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PULMONARY PRACTICE TEST
1. A type of pressure mode that provides a continuous pressure throughout the entire respiratory
cycle, helping to improve oxygenation in spontaneously breathing patients. This mode can be
used for intubated patients or non-intubated patients via mask. This mode may be used to wean
patients from mechanical ventilation and for nocturnal ventilation via mask for patients with sleep
apnea.
A. Continuous Positive Airway Pressure (CPAP) Mode
B. Assist/Control (A/C) Mode
C. Synchronized Intermittent Mandatory Ventilation (SIMV)
D. Pressure Control Mode
A Rationale: is correct answer
B is incorrect
Rationale: A volume control mode where the ventilator will provide a set tidal volume for a set
rate. If the patient initiates additional breaths above the set rate the ventilator will
provide a tidal volume for those additional breaths (assisted breaths).
C is incorrect
Rationale: A volume control mode where the ventilator will provide a set tidal volume for a set
rate. If the patient initiates additional breaths above the set rate the ventilator will
not provide a tidal volume for those additional breaths (spontaneous breaths).
D is incorrect
Rationale: this mode delivers a set maximum peak inspiratory pressure (PIP). The PIP is the
maximum highest pressure allowed in the ventilator circuit (tubing). This mode does
not deliver a set tidal volume. The tidal volume varies per breath due to lung
compliance and airway resistance. This mode is used for patients that have
developed ARDS, and sedation is usually necessary in this mode.
2. A patient on a ventilator with 5cm of H2O PEEP develops severe hypotension when disconnected
from the ventilator. The nurse realizes that:
A. The patient cannot be removed from the ventilator when PEEP is used.
B. The patient is hypovolemic as a result of the PEEP setting.
C. The patient is anxious about being removed from the ventilator.
D. When the patient is removed from the ventilator and the AMBU is used it causes over
inflation from the AMBU aggressive rates.
A is incorrect
Rationale: The patient can be removed from the ventilator for transport or for suctioning. It
does not matter if PEEP is on or not when being removed from ventilator for
transport or suctioning. Ventilation is provided by AMBU Bag.
B is incorrect
Rationale: PEEP does not have any correlation with hypovolemia.
C is incorrect
Rationale: this is not related to hypotension, anxiety usually causes hypertension.
D is Correct answer.
Rationale: Rationale: Most ventilated patients should have PEEP of at least 5 cm of H2O to prevent the
pressure in the alveoli from dropping to zero at the end of expiration. The nurse can cause auto-PEEP
with over aggressive rates with an air-mask-bag unit (AMBU). Rapid rates are used to bag the patient
instead of the rate that was set on the ventilator. The patient might become hypotensive with the built up
pressure in the lungs from "auto-PEEP". Treatment would involve disconnecting the patient from the
AMBU or ventilator for a few seconds; this would allow the excess pressure to dissipate.
3. The nurse is caring for a patient with non-cardiogenic pulmonary edema. The nurse should notify
the physician if the patient develops which of the following?
A. Heart rate 124 bpm
B. 3+ pulses in the lower extremities
C. B/P 152/88
D. PCWP > 30 mm Hg
A is incorrect
Rationale: this is an s/s of NCPE, the questions states patient already has NCPE
B is incorrect
Rationale: fluid overload may be present but not the best answer because an increase in PCWP is more
indicative of developing CPE
C is incorrect
Rationale: this is an s/s of NCPE, the question states patient already has NCPE
D is correct answer
Rationale: Rationale: The patient with non-cardiogenic pulmonary edema will develop tachycardia,
hypertension, bounding pulses, and a drop in PCWP. If the patient’s PCWP increases, the
physician should be notified because this could indicate the development of cardiogenic
pulmonary edema where the PCWP > 18 mmHg.
4. A type of ventilator breath that the patient can initiate but the ventilator will still control volume or
pressure delivered. (Depending on Volume modes or Pressure modes) The ventilator will also
control when expiration starts after inspiration that was initiated by the patient.
A. Spontaneous Breath
B. Mandatory Breath
C. Assisted Breath
D. Apnea
A is incorrect
Rationale: breaths are controlled entirely by patient
B is incorrect
Rationale: breaths are controlled entirely by ventilator
C is correct answer
Rationale: patient initiates the breath but the ventilator assists with the breathing cycle (volume,
support and expiration cycle).
