1.Which value indicates clinical hypoxemia and the need to increase oxygen delivery?

A. Hemoglobin of 22 g/dL
B. PaCO2 of 30 mm Hg
C. PaO2 of 65 mm Hg
D. Oxygen saturation of 88%
C
PaO2 of 65 mm Hg indicates low levels of oxygen in the arterial blood; this is termed hypoxemia.

2.A client with COPD has a physician's prescription stating, "Adjust oxygen to SpO2 at 90% to 92%."
Which nursing action can be delegated to a nursing assistant working under the supervision of an
RN?

A. Adjust the position of the oxygen tubing

B. Assess for signs and symptoms of hypoventilation
C. Change the O2 flow rate to keep SpO2 as prescribed
D. Choose which O2 delivery device should be used for the client
A
The scope of a nursing assistant's work includes positioning of oxygen tubing for client comfort.

3. A client who smokes is being discharged home on oxygen. The client states, "My lungs are already
damaged, so I'm not going to quit smoking." What is the discharge nurse's best response?

A. "You can quit when you are ready."

B. "It's never too late to quit."
C. "Just turn off your oxygen when you smoke."
D. "You are right, the damage has been done. But let's talk about why smoking around oxygen is
dangerous."
D
This is a great opening for the nurse to educate the client about the dangers of smoking in the
presence of oxygen, as well as the benefits of quitting.

4. Which client has the most urgent need for frequent nursing assessment?

A. An older client who was admitted 2 hours ago with emphysema and dyspnea and has a 45-year 2-
pack-per-day smoking history, and is receiving 50% oxygen through a Venturi mask
B. A young client who has had a tracheostomy for 1 week, who is on room air with SpO2 in the upper
90's, who has been receiving antibiotic therapy for 16 hours, and who has foul-smelling drainage on
the tracheostomy ties
C. An older adult client who is anxious to go home with her new tank of oxygen and supply of nasal
cannulas and is being discharged with a new prescription for home oxygen therapy
D. A middle-aged client who was admitted yesterday with pneumonia and is receiving oxygen at 2
L/min through a nasal cannula
A
An older adult client with a long history of smoking and chronic lung disease who is receiving high-
flow oxygen delivery is at elevated risk for respiratory depression owing to the hypoxic drive of
respirations countered by high levels of oxygen. This client must be assessed frequently while
receiving high-flow oxygen.

5. A client has just been admitted to the emergency department and requires high-flow oxygen
therapy after suffering facial burns and smoke inhalation. Which oxygen delivery device should the
nurse use initially?

A. Face tent
B. Venturi mask
C. Nasal cannula
D. Non-rebreather mask
A
A client with smoke inhalation and facial burns who requires high-flow oxygen should initially be
placed on a face tent because this is the only noninvasive high-flow device that will minimize painful
and contaminating contact with burned facial tissue.

6. A (DNR) client has a non-rebreather oxygen mask and breathing appears to be labored. What
does the nurse do first?

A. Ensures that the tubing is patent and that oxygen flow is high
B. Notifies the chaplain and the family member of record
C. Calls the Rapid Response Team and prepares to intubate
D. Comforts the client and confirms that signed DNR orders are in the chart
A
Labored breathing and ultimately suffocation can occur if the reservoir bag kinks, or if the oxygen
source disconnects or is not set to high flow levels.

7. The client is admitted to the hospital for COPD, and the physician requests a nasal cannula at 2
L/min. Within 30 minutes, the client's color improves. What does the nurse continue to monitor that
may require immediate attention?

A. Increasing carbon dioxide levels

B. Decreasing respiratory rate
C. Increasing adventitious breath sounds
D. Increased coughing
B
Respiratory rate and depth should be monitored closely while the client receives oxygen, because
hypoventilation is seen during the first 30 minutes of oxygen therapy in clients with hypoxic drive for
respiration. The client's color will improve (from ashen or gray to pink) because of an increase in
PaO2 level before apnea or respiratory arrest occurs from loss of the hypoxic drive.

