate to be
38. A nurse is preparing to obtain an arterial blood gas specimen from a prescribed?
client and plans to perform the Allen’s test on the client. Number in a. Venturi mask
order of priority the steps for performing t he Allen’s test (#1 is first b. Aerosol mask
step). c. Face tent
a. Ask the client to open and close the hand repeatedly. d. Tracheostomy collar
b. Apply pressure over the ulnar and radial arteries.
c. Assess the color of the extremity distal to the pressure 46. Theophylline (Theo-Dur) tablets are prescribed for a client with
point chronic airflow limitation, and the nurse instructs the client about
d. Release pressure from the ulnar artery the medication. Which statement by the client indicates a need for
e. Explain the procedure to the client. further teaching?
a. “I will take the medication on an empty stomach.”
39. A nurse is preparing to obtain a sputum specimen from a client. b. “I will take the medication with food.”
Which of the following nursing actions will facilitate obtaining the c. “I will continue to take the medication even if I am feeling
specimen? better.”
a. Limiting fluids d. “Periodic blood levels will need to be obtained.”
b. Having the client take 3 deep breaths.
c. Asking the client to spit into the collection container. 47. A nurse is caring for a client with e mphysema. The client is receiving
d. Asking the client to obtain the specimen after eating. oxygen. The nurse assesses the oxygen flow rate to ensure that it
does not exceed

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 KABC – RESPI Q&A

a. 1 L/min
b. 2 L/min
c. 6 L/min
d. 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?
a. pH of 7.48
b. PCO2 of 32 mm Hg
c. pH of 7.30
d. 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 o f breathing.
The nurse responds, knowing that the primary purpose of pursed lip
breathing is:
a. Promote oxygen intake
b. Strengthen the diaphragm
c. Strengthen the intercostal muscles
d. Promote carbon dioxide elimination

50. A nurse reviews the ABG values and notes a p H of 7.50, a PCO2 of 30
mm Hg, and an HCO3 of 25 mEq/L. The nurse interprets these values
as indicating:
a. Respiratory acidosis uncompensated
b. Respiratory alkalosis uncompensated
c. Metabolic acidosis uncompensated
d. Metabolic acidosis partiall y compensated.

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 KABC – RESPI Q&A

1. Answer: A. Altered mental status and dehydration characteristics of chronic disease, and clients with emphysema
Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain appear pink and cachectic (a state of ill health, malnutrition, and
are the common symptoms of pneumonia, but elderly clients may wasting).
first appear with only an altered mental status and dehydration due
to a blunted immune response. 10. Answer: D. Emphysema
Because of the large amount of energy it takes to breathe, clients
2. Answer: D. Inflammation with emphysema are usually cachectic. They’re pink and usually
The most common feature of all types of pneumonia is an breathe through pursed lips, hence the term “puffer”. Clients with
inflammatory pulmonary response to the offending organism or ARDS are usually acutely short of breath. Clients with asthma don’t
agent. Atelectasis and bronchiectasis indicate a collapse of a porti on have any particular characteristics, and clients with chronic
of the airway that doesn’t occur with pneumonia. An effusion is an obstructive bronchitis are bloated and cyanotic in appearance.
accumulation of excess pleural fluid in the pleural space, which may
be a secondary response to pneumonia. 11. Answer: D. Emphysema
These are classic signs and symptoms of a client with emphysema.
3. Answer: A. Acute asthma Clients with ARDS are acutely short of breath and require emergency
Based on the client’s history and symptoms, acute asth ma is the most care; those with asthma are also acutely short of breath during an
likely diagnosis. He’s unlikely to have bronchial pneumonia without attack and appear very frightened. Clients with chronic obstructive
a productive cough and fever and he’s too young to have developed bronchitis are bloated and cyanotic in appearance.
COPD or emphysema.
12. Answer: D. Respiratory infections can cause severe hypoxia and
4. Answer: C. Inspiratory and expiratory wheezing possibly death in these clients.
Inspiratory and expiratory wheezes are t ypical findings in asthma. It’s highly recommended that clients with respiratory disorders be
Circumoral cyanosis may be present in extreme cases of respiratory given vaccines to protect against respiratory infection. Infections
distress. The nurse would expect the client to have a decreased can cause these clients to need intubation and mechanical
forced expiratory volume because asthma is an obstructive ventilation, and it may be difficult to wean these clients from the
pulmonary disease. Breath sounds will be “tight” sounding or ventilator. The vaccines have no effect on bronchodilation or
markedly decreased; they won’t be normal. respiratory care.

5. Answer: C. Intrinsic 13. Answer: A. It enhances cardiovascular fitness.

Intrinsic asthma doesn’t have an easily identifiable allergen and can
be triggered by the common cold. Asthma caused be emotional
reasons is considered to be in the extrinsic category. Extrinsic
asthma is caused by dust, molds, and pets; easily identifiable
allergens. Mediated asthma doesn’t exist.
6. Answer: B. Bronchodilators
Bronchodilators are the first line of treatment for asthma because
bronchoconstriction is the cause of reduced airflow. Beta-adrenergic
blockers aren’t used to treat asthma
bronchoconstriction. Inhaled or oral steroids may be given to reduce
the inflammation but aren’t used for emergency relief.
7. Answer: B. Give a bronchodilator by nebulizer
The client is having an acute asthma attack and needs to increase
oxygen delivery to the lung and body. Nebulized bronchodilators
open airways and increase the amount of oxygen delivered. First,
resolve the acute phase of the attack ad how to prev ent attacks in
the future. It may not be necessary to place the client on a cardiac
monitor because he’s only 19-years-old, unless he has a past medical
history of cardiac problems
. requires mechanical ventilation. In asthma and bronchitis, wheezing
8. Answer: C. Chronic obstructive bronchitis
Because of his extensive smoki ng history and symptoms, the client
most likely has chronic obstructive bronchitis. Clients with ARDS
have acute symptoms of and typically need large amounts of oxygen.
Clients with asthma and emphysema tend not to have a chronic cough
or peripheral edema.
9. Answer: C. Chronic obstructive bronchitis
Clients with chronic obstructive bronchitis appear bloated; they have
large barrel chests and peripheral edema, cyanotic nail beds and, at
times, circumoral cyanosis. Clients with ARDS are acutely short of
breath and frequently need intubation for mechanical ventilation and
large amounts of oxygen. Clients with asthma
Exercise can improve cardiovascular fitness and help the client
tolerate periods of hypoxia better, perhaps reducing the risk of heart
attack. Most exercise has little effect on respiratory muscle
strength, and these clients can’t tolerate the type of exercise
necessary to do this. Exercise won’t reduce the number of acute
attacks. In some instances, exercise may be contraindicated, and the
client should check with his physician before starting any exercise
program.
and can cause
14. Answer: A. Reducing fluid volume reduces oxygen demand.
Reducing fluid volume reduces the workload of the heart, which
reduces oxygen demand and, in turn, reduces the respiratory rate. It
may also reduce edema and improve mobility a little, but exercise
tolerance will still be harder to clear airways. Reducing fluid volume
won’t improve respiratory function, but may improve oxygenation.
15. Answer: D. Emphysema
In emphysema, the wall integrity of the individual air sacs is
damaged, reducing the surface area available for gas exchange. Very
little air movement occurs in the lungs be cause of bronchial collapse,
as well. In ARDS, the client’s condition is more acute and typically
is prevalent.
16. Answer: C. The client breathes only when his oxygen levels dip
below a certain point.
Clients with emphysema breathe when their oxygen levels drop to a
certain level; this is known as the hypoxic drive. They don’t take a
breath when their levels of carbon dioxide are higher than normal,
as do those with healthy respiratory physio logy. If too much oxygen
is given, the client has little stimulus to take another breath. In the
meantime, his carbon dioxide levels continue to climb, and the client
will pass out, leading to a respiratory arrest.
don’t exhibit