D is incorrect
Rationale: this is absence of breathing
5. A type of ventilator breath that the patient initiates and controls the entire respiratory cycle. With
these types of breaths the patient controls inspiratory, expiratory, volume and pressure.
A. Assisted Breath
B. Spontaneous Breath
C. Mandatory Breath
D. PEEP
A is incorrect
Rationale: this ventilator breath the patient initiates but the ventilator will still control either
volume or pressure and when expiration cycle will begin
B is correct answer
Rationale: this breath is initiated and controlled by the patient. these types of breaths are used
in weaning modes (CPAP) and in SIMV modes.
C is incorrect
Rationale: Mandatory Breath is controlled entirely by the ventilator
D is incorrect
Rationale: PEEP is a setting on the ventilator for continuous pressure at end expiration and
not a ventilator breath type
6. A nurse is caring for an older adult client who is physically frail and who has been in bed for more
than a week. Which of the following clinical manifestations indicates to the nurse that the client is
developing pneumonia?
A. Chills
B. Cough
C. Confusion
D. Chest pain
A is incorrect
Rationale: Often with pneumonia, older adults do not have chills and fever but instead have
fatigue, weakness, lethargy, and anorexia.
B is incorrect
Rationale: Often with pneumonia, older adults do not cough but instead have fatigue,
weakness, lethargy, and anorexia.
C is correct answer
Rationale: The most common clinical indication of pneumonia in older adult clients is confusion
as a result of hypoxia. Often with pneumonia, they do not have chills, fever, coughing, and chest
pain, but instead have fatigue, weakness, lethargy, and anorexia.
D is incorrect
Rationale: Often with pneumonia, older adults do not have chest pain but instead have fatigue,
weakness, lethargy, and anorexia.
7. A nurse is caring for a child with a suspected diagnosis of cystic fibrosis. Which of the following
diagnostic tests will the nurse prepare the child for to confirm the diagnosis?
A. Sweat chloride test
B. A sputum culture
C. A stool fat content analysis
D. Pulmonary function test
A is correct answer
Rationale: Clients with cystic fibrosis have an increase of sodium and chloride in both saliva
and sweat. Therefore, a sweat chloride test is a definitive diagnostic test to determine the
diagnosis of cystic fibrosis.
B is incorrect
Rationale: A sputum culture will determine the organism infecting the lungs. However, it is not
a diagnostic test to determine the diagnosis of cystic fibrosis.
C is incorrect
Rationale: A stool fat content analysis will determine the amount of fat within a stool. However,
it is not the best diagnostic test to determine the diagnosis of cystic fibrosis.
D is incorrect
Rationale: Pulmonary function tests will determine the lung capability. However, it is not a
diagnostic test to determine the diagnosis of cystic fibrosis.
8. A nurse is caring for a client who has an acute respiratory illness. The nurse should monitor the
client for which of the following manifestations of impending airway obstruction. (Select all that
apply.)
A. Tachycardia
B. Nausea
C. Retractions
D. Muscle tremors
E. Restlessness
A, C & E are correct
Rationale: Tachycardia is correct. Increases in pulse and respiratory rates are indications of impending
airway obstruction. Nausea is incorrect. Gastrointestinal upset is not an indication of impending airway
obstruction. Retractions are correct. Substernal, suprasternal, and intercostal retractions and
flaring nares are indications of impending airway obstruction. Muscle tremors are incorrect. Muscle
tremors are not an indication of impending airway obstruction. Restlessness is correct. Restlessness is an
indication of impending airway obstruction.
9. A ventilator setting for the percentage of oxygen in the air delivered to the patient. This setting is
adjusted on the ventilator to maintain a saturation of oxygen level of >90%. If this setting is
adjusted to higher than 60% for longer than 24hrs on the ventilator, the patient is at risk for
oxygen toxicity and other strategies must be implemented.
