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1. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?

a. Place the end of the chest tube in a container of sterile saline.
b. Apply an occlusive dressing and notify the physician.
c. Clamp the chest tube immediately.
d. Secure the chest tube with tape.

2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza?

a. Septicemia
b. Pneumonia
c. Meningitis
d. Pulmonary edema


3. A female client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:

a. 15 to 60 seconds.
b. 5 to 20 minutes.
c. 30 to 40 minutes.
d. 45 to 60 minutes.


4. Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?

a. Hypoxia
b. Delirium
c. Hyperventilation
d. Semiconsciousness


5. A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

a. pH, 5.0; PaCO2 30 mm Hg
b. pH, 7.40; PaCO2 35 mm Hg
c. pH, 7.35; PaCO2 40 mm Hg
d. pH, 7.25; PaCO2 50 mm Hg

6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience:

a. hyperglycemia and glycosuria.
b. acute adrenocortical insufficiency.
c. GI bleeding.
d. restlessness and seizures.


7. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?

a. Activity intolerance related to fatigue
b. Anxiety related to actual threat to health status
c. Risk for infection related to retained secretions
d. Impaired gas exchange related to airflow obstruction


8. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

a. Simple mask
b. Non-rebreather mask
c. Face tent
d. Nasal cannula


9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure?

a. Immediately before a meal
b. At least 2 hours after a meal
c. When bronchospasms occur
d. When secretions have mobilized


10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client's arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values?

a. Fever
b. Tachypnea
c. Tachycardia
d. Hypotension


11. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is:

a. helping him communicate.
b. keeping his airway patent.
c. encouraging him to perform activities of daily living.
d. preventing him from developing an infection.


12. For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?

a. Restricting fluid intake to 1,000 ml/day
b. Enforcing absolute bed rest
c. Teaching the client how to perform controlled coughing
d. Administering prescribed sedatives regularly and in large amounts


13. The amount of air inspired and expired with each breath is called:

a. tidal volume.
b. residual volume.
c. vital capacity.
d. dead-space volume.


14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He's placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than:

a. 0.21
b. 0.35
c. 0.5
d. 0.7


15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true?

a. A positive reaction indicates that the client has active tuberculosis (TB).
b. A positive reaction indicates that the client has been exposed to the disease.
c. A negative reaction always excludes the diagnosis of TB.
d. The PPD can be read within 12 hours after the injection.


16. Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review?

a. Fluid intake for the last 24 hours
b. Baseline arterial blood gas (ABG) levels
c. Prior outcomes of weaning
d. Electrocardiogram (ECG) results


17. Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?

a. Administer a prescribed decongestant.
b. Instruct the client to breathe into a paper bag.
c. Offer the client fluids frequently.
d. Administer prescribed supplemental oxygen.


18. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?

a. pH
b. Bicarbonate (HCO3-)
c. Partial pressure of arterial oxygen (PaO2)
d. Partial pressure of arterial carbon dioxide (PaCO2)


19. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following interventions will most likely lower the client's arterial blood oxygen saturation?

a. Endotracheal suctioning
b. Encouragement of coughing
c. Use of cooling blanket
d. Incentive spirometry


20. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the plan of care?

a. Measuring and documenting the drainage in the collection chamber
b. Maintaining continuous bubbling in the water-seal chamber
c. Keeping the collection chamber at chest level
d. Stripping the chest tube every hour


21. Nurse Eve 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.


22. A black male client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the:

a. lips.
b. mucous membranes.
c. nail beds.
d. earlobes.


23. A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client's serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range?

a. 1 to 2 mcg/ml
b. 2 to 5 mcg/ml
c. 5 to 10 mcg/ml
d. 10 to 20 mcg/ml


24. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind that:

a. vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.
b. vancomycin may cause irreversible neutropenia.
c. vancomycin should be administered rapidly in a large volume of fluid.
d. vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.

25. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis?

a. Myasthenia gravis
b. Type 1 diabetes mellitus
c. Extreme anxiety
d. Narcotic overdose

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

a. alprazolam (Xanax).
b. propranolol (Inderal)
c. morphine.
d. albuterol (Proventil).


27. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

a. Encouraging the client to drink three glasses of fluid daily
b. Keeping the client in semi-Fowler's position
c. Using a high-flow Venturi mask to deliver oxygen as prescribed
d. Administering a sedative as prescribed


28. Nurse Joana is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

a. It helps prevent early airway collapse.
b. It increases inspiratory muscle strength
c. It decreases use of accessory breathing muscles.
d. It prolongs the inspiratory phase of respiration.


29. A male client who takes theophylline for chronic obstructive pulmonary disease is seen in the urgent care center for respiratory distress. Once the client is stabilized, the nurse begins discharge teaching. The nurse would be especially vigilant to include information about complying with medication therapy if the client's baseline theophylline level was:

a. 10 mcg/mL
b. 12 mcg/mL
c. 15 mcg/mL
d. 18mcg/mL


30. Nurse Kim is caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is appropriate?

a. Do nothing, because this is an expected finding.
b. Immediately clamp the chest tube and notify the physician.
c. Check for an air leak because the bubbling should be intermittent.
d. Increase the suction pressure so that bubbling becomes vigorous.


31. A nurse has assisted a physician with the insertion of a chest tube. The nurse monitors the adult client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?

a. Inform the physician.
b. Continue to monitor the client.
c. Reinforce the occlusive dressing.
d. Encourage the client to deep-breathe.


32. The nurse caring for a male client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:

a. Call the physician.
b. Place the tube in a bottle of sterile water.
c. Immediately replace the chest tube system.
d. Place the sterile dressing over the disconnection site.


33. Nurse Paul is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:

a. Exhale slowly.
b. Stay very still.
c. Inhale and exhale quickly.
d. Perform the Valsalva maneuver.


34. While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged. The initial nursing action is to:

a. Call the physician to reinsert the tube.
b. Grasp the retention sutures to spread the opening.
c. Call the respiratory therapy department to reinsert the tracheotomy.
d. Cover the tracheostomy site with a sterile dressing to prevent infection.


35. A nurse is caring for a male client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?

a. Stridor
b. Occasional pink-tinged sputum
c. A few basilar lung crackles on the right
d. Respiratory rate of 24 breaths/min


36. An emergency room nurse is assessing a female client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

a. A low respiratory
b. Diminished breathe sounds
c. The presence of a barrel chest
d. A sucking sound at the site of injury


37. A nurse is caring for a male client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?

a. Hypocapnia
b. A hyperinflated chest noted on the chest x-ray
c. Increase oxygen saturation with exercise
d. A widened diaphragm noted on the chest x-ray


38. A community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:

a. Dyspnea
b. Chest pain
c. A bloody, productive cough
d. A cough with the expectoration of mucoid sputum


39. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the results of which diagnostic test that will confirm this diagnosis?

a. Bronchoscopy
b. Sputum culture
c. Chest x-ray
d. Tuberculin skin test


40. The nursing instructor asks a nursing student to describe the route of transmission of tuberculosis. The instructor concludes that the student understands this information if the student states that the tuberculosis is transmitted by:

a. Hand and mouth
b. The airborne route
c. The fecal-oral route
d. Blood and body fluids


41. A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:

a. 1 L/min
b. 2 L/min
c. 6 L/min
d. 10 L/min


42. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:

a. Promote oxygen intake.
b. Strengthen the diaphragm.
c. Strengthen the intercostal muscles.
d. Promote carbon dioxide elimination.


43. Nurse Hannah is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen?

a. Limiting fluids
b. Having the clients take three deep breaths
c. Asking the client to split into the collection container
d. Asking the client to obtain the specimen after eating


44. A nurse is caring for a female client after a bronchoscope and biopsy. Which of the following signs, if noted in the client, should be reported immediately to the physicians?

a. Dry cough
b. Hematuria
c. Bronchospasm
d. Blood-streaked sputum


45. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the 
suctioning time to a maximum of:

a. 1 minute
b. 5 seconds
c. 10 seconds
d. 30 seconds


46. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which of the following is the appropriate nursing 

a. Continue to suction.
b. Notify the physician immediately.
c. Stop the procedure and reoxygenate the client.
d. Ensure that the suction is limited to 15 seconds.


