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RESPIRATORY ASSESSMENT

NAME:_____________________________________________ SECTION_________ DATE:____________

INSTRUCTION: Please answer directly on the paper by encircling your answer using a pen with black ink.

1. Normal breathing depends partly upon the ability of lung tissue to stretch and recoil. Another
important factor is:
A) negative intrapleural pressure.
B) positive intrapleural pressure.
C) absence of intrapulmonic pressure.
D) equal intrapleural and intrapulmonic pressures.

2. The normal volume of air inspired and expired is called:

A) tidal volume.
B) inspiratory reserve volume.
C) total lung capacity.
D) vital capacity.

3. The respiratory control center is located in the:

A) medulla and pons.
B) hypothalamus.
C) cerebellum.
D) pituitary.

4. Which of the following clients should be watched most closely for a problem with the transport of
oxygen from the lungs to the tissues?
A) a client who has anemia
B) a client who has an infection
C) a client who has a broken rib
D) a client who has a tumor of the medulla

5. A normal respiratory rate for the average adult is:

A) 8 to 14 per minute.
B) 12 to 18 per minute.
C) 20 to 40 per minute.
D) 30 to 80 per minute.

6. A client has dyspnea when lying down and must assume an upright or sitting position in order to
breathe more comfortably and effectively. The nurse should chart this condition as:
A) dyspnea.
B) hyperpnea.
C) orthopnea.
D) acapnea.

7. The term that refers specifically to reduced oxygen in the blood is:
A) hypoxia.
B) hypoxemia.
C) cyanosis.
D) eupnea.

8. A 72-year-old client with chronic obstructive pulmonary disease lived for many years in San
Francisco, California (near sea level). When he moved to Denver, Colorado (one mile above sea
level), he experienced exacerbation of his disease and was admitted to the emergency room for
treatment. A logical explanation is that the client is reacting to:
A) the lower oxygen and barometric pressure in Denver.
B) anxiety related to crowded living conditions in the city.
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C) the higher concentration of oxygen found at high altitudes.

D) the atmospheric differences in the heavy, cold air in Denver and the warmer air in San Francisco.

9. The intensive-care nurse has had to suction the tracheostomy tube of a 70-year-old client with
emphysema every hour for thick, tenacious secretions. His respiratory rate is 34 per minute. On
auscultation of his lungs, the nurse notes crackles, wheezes, and coarse sounds over the bronchi.
The client seems very tired and has only a weak cough. Based on this data, the most appropriate
nursing diagnosis for this client is:
A) ineffective breathing pattern related to fatigue and pain.
B) ineffective airway clearance related to excessive, thick tracheobronchial secretions.
C) sleep pattern disturbance related to dyspnea and fatigue.
D) powerlessness related to inability to maintain independence associated with COPD.

10. For a client with a nursing diagnosis of ineffective airway related to tracheobronchial obstruction, an
essential outcome criteria to include in the care plan is:
A) clear breath sounds bilaterally.
B) all pulses palpable and strong.
C) normal arterial blood gases.
D) performs activities of daily living without shortness of breath.

11. A client has a nursing diagnosis of ineffective airway clearance related to inadequate chest excursion
and poor cough effort secondary to pain from chest trauma. What is an appropriate nursing order to
help him achieve the outcome of a patent airway?
A) Provide uninterrupted periods of sleep.
B) Encourage and assist with frequent position changes.
C) Assess for cyanosis and clubbing of the fingers.
D) Teach the rationale for his clear liquid diet.

12. A client has a nursing diagnosis of ineffective airway clearance related to inadequate chest excursion
and poor cough effort related to pain secondary to trauma. To best evaluate whether he has
achieved the outcome of a patent airway, the nurse should:
A) examine his fingers for cyanosis and clubbing.
B) assess his level of anxiety.
C) measure his respiratory excursion.
D) auscultate his lungs.

13. Which of the following is a sterile procedure?

A) pulmonary function tests
B) bronchoscopy
C) chest X-ray
D) lung scan

14. Which intervention strengthens respiratory and abdominal muscles and promotes gaseous
exchange by inflating the lungs?
A) IPPB treatments
B) coughing exercises
C) breathing exercises
D) percussion and vibration
15. When instructing a client about pursed-lip breathing, the nurse should tell the client to inhale:
A) through the nose and exhale through pursed lips.
B) through the mouth and exhale through pursed lips.
C) and exhale through pursed lips.
D) through pursed lips and exhale through the nose.