A. FiO2%
B. Rate (f)
C. Tidal Volume (Vt)
D. Assist Control (A/C)
D is incorrect
Rationale: this is a volume controlled mode, not a setting
10. During the assessment of a patient with a respiratory disorder, the nurse observes lower
extremity edema. This finding is important in respiratory disorders because:
A. It will indicate the patient’s ability to ambulate.
B. Edema indicates the amount of fluid the patient can tolerate.
C. Edema indicates heart failure, a common finding in a patient with COPD.
D. It aids in determining if the patient will need assistance with activities of daily living.
Rationale: Rationale: Edema of the lower extremities is generally related to right heart or congestive
heart failure. Right heart failure and combined left and right sided failure are common in patients with
COPD. Right sided failure is caused by pulmonary hypertension. Chronic distention of the lower airways
makes forward blood flow more difficult. The right heart hypertrophies in an attempt to increase force of
blood through the pulmonary tree. The right heart fails and fluid unable to be accommodated is
sequestered in dependent interstitial spaces and causes edema.
11. A nurse is caring for a group of clients in an infectious disease unit. The nurse should wear an
OSHA approved N95 respirator mask when caring for a client with which of the following
infectious diseases?
A. Pertussis
B. Mycoplasmal pneumonia
C. Tuberculosis
D. Respiratory syncytial virus
A is incorrect
Rationale: Pertussis is transmitted by large droplets and does not require the use of an
individually fitted N95 respirator mask. The nurse should wear a fluid resistant surgical mask when caring
for a client who has Pertussis.
B is incorrect
Rationale: Mycoplasmal pneumonia is transmitted by large droplets and does not require the use of an
N95 respirator mask. The nurse should wear a fluid resistant surgical mask when caring for a client who
has mycoplasmal pneumonia.
C is correct answer
Rationale: Tuberculosis is transmitted by small droplets and requires the nurse to wear an individually
fitted N95 respirator mask when caring for clients who have this disease.
D is incorrect
Rationale: Respiratory syncytial virus is transmitted by large droplets and does not require the use of an
N95 respirator mask. The nurse should wear a fluid resistant surgical mask when caring for a client who is
infected with the respiratory syncytial virus.
12. A nurse is caring for a client who is having difficulty using an incentive spirometer. The nurse
should suggest that the client..
A. start slowly and increase volume over several sessions.
B. do regular deep-breathing exercises instead.
C. use another device because this one is might be faulty.
D. be much more vigorous in increasing increments.
Rationale: The best advice is to have the client should start very slowly and gradually increase the
volume. It also helps to take several slow, deep breaths in between spirometer inhalations.
B is incorrect.
Rationale: Other deep breathing exercises are important, but they should not replace spirometer use.
They can help enhance it.
C is incorrect
Rationale: Unless the device is obviously damaged or does not work at all, not even minimally, there is
no reason to suspect that it is faulty.
D is incorrect
Rationale: Increasing vigor increases fatigue and might further discourage the client from using
the spirometer.
13. A volume control mode where the ventilator will provide a set tidal volume for a set rate. If the
patient initiates additional breaths above the set rate the ventilator will not provide a tidal volume
for those additional breaths (spontaneous breaths).
A. Pressure Support
B. Assist Control (A/C)
C. Synchronized Intermittent Mandatory Ventilation (SIMV)
D. Pressure Control Mode
C is correct answer
A is incorrect
Rationale: A type of pressure mode that augments or assists spontaneous breathing efforts by delivering
a high flow of gas to a selected pressure level early in inspiration (to overcome tube resistance) and
maintains this pressure level throughout the inspiratory phase. By meeting the patient's inspiratory flow
demand throughout the inspiratory phase, patient effort is reduced and comfort is increased. This mode
can also be used in combination with other modes and used as a weaning technique.
B is incorrect
Rationale: A type of volume control mode that will provide an assisted breath if the patient initiates a
breath. Each breath taken whether initiated by the patient or not will have the pre-set tidal volume
delivered. (breaths are mandatory or assisted).
D is incorrect
Rationale: In this ventilator mode a selected gas pressure is delivered to the patient and sustained
throughout the phase of ventilation. This mode does not have a set tidal volume. When the ventilator
delivers a breath, it continues delivering the volume until the pre-set pressure limit is reached. When this
mode of ventilation is used the tidal volume with each breath varies due to lung compliance.
14. A ventilator setting that is the pressure that is maintained in the lungs at the end of expiration.
This setting is adjusted to maintain lung compliance by maintaining the alveoli in an open
position.