8. A client who has experienced a panic attack is being transferred to the medical-surgical ward. The
transfer nurse reports that the client is doing much better after receiving bronchodilators via nebulizer
and a small dose of oral Valium 4 hours ago in the emergency department. Vital signs are stable with
oxygen delivered at 4 L/min via simple facemask. Why is this client at high risk for subsequent
respiratory distress?

A. The client is not being treated for asthma

B. The client has a mental disorder
C. The client received a dose of Valium
D. The client is receiving oxygen at 4 L/min
D
A simple facemask must receive oxygen at a rate of at least 5 L/min to prevent inhalation of exhaled
breath, which has low levels of oxygen and can eventually suffocate the client.

9. A patient has been diagnosed with severe iron deficiency anemia. During physical assessment for
which of the following symptoms would the nurse assess to determine the patient's oxygen status?

A: Increased breathlessness but increased activity tolerance

B: Decreased breathlessness and decreased activity tolerance
C: Increased activity tolerance and decreased breathlessness
D: Decreased activity tolerance and increased breathlessness
D
10. A 6-year-old boy is admitted to the pediatric unit with chills and a fever of 104°F (40°C). What
physiological process explains why the child is at risk for developing dyspnea?

A: Fever increases metabolic demands, requiring increased oxygen need.

B: Blood glucose stores are depleted, and the cells do not have energy to use oxygen.
C: Carbon dioxide production increases as result of hyperventilation.
D: Carbon dioxide production decreases as a result of hypoventilation.
A
11. The nurse is caring for a patient who has decreased mobility. Which intervention is a simple and
cost-effective method for reducing the risks of stasis of pulmonary secretions and decreased chest
wall expansion?

A: Antibiotics
B: Frequent change of position
C: Oxygen humidification
D: Chest physiotherapy
B

12.A patient is admitted with severe lobar pneumonia. Which of the following assessment findings
would indicate that the patient needs airway suctioning?

A: Coughing up thick sputum only occasionally

B: Coughing up thin, watery sputum easily after nebulization
C: Decreased independent ability to cough
D: Lung sounds clear only after coughing
C
13. A patient has been newly diagnosed with emphysema. In discussing his condition with the nurse,
which of his statements would indicate a need for further education?

A: "I'll make sure that I rest between activities so I don't get so short of breath."
B: "I'll rest for 30 minutes before I eat my meal."
C: "If I have trouble breathing at night, I'll use two to three pillows to prop up."
D: "If I get short of breath, I'll turn up my oxygen level to 6 L/min."
D
14. The nurse goes to assess a new patient and finds him lying supine in bed. The patient tells the
nurse that he feels short of breath. Which nursing action should the nurse perform first?

A: Raise the head of the bed to 45 degrees.

B: Take his oxygen saturation with a pulse oximeter.
C: Take his blood pressure and respiratory rate.
D: Notify the health care provider of his shortness of breath
A
15. The nurse is caring for a patient who exhibits labored breathing and uses accessory muscles. The
patient has crackles in both lung bases and diminished breath sounds. Which would be priority
assessments for the nurse to perform? (Select all that apply.)

A: SpO2 levels
B: Amount of sputum production
C: Change in respiratory rate and pattern
D: Pain in lower calf area
ABC
16. Which nursing intervention is appropriate for preventing atelectasis in the postoperative patient?

A: Postural drainage
B: Chest percussion
C: Incentive spirometer
D: Suctioning
C
17. The nurse needs to apply oxygen to a patient who has a precise oxygen level prescribed. Which
of the following oxygen-delivery systems should the nurse select to administer the oxygen to the
patient?

A: Nasal cannula
B: Venturi mask
C: Simple face mask without inflated reservoir bag
D: Plastic face mask with inflated reservoir bag
A
18. 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
C
19. For a client who is having respiratory symptoms of unknown etiology, the diagnostic test that is
most invasive is:

A. Pulse oximetry to determine oxygen saturation levels

B. Throat cultures with sterile swabs
C. Bronchoscopy of the bronchial trees
D. Computed tomography of the lung fields
C
20. The nurse identifies that the client is unable to cough to produce a sputum specimen and must be
suctioned. Which suctioning route is preferred?