16. Which of the following would indicate that a client with a nursing diagnosis of Ineffective Breathing
Pattern is achieving the goal of establishing a normal, effective respiratory pattern?
A) He has an effective cough effort.
B) His intake is 2000 ml/day of fluids.
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C) He breathes without use of accessory muscles.

D) He has a respiratory rate of 30 to 40 per minute.

17. When a client is receiving oxygen therapy through a nasal cannula delivery system, the nursing care
must include:
A) removing the cannula when the client is eating or drinking.
B) assuring that the rebreather bag does not totally deflate.
C) checking the color code on the cannula to determine the precise oxygen concentration.
D) inspecting the nares for encrustation and irritation.

18. Which of the following is an appropriate safety precaution to observe with the use of oxygen
therapy?
A) Use woolen or synthetic blankets on the bed.
B) Be sure that electric monitoring equipment is grounded.
C) Keep a fire extinguisher by the bedside.
D) Clean the equipment and tubing with alcohol daily.

19. When suctioning a client with a tracheostomy, the purpose of using an unsterile glove is to:
A) prevent the transmission of microorganisms to the nurse.
B) prevent the transmission of microorganisms to the client.
C) attach the catheter to suction.
D) keep the suction catheter clean.

20. A client has a very shallow breathing pattern that is interrupted by periods of apnea. The nurse
should chart this as:
A) Cheyne-Stokes respirations.
B) Kussmaul's respirations.
C) Biot's breathing.
D) Apneustic breathing.

21. The proper position for a chest tube drainage system is:
A) at the level of the client's right atrium.
B) below the level of the client's chest.
C) just above the level of the client's chest.
D) at the level of the client's diaphragm.

22. During the nursing assessment of a client the nurse notes the anteroposterior diameter of the chest
is two times smaller that its transverse diameter. The nurse documents this finding as a:
A) pigeon chest.
B) funnel chest.
C) barrel chest.
D) pectus carinatum.

23. What is a nursing intervention to maintain normal respiratory function for a client who is receiving
narcotics for pain management?
A) Position legs in elevated position.
B) Maintain the head of bed in semi-Fowler's position.
C) Make frequent position changes.
D) Reduce fluid intake.

24. What equipment should a nurse ensure is at the bedside of a client with a chest tube?
A) crash cart
B) rubber-tipped clamps and sterile occlusive dressing
C) endotracheal tube and suction equipment
D) partial rebreather oxygen mask

25. The nurse is caring for a premature infant in the neonatal intensive-care unit. Which of the following
actions would be most appropriate in regards to this infant's respiratory status?
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A) Contact the physician if the infants breathing rate is between 40 and 80.
B) Be concerned if the infant starts to breath with the diaphragm.
C) Assess for potential respiratory distress syndrome.
D) Assess every hour for potential for sudden infant death.

26. A client with emphysema is admitted an exacerbation of the disease. Which of the following would
be appropriate for the nurse to do to support his respiratory status?
A) Call the physician for an order for high volume oxygen.
B) Call the physician for an order for low volume oxygen.
C) Make sure the client maintains a fluid restriction.
D) Keep the client on bed rest.

27. A client learns about the findings from a diagnostic test and later complains of being dizzy and
having tingling of her fingers and around her mouth. Which of the following should the nurse do to
help this client?
A) Coach the client to take slow breaths.
B) Coach the client to breath faster.
C) Nothing.
D) Call the physician.

28. During the assessment of a client's skin, the nurse concludes the client has had chronic hypoxia.
Which of the following findings would provide that information to the nurse?
A) good skin turgor
B) lung sounds clear upon auscultation
C) urine appears cloudy
D) clubbed nails

29. The nurse is instructing a client on pursed lip breathing. Which of the following would be beneficial
for the nurse to include?
A) Instruct the client to place their lips like they are going to suck on a straw.
B) Instruct the client to tighten their abdominal muscles while exhaling.
C) Instruct the client that this is the only way they should breath.
D) Instruct the client to do this only while laying down in bed.

30. A client is having difficulty sleeping because of constant coughing. Which of the following would
help this client?
A) Call the physician to obtain an order for a bronchodilator.
B) Call the physician to obtain an order for Guaifenesin.
C) Call the physician to obtain an order for codeine.
D) Give the client a cup of water.

31. A client with a tracheostomy is prescribed endotracheal suctioning as needed. This client has a
history of cardiac dysrhythmias and hospital acquired infections. What should the nurse do to help
this client?
A) Only suction once a day.
B) Hyperinflate the client's lungs before suctioning.
C) Administer a dose of an antibiotic before suctioning.
D) Use clean technique when suctioning.