A. Synchronized Intermittent mandatory Ventilation (SIMV)
B. Assist Control (A/C) Mode
C. Pressure Support
D. Positive End Expiratory Pressure (PEEP)
A is incorrect
Rationale: this is a volume control mode that delivers a mandatory breath intermittently with
spontaneous breaths
B is incorrect
Rationale: this is a volume control mode that delivers a set tidal volume with each breath
C is incorrect
Rationale: this setting (or mode) gives a high flow of gas at the beginning of the inspiratory
cycle to overcome tube or airway resistance.
D is correct answer
Rationale: this is a ventilator setting that can be used in all ventilator modes, it increases
oxygenation by opening up alveoli and not allowing them to collapse
15. A patient is over breathing the ventilator at a very high rate, the nurse knows that this may cause
"stacking breaths" and will cause the ventilator to alarm high pressures. The nurse knows this
type of complication is associated most with which ventilator mode?
A. Synchronized Intermittent Mandatory Ventilation (SIMV) with Pressure Support
B. Assist Control Mode (A/C)
C. Continuous Positive Airway Pressure Mode (CPAP)
D. Synchronized Intermittent Mandatory Ventilation
A is incorrect
Rationale: Same as SIMV over breathing is encouraged, but with PS that decreases patient
effort in overcoming tube resistance.
B is correct answer
Rationale: Patient can become hypoxic by attempt to breathe faster, stacking breaths. At high
respiratory rates – air trapping may occur and cause high pressures and the high
pressure to alarm on the ventilator.
C is incorrect
Rationale: The patient sets their own rate, pressure and volumes in this mode. (i.e. All breaths are
spontaneous). If the patient over breaths the ventilator it will not cause air trapping since patient controls
D is incorrect
Rationale: It is desirable for the patient to "over breath" the ventilator in this mode.
16. While caring for a patient on a ventilator, the nurse notes that the patient is experiencing acute
distress with a decrease in oxygen saturation to 82%. The nurse’s initial intervention would be to:
A. Call the respiratory therapist stat to assess the problem.
B. Remove the patient from the ventilator and use the AMBU bag with 100% oxygen.
C. Call the physician stat regarding the patient’s drop in oxygen saturation.
D. Administer a sedative per physician’s orders to reduce the patient’s anxiety.
A is incorrect
Rationale: It is with the scope of the registered nurse to provide this intervention.
B is correct answer
Rationale: Rationale: When the patient is experiencing hypoxia, it is imperative that the nurse remove the
patient from the mechanical ventilator and administer 100 % oxygen until the problem can be detected.
Once the oxygenation returns to an acceptable range the nurse should continue the assessment process.
It is also important that the nurse listen anteriorly and posteriorly in all lung fields. The importance of this
exam cannot be overemphasized. When listening, the nurse should compare right against left lung and
never listen through clothing or other material. The clinician should listen laterally in order to appreciate
certain lung segments that can be heard in this position.
C is incorrect
Rationale: This will take too long, most intubated patients have standing orders to keep sats above 90%.
It is within the scope of practice to ambu bag patient to return saturations to above physician ordered
parameters till other remedies can be initiated by the physician.
D is incorrect
Rationale: This is contraindicated. Patient's oxygenation status is being compromised, sedation is not an
intervention that will help this patient.
17. A patient with community-acquired pneumonia is being discharged. Which of the following should
the nurse include in this patient’s discharge plan of care?
A. Take the prescribed antibiotics until the coughing stops.
B. Limit fluid intake to reduce secretions.
C. Avoid smoking or environments with smoke.
D. Resume normal activity level.
A is incorrect
Rationale: The patient should also be taught about all medications that will be continued at home.
Medications should be taken as directed until the prescribed dose is gone, not only until symptoms
disappear.
B is incorrect.
Rationale: Instructions should include ways to maintain resistance to infection with proper nutrition and
adequate fluid intake. Fluids should be increased to help loosen secretions and encourage a productive
cough.
C is correct answer
Rationale: The incidence of community-acquired pneumonia is highest in winter months, with
smoking being an important risk factor.
D is incorrect
Rationale: The nurse should emphasize the importance of rest and a gradual increase in
activity to avoid fatigue.
18. A nurse is giving a presentation at a community center about chronic bronchitis. Which of the
following should the nurse include as effective for preventing this disorder?
A. Maintenance of ideal weight
B. Annual influenza immunization
C. Smoking cessation
D. Regular moderate exercise
A is incorrect
Rationale: Staying at an ideal weight for height, frame, and gender will help most people maintain
optimal health in general and cope with many chronic illnesses, but it is not a preventive strategy for
chronic bronchitis.