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17. Answer: D. How to recognize the signs of an impending respiratory
infection.
Respiratory infection in clients with a respiratory disorder can be
fatal. It’s important that the client understands how to recognize the
signs and symptoms of an impending respiratory infection. It isn’t
appropriate for the wife to listen to his lung sounds, besides, you
can’t purchase stethoscopes from Wal -Mart. If the client has signs
and symptoms of an infection, he should contact his physician at
once.
18. Answer: A. Atelectasis
Atelectasis develops when there’s inter ference with the normal
negative pressure that promotes lung expansion. Clients in the
postoperative phase often splint their breathing because of pain and
positioning, which causes hypoxia. It’s uncommon for any of the
other respiratory disorders to devel op.
19. Answer: D. Use of an incentive spirometer
Using an incentive spirometer requires the client to take deep
breaths and promotes lung expansion. Chest physiotherapy helps
mobilize secretions but won’t prevent atelectasis. Reducing oxygen
requirements or placing someone on mechanical ventilation doesn’t
affect the development of atelectasis.
20. Answer: A. Inhaled beta-adrenergic agents
Inhaled beta-adrenergic agents help promote bronchodilation, which
improves oxygenation. I.V. beta-adrenergic agents can be used but
have to be monitored because of their greater systemic effects.
They’re typically used when the inhaled beta -adrenergic agents
don’t work. Corticosteroids are slow -acting, so their use won’t
reduce hypoxia in the acute phase.
21. Answer: A. Avoiding intubation
Inhaled beta-adrenergic agents, I.V. corticosteroids,
supplemental oxygen are used to reduce bronchospasm, improve
oxygenation, and avoid intubation. Determining the trigger for the
client’s attack and improving exercise tolerance are later goals.
Typically, secretions aren’t a problem in status asthmaticus.
22. Answer: B. Respiratory arrest
Narcotics can cause respiratory arrest if given in large quantities.
23. Answer: B. Level of consciousness and a pulse oximetry value.
First, the nurse should attempt to rouse the client because this
should increase the client’s respiratory rate. If available, a spot
pulse oximetry check should be done and breath sounds should be
checked. The physician should be notified immediately if of the
findings. He’ll probably order ABG analysis to determine specific
carbon dioxide and oxygen levels, which will
effectiveness of ventilation. Reflexes and heart sounds will be part
of the more extensive examination done after these initial actions
are completed.
24. Answer: D. 80 mm Hg
A client about to go into respiratory arrest will have inefficient
ventilation and will be retaining carbon dioxide. The value expected
would be around 80 mm Hg. All other values are lower than expected.
25. Answer: C. Respiratory Failure
The client was reacting to the drug with respiratory signs of
impending anaphylaxis, which could lead to eventual respiratory
failure. Although the signs are also related to an asthma attack or a
pulmonary embolism, consider the new drug first.
arthritis doesn’t manifest these signs.
KABC – RESPI Q&A
26. Answer: A. Administering oxygen
Giving oxygen would be the best first action in this case. Vital signs
then should be checked and the physician immediately notified. If
the client doesn’t already have an I.V . catheter, one may be inserted
now if anaphylactic shock is developing. Obtaining a CBC wouldn’t
help the emergency situation.
27. Answer: B. Administer bronchodilators
Bronchodilators would help open the client’s airway and improve his
oxygenation status. Beta-adrenergic blockers aren’t indicated in the
management of asthma because they may cause bronchospasm.
Obtaining laboratory values wouldn’t be done on an emergency basis,
and having the client lie flat in bed could worsen his ability to
breathe.
28. Answer: C. Respiratory acidosis
You all should know this. Practice some problems if you got this
wrong.
29. Answer: A. Respiratory acidosis
Respiratory acidosis is most often due to hypoventilation. Chronic
respiratory acidosis is most commonly caused by COPD. I n end-stage
disease, pathological changes lead to airway collapse, air trapping,
and disturbance of ventilation-perfusion relationships.
30. Answer: B. Potassium level of 3.0 mEq/L
Clinical manifestations of respiratory alkalosis include headache,
tachypnea, paresthesias, tetany, vertigo, convulsions, hypokalemia,
and hypocalcemia. Options 1, 3, and 4 identify normal laboratory
values. Option 2 identifies the presence of hypokalemia.
and
31. Answer: C. Respiratory alkalosis, compensated.
The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite
(see-saw) will be seen between the pH and the PCO2. In this
situation, the pH is at the high end of the normal value and the PCO2
is low. In an alkalotic condition, the pH is up. Therefore, the values
identified in the question indicate a respiratory alkalosis.
Compensation occurs when the pH returns to a normal value. Because
the pH is in the normal range at the high end, compensation has
occurred.
32. Answer: B. Ulnar circulation
Before radial puncture for obtaining an ABG, you should perform an
Allen’s test to determine adequate ulnar circulation. Failure to
determine the presence of adequate collateral circulation could
indicate the result in severe ischemic injury o the hand if damage to the radial
artery occurs with arteri al puncture.
33. Answer: D. Metabolic alkalosis
Loss of gastric fluid via nasogastric suction or vomiting causes
metabolic alkalosis as a result of the loss of hydrochloric acid.
34. Answer: C. Metabolic acidosis
Intestinal secretions are high in bicarbonate and may be lost through
enteric drainage tubes or an ileostomy or with diarrhea. These
conditions result in metabolic acidosis.
35. Answer: A. Respirations that are abnormally deep, regular, and
increased in rate.
Rhe umatoid Kussmaul’s respirations are abnormally deep, reg ular, and increased
in rate.
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 KABC – RESPI Q&A

tracheostomy collar are also high -flow oxygen delivery systems but
36. Answer: D. Metabolic alkalosis most often are used to administer high humidity.
Increases in base components occur as a result of oral or parenteral
intake of bicarbonates, carbonates, acetates, citrates, or lactates. 46. Answer: A. “I will take the medication on an empty stomach.”
Excessive use of oral antacids containing bicarbonate can cause Theo-Dur is a bronchodilator. The medication should be
metabolic alkalosis. administered with food such as milk and crackers to prevent GI
irritation.
37. Answer: C. Potassium level of 5.2 mEq/L
Clinical manifestations of metabolic acidosis include hyperpnea with 47. Answer: B. 2 L/min
Kussmaul’s respirations; headache; N/V, and diarrhea; fruity - One to 3 L/min of oxygen by nasal cannula may be required to raise
smelling breath resulting from improper fat metabolism; C NS to PaO2 to 60 to 80 mm Hg. However, oxygen is used cautiously and
depression, including mental dullness, drowsiness, stupor, and should not exceed 2 L/min. Because of the long -standing
coma; twitching, and coma. Hyperkalemia will occur. hypercapnia, the respiratory drive is triggered by low oxygen levels
rather than increased carbon dioxide levels, as is the case in normal
38. Answer: E, B, A, D, and then C. respiratory system.

39. Answer: B. Having the client take 3 deep breaths. 48. Answer: C. pH of 7.30
To obtain a sputum specimen, the client should rinse the mouth to
prevent contamination, breathe deeply, and then cough unto a 49. Answer: D. Promote carbon dioxide elimination
sputum specimen container. The client should be encouraged to Pursed lip breathing facilitates maximum expiration for clients with
cough and not spit so as to obtain sputum. Sputum can be thinned by obstructive lung disease. This type of breathing allows better
fluids or by a respiratory treatment such as inhalat ion of nebulized expiration by increasing airway pressure that keeps air passages
saline or water. The optimal time to obtain a specimen is on arising open during exhalation.
in the morning.
50. Answer: B. Respiratory alkalosis uncompensated
40. Answer: D. Bronchospasm In respiratory alkalosis, the pH will be higher than normal and the
If a biopsy was performed during a bronchoscopy, blood -streaked PCO2 will be low.
sputum is expected for several hours. Frank blood indicates
hemorrhage. A dry cough may be expected. The client should be
assessed for signs of complications, which would include cyanosis,
dyspnea, stridor, bronchospasm, hemoptysis, hypotension,
tachycardia, and arrhythmias. Hematuria is unrelated to this
procedure.

41. Answer: B. 10 seconds

Hypoxemia can be caused by prolonged suctioning, which stimulates
the pacemaker cells within the heart. A vasovagal response may
occur causing bradycardia. The nurse must preoxygenate the client
before suctioning and limit the suctionin g pass to 10 seconds.

42. Answer: C. Stop the procedure and reoxygenated the client

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

43. Answer: A. Metabolic acidosis

In an acidotic condition, the pH would be low, indicating the
acidosis. In addition, a low bicarbonate level along with the pH would
indicate a metabolic state.

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

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

45. Answer: A. Venturi mask

The venture mask delivers the most acc urate oxygen concentration.
The Venturi mask is the best oxygen delivery system for the client
with chronic airflow limitation because it delivers a precise oxygen
concentration. The face tent, the aerosol mask, and the

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 KABC – RESPI Q&A

1. Aminophylline (theophylline) is prescribed for a client with acute b. Increased comfort level
bronchitis. A nurse administers the medication, knowing that the c. Reduction of N/V
primary action of this medication is to: d. Decreased frequency and intensity of cough
a. Promote expectoratio n
b. Suppress the cough 9. Which of the following would be an expected outcome for a client
c. Relax smooth muscles of the bronchial airway recovering from an upper respiratory tract infection? The client will:
d. Prevent infection a. Maintain a fluid intake of 800 ml every 24 hours.
b. Experience chills only once a day
2. A client is receiving isoetharine hydrochloride (Bronkosol) via a c. Cough productively without chest discomfort.
nebulizer. The nurse monitors the client for which side effect of this d. Experience less nasal obstruction and discharge.
medication?
a. Constipation 10. Which of the following individuals would the nurse consider to have
b. Diarrhea the highest priority for receiving an influenza vaccination?
c. Bradycardia a. A 60-year-old man with a hiatal hernia
d. Tachycardia b. A 36-year-old woman with 3 children
c. A 50-year-old woman caring for a spouse with cancer
3. A nurse teaches a client about the use of a respiratory inhaler. Which d. a 60-year-old woman with osteoarthritis
action by the client indicated a need for further teaching?
a. Removes the cap and shakes the inhaler well before use. 11. A client with allergic rhinitis asks the nurse what he should do to
b. Presses the canister down with finger as he breathes in. decrease his symptoms. Which of the following instructions would be
c. Inhales the mist and quickly exhales. appropriate for the nurse to give the client?
d. Waits 1 to 2 minutes between puffs if more than one puff a. “Use your nasal decongestant spray regularly to help clear
has been prescribed. your nasal passages.”
b. “Ask the doctor for antibiotics. Antibiotics will help
4. A female client is scheduled to have a chest radiograph. Which of the decrease the secretion.”
following questions is of most importance to the nurse a ssessing this c. “It is important to increase your activity. A daily brisk
client? walk will help promote drainage.”
a. “Is there any possibility that you could be pregnant?” d. “Keep a diary if when your symptoms occur. This can help
b. “Are you wearing any metal chains or jewelry?” you identify what precipitates your attacks.”
c. “Can you hold your breath easily?”
d. “Are you able to hold your arms above your head?” 12. An elderly client has been ill with the flu, experiencing heada che,
fever, and chills. After 3 days, she develops a cough productive of
5. A client has just returned to a nursing unit f ollowing bronchoscopy. yellow sputum. The nurse auscultates her lungs and hears diffuse
A nurse would implement which of the following nursing crackles. How would the nurse best interpret these assessment
interventions for this client? findings?
a. Encouraging additional fluids for the next 24 hours
b. Ensuring the return of the gag reflex before offering foods a. It is likely that the client is developing a secondary
or fluids bacterial pneumonia.
c. Administering atropine intravenously b. The assessment findings are consistent with influenza and
d. Administering small doses of midazolam (Versed). are to be expected.
c. The client is getting dehydrated and needs to increase her
6. A client has an order to have radial ABG drawn. Before drawing the fluid intake to decrease secretions.
sample, a nurse occludes the: d. The client has not been taking her decongestants an d
a. Brachial and radial arteries, and then releases them and bronchodilators as prescribed.
observes the circulation of the hand.
b. Radial and ulnar arteries, releases one, evaluates the 13. Guaifenesin 300 mg four times daily has been ordered as an
color of the hand, and repeats the process with the other expectorant. The dosage strength of the liquid is 200mg/5ml. How
artery. many mL should the nurse administer each dose?
c. Radial artery and observes for color changes in the a. 5.0 ml
affected hand. b. 7.5 ml
d. Ulnar artery and observes for color changes in the c. 9.5 ml
affected hand. d. 10 ml

7. A nurse is assessing a client with chronic airflow limitation and notes 14. Pseudoephedrine (Sudafed) has been ordered as a nasal
that the client has a “barrel chest.” The nurse interprets that this decongestant. Which of the following is a possible side effect of this
client has which of the following forms of chronic airflow limitation? drug?
a. Chronic obstructive bronchitis a. Constipation
b. Emphysema b. Bradycardia
c. Bronchial asthma c. Diplopia
d. Bronchial asthma and bronchitis d. Restlessness

8. A client has been taking benzonatate (Tessalon Perles) as 15. A client with COPD reports steady weight loss and being “too tired
prescribed. A nurse concludes that the medication is having the from just breathing to eat .” Which of the following nursing diagnoses
intended effect if the client experiences: would be most appropriate when planning nutritional interventions
a. Decreased anxiety level for this client?