32. The nurse is planning for oxygen to be delivered to a client receiving home care. Which are the
major modes of oxygen delivery in the home? Select all that apply (3 ANSWERS)
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A) red tanks
B) green tanks
C) frozen oxygen
D) liquid oxygen
E) oxygen concentrator

33. Which of the following measurements are included in the assessment of pulmonary capacity? Select
all that apply (3 ANSWERS)
A) RV
B) ABG
C) EKG
D) FRC
E) MV

34. Respiratory assessment is a very important component of the physical assessment process because:
A) Other system dysfunction may be identified.
B) Potential problems caused by genetic predisposition may be identified.
C) Early dysfunction of the respiratory system may be identified.
D) All of the above.

35. Pulmonary ventilation is the exchange of oxygen and carbon dioxide:

A) Between the alveoli and the blood through the alveolar-capillary membrane.
B) Between the lungs and the atmosphere through the naso- and oropharynx.
C) Between the systemic capillaries and the tissue at the cellular level.
D) Within the cell membrane.

36. Which structure covers the lung?

A) Visceral pleura
B) Parietal pleura
C) Carina
D) Hilum

37. The functional unit of the lung where oxygen and carbon dioxide gas exchange occurs is the:
A) Carina.
B) Laryngopharynx.
C) Alveoli.
D) Bronchioles.

38. The likely outcome of hypoventilation caused by pneumonia is:

A) Respiratory acidosis.
B) Respiratory alkalosis.
C) Metabolic acidosis.
D) Metabolic alkalosis.

39. For a person with normal respiratory function, which chemical has the greatest impact on
respiration?
A) Oxygen
B) Carbon dioxide
C) Hydrogen
D) Lactic acid

40. When suctioning a newborn, which area should be suctioned first?

A) Mouth.
B) Nose.
C) It doesn't matter which area is suctioned first.
D) Infants should not be suctioned.
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41. Infant respiratory rhythm is often irregular with brief periods of apnea. Further evaluation of the
infant's respiratory status is indicated if:
A) The apnea lasts for 5 seconds.
B) The apnea exceeds 15 seconds.
C) The infant is sleeping.
D) The infant's color is pink.

42. On auscultation, a patient's breath sounds include high-pitched wheezing, anterior and posterior, in
the upper lobes. Sibilant wheezing is caused by:
A) Fluid accumulated in the airways.
B) Decreased ventilatory effort.
C) Narrowed airways.
D) All of the above.

43. Which of the following assessments of sputum would be of most concern in a 40-year-old smoker
who reports a 20-year history of smoking?
A) Thin gray
B) Thin rust
C) Thick yellow
D) Frothy white

44. Paroxysmal nocturnal dyspnea (PND) usually indicates which of the following conditions?
A) Pneumonia
B) Asthma
C) Croup
D) Congestive heart failure

45. Which of the following respiratory disorders may be genetically linked?

A) Emphysema
B) Tuberculosis
C) Cor pulmonale
D) Pneumonia

46. Which of the following situations may explain why a patient who has recently emigrated to the
United States tests positive for tuberculosis without any indication of active infection?
A) Human immunodeficiency virus (HIV) infection
B) Vaccination with bacilli Calmette-Guérin (BCG)
C) Vaccination with hepatitis B
D) Exposure to varicella

47. The best position to place the patient in to assess the lungs is:
A) Supine.
B) Semi-Fowler's.
C) Fowler's.
D) Side-lying.

48. A respiratory rate of 18 with a tidal volume of 450 may be termed:

A) Eupnea.
B) Dyspnea.
C) Bradypnea.
D) Tachypnea.

49. Which definition best describes Kussmaul's breathing, seen in diabetic ketoacidosis or lactic
acidosis?
A) Progressively increasing, rapid, deep respiration that peaks and then gradually decreases.
B) Rapid and deep respirations.
C) Irregular rate and depth that alternates with periods of apnea.
D) Regular breathing pattern followed by brief periods of apnea.
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50. Pursed-lip breathing is most often seen in patients with which disease process?
A) Asthma
B) Pneumonia
C) COPD
D) Cor pulmonale

51. Clubbing of the nails may indicate:

A) Iron deficiency anemia.
B) Hypoglycemia.
C) Hyperthyroidism.
D) Polycythemia.

52. A patient's chest excursion should be measured to assess for:

A) Complete or partial airway obstruction.
B) Pleural effusion.
C) Pneumothorax.
D) All of the above.