B is incorrect
Rationale: Receiving an annual influenza vaccination is important for clients who have chronic bronchitis,
but it will not prevent the development of chronic bronchitis.
C is correct answer
Rationale: Smoking is a major cause of chronic bronchitis; therefore smoking cessation is an effective
preventive strategy.
D is incorrect
Rationale: Regular moderate exercise is a healthful practice, but it will not prevent the development of
chronic bronchitis.
19. A nurse in the PACU is caring for a client with an ET tube in place and observes the absence of
left-sided chest wall expansion with respirations. This finding indicates which of the following
post-operative complications has occurred?
A. Blockage of the ET tube by the client’s tongue
B. Laryngeal edema
C. Movement of the ET tube into the right main bronchus.
D. Paralysis of the vocal cords
A is incorrect
Rationale: The presence of an ET tube prevents airway obstruction by the client’s tongue.
B is incorrect
Rationale: The ET tube ensures a patent airway when laryngeal edema occurs.
C is correct answer
Rationale: Movement of the ET tube into the right main bronchus is indicated by the absence
of left-sided chest wall movement with respirations.
D is incorrect
Rationale: The ET tube ensures a patent airway when vocal cord paralysis occurs.
20. A nurse is teaching a client who is obese and has obstructive sleep apnea how to decrease the
number of apneic episodes experienced each night. The nurse should recognize that the teaching
has been effective when the client states,
A. "It might help if I tried sleeping only on my back."
B. "I'll sleep better if I take a sleeping pill at night."
C. "I'll get a humidifier to run at my bedside at night."
D. "If I could lose about 50 pounds, I may stop having apneic episodes."
D is correct answer
A is incorrect
Rationale: Hypnotics (sleeping pills) aggravate sleep apnea and may also cause increased
daytime somnolence (sleepiness).
B is incorrect
Rationale: Bedside humidifiers are an effective way to help clients who have thick pulmonary
secretions, not sleep apnea.
C is incorrect
Rationale: Sleep apnea is a disorder in which breathing stops during sleep for at least 10 seconds and
occurs at least five times an hour. Excessive weight is one of the three major risk factors (gender and age
are the other two) associated with sleep apnea, and it is the only one the client can modify. Weight loss
and maintenance are the primary interventions for the cure of sleep apnea.
21. A nurse is caring for a client who has tuberculosis and is about to start taking pyrazinamide
(Tebrazid). The nurse should explain that the client needs which of the following tests regularly
for the duration of this medication therapy?
A. Liver function tests
B. Gallbladder studies.
C. Thyroid function studies
D. Blood glucose levels
A is correct answer
Rationale: Pyrazinamide can cause hepatotoxicity, thus the provider will monitor liver function regularly.
B is incorrect
Rationale: Pyrazinamide does not interfere with gall bladder function, although it can cause splenic
enlargement.
C is incorrect
Rationale: Pyrazinamide does not interfere with thyroid function, although it can cause an increase in
protein-bound iodine.
D is incorrect
Rationale: Pyrazinamide does not interfere with glucose metabolism, although it can elevate serum uric
acid levels.
22. In this ventilator mode a selected gas pressure is delivered to the patient and sustained
throughout the phase of ventilation. This mode does not have a set tidal volume. When the
ventilator delivers a breath, it continues delivering the volume until the pre-set pressure limit is
reached. When this mode of ventilation is used the tidal volume with each breath varies due to
lung compliance.
A. Pressure Controlled Ventilation Modes
B. Assist Control (A/C) Mode
C. CPAP Mode
D. SIMV
A is the correct answer
Rationale: A volume control mode where the ventilator will provide a set tidal volume for a set
rate. If the patient initiates additional breaths above the set rate the ventilator will
provide a tidal volume for those additional breaths (assisted breaths).
B is incorrect
Rationale: A type of pressure mode that provides a continuous pressure throughout the entire
respiratory cycle, helping to improve oxygenation in spontaneously breathing
patients. This mode can be used for intubated patients or non-intubated patients via
mask. This mode may be used to wean patients from mechanical ventilation and for
nocturnal ventilation via mask for patients with sleep apnea.
C is incorrect
Rationale: A volume control mode where the ventilator will provide a set tidal volume for a set
rate. If the patient initiates additional breaths above the set rate the ventilator will
not provide a tidal volume for those additional breaths (spontaneous breaths).