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 KABC – RESPI Q&A

a. Altered nutrition: Less than body requirements related to d. Increased appetite

fatigue.
b. Activity intolerance related to dyspnea. 24. The nurse assesses the respiratory status of a client who is
c. Weight loss related to COPD. experiencing an exacerbation of COPD secondary to an upper
d. Ineffective breathing pattern related to alveolar respiratory tract infection. Which of the following findings would be
hypoventilation. expected?
a. Normal breath sounds
16. When developing a discharge plan to manage the care of a client with b. Prolonged inspiration
COPD, the nurse should anticipate that the client will do which of c. Normal chest movement
the following? d. Coarse crackles and rhonchi
a. Develop infections easily
b. Maintain current status 25. Which of the following ABG abnormalities should the nurse
c. Require less supplemental oxygen anticipate in a client with advanced COPD?
d. Show permanent improvement. a. Increased PaCO2
b. Increased PaO2
17. Which of the following outcomes would be appropriate for a client c. Increased pH.
with COPD who has been discharged to home? The client: d. Increased oxygen saturation
a. Promises to do pursed lip breathing at home.
b. States actions to reduce pain. 26. Which of the following diets would be most appropriate for a client
c. States that he will use oxygen via a nasal cannula at 5 with COPD?
L/minute. a. Low fat, low cholesterol
d. Agrees to call the physician if dyspnea on exertion b. Bland, soft diet
increases. c. Low-Sodium diet
d. High calorie, high-protein diet
18. Which of the following physical assessment findings would the nurse
expect to find in a client with ad vanced COPD? 27. The nurse is planning to teach a client with COPD how to cough
a. Increased anteroposterior chest diameter effectively. Which of the following instructions should be include d?
b. Underdeveloped neck muscles a. Take a deep abdominal breath, bend forward, and cough 3
c. Collapsed neck veins to 4 times on exhalation.
d. Increased chest excursions with respiration b. Lie flat on back, splint the thorax, take two deep breaths
and cough.
19. Which of the following is the primary reason to teach pursed -lip c. Take several rapid, shallow breaths and then cough
breathing to clients with emphysema? forcefully.
a. To promote oxygen intake d. Assume a side-lying position, extend the arm over the
b. To strengthen the diaphragm head, and alternate deep breathing with coughing.
c. To strengthen the intercostal muscles
d. To promote carbon dioxide elimination 28. A 34-year-old woman with a history of asthma is admitted to the
emergency department. The nurse notes that the client is dyspneic,
20. Which of the following is a priority goal for the client with COPD? with a respiratory rate of 35 breaths/minute, nasal flarin g, and use
a. Maintaining functional ability of accessory muscles. Auscultation of the lung fields reveals greatly
b. Minimizing chest pain diminished breath sounds. Based on these findings, what action
c. Increasing carbon dioxide levels in the blood should the nurse take to initiate care of the client?
d. Treating infectious agents a. Initiate oxygen therapy and reassess the client in 10
minutes.
21. A client’s arterial blood gas levels are as follows: pH 7.31; PaO2 80 b. Draw blood for an ABG analysis and send the client for a
mm Hg, PaCO2 65 mm Hg; HCO3 - 36 mEq/L. Which of the following chest x-ray.
signs or symptoms would the nurse expect? c. Encourage the client to relax and breathe slowly through
a. Cyanosis the mouth
b. Flushed skin d. Administer bronchodilators
c. Irritability
d. Anxiety 29. The nurse would anticipate which of the following ABG results in a
client experiencing a prolonged, severe asthma attack?
22. When teaching a client with COPD to conserve energy, the nurse a. Decreased PaCO2, increased PaO2, and decreased pH.
should teach the client to lift objects: b. Increased PaCO2, decreased PaO2, and decreased pH.
a. While inhaling through an open mouth. c. Increased PaCO2, increased PaO2, and increased pH.
b. While exhaling through pursed lips d. Decreased PaCO2, decreased PaO2, and increased pH.
c. After exhaling but before inhaling.
d. While taking a deep breath and holding it. 30. A client with acute asthma is prescribed short-term corticosteroid
therapy. What is the rationale for the use of steroids in clients with
23. The nurse teaches a client with COPD to assess for s/s of right -sided asthma?
heart failure. Which of the following s/s would be included in the a. Corticosteroids promote bronchodilation
teaching plan? b. Corticosteroids act as an expectorant
a. Clubbing of nail beds c. Corticosteroids have an anti -inflammatory effec t
b. Hypertension d. Corticosteroids prevent development of respiratory
c. Peripheral edema infections.

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 KABC – RESPI Q&A

c. Produced by airflow across passages narrowed by

31. The nurse is teaching the client how to use a metered dose inhaler secretions
(MDI) to administer a Corticosteroid drug. Which of the following d. Found primarily in the pleura.
client actions indicates that he is using the MDI correct ly? Select all
that apply. 38. A cyanotic client with an unknown diagnosis is admitted to the E.R.
a. The inhaler is held upright. In relation to oxygen, the first nursing action would be to:
b. Head is tilted down while inhaling the medication a. Wait until the client’s lab work is done.
c. Client waits 5 minutes between puffs. b. Not administer oxygen unless o rdered by the physician.
d. Mouth is rinsed with water following administration c. Administer oxygen at 2 L flow per minute.
e. Client lies supine for 15 minutes following administration. d. Administer oxygen at 10 L flow per minute and check the
client’s nail beds.
32. A client is prescribed metaproterenol (Alupent) via a metered dose
inhaler (MDI), two puffs every 4 hours. The nurse instructs the client 39. Immediately following a thoracentesis, which clinical manifestations
to report side effects. Which of the following are potential side indicate that a complication has occurred a nd the physician should
effects of metaproterenol? be notified?
a. Irregular heartbeat a. Serosanguineous drainage from the puncture site
b. Constipation b. Increased temperature and blood pressure
c. Pedal edema c. Increased pulse and pallor
d. Decreased heart rate. d. Hypotension and hypothermia

33. A client has been taking flunisolide (Aerobid), two inhalations a day, 40. If a client continues to hypoventilate, the nurse will continually
for treatment of asthma. He tells the nurse that he has painful, white assess for a complication of:
patches in his mouth. Which response by the nurse would be the most a. Respiratory acidosis
appropriate? b. Respiratory alkalosis
a. “This is an anticipated side-effect of your medication. It c. Metabolic acidosis
should go away in a couple of weeks.” d. Metabolic alkalosis
b. “You are using your inhaler too much and it has irritated
your mouth.” 41. A client is admitted to the hospital with acute bronchitis. While
c. “You have developed a fungal infection from your taking the client’s VS, the nurse notices he has an irregular pulse.
medication. It will need to be treated with an antibiotic.” The nurse understands that cardiac arrhythmias in chronic
d. “Be sure to brush your teeth and floss daily. Good oral respiratory distress are usually the result of:
hygiene will treat this problem.” a. Respiratory acidosis
b. A build-up of carbon dioxide
34. Which of the following health promotion activities should the nurse c. A build-up of oxygen without adequate expelling of carbon
include in the discharge teaching plan for a client with asthma ? dioxide.
a. Incorporate physical exercise as tolerated into the d. An acute respiratory infection.
treatment plan.
b. Monitor peak flow numbers after meals and at bedtime. 42. Auscultation of a client’s lungs reveals crackles in the left posterior
c. Eliminate stressors in the work and home environment base. The nursing intervention is to:
d. Use sedatives to ensure uninterrupted sleep at night. a. Repeat auscultation after asking the client to deep
breathe and cough.
35. The client with asthma should be taught that which of the following b. Instruct the client to limit fluid intake to less than 2000
is one of the most common precipitating factors of an acute asthma ml/day.
attack? c. Inspect the client’s ankles and sacrum for the presence of
a. Occupational exposure to toxins edema
b. Viral respiratory infections d. Place the client on bedrest in a semi -Fowlers position.
c. Exposure to cigarette smoke
d. Exercising in cold temperatures 43. The most reliable index to determine the respiratory status of a
client is to:
36. A female client comes into the emergency room complaining of SOB a. Observe the chest rising and falling
and pain in the lung area. She states that she started taking birth b. Observe the skin and mucous membrane color.
control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P c. Listen and feel the air movement.
110, R 40. The physician orders ABG’s, results are as follows: pH: d. Determine the presence of a femoral pulse.
7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3 - 24 mEq/L; SaO2 86%.
Considering these results, the first intervention is to: 44. A client with COPD has developed secondary polycythemia. Which
a. Begin mechanical ventilation nursing diagnosis would be included in the plan of care because of
b. Place the client on oxygen the polycythemia?
c. Give the client sodium bicarbonate a. Fluid volume deficit related to blood loss.
d. Monitor for pulmonary embolism. b. Impaired tissue perfusion related to thrombosis
c. Activity intolerance related to dyspnea
37. Basilar crackles are present in a client’s lungs on auscultation. The d. Risk for infection related to suppressed immune response.
nurse knows that these are discrete, non-continuous sounds that are:
a. Caused by the sudden opening of alveoli 45. The physician has scheduled a client for a left pneumonectomy. The
b. Usually more prominent during expiration position that will most likely be ordered postoperatively for his is
the:

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 KABC – RESPI Q&A

a. Nonoperative side or back

b. Operative side or back
c. Back only
d. Back or either side.