53. On auscultation of the patient's lung fields, crackles that do not clear with coughing are heard
bilaterally at the bases. This assessment is indicative of:
A) Collapsed alveoli popping open.
B) Fluid in the lungs.
C) Rales auscultated at the bases.
D) All of the above.

54. Upon palpation of the patient's rib cage, the nurse notes a crackling sensation like crumpling
cellophane. This indicates:
A) Fluid leaking into the surrounding tissue.
B) Air leaking into the surrounding tissue.
C) Infection of the lung.
D) Cancer in the lung.

55. The nurse asks the patient to repeat saying the number “99” several times as the rib cage is lightly
palpated. The nurse is assessing for:
A) Fremitus.
B) Egophony.
C) Excursion.
D) Crepitus.

56. A major risk factor for developing atelectasis postoperatively is:

A) Smoking.
B) Genetics.
C) Age.
D) Ethnicity.

57. Which of the following is not a warning sign of lung cancer?

A) Blood-streaked sputum
B) Arm pain
C) Recurring pleural effusion
D) Abdominal bloating

58. John Green, age 53, is admitted to the hospital with an acute exacerbation of COPD. Mr. Green
admits dyspnea on exertion (DOE), cough, weight gain, and swollen ankles. Which of these findings
is most frequently associated with respiratory disorders?
A) DOE
B) Cough
C) Weight gain
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D) Swollen ankles

59. Upon inspection, the nurse notes that Mr. Green has a barrel chest. What is the normal
anteroposterior (AP)-to-lateral chest ratio?
A) 1:1
B) 1:2
C) 1:3
D) 1:4

60. Inspection of Mr. Green's chest also reveals a wider costal angle. What is the costal angle for a
healthy adult?
A) 45 degrees
B) 90 degrees
C) 160 degrees
D) 180 degrees

61. The nurse observes that Mr. Green is using his intercostal muscles for breathing. Adult males
normally use which muscles for breathing?
A) Sternocleidomastoid
B) Thoracic
C) Abdominal
D) Cervical

62. Considering Mr. Green's diagnosis of COPD, the nurse assesses for signs and symptoms of hypoxia.
What may alert the nurse to early signs and symptoms of hypoxia?
A) Change in mental status
B) Cyanosis
C) Tachycardia
D) Clubbing

63. While palpating Mr. Green's chest, the nurse assesses his respiratory excursion. What does this
technique assess?
A) Chest movement
B) Breath sounds
C) Lung vibrations
D) Voice sounds

64. The nurse then assesses for tactile fremitus. Which statement best defines tactile fremitus?
A) Palpable vibrations
B) Audible voice sounds
C) Audible breath sounds
D) Palpable chest movement

65. Percussion over healthy lung tissue normally elicits which sound?
A) Tympany
B) Dullness
C) Resonance
D) Hyperresonance

66. Percussion over Mr. Green's lungs is likely to produce which sound?
A) Tympany
B) Dullness
C) Resonance
D) Hyperresonance

67. Stanley Walters, age 74, is admitted to the hospital with aspiration pneumonia of the right middle
lobe. Which approaches will best facilitate assessment of the right middle lobe of the lung?
A) Anterior and lateral
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B) Posterior and lateral

C) Posterior and anterior
D) Superior and inferior

68. When assessing for cyanotic changes, central cyanosis may be distinguished from peripheral
cyanosis. Central cyanosis is best assessed:
A) On the ear lobes.
B) In the nailbeds.
C) In the mucous membranes.
D) On the fingers.

69. The nurse detects crackles when auscultating Mr. Walter's chest. Which statement accurately
characterizes crackles?
A) Crackles are more predominant on inspiration.
B) Crackles are unaffected by coughing.
C) Crackles are heard over the large airways.
D) Crackles occur on inspiration and expiration.

70. The nurse also notes scattered rhonchi when auscultating Mr. Walter's chest. How do rhonchi differ
from crackles?
A) Rhonchi are best heard in the periphery of the lungs.
B) Rhonchi are unaffected by coughing.
C) Rhonchi occur predominantly on inspiration.
D) Rhonchi result from a narrowing of the airways.