D is incorrect
Rationale: this is a volume control mode that delivers a mandatory breath intermittently with
spontaneous breaths
23. A nurse is caring for a child in status asthmaticus. Which of the following is the priority action for
the nurse to take?
A. Administer a short-acting β2–agonist.
B. Obtain a peak flow reading.
C. Administer a corticosteroid.
D. Start intravenous fluids.
A is correct answer
Rationale: Therapy for status asthmaticus is improving ventilation and decreasing airway resistance.
Therefore, administering a short-acting β2–agonist is the priority action for the nurse to take.
B is incorrect
Rationale: Therapy for status asthmaticus is improving ventilation and decreasing airway resistance.
Therefore, obtaining a peak flow reading is not the priority action for the nurse to take.
C is incorrect
Rationale: Therapy for status asthmaticus is improving ventilation and decreasing airway
resistance. Corticosteroids will assist in decreasing airway resistance but need time to take full effect.
Therefore, administering a corticosteroid is not the priority action for the nurse to take.
D is incorrect
Rationale: Therapy for status asthmaticus is improving ventilation and decreasing airway resistance.
Intravenous fluids are administered to correct dehydration. Therefore, administering intravenous fluids is
not the priority action for the nurse to take.
24. A type of breath that is controlled entirely by the ventilator. Ventilator control includes inspiration,
expiration, volume and/ or pressure of gas delivery.
A. Mandatory Breaths
B. Spontaneous Breaths
C. Pressure Support Breaths
D. Assisted Breaths
Rationale: Spontaneous Breaths are controlled entirely by patient, Pressure Support is a setting on the
ventilator that assists breathing by delivering a high flow of gas to a selected pressure early in inspiration
phase, help with patient to overcome tube resistance and decreases work of breathing. Used in weaning,
Pressure Support can also be used as a standalone mode. Assisted Breaths are a ventilator breath that
the patient initiates but the ventilator will still control either volume or pressure and when expiration cycle
will begin.
25. A patient, admitted with respiratory failure, develops ARDS and requires intubation. Which of the
following clinical manifestations are usually consistent with this stage of ARDS?
A. Chest x-ray showing absence of infiltrates
B. Temperature of 99˚ F
C. Arterial blood gases showing respiratory acidosis
D. B/P 124/76 Pulse 86 Respiratory rate 18
A is the correct answer
Rationale: The hypoxemia of a patient with ARDS quickly becomes refractory to standard oxygen
therapies, and the patient requires intubation and mechanical ventilation to maintain oxygenation
and ventilation. The arterial blood gasses frequently demonstrate respiratory acidosis.
Rationale: The chest x-ray exhibits the bilateral patchy infiltrates that are characteristic of the disease
instead of the absence of infiltrates. Patchy infiltrates or “white-out” observed on the chest x-ray can cover
the entire lung field as the disease progresses. A chest x-ray showing absence of infiltrates will be
incorrect for diagnosis ARDS. A temperature maybe associated with an infection that could cause ARDS.
but this is not the best answer. The vital signs are within normal range and will not usually be noted with a
patient who has ARDS.
26. A nurse is providing discharge teaching for a client who has pulmonary edema and is about to
start taking furosemide (Lasix). Which of the following instructions should the nurse include?
A. Take aspirin if headaches develop.
B. Eat foods that contain plenty of potassium.
C. Expect some swelling in the hands and feet.
D. Take the medication at bedtime.
B is correct answer
Rationale: Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. To prevent
this, the client should add potassium-rich foods to his diet.
Rationale: Aspirin and other NSAIDs can increase furosemide’s effects. Acetaminophen
(Tylenol) is a better choice. Furosemide should reduce swelling in the hands and feet. The client should
take furosemide early in the day so that the medication’s action will not disturb his sleep.
27. Number of breaths per minute that is set on the ventilator. This setting is the minimal rate that will
be delivered to the patient. In most modes, the patient will be able to initiate breaths above this
setting.
A. Rate (f)
B. Tidal Volume (Vt)
C. FiO2%
D. PEEP
A is correct answer
Rationale: B is incorrect because this is the total volume of air delivered in one breath. C is incorrect
because this is the percentage of oxygen in the air delivered to the patient. D is incorrect because PEEP
is pressure that is maintained at end of expiration cycle to maintain alveoli in an open position.