46. Assessing a client who has developed atelectasis postoperatively,

the nurse will most likely find:
a. A flushed face
b. Dyspnea and pain
c. Decreased temperature
d. Severe cough and no pain.

47. A fifty-year-old client has a tracheostomy and requires tracheal

suctioning. The first intervention in completing this procedure would
be to:
a. Change the tracheostomy dressing
b. Provide humidity with a trach mask
c. Apply oral or nasal suction
d. Deflate the tracheal cuff

48. 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:
a. Exhaled forcibly after a normal expiration
b. Exhaled after there is a normal inspiration
c. Trapped in the alveoli that cannot be exhaled
d. Forcibly inspired over and above a normal respiration.

49. An acceleration in oxygen dissociation from hemoglobin, and thus

oxygen delivery to the tissues, is caused by:
a. A decreasing oxygen pressure in the blood
b. An increasing carbon dioxide pressure in the blood
c. A decreasing oxygen pressure and/or an increasing carbon
dioxide pressure in the blood.
d. An increasing oxygen pressure and/or a decreasing carbon
dioxide pressure in the blood.

50. The BEST method of oxygen administration for client with COPD
uses:
a. Cannula
b. Simple Face mask
c. Non-rebreather mask
d. Venturi mask

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 KABC – RESPI Q&A

1. Answer: C. Relax smooth muscles of the bronchial airway Individuals who are household members or home care providers for
Aminophylline is a bronchodilator that directly relaxes the smooth high-risk individuals are high-priority targeted groups for
muscles of the bronchial airway. immunization against influenza to prevent transmission to those who
have a decreased capacity to deal with the disease. The wife who is
2. Answer: D. Tachycardia caring for a husband with cancer has the highest priority of the
Side effects that can occur from a beta 2 agonist include tremors, clients described.
nausea, nervousness, palpitations, tachycardia, peripheral
vasodilation, and dryness of the mouth or throat. 11. Answer: D. “Keep a diary if when your symptoms occur. This can
help you ident ify what precipitates your attacks.”
3. Answer: C. Inhales the mist and quickly exhales. It is important for clients with allergic rhinitis to determine the
The client should be instructed to hold his or her breath at least 10 precipitating factors so that they can be avoided. Keeping a diary
to 15 seconds before exhaling the mist. can help identify these triggers. Nasal decongestant sprays should
not be used regul arly because they can cause a rebound effect.
4. Answer: A. “Is there any possibility that you could be pregnant?” Antibiotics are not appropriate. Increasing activity will not control
The most important item to ask about is the client’s pregnancy status the client’s symptoms; in fact, walking outdoors may increase them
because pregnant women should not be exposed to radiation. Clients if the client is allergic to pollen.
are also asked to remove any chains or metal objects that could
interfere with obtaining an adequa te film. A chest radiograph most 12. Answer: A. It is likely that the cl ient is developing a secondary
often is done at full inspiration, which gives optimal lung expansion. bacterial pneumonia.
If a lateral view of the chest is ordered, the client is asked to raise Pneumonia is the most common complication of influenza, especially
the arms above the head. Most films are done in posterior -anterior in the elderly. The development of a purulent cough and crackles may
view. be indicative of a bacterial infection are not consistent with a
diagnosis of influenza. These findings are not indicative of
5. Answer: D. Ensuring the return of the gag reflex before offering dehydration. Decongestants and bronchodilators are not typically
foods or fluids prescribed for the flu.
After bronchoscopy, the nurse keeps the client on NPO status until
the gag reflex returns because the preoperative sedation and the 13. Answer: B. 7.5 ml
local anesthesia impair swallowing and the protec tive laryngeal
reflexes for a number of hours. Additional fluids is unnecessary 14. Answer: D. Restlessness
because no contrast dye is used that would need to be flushed from Side effects of pseudoephedrine are experienced primarily in the
the system. Atropine and Versed would be administered before the cardiovascular system and through sympathetic effects on the CNS.
procedure, not after. The most common CNS effects include restlessness, dizziness,
tension, anxiety, insomnia, and weakness. Common cardiovascular
6. Answer: B. Radial and ulnar arteries, releases one, evaluates the side effects include tachycardia, hypertension, palpitations, and
color of the hand, and repeats the process with the other artery. arrhythmias. Constipation and diplopia are not side effects of
Before drawing an ABG, the nurse assesses the collateral circulation pseudoephedrine. Tachycardia, not bradycardia, is a side effect of
to the hand with Allen’s test. This involves compressing the radial pseudoephedrine.
and ulnar arteries and asking the client to close and open the fist.
This should cause the hand to become pale. The nurse then releases 15. Answer: A. Altered nutrition: Less than body requirements related
pressure on one artery and observes whether circulation is restored to fatigue.
quickly. The nurse repeats the process, releasing the other artery. The client’s problem is altered nutrition—specifically, less than
The blood sample may be taken safely if collateral circulation is required. The cause, as stated by the client, is the fatigue associated
adequate. with the disease process. Activity intolerance is a likely diagnosis
but is not related to the client’s nutritional problems. Weight loss is
7. Answer: B. Emphysema not a nursing diagnosis. Ineffective breathing pattern may be a
The client with emphysema has hyperinflation of the alveoli and problem, but this diagnosis does not specifically address the
flattening of the diaphragm. These lead to increased anteroposterior problem of weight loss described by the client.
diameter, which is referred to as “barrel chest.” The client also has
dyspnea with prolonged expiration and has hyperresonant lungs to 16. Answer: A. Develop infections easily
percussion. A client with COPD is at high risk for development of respiratory
infections. COPD is a slowly progressive; therefore, maintaining
8. Answer: D. Decreased frequency and intensity of cough current status and establishing a goal that the client will require less
Benzonatate is a locally acting antitussive the effectiveness of which supplemental oxygen are unrealistic expectations. Treatment may
is measured by the degree to which it decreases the intensity and slow progression of the disease, but p ermanent improvement is
frequency of cough without eliminating the cough reflex. highly unlikely.

9. Answer: D. Experience less nasal obstruction and discharge.
A client recovering from an URI should report decreasing or no nasal
discharge and obstruction. Daily fluid intake should be increased to
more than 1 L every 24 hours to liquefy secretions. The temperature
should be below 100*F (37.8*C) with no chills or diaphoresis. A
productive cough with chest pain indicated pulmonary infec tion, not
an URI.
10. Answer: C. A 50-year-old woman caring for a spouse with cancer
17. Answer: D. Agrees to call the physician if dyspnea on exertion
increases.
Increasing dyspnea on exertion indicates that the client may be
experiencing complications of COPD, and therefore the physician
should be notified. Extracting promises from clients is not an
outcome criterion. Pain is not a common symptom of COPD. Clients
with COPD use low-flow oxygen supplementation (1 to 2 L/minute) to
avoid suppressing the respiratory drive, which, for these clients, is
stimulated by hypoxia.

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25. Answer: A. Increased PaCO2

18. Answer: A. Increased anteroposterior chest diameter As COPD progresses, the client typically develops increased PaCO2
Increased anteroposterior chest diameter is characteristic of levels and decreased PaO2 levels. This results in decreased pH and
advanced COPD. Air is trapped in the overextended alveoli, and the decreased oxygen saturation. These changes are the result of air
ribs are fixed in an inspiratory position. The resul t is the typical trapping and hypoventilation.
barrel-chested appearance. Overly developed, not underdeveloped,
neck muscles are associated with COPD because of their increased
use in the work of breathing. Distended, not collapsed, neck veins
are associated with COPD as a symptom of t he heart failure that the
client may experience secondary to the increased workload on the 26. Answer: D. High-calorie, high-protein diet
heart to pump into pulmonary vasculature. Diminished, not The client should eat high-calorie, high-protein meals to maintain
increased, chest excursion is associated with COPD. nutritional status and prevent weight loss that results from the
increased work of breathing. The client should be encouraged to eat
19. Answer: D. To promote carbon dioxide elimination small, frequent meals. A low-fat, low-cholesterol diet is indicated
Pursed lip breathing prolongs exhalation and prevents air trapping for clients with coronary artery disease. The client with COPD does
in the alveoli, thereby promoting carbon dioxide elimination. By not necessarily need to follow a sodium -restricted diet, unless
prolonged exhalation and helping the client relax, pursed -lip otherwise medically indicated.
breathing helps the client learn to control the rate and depth of
respiration. Pursed-lip breathing does not promote the intake of 27. Answer: A. Take a deep abdominal breath, bend fo rward, and
oxygen, strengthen the diaphragm, or strengthen intercostal cough 3 to 4 times on exhalation.
muscles. The goal of effective coughing is to conserve energy, facilitate
removal of secretions, and minimize airway collapse. The client
20. Answer: A. Maintaining functional ability should assume a sitting position with feet on the floor if possible.
A priority goal for the client with COPD is to manage the s/s of the The client should bend forward slightly and, using pursed -lip
disease process so as to maintain the client’s functional ability. breathing, exhale. After resuming an upright position, the client
Chest pain is not a typical sign of COPD. The carbon dioxide should use abdominal breathing to slowly and deeply inhale. After
concentration in the blood is increased to an abnormal level in repeating this process 3 or 4 times, the client should take a deep
clients with COPD; it would not be a goal to increase the level abdominal breath, bend forward and cough 3 or 4 times upon
further. Preventing infection would be a goal of care for the client exhalation (“huff” cough). Lying flat does not enhance lung
with COPD. expansion; sitting upright promotes full expansion of the thorax.
Shallow breathing does not facilitate removal of secretions, and
21. Answer: B. Flushed skin forceful coughing promotes collapse of airways. A side -lying
The high PaCO2 level causes flushing due to vasodilation. The client position does not allow for adequate chest expansion to promote
also becomes drowsy and lethargic because carbon dioxide has a deep breathing.
depressant effect on the CNS. Cyanosis is a late sign of hypoxia.
Irritability and anxiety are not common with a PaCO2 level of 65 mm 28. Answer: D. Administer bronchodilators
Hg but are associated with hypoxia. In an acute asthma attack, diminished or absent breath sounds can
be an ominous sign of indicating lack of air movement in the lungs
22. Answer: B. While exhaling through pursed lips and impending respiratory failure. The client requires immediate
Exhaling requires less energy than inhaling. Therefore, lifting while intervention with inhaled bronchodilators, intravenous
exhaling saves energy and reduced perceived dyspnea. Pursing the corticosteroids, and possibly intravenous theophylline.
lips prolongs exhalation and provides the client with more control Administering oxygen and reassessing the client 10 minutes later
over breathing. Lifting after exhalation but before inhaling is similar would delay needed medical intervention, as would drawing an ABG
to lifting with the breath held. This should not be recommended and obtaining a chest x-ray. It would be futile to encourage the client
because it is similar to the Valsalva maneuver, which can stimulate to relax and breathe slowly without providing necessary
cardiac dysrhythmias. pharmacologic intervention.