71. Because Mr. Walters has pneumonia, the nurse assesses for abnormal voice sounds. Mr. Walters has
clearer transmission of spoken voice sounds. This is an example of which type of voice sound?
A) Bronchophony
B) Whispered pectoriloquy
C) Egophony
D) Stridor

72. Considering that Mr. Walters has consolidation pneumonia, what type of breath sounds would you
expect to auscultate over the affected area?
A) Rales
B) Tracheal
C) Vesicular
D) Bronchial

73. What type of breath sound would you expect to auscultate over most of the lung fields in a healthy
patient?
A) Bronchial
B) Tracheal
C) Vesicular
D) Bronchovesicular

74. Robert Howe, age 67, is admitted with the diagnosis of pleuritis. Auscultation of Mr. Howe's thorax
reveals a pleural friction rub. How can the nurse differentiate this sound from other abnormal
breath sounds?
A) Rubs occur during inspiration and clear with coughing.
B) Rubs occur during expiration and produce a light popping sound.
C) Rubs occur during inspiration and may be heard anywhere.
D) Rubs occur during inspiration and expiration and are unaffected by coughing.

75. Mr. Howe develops a pleural effusion, so a chest tube is inserted. The nurse detects crepitus at the
insertion site. Crepitus is indicative of:
A) Consolidated lung tissue.
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B) Pleural thickening.
C) Air leakage into subcutaneous tissue.
D) Obstructed airway.

76. Which physical assessment technique would be used to determine AP:lateral ratio?
A) Inspection
B) Palpation
C) Percussion
D) Auscultation

77. Which physical assessment technique would be used to identify tactile fremitus?
A) Inspection
B) Palpation
C) Percussion
D) Auscultation

78. Which physical assessment technique would best determine chest excursion?
A) Inspection
B) Palpation
C) Percussion
D) Auscultation

79. Which physical assessment technique would be used to identify egophony?

A) Inspection
B) Palpation
C) Percussion
D) Auscultation

80. Which physical assessment technique would be used to identify dullness?

A) Inspection
B) Palpation
C) Percussion
D) Auscultation

81. Which physical assessment technique would be used to identify a friction rub?
A) Inspection
B) Palpation
C) Percussion
D) Auscultation

82. Which physical assessment technique would be used to identify rhonchi?

A) Inspection
B) Palpation
C) Percussion
D) Auscultation

83. Which physical assessment technique would be used to identify resonance?

A) Inspection
B) Palpation
C) Percussion
D) Auscultation

84. Which physical assessment technique would be used to identify sternal retraction?
A) Inspection
B) Palpation
C) Percussion
D) Auscultation
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85. The respiratory assessment is approached from all of the following standard views, except:
A) Anterior.
B) Posterior.
C) Lateral.
D) Superior.

86. Kathleen Walsh, age 75, is being admitted to the hospital with aspiration pneumonia of the right
middle lobe. Which approach will give you best access to the right middle lobe?
A) Anterior, lateral
B) Posterior, lateral
C) Anterior, posterior
D) Anterior, posterior, lateral

87. Since Ms. Walsh is diagnosed with pneumonia, you assess for abnormal voice sounds. As she says
“ee,” you hear “aa” over the affected lung. What type of abnormal voice sound is this?
A) Bronchophony
B) Egophony
C) Whispered pectoriloquy

88. When auscultating Ms. Walsh's right lung, you hear an extra sound occurring predominantly on
inspiration. This sound is most likely:
A) Crackles.
B) Rhonchi.
C) Wheezes.
D) Rub.

89. Your patient is complaining of right-sided chest pain associated with breathing. You hear a scratchy,
high-pitched extra sound unaffected by coughing. This sound is most likely:
A) Crackles.
B) Rhonchi.
C) Wheezes.
D) Friction rub.

90. If you detect an added sound when auscultating the lungs, what should be your next intervention?
A) Call the doctor.
B) Have the patient take a deep breath.
C) Have the patient cough.
D) Complete your assessment.

91. Joan Cleaver, age 8, reports to the school health office. She had been running around in the
schoolyard and is now having difficulty catching her breath. She has a history of asthma. You listen
to her lungs and hear a high-pitched, musical expiratory sound. This sound is most likely:
A) Crackles.
B) Rhonchi.
C) Wheezes.
D) Friction rub.

92. Mrs. Bowes has brought her 2-year-old son to the emergency room, stating “he's having trouble
breathing.” He was being treated for croup. You hear a high-pitched inspiratory sound over the
trachea. This sound is most likely:
A) Rhonchi.
B) Wheezes.
C) Grunting.
D) Stridor.

93. A cough always indicates respiratory dysfunction.

A) True
B) False
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94. Egophony is an “e” to an “a” change over the affected area.

A) True
B) False

95. Bronchovesicular breath sounds are normally auscultated in the periphery of the lungs.
A) True
B) False

96. The inspiratory and expiratory phases are equal with vesicular sounds.
A) True
B) False