28. A nurse is caring for a client who has just developed pulmonary embolism. The nurse should
prepare to administer which of the following medications?
A. Furosemide (Lasix)
B. Dexamethasone (Decadron)
C. Heparin
D. Atropine
A Rationale: Furosemide, a diuretic, treats pulmonary edema, not pulmonary embolism.
B Rationale: Dexamethasone, a glucocorticoid, treats a wide variety of disorders, including
inflammatory bowel disease and cerebral edema, but not pulmonary emboli.
C (correct answer ) Rationale: Heparin acts rapidly to prevent extension of emboli and the formation of
more thrombi.
D Rationale: Atropine, an anticholinergic, treats bradycardia, not pulmonary embolism.
29. A nurse is caring for a client who has just returned from the surgical suite following a
thoracotomy. Which of the following postoperative interventions should the nurse give highest
priority to?
A. Administer oxygen by mask via nasal cannula at 6 L/min.
B. Monitor urinary output via Foley catheter every 2 hr.
C. Assess chest tube drainage hourly.
D. Maintain intravenous of D5 1/2 Normal Saline at 125 mL/hr.
A (correct answer) Rationale: According to the ABC priority-setting framework, the postoperative
surgical client may need supplemental oxygen in order to maintain normal blood oxygen levels.
B Rationale: While this is an appropriate intervention, there is another intervention that would take
priority.
C Rationale: While this is an appropriate intervention, there is another intervention that would take
priority.
D Rationale: While this is an appropriate intervention, there is another intervention that would take
priority.
30. A nurse is teaching a client how to use a metered-dose inhaler (MDI). Identify the sequence the
client should follow. (Move the steps into the box on the right, placing them in the selected order
of performance. Use all steps.)
A.
B.
C.
D.
E.
F.
Place her lips firmly around the mouthpiece
Exhale slowly through pursed lips.
Inhale deeply and then exhale completely.
Hold her breath for 10 seconds.
Breathe in slowly over 2 to 3 seconds while pushing down on the canister.
Wait 30 to 60 seconds between each puff.
This is correct order:
Inhale deeply and then exhale completely.
Place her lips firmly around the mouthpiece.
Breathe in slowly over 2 to 3 seconds while pushing down on the canister.
Hold her breath for 10 seconds.
Exhale slowly through pursed lips.
Wait 30 to 60 seconds between each puff.
31. The amount of air delivered with each breath. This is a ventilator setting in volume control modes.
A. Rate (r)
B. PEEP
C. Tidal Volume (Vt)
D. FiO2
32. A nurse is monitoring a client who has just had a thoracentesis to remove pleural fluid. Which of
the following, clinical manifestations indicates a complication that requires notifying the provider
immediately?
A. Serosanguineous drainage from the puncture site
B. Discomfort at the puncture site
C. Increased heart rate
D. Decreased temperature
33. A nurse is preparing to suction a client who has a tracheostomy. (Identify the sequence of actions
the nurse should take after hand washing and place in the correct order of performance. All
actions are to be used.)
A.
B.
C.
D.
E.
F.
E.
Adjust the suction to 100 to 150 mm Hg.
Assess for secretion clearance
Don sterile gloves.
Check function of suction catheter.
Insert the catheter without suction.
Hyperoxygenate client.
Assess for secretion clearance
.
34. A type of pressure mode that augments or assists spontaneous breathing efforts by delivering a
high flow of gas to a selected pressure level early in inspiration (to overcome tube resistance) and
maintains this pressure level throughout the inspiratory phase. By meeting the patient's
inspiratory flow demand throughout the inspiratory phase, patient effort is reduced and comfort is
increased. This mode can also be used in combination with other modes and used as a weaning
technique.
A. Pressure Control Ventilation Mode (PCV)
B. Pressure Support Mode (PSM)
C. Assist Control Mode (A/C)
D. Synchronized Intermittent Mandatory Ventilation (SIMV)
35. A nurse is teaching a client who has emphysema about self-management strategies. Which of the
following client statements indicates that the client understands the instructions?
A. “I will inhale slowly through pursed lips to help me breathe better.”
B. “I will drink a total of 2 quarts of fluid every day.”
C. “I will follow a daily diet high in calories and protein.”
D. “I will lie on my stomach to practice abdominal breathing every day.”
C is the correct answer
Rationale: Clients who have emphysema have greater-than-usual nutritional requirements for
calories and protein and often need nutritional supplements between meals. Weight
loss and malnutrition are common in these clients.