23. Answer: C. Peripheral edema 29. Answer: B. Increased PaCO2, decreased PaO2, and decreased pH.
Right-sided heart failure is a complication of COPD that occurs As the severe asthma attack worsens, the client becomes fatigued
because of pulmonary hypertension. Signs and symptoms of rig ht- and alveolar hypotension develops. This leads to carbon dioxide
sided heart failure include peripheral edema, jugular venous retention and hypoxemia. The client develops respiratory acidosis.
distention, hepatomegaly, and weight gain due to increased fluid Therefore, the PaCO2 level increase, the PaO2 level decreases, and
volume. Clubbing of nail beds is associated with conditions of the pH decreases, indicating acidosis.
chronic hypoxia. Hypertension is associated with left -sided hear t
failure. Clients with heart failure have decreased appetites. 30. Answer: C. Corticosteroids have an anti-inflammatory effect
Corticosteroids have an anti -inflammatory effect and act to decrease
24. Answer: D. Coarse crackles and rhonchi edema in the bronchial airways and decrease mucus secretion.
Exacerbations of COPD are frequently caused by respiratory Corticosteroids do not have a bronchodilator effect, act as
infections. Coarse crackles and rhonchi would be auscultated as air expectorants, or prevent respiratory infections.
moves through airways obs tructed with secretions. In COPD, breath
sounds are diminished because of an enlarged anteroposterior 31. Answer: A and D.
diameter of the chest. Expiration, not inspiration, becomes
prolonged. Chest movement is decreased as lungs become 32. Answer: B. Irregular heartbeat
overdistended. Irregular heart rates should be reported promptly to the care
provider. Metaproterenol may cause irregular heartbeat,

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 KABC – RESPI Q&A

tachycardia, or anginal pain because of its adrenergic effect on the 41. Answer: B. A build-up of carbon dioxide
beta-adrenergic receptors in the heart. It is not recommended for The arrhythmias are caused by a build -up of carbon dioxide and not
use in clients with known cardiac disorders. Metaproterenol does not enough oxygen so that the heart is in a constant state of hypoxia.
cause constipation, petal edema, or bradycardia.
42. Answer: A. Repeat auscultation after asking the client to deep
33. Answer: C. “You have developed a fungal infection from your breathe and cough.
medication. It will need to be treated with an antibiotic.” Although crackles often indicate fluid in the alveoli, they may also
Use of oral inhalant corticosteroids, such as flunisolide, can lead to be related to hypoventilation and will clear after a deep breath or a
the development of oral thrush, a fungal infection. Once developed, cough. It is, therefore, premature to impose fluid (2) or activity (4)
thrush must be treated by antibiotic therapy; it will not resolve on restrictions (which Margaret would totally do if Dani weren’t there
its own. Fungal infections can develop even without overuse of the to smack her). Inspection for edema (3) would be appropriate after
Corticosteroid inhaler. Although good oral hygiene can hel p prevent re-auscultation.
the development of a fungal infection, it cannot be used alone to
treat the problem. 43. Answer: C. Listen and feel the air movement.
To check for breathing, the nurse places her ear and cheek next to
34. Answer: A. Incorporate physical exercise as tolerated into the the client’s mouth and nose to listen and feel for air movement. The
treatment plan. chest rising and falling (1) is not conclusive of a patent airway.
Physical exercise is beneficial and should be incorporated as Observing skin color (2) is not an accurate assessment of respiratory
tolerated into the client’s schedule. Peak flow numbers should be status, nor is checking the femoral pulse.
monitored daily, usually in the morning (before taking medication).
Peak flow does not need to be monitored after each meal. Stressors 44. Answer: B. Impaired tissue perfusion related to thrombosis
in the client’s life should be modified but cannot be totally Chronic hypoxia associated with COPD may stimulate excessive RBC
eliminated. Although adequate sleep is important, it is not production (polycythemia). This results in increased blood viscosity
recommended that sedatives be routinely taken to induce sleep. and the risk of thrombosis. The other nursing diagnoses are not
applicable in this situation.
35. Answer: B. Viral respiratory infections
The most common precipitator of asthma attacks is viral respiratory 45. Answer: B. Operative side or back
infection. Clients with asthma shoul d avoid people who have the flu Positioning the client on the operative side facilitates the
or a cold and should get yearly flu vaccinations. Environmental accumulation of serosanguineous fluid. The fluid f orms a solid mass,
exposure to toxins or heavy particulate matter can trigger asthma which prevents the remaining lung from being drawn into the space.
attacks; however, far fewer asthmatics are exposed to such toxins 46. Answer: B. Dyspnea and pain
than are exposed to viruses. Cigarette smoke can also trigger asthma Atelectasis is a collapse of the alveoli due to obstruction or
attacks, but to a lesser extent than viral respiratory infections. Some hypoventilation. Clients become short of breath, have a high
asthmatic attacks are triggered by exercising in cold weather. temperature, and u sually experience severe pain but do not have a
severe cough (4). The shortness of breath is a result of decreased
36. Answer: B. Place the client on oxygen oxygen-carbon dioxide exchange at the alveolar level.
The pH (7.50) reflects alkalosis, and the low PaCO2 indicated the
lungs are involved. The client should immediately be placed on 47. Answer: C. Apply oral or nasal suction
oxygen via mask so that the SaO2 is brought up to 95%. Encourage Before deflating the tracheal cuff (4), the nur se will apply oral or
slow, regular breathing to decrease the amount of CO2 she is losing. nasal suction to the airway to prevent secretions from falling into
This client may have pulmonary emb olism, so she should be the lung. Dressing change (1) and humidity (2) do not relate to
monitored for this condition (4), but it is not the first intervention. suctioning.
Sodium bicarbonate (3) would be given to reverse acidosis;
mechanical ventilation (1) may be ordered for acute respiratory 48. Answer: B. Exhaled after there is a normal inspiration
acidosis. Tidal volume (TV) is defined as the amount of air exhaled after a
37. Answer: A. Caused by the sudden opening of alveoli normal inspiration.
Basilar crackles are usually heard during inspiration and are caused
by sudden opening of the alveoli. 49. Answer: C. A decreasing oxygen pressure and/or an increasing
carbon dioxide pressure in the blood.
38. Answer: C. Administer oxygen at 2 L flow per minute. The lower the PO2 and the higher the PCO2, the more rapidly oxygen
Administer oxygen at 2 L/minute and no more, for if the client if dissociated from the oxyhemoglobin molecule.
emphysemic and receives too high a level of oxygen, he will develop
CO2 narcosis and the respiratory system will cease to function. 50. Answer: D. Venturi mask
Venturi delivers controlled oxygen.
39. Answer: C. Increased pulse and pallor
Increased pulse and pallor are symptoms associated with shock. A
compromised venous return may occur if there is a mediastinal shift
as a result of excessive fluid removal. Usually, no more than 1 L of
fluid is removed at one time to prevent this from occurring.

40. Answer: A. Respiratory acidosis

Respiratory acidosis represents an increase in the acid component,
carbon dioxide, and an increase in the hydrogen ion concentration
(decreased pH) of the arterial blood.

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1. Clients with chronic illnesses are more likely to get pneumonia when the test was given. This PPD would be read as having which of the
which of the following situations is present? following results?
a. Dehydration a. Indeterminate
b. Group living b. Needs to be redone
c. Malnutrition c. Negative
d. Severe periodontal disease d. Positive

2. Which of the following pathophysiological mechanisms that occurs 10. A client with primary TB infection can expect to develop which of the
in the lung parenchyma allows pneumonia to develop? following conditions?
a. Atelectasis a. Active TB within 2 weeks
b. Bronchiectasis b. Active TB within 1 month
c. Effusion c. A fever that requires hospitalization
d. Inflammation d. A positive skin test

3. Which of the following organisms most commonly causes community - 11. A client was infected with TB 10 years ago but never developed the
acquired pneumonia in adults? disease. He’s now being treated for cancer. The client begins to
a. Haemiphilus influenzae develop signs of TB. This is known as which of the following t ypes of
b. Klebsiella pneumoniae infection?
c. Streptococcus pneumoniae a. Active infection
d. Staphylococcus aureus b. Primary infection
c. Superinfection
4. An elderly client with pneumonia may appear with which of the d. Tertiary infection
following symptoms first?
a. Altered mental status and dehydration 12. A client has active TB. Which of the following symptoms will he
b. Fever and chills exhibit?
c. Hemoptysis and dyspnea a. Chest and lower back pain
d. Pleuritic chest pain and cough b. Chills, fever, night sweats, and hemoptysis
c. Fever of more than 104*F and nausea
5. When auscultating the chest of a client with pneumonia, the nurse d. Headache and photophobia
would expect to hear which of the following sounds over areas of
consolidation? 13. Which of the following diagnostic tests is definitive for TB?
a. Bronchial a. Chest x-ray
b. Bronchovesicular b. Mantoux test
c. Tubular c. Sputum culture
d. Vesicular d. Tuberculin test

6. A diagnosis of pneumonia is typically achieved by which of the 14. A client with a positive Mantoux test result will be sent for a chest
following diagnostic tests? x-ray. For which of the following reasons is this done?
a. ABG analysis a. To confirm the diagnosis
b. Chest x-ray b. To determine if a repeat skin test is needed
c. Blood cultures c. To determine the extent of the lesions
d. sputum culture and sensitivity d. To determine if this is a primary or secondary infection