47. An unconscious male client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, a normal oxygen level, and an elevated potassium level. These results indicate the presence of:

a. Metabolic acidosis
b. Respiratory acidosis
c. Overcompensated respiratory acidosis
d. Combined respiratory and metabolic acidosis


48. A female client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?

a. Dyspnea
b. Bradypnea
c. Bradycardia
d. Decreased respiratory


49. A nurse teaches a male client about the use of a respiratory inhaler. Which action by the client indicates a need for further teaching?

a. Inhales the mist and quickly exhales
b. Removes the cap and shakes the inhaler well before use
c. Presses the canister down with the finger as he breathes in
d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed


50. A female client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?

a. Administering atropine intravenously
b. Administering small doses of midazolam (Versed)
c. Encouraging additional fluids for the next 24 hours
d. Ensuring the return of the gag reflex before offering food or fluids


51. A nurse is assessing the respiratory status of a male client who has suffered a fractured rib. The nurse would expect to note which of the following?

a. Slow deep respirations
b. Rapid deep respirations
c. Paradoxical respirations
d. Pain, especially with inspiration


52. A female client with chest injury has suffered flail chest. A nurse assesses the client for which most distinctive sign of flail chest?

a. Cyanosis
b. Hypotension
c. Paradoxical chest movement
d. Dyspnea, especially on exhalation


53. A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of:

a. Right pneumothorax
b. Pulmonary embolism
c. Displaced endotracheal tube
d. Acute respiratory distress syndrome


54. A nurse is teaching a male client with chronic respiratory failure how to use a metered-dose inhaler correctly. The nurse instructs the client to:

a. Inhale quickly
b. Inhale through the nose
c. Hold the breath after inhalation
d. Take two inhalations during one breath


55. A nurse is assessing a female client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute respiratory distress syndrome?

a. Bilateral wheezing
b. Inspiratory crackles
c. Intercostal retractions
d. Increased respiratory rate


56. A nurse is taking pulmonary artery catheter measurements of a male client with acute respiratory distress syndrome. The pulmonary capillary wedge pressure reading is 12mm Hg. The nurse interprets that this readings is:

a. High and expected
b. Low and unexpected
c. Normal and expected
d. Uncertain and unexpected


57. A nurse is assessing a male client with chronic airflow limitations and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitations?

a. Emphysema
b. Bronchial asthma
c. Chronic obstructive bronchitis
d. Bronchial asthma and bronchitis


58. A nurse is caring for a female client diagnosed with tuberculosis. Which assessment, if made by the nurse, is inconsistent with the usual clinical presentation of tuberculosis and may indicate the development of a concurrent 

a. Cough
b. High-grade fever
c. Chills and night sweats
d. Anorexia and weight loss


59. A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client's chest wall, the nurse expects to elicit:


a. Resonant sounds.
b. Hyperresonant sounds.
c. Dull sounds.
d. Flat sounds.

60. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

a. The system is functioning normally
b. The client has a pneumothorax.
c. The system has an air leak.
d. The chest tube is obstructed.

61. For a male client with an endotracheal (ET) tube, which nursing action is most essential?
a. Auscultating the lungs for bilateral breath sounds
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


62. The nurse assesses a male client's respiratory status. Which observation indicates that the client is experiencing difficulty breathing?

a. Diaphragmatic breathing
b. Use of accessory muscles
c. Pursed-lip breathing
d. Controlled breathing


63. A female client is undergoing a complete physical examination as a requirement for college. When checking the client's respiratory status, the nurse observes respiratory excursion to help assess:

a. Lung vibrations.
b. Vocal sounds.
c. Breath sounds.
d. Chest movements.


64. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for:

a. Pleural effusion.
b. Pulmonary edema.
c. Atelectasis.
d. Oxygen toxicity

65. A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature?

a. Inflamed lung tissue
b. Sudden onset
c. Responsiveness to penicillin.
d. Elevated white blood cell (WBC) count


66. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client's history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client's respiratory status. Which complication may arise if the client receives a high oxygen concentration?

a. Apnea
b. Anginal pain
c. Respiratory alkalosis
d. Metabolic acidosis


67. After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia?

a. Heightened alertness
b. Increased heart rate
c. Numbness and tingling of the extremities
d. Respiratory depression

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