Rationale: The client should first inhale slowly through the nose, then exhale slowly through
pursed lips. Clients with emphysema should drink 2 to 3 L (quarts) of fluid per day unless contraindicated.
Fluids help liquefy secretions and facilitate their expectoration. The client should practice abdominal
(diaphragmatic) breathing exercises daily while lying on his back with his knees flexed. The client should
focus on using the diaphragm to achieve maximum inhalation and to slow the respiratory rate.
36. The nurse is providing care to a patient who has a new tracheostomy due to neck cancer. Which
of the following should be included in this patient’s plan of care?
A. Provide tracheostomy care every 24 hours.
B. Change tracheostomy ties every 4 hours.
C. Provide inner cannula care every day.
D. Secure the tube ties laterally to the chest with suspended ties.
A Rationale: The tracheostomy site should be cleaned on a regular basis, such as every eight
hours, and more frequently as needed to remove crusts and secretions that could obstruct the airway.
B Rationale: The ties should be changed every day or when soiled to decrease the possibility of
infection.
C Rationale: If the tracheostomy tube has an inner cannula, it should be changed if disposable or
cleaned when every tie tracheostomy care is done.
D (correct answer) Rationale: Nursing interventions include securing the airway with the appropriate ties
in order to prevent the possibility of the tube being dislodged or accidentally removed. The tracheostomy
tube ties should be secured to the chest laterally with suspended ties. Circumferential ties can place
pressure on the incision lines or reconstruction flaps or grafts.
37. A type of volume control mode where the ventilator will provide a set tidal volume for a set rate. If
the patient initiates additional breaths above the set rate the ventilator will provide a tidal volume
for those additional breaths (assisted breaths).
A. Pressure Control Ventilation
B. Assist Control (A/C) Mode
C. Continuous Positive Expiratory Pressure (CPAP) Mode
D. Synchronized Intermittent Mandatory Ventilation (SIMV) Mode
B is correct answer
A Rationale: In this ventilator mode a selected gas pressure is delivered to the patient and
sustained throughout the phase of ventilation. This mode does not have a set tidal
volume. When the ventilator delivers a breath, it continues delivering the volume
until the pre-set pressure limit is reached. When this mode of ventilation is used the
tidal volume with each breath varies due to lung compliance.
C Rationale: A type of pressure mode that provides a continuous pressure throughout the entire
respiratory cycle, helping to improve oxygenation in spontaneously breathing
patients. This mode can be used for intubated patients or non-intubated patients via
mask. This mode may be used to wean patients from mechanical ventilation and for
nocturnal ventilation via mask for patients with sleep apnea.
D Rationale: A volume control mode where the ventilator will provide a set tidal volume for a set
rate. If the patient initiates additional breaths above the set rate the ventilator will
not provide a tidal volume for those additional breaths (spontaneous breaths).
38. A patient is admitted with asbestosis. Which of the following should be included in the
assessment of this patient?
A.
B.
C.
D.
Location of home and surrounding industrial community.
Current place of employment
Place of employment(s) 10 to 20 years prior to current admission.
Employment with roofing materials.
Rationale: this is straight out of book and power point. Asbestos lung problems show up several
years later or are latent for a time.
39. Upon auscultation of the chest, the new nurse reports to the preceptor what is heard. Which
statement should the preceptor be most concerned?
A.
B.
C.
D.
“I heard crackles earlier, but now I am not able to hear anything.”
“I hear wheezing in the right lobes, but clear on the left lobes.”
“There are course breath sounds that clear with coughing.”
“The client was clear, but now there are scattered wheezes bilaterally.”
Rationale: hearing crackles then nothing indicated absent breath sounds which indicate no air
movement and would be the priority.
40. Capnography would most likely be used in which of the following situations?
A. A client in intensive care that has just been extubated.
B. A client in the emergency department that arrives with circumoral cyanosis.
C. A client with a history of chronic obstructive pulmonary disease that is admitted for difficulty
breathing.
D. An ambulance arrives with a client found unresponsive at home and was just intubated
with an Endotracheal Tube.
Capnography is used for ET tube placement check for newly intubated patients.