7. A client with pneumonia develops dyspnea with a respiratory rate of 15. A chest x-ray should a client’s lungs to be clear. His Mantoux test is
32 breaths/minute and diffi culty expelling his secretions. The nurse positive, with a 10mm if induration. His previous test was negative.
auscultates his lung fields and hears bronchial sounds in the left These test results are possible because:
lower lobe. The nurse determines that the client requires which of
the following treatments first? a. He had TB in the past and no longer has it.
a. Antibiotics b. He was successfully treated for TB, but skin tests always
b. Bed rest stay positive.
c. Oxygen c. He’s a “seroconverter”, meaning the TB has gotten to his
d. Nutritional intake bloodstream.
d. He’s a “tuberculin converter,” which means he has been
8. A client has been treated with antibiotic therapy for right lower -lobe infected with TB since his last skin test.
pneumonia for 10 days and will be discharged today. Which of the
following physical findings would lead the nurse to believe it is 16. A client with a positive skin test for TB isn’t showing signs of active
appropriate to discharge this client? disease. To help prevent the devel opment of active TB, the client
a. Continued dyspnea should be treated with isoniazid, 300 mg daily, for how long?
b. Fever of 102*F a. 10 to 14 days
c. Respiratory rate of 32 breaths/minute b. 2 to 4 weeks
d. Vesicular breath sounds in right base c. 3 to 6 months
d. 9 to 12 months
9. The right forearm of a client who had a purified protein derivative
(PPD) test for tuberculosis is reddened and raised about 3mm where

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17. A client with a productive cough, chills, and night sweats is 25. A pulse oximetry gives what type of informat ion about the client?
suspected of having active TB. The physicia n should take which of a. Amount of carbon dioxide in the blood
the following actions? b. Amount of oxygen in the blood
a. Admit him to the hospital in respiratory isolation c. Percentage of hemoglobin carrying oxygen
b. Prescribe isoniazid and tell him to go home and rest d. Respiratory rate
c. Give a tuberculin test and tell him to come back in 48
hours and have it read. 26. What effect does hemoglobin amount have on oxygenation status?
d. Give a prescription for isoniazid, 300 mg daily for 2 weeks, a. No effect
and send him home. b. More hemoglobin reduces the client’s respiratory rate
c. Low hemoglobin levels cause reduces oxygen -carrying
18. A client is diagnosed with active TB and started on triple antibiotic capacity
therapy. What signs and symptoms would the client show if therapy d. Low hemoglobin levels cause increased oxygen -carrying
is inadequate? capacity.
a. Decreased shortness of breath
b. Improved chest x-ray 27. Which of the following statements best explains how opening up
c. Nonproductive cough collapsed alveoli improves oxygenation?
d. Positive acid-fast bacilli in a sputum sample after 2 a. Alveoli need oxygen to live
months of treatment. b. Alveoli have no effect on oxygenation
c. Collapsed alveoli increase oxygen demand
19. A client diagnosed with active TB would be hospitalized primarily for d. Gaseous exchange occurs in the alveolar membrane.
which of the following reasons?
a. To evaluate his condition 28. Continuous positive airway pressure (CPAP) can be provided through
b. To determine his compliance an oxygen mask to improve oxygen ation in hypoxic patients by which
c. To prevent spread of the disease of the following methods?
d. To determine the need for antibiotic therapy.
a. The mask provides 100% oxygen to the client.
20. A high level of oxygen exerts which of the following effects on the b. The mask provides continuous air that the client can
lung? breathe.
a. Improves oxygen uptake c. The mask provides pressurized oxygen so the client can
b. Increases carbon dioxide levels breathe more easily.
c. Stabilizes carbon dioxide levels d. The mask provides pressurized at the end of expiration to
d. Reduces amount of functional alveolar surface area open collapsed alveoli.

21. A 24-year-old client comes into the clinic complaining of right -sided 29. Which of the following best describes pleural effusion?
chest pain and shortness of breath. He reports that it started a. The collapse of alveoli
suddenly. The assessment should include which of the following b. The collapse of bronchiole
interventions? c. The fluid in the alveolar space
d. The accumulation of fluid between the linings of the
a. Auscultation of breath sounds pleural space.
b. Chest x-ray
c. Echocardiogram 30. If a pleural effusion develops, which of the following actions best
d. Electrocardiogram (ECG) describes how the fluid can be removed from the pleural space and
proper lung status restored?
22. A client with shortness of breath has decreased to absent breath a. Inserting a chest tube
sounds on the right side, from the apex to the base. Which of the b. Performing thoracentesis
following conditions would best explain this? c. Performing paracentesis
a. Acute asthma d. Allowing the pleural effusion to drain by itself.
b. Chronic bronchitis
c. Pneumonia 31. A comatose client needs a nasopharyngeal airway for suctioning.
d. Spontaneous pneumothorax After the airway is inserted, he gags and coughs. Which action should
the nurse take?
23. Which of the following treatments would the nurse expect for a client a. Remove the airway and insert a shorter one .
with a spontaneous pneumothorax? b. Reposition the airway.
a. Antibiotics c. Leave the airway in place until the client gets used to it.
b. Bronchodilators d. Remove the airway and attempt suctioning without it.
c. Chest tube placement
d. Hyperbaric chamber 32. An 87-year-old client requires long -term ventilator therapy. He has
a tracheostomy in place and requires frequent suc tioning. Which of
24. Which of the following methods is the best way to confirm the the following techniques is correct?
diagnosis of a pneumothorax? a. Using intermittent suction while advancing the catheter.
a. Auscultate breath sounds b. Using continuous suction while withdrawing the catheter.
b. Have the client use an incentive spirometer c. Using intermittent suction while withdrawing the
c. Take a chest x-ray catheter.
d. stick a needle in the area of decreased breath sounds d. Using continuous suction whi le advancing the catheter.

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 KABC – RESPI Q&A

33. A client’s ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg, 72 mm Hg, whereas the PaO2 level is 64 mm Hg. A nurse interprets
PaO2 of 77 mm Hg, and HCO3 - of 24 mEq/L. What do these values that the client is most likely experiencing:
indicate? a. Carbon monoxide poisoning
a. Metabolic acidosis b. Carbon dioxide narcosis
b. Respiratory alkalosis c. Respiratory alkalosis
c. Metabolic alkalosis d. Metabolic acidosis
d. Respiratory acidosis
41. A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm
34. A police officer brings in a homeless client to the ER. A chest x -ray area of induration at the site of the skin test. The nurse interprets
suggests he has TB. The physician orders an intradermal injection of the results as:
5 tuberculin units/0.1 ml of tuberculin purified derivative. Which a. Positive
needle is appropriate for this injection? b. Negative
a. 5/8” to ½” 25G to 27G needle. c. Inconclusive
b. 1” to 3” 20G to 25G needle. d. The need for repeat testing.
c. ½” to 3/8” 26 or 27G needle.
d. 1” 20G needle. 42. A nurse is caring for a client diagnosed with TB. Which assessment,
if made by the nurse, would not be consistent with the usual clinical
35. A 76-year old client is admitted for elective knee surgery. Physical presentation of TB and may indicate the development of a concurrent
examination reveals shallow respirations but no signs of respiratory problem?
distress. Which of the following is a normal physiologic change a. Nonproductive or productive cough
related to aging? b. Anorexia and weight loss
a. Increased elastic recoil of the lungs c. Chills and night sweats
b. Increased number of functional capillaries in the alveoli d. High-grade fever
c. Decreased residual volume
d. Decreased vital capacity. 43. A nurse is teaching a client with TB about dietary elements that
should be increased in the diet. The nurse suggests that the client
36. A 79-year-old client is admitted with pneumonia. Which nursing increase intake of:
diagnosis should take priority? a. Meats and citrus fruits
a. Acute pain related to lung expansion secondary to lung b. Grains and broccoli
infection c. Eggs and spinach
b. Risk for imbalanced fluid volume related to increased d. Potatoes and fish
insensible fluid losses secondary to fever.
c. Anxiety related to dyspnea and chest pain. 44. Which of the following would be priority assessment data to gather
d. Ineffective airway clearance related to retained from a client who has been diagnosed with pneumonia? Select all
secretions. that apply.
a. Auscultation of breath sounds
37. A community health nurse is conducting an educational session with b. Auscultation of bowel sounds
community members regarding TB. The nurse tells the group that one c. Presence of chest pain.
of the first symptoms associated with TB is: d. Presence of peripheral edema
a. A bloody, productive cough e. Color of nail beds
b. A cough with the expectoration of mucoid sputum
c. Chest pain 45. A client with pneumonia has a temperature of 102.6*F (39.2*C), is
d. Dyspnea diaphoretic, and has a productive cough. The nurse should include
which of the following measures in the plan of care?
38. A nurse evaluates the blood theophylline level of a client receiving a. Position changes q4h
aminophylline (theophylline) by intravenous infusion. The nurse b. Nasotracheal suctioning to clear secretions
would determine that a therapeutic blood level exists if which of the c. Frequent linen changes
following were noted in the laboratory report? d. Frequent offering of a bedpan.
a. 5 mcg/mL
b. 15 mcg/mL 46. The cyanosis that accompanies bacterial pneumonia is primarily
c. 25 mcg/mL caused by which of the following?
d. 30 mcg/mL a. Decreased cardiac output
b. Pleural effusion
39. Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a c. Inadequate peripheral circulation
client with TB. A nurse reviews the medical record of the client. d. Decreased oxygenation of the blood.
Which of the following, if noted in the client’s history, would require 47. Which of the following mental status changes may occur when a
physician notification? client with pneumonia is first experiencing hypoxia?
a. Heart disease a. Coma
b. Allergy to penicillin b. Apathy
c. Hepatitis B c. Irritability
d. Rheumatic fever d. Depression

40. A client is experiencing confusion and tremors is admitted to a 48. A client with pneumonia has a temperature ranging between 101* and
nursing unit. An initial ABG report indicate s that the PaCO2 level is 102*F and periods of diaphoresis. Based on t his information, which
of the following nursing interventions would be a priority?

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 KABC – RESPI Q&A

a. Maintain complete bedrest c. Developed a resistance to tubercle bacilli

b. Administer oxygen therapy d. Developed passive immunity to TB.
c. Provide frequent linen changes.
d. Provide fluid intake of 3 L/day 57. INH treatment is associated with the development of peripheral
neuropathies. Which of the following interventions would the nurse
49. Which of the following would be an appropriate expected outcome teach the client to help prevent this complication?
for an elderly client recovering from bacterial pneumonia? a. Adhere to a low cholesterol diet
a. A respiratory rate of 25 to 30 breaths per minute b. Supplement the diet with pyridoxine (vitamin B6)
b. The ability to perform ADL’s without dyspnea c. Get extra rest
c. A maximum loss of 5 to 10 pounds of body weight d. Avoid excessive sun exposure.
d. Chest pain that is minimized by splinting the ribcage.
58. The nurse should include which of the following instructions when
50. Which of the following symptoms is common in clients with TB? developing a teaching plan for clients receiving INH and rifampin for
a. Weight loss treatment for TB?
b. Increased appetite a. Take the medication with antacids
c. Dyspnea on exertion b. Double the dosage if a drug dose is forgotten
d. Mental status changes c. Increase intake of dairy products
d. Limit alcohol intake
51. The nurse obtains a sputum specimen from a client with suspected
TB for laboratory study. Which of the followi ng laboratory 59. The public health nurse is providing follow -up care to a client with
techniques is most commonly used to identify tubercle bacilli in TB who does not regularly take his medication. Which nursing action
sputum? would be most appropriate for this client?
a. Acid-fast staining a. Ask the client’s spouse to supervise the daily
b. Sensitivity testing administration of the medications.
c. Agglutination testing b. Visit the clinic weekly to ask him whether he is taking his
d. Dark-field illumination medications regularly.
c. Notify the physician of the client’s non -compliance and
52. Which of the following antituberculous drugs can cause damage to request a different prescription.
the eighth cranial nerve?
a. Streptomycin 60. Remind the client that TB can be fatal if not taken properly. The
b. Isoniazid Causative agent of Tuberculosis is said to be:
c. Para-aminosalicylic acid a. Mycobacterium Tuberculosis
d. Ethambutol hydrochloride b. Hansen’s Bacilli
c. Bacillus Anthracis
53. The client experiencing eighth cranial nerve damage will most likely d. Group A Beta Hemolytic Streptococcus
report which of the following symptoms?
a. Vertigo
b. Facial paralysis
c. Impaired vision
d. Difficulty swallowing

54. Which of the following family members exposed to TB would be at

highest risk for contracting the disease?
a. 45-year-old mother
b. 17-year-old daughter
c. 8-year-old son
d. 76-year-old grandmother

55. The nurse is teaching a client who has been diagnosed with TB how
to avoid spreading the disease to family members. Which
statement(s) by the client indicate(s) that he has understood the
nurses instructions? Select all that apply.
a. “I will need to dispose of my old clothing when I return
home.”
b. “I should always cover my mouth and nose when sneezing.”
c. “It is important that I isolate myself from family when
possible.”
d. “I should use paper tissues to cough in and dispose of them
properly.”
e. “I can use regular plate and utensils whenever I eat.”

56. A client has a positive reaction to the PPD test. The nurse correctly
interprets this reaction to mean that the client has:
a. Active TB
b. Had contact with Mycobacterium tuberculosis

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1. Answer: B. Group living describe results of a PPD test. If the PPD is reddened and raised
Clients with chronic illnesses generally have poor immune systems. 10mm or more, it’s considered positive according to the CDC.
Often, residing in group living situations increases the chance of
disease transmission. 10. Answer: D. A positive skin test
A primary TB infection occurs when the bacillus has successfully
2. Answer: D. Inflammation invaded the entire body after entering through the lungs. At this
The common feature of all type of pneumonia is an inflammatory point, the bacilli are walled o ff and skin tests read positive.
pulmonary response to the offending organism or agent. Atelectasis However, all but infants and immunosuppressed people will remain
and bronchiectasis indicate a collapse of a portion of the airway that asymptomatic. The general population has a 10% risk of developing
doesn’t occur in pneumonia. An effusion is an accumulation of excess active TB over their lifetime, in many cases because of a break in the
pleural fluid in the pleural space, which may be a secondary response body’s immune defense s. The active stage shows the classic
to p neumonia. symptoms of TB: fever, hemoptysis, and night sweats.

3. Answer: C. Streptococcus pneumoniae 11. Answer: A. Active infection

Pneumococcal or streptococcal pneumonia, caused by streptococcus Some people carry dormant TB infections that may develop into
pneumoniae, is the most common cause of community -acquired active disease. In addition, primary sites of infection containing TB
pneumonia. H. influenzae is the most common cause of infection in bacilli may remain inactive for years and then activate when the
children. Klebsiella species is the most common gram-negative client’s resistance is lowered, as when a client is being treated for
organism found in the hospital setting. Staphylococcus aureus is the cancer. There’s no such thing as tertiary infection, and
most common cause of hospital -acquired pneumonia. superinfection doesn’t apply in this case.

4. Answer: A. Altered mental status and dehydration 12. Answer: B. Chills, fever, night sweats, and hemoptysis
Fever, chills, hemoptysis, dyspnea, cough, a nd pleuritic chest pain Typical signs and symptoms are chills, fever, night sweats, and
are common symptoms of pneumonia, but elderly clients may first hemoptysis. Chest pain may be present from coughing but isn’t
appear with only an altered mental status and dehydration due to a usual. Clients with TB typically have low -grade fevers, not higher
blunted immune response. than 102*F. Nausea, headache, and photophobia aren’t usual TB
symptoms.
5. Answer: A. Bronchial
Chest auscultation reveals bronchial breath sounds ove r areas of 13. Answer: C. Sputum culture
consolidation. Bronchovesicular are normal over midlobe lung The sputum culture for Mycobacterium tuberculosis is the only
regions, tubular sounds are commonly heard over large airways, and method of confirming the diagnosis. Lesions in the lung may not be
vesicular breath sounds are commonly heard in the bases of the lung big enough to be seen on x-ray. Skin tests may be falsely positive or
fields. falsely negative.

6. Answer: D. sputum culture and sensitivit y
Sputum C & S is the best way to identify the organism causing the
pneumonia. Chest x-ray will show the area of lung consolidation. ABG
analysis will determine the extent of hypoxia present due to the
pneumonia, and blood cultures will help determine if the infection is
systemic.
14. Answer: C. To determine the extent of the lesions
If the lesions are large enough, the chest x -ray will show their
presence in the lungs. Sputum culture confirms the diagnosis. There
can be false-positive and false-negative skin test results. A chest x -
ray can’t determine if this is a primary or secondary infection.

7. Answer: C. Oxygen 15. Answer: D. He’s a “tuberculin converter,” which means he has been
The client is having difficulty breathing and is probably becoming infected with TB since his last skin test.
hypoxic. As an emergency measure, the nurse can provide oxygen A tuberculin converter’s skin test will be positive, meaning he has
without waiting for a physician’s order. Antibiotics may be been exposed to an infected with TB and now has a cell -mediated
warranted, but this isn’t a nursing decision. The client should be immune response to the skin test. The client’s blood and x -ray
maintained on bedrest if he is dyspneic to minimize his oxygen results may stay negative. It doesn’t mean the infection has
demands but providing additional will deal more immediately with advanced to the active stage. Because his x -ray is negative, he
his problem. The client will need nutritional support, but while should be monitored every 6 months to see if he develops changes in
dyspneic, he may be unable to spare the energy needed to eat and at his x-ray or pulmonary examination. Being a seroconverter doesn’t
the same time maintain adequate oxygenation. mean the TB has gotten into his bloodstream; it means it can be
detected by a blood test.

8. Answer: D. Vesicular breath sounds in right base 16. Answer: D. 9 to 12 months

If the client still has pneumonia, the breath sounds in the right base Because of the increased incidence of resistant strains of TB, the
will be bronchial, not the normal ves icular breath sounds. If the disease must be treated for up to 24 months in some cases, but
client still has dyspnea, fever, and increased respiratory rate, he treatment typically lasts for 9-12 months. Isoniazid is the most
should be examined by the physician before discharge because he common medication used for the treatment of TB, but other
may have another source of infection or still have pneumonia. antibiotics are added to the regimen to obtain the best results.

9. Answer: C. Negative
This test would be classed as negative. A 5 mm raised area would be
a positive result if a client was HIV+ or had recent close contact with
someone diagnosed with TB. Indeterminate isn’t a term used to
17. Answer: A. Admit him to the hospital in respiratory isolation
The client is showing s/s of active TB and because of a productive
cough is highly contagious. He should be admitted to the hospital,
placed in respiratory isolation, and three sputum cultures should be
obtained to confirm the diagnosis. He would most likely be given

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isoniazi d and two or three other antitubercular antibiotics until the
diagnosis is confirmed, then isolation and treatment would continue
if the cultures were positive for TB. After 7 to 10 days, three more
consecutive sputum cultures will be obtained. If they’re negative, he
would be considered non-contagious and may be sent home, although
he’ll continue to take the antitubercular drugs for 9 to 12 months.
27. Answer: D. Gaseous exchange occurs in the alveolar membrane.
Gaseous exchange occurs in the alveolar membrane, so if the alveoli
collapse, no exchange occurs, Collaps ed alveoli receive oxygen, as
well as other nutrients, from the bloodstream. Collapsed alveoli have
no effect on oxygen demand, though by decreasing the surface area
available for gas exchange, they decrease oxygenation of the blood.

18. Answer: D. Positive acid-fast bacilli in a sputum sample after 2 28. Answer: C. The mask provides pressurized oxygen so the client can
months of treatment. breathe more easily.
Continuing to have acid-fast bacilli in the sputum after 2 months The mask provides pressurized oxygen continuously through both
indicated continued infection. inspiration and expiration. The mask can be set to deliver any
amount of oxygen needed. By providing the client with pressurize d
19. Answer: C. To prevent spread of the disease oxygen, the client has less resistance to overcome in taking his next
The client with active TB is highly contagious until three consecutive breath, making it easier to breathe. Pressurized oxygen delivered at
sputum cultures are negative, so he’s put in respiratory isolatio n in the end of expiration is positive end -expiratory pressure (PEEP), not
the hospital. continuous positive airway pressure.

20. Answer: D. Reduces amount of functional alveolar surface area 29. Answer: D. The accumulation of fluid between the linings of the
Oxygen toxicity causes direct pulmonary trauma, reducing the pleural space.
amount of alveolar surface area available for gaseous exchange, The pleural fluid normally seeps continually into the pleural space
which results in increased carbon dioxide levels and decreased from the capillaries lining the parietal pleura and is reabsorbed by
oxygen uptake. the visceral pleural capillaries and lym phatics. Any condition that
interferes with either the secretion or drainage of this fluid will lead
21. Answer: A Auscultation of breath sounds to a pleural effusion.
Because the client is short of breath, listening to breath sounds is a
good idea. He may need a chest x -ray and an ECG, but a physician 30. Answer: B. Performing thoracentesis
must order these tests. Unless a cardiac source for the client’s pain Performing thoracentesis is used to remove excess pleural fluid. The
is identified, he won’t need an echocardiogram. fluid is then analyzed to determine if it’s transudative or exudative.
Transudates are substances that have passed through a membrane
22. Answer: D. Spontaneous pneumothorax and usually occur in low protein states. Exudates are substances that
A spontaneous pneumothorax occurs when the client’s lung have escaped from blood vessels. They contain an accumulation of
collapses, causing an acute decrease in the amount of functional lung cells and have a high specific gravity and a high lactate
used in oxygenation. The sudden collapse was the cause of his chest dehydrogenase level. Exudates usually occur in response to a
pain and shortness of breath. An asthma attack would show wheezing malignancy, infection, or inflammatory process. A chest tube is
breath sounds, and bronchitis would have rhonchi. Pneumonia would rarely necessary because the amount of fluid typically isn’t large
have bronchial breath sounds over the area of consolidation. enough to warrant such a measure. Pleural effusions can’t drain by
themselves.
23. Answer: C. Chest tube placement
The only way to re-expand the lung is to place a chest tube on the 31. Answer: A. Remove the airway and insert a shorter one.
right side so the air in the pleural space can be removed and the lung If a client gags or coughs after nasopharyngeal airway placement,
re-expanded. the tube may be too long. The nurse should remove it and insert a
shorter one. Simply repositioning the airway won’t solve the
24. Answer: C. Take a chest x-ray problem. The client won’t get used to the tube because it’s the wrong
A chest x-ray will show the area of collapsed lung if pneumothorax size. Suctioning without a nasopharyngeal airway causes trauma to
is present as well as the volume of air in the pleural space. Listening the natural airway.
to breath sounds won’t confirm a diagnosis. An IS is used to
encourage deep breathing. A needle thoracostomy is done only in an 32. Answer: C. Using intermittent suction while withdrawing the
emergency and only by someone trained to do it. catheter.
Intermittent suction should be applied during catheter withdrawal.
25. Answer: C. Percentage of hemoglobin carrying oxygen To prevent hypoxia, suctioning shouldn’t last more than 10 -seconds
The pulse oximeter determines the percentage of hemoglobin at a time. Suction shouldn’t be applied while the catheter is being
carrying oxygen. This doesn’t ensure that the oxygen being carried advanced.
through the bloods tream is actually being taken up by the tissue.
33. Answer: D. Respiratory acidosis
26. Answer: C. Low hemoglobin levels cause reduces oxygen -carrying
capacity 34. Answer: C. ½” to 3/8” 26 or 27G needle.
Hemoglobin carries oxygen to all tissues in the body. If the Intradermal injections like those used in TN skin tests are
hemoglobin level is low, the amount of oxygen -carrying capacity is administered in small volumes (usually 0.5 ml or less) into the outer
also low. More hemoglobin will increase oxygen -carrying capacity skin layers to produce a local effect. A TB syringe with a ½” to 3/8”
and thus increase the total amount of oxygen available in the blood. 26G or 27G needle should be inserted about 1/8” below the epidermis.
If the client has been tachypneic during exertion, or even at rest,
because oxygen demand is higher than the available oxygen con tent, 35. Answer: D. Decreased vital capacity.
then an increase in hemoglobin may decrease the respiratory rate to Reduction in VC is a normal physiologic change in the older adult.
normal levels. Other normal physiologic changes include decreased elastic recoil of

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 KABC – RESPI Q&A

the lungs, fewer functional capillaries in the alveoli, and an increase blood. The client becomes cyanotic because blood is not adequately
is residual volume. oxygenated in the lungs before it enters the peripheral circulation.

36. Answer: D. Ineffective airway clearance related to retained 47. Answer: C. Irritability
secretions. Clients who are experiencing hypoxia characteristically exhibit
Pneumonia is an acute infection of the lung parenchyma. The irritability, restlessness, or anxiety as initial mental status changes.
inflammatory reaction may cause an outpouring of exudate into the As the hypoxia becomes more pronounced, the client may become
alveolar spaces, leading to an ineffective airway clearance related confused and combative. Coma is a late clinical manifestation of
to retained secretions. hypoxia. Apathy and depression are not symptoms of hypoxia.

37. Answer: B. A cough with the expectoration of mucoid sputum
One of the first pulmonary symptoms includes a slight cough with
the expectoration of mucoid sputum.
38. Answer: B. 15 mcg/mL
The therapeutic theophylline blood level range from 10 -20 mcg/mL.
39. Answer: C. Hepatitis B
Isoniazid and rifampin are contraindicated in clients with acute liver
disease or a history of hepatic injury.
40. Answer: B. Carbon dioxide narcosis
Carbon dioxide narcosis is a condition that results from extreme
hypercapnia, with carbon dioxide levels in excess of 70 mm Hg. The
client experiences symptoms such as confusion and tremors, which
may progress to convulsions and possib le coma.
41. Answer: A. Positive
The client with HIV+ status is considered to have positive results on
PPD skin test with an area greater than 5 -mm of induration. The
client with HIV is immunosuppressed, making a smaller area of
induration positive for this t ype of client.
42. Answer: D. High-grade fever
The client with TB usually experiences cough (non -productive or
productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis,
chest discomfort or pain, chills and sweats (which may occur at
night), and a low-grade fever.
48. Answer: D. Provide fluid intake of 3 L/day
A fluid intake of at least 3 L/day should be provided to replace any
fluid loss occurring as a result the fever and diaphoresis; this is a
high-priority intervention.
49. Answer: B. The ability to perform ADL’s without dyspnea
An expected outcome for a client recovering from pneumonia would
be the ability to perform ADL’s without experiencing dyspnea. A
respiratory rate of 25 to 30 breaths/minute indicates the client is
experiencing tachypnea, which would not be expected on reco very.
A weight loss of 5-10 pounds is undesirable; the expected outcome
would be to maintain normal weight. A client who is recovering from
pneumonia should experience decreased or no chest pain.
50. Answer: A. Weight loss
TB typically produces anorexia and w eight loss. Other signs and
symptoms may include fatigue, low -grade fever, and night sweats.
51. Answer: B. Acid-fast staining
The most commonly used technique to identify tubercle bacilli is
acid-fast staining. The bacilli have a waxy surface, which makes them
difficult to stain in the lab. However, once they are stained, the stain
is resistant to removal, even with acids. Therefore, tubercle bacilli
are often called acid-fast bacilli.
52. Answer: A. Streptomycin
Streptomycin is an aminoglycoside, and eight cr anial nerve damage
(ototoxicity) is a common side effect from aminoglycosides.

43. Answer: A. Meats and citrus fruits 53. Answer: A. Vertigo

The nurse teaches the client with TB to increase intake of protein, The eighth cranial nerve is the vestibulocochlear nerve, which is
iron, and vitamin C. responsible for hearing and equilibrium. Streptomycin can damage
this nerve.
44. Answer: A, C, E.
A respiratory assessment, which includes auscultating breath sounds 54. Answer: D. 76-year-old grandmother
and assessing the color of the n ail beds, is a priority for clients with Elderly persons are believed to be at higher risk for contracting TB
pneumonia. Assessing for the presence of chest pain is also an because of decreased immunocompetence. Other high -risk
important respiratory assessment as chest pain can interfere with populations in the US include the urban poor, AIDS, and minority
the client’s ability to breathe deeply. Auscultating bowel sounds and groups.
assessing for peripheral edema may be appropriate assessments, but
these are not priority assessments for the patient with pneumonia. 55. Answer: B, D, E.

45. Answer: C. Frequent linen changes
Frequent linen changes are appropriate for this client because of
diaphoresis. Diaphoresis produces general discomfort. The client
should be kept dry to promote comfort. Position changes need to be
done every 2 hours. Nasotracheal suctioning is not indicated with
the client’s productive cough. Frequent offering of a bedpan is not
indicated by the data provided in this scenario.
46. Answer: D. Decreased oxygenation of the blood.
A client with pneumonia has less lung surface available for the
diffusion of gases because of the inflammatory pulmonary response
that creates lung exudate and results in reduced oxyg enation of the
56. Answer: B. Had contact with Mycobacterium tuberculosis
A positive PPD test indicates that the client has been exposed to
tubercle bacilli. Exposure does not necessarily mean that active
disease exists.
57. Answer: B. Supplement the diet with pyridoxine (vitamin B6)
INH competes with the available vitamin B6 in the body and leaves
the client at risk for development of neuropathies related to vitamin
deficiency. Supplemental vitamin B6 is routinely prescribed.
58. Answer: D. Limit alcohol intake
INH and rifampin are hepatotoxic dr ugs. Clients should be warned to
limit intake of alcohol during drug therapy. Both drugs should be

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 KABC – RESPI Q&A

taken on an empty stomach. If antacids are needed for GI distress,

they should be taken 1 hour before or 2 hours after these drugs are
administered. Clients should not double the dosage of these drugs
because of their potential toxicity. Clients taking INH should avoid
foods that are rich in tyramine, such as cheese and dairy products,
or they may develop hypertension.

59. Answer: A. Ask the client’s spouse to su pervise the daily

administration of the medications.
Directly observed therapy (DOT) can be implemented with clients
who are not compliant with drug therapy. In DOT, a responsible
person, who may be a family member or a health care provider,
observes the client taking the medication. Visiting the client,
changing the prescription, or threatening the client will not ensure
compliance if the client will not or cannot follow the prescribed
treatment.

60. Answer: A. Mycobacterium Tuberculosis

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