A. Nasopharyngeal
B. Nasotracheal
C. Oropharyngeal
D. Orotracheal
B
21. The nurse is reviewing the results of the patient's diagnostic testing. Of the following results, the
finding that falls within expected or normal limits is:

A. Palpable, elevated hardened area around a tuberculosis skin testing site.

B. Sputum for culture and sensitivity identifies mycobacterium tuberculosis
C. Presence of acid fast bacilli in sputum
D. Arterial oxygen tension (PaO2) of 95 mmHg
D
What is the correct sequence for suctioning a patient?

22.A nurse working in a long-term care facility is providing teaching to patients with altered
oxygenation due to conditions such as asthma and COPD. Which measures would the nurse
recommend? Select all that apply.

a) Refrain from exercise.

b) Reduce anxiety.
c) Eat meals 1 to 2 hours prior to breathing treatments.
d) Eat a high-protein/high-calorie diet.
e) Maintain a high-Fowler's position when possible.
f) Drink 2 to 3 pints of clear fluids daily.
BDE
When caring for patients with COPD, it is important to create an environment that is likely to reduce
anxiety and ensure that they eat a high-protein/high-calorie diet. People with dyspnea and orthopnea
are most comfortable in a high Fowler's position because accessory muscles can easily be used to
promote respiration. Patients with COPD should pace physical activities and schedule frequent rest
periods to conserve energy. Meals should be eaten 1 to 2 hours after breathing treatments and
exercises, and drinking 2 to 3 quarts (1.9-2.9 L) of clear fluids daily is recommended.

23.A nurse is providing postural drainage for a patient with cystic fibrosis. In which position should the
nurse place the patient to drain the right lobe of the lung?

a) High Fowler's position

b) Left side with pillow under chest wall
c) Lying position/half on abdomen and half on side
d) Trendelenberg position
B

24.When planning care for a patient with chronic lung disease who is receiving oxygen through a
nasal cannula, what does the nurse expect?

a) The oxygen must be humidified.

b) The rate will be no more than 2 to 3 L/min or less.
c) Arterial blood gases will be drawn every 4 hours to assess flow rate.
d) The rate will be 6 L/min or more.
B
A rate higher than 3 L/min may destroy the hypoxic drive that stimulates respirations in the medulla in
a patient with chronic lung disease. Oxygen delivered at low rates does not necessarily have to be
humidified, and arterial blood gases are not required at regular intervals to determine the flow rate.

25.What action does the nurse perform to follow safe technique when using a portable oxygen
cylinder?

a) Checking the amount of oxygen in the cylinder before using it

b) Using a cylinder for a patient transfer that indicates available oxygen is 500 psi
c) Placing the oxygen cylinder on the stretcher next to the patient
d) Discontinuing oxygen flow by turning cylinder key counterclockwise until tight
A

26.An emergency department nurse is using a manual resuscitation bag (Ambu bag) to assist
ventilation in a patient with lung cancer who has stopped breathing on his own. What is an
appropriate step in this procedure?

a) Tilt the patient's head forward.

b) Hold the mask tightly over the patient's nose and mouth.
c) Pull the patient's jaw backward.
d) Compress the bag twice the normal respiratory rate for the patient.
B

27.A patient with a diagnosis of advanced Alzheimer disease who is unable to follow directions
requires an inhaled bronchodilator. Which of the following medication delivery systems is most
appropriate for this patient?

a) metered-dose inhaler with spacer

b) nebulizer
c) metered-dose inhaler without spacer
d) dry powder inhaler
B

28.The nurse is caring for a client who is diagnosed with impaired gas exchange. While performing a
physical assessment of the client, which data is the nurse likely to find, keeping in mind the client's
diagnosis?

a) high respiratory rate

b) low pulse rate
c) high temperature
d) low blood pressure
A

29.A nurse assessing a patient's respiratory effort notes that the client's breaths are shallow and 8
per minute. Shortly after, the client's respirations cease. Which of the following should the nurse use
for this patient?

a) Oxygen tent
b) Oxygen mask
c) Nasal cannula
d) Ambu bag
D
If the patient is not breathing with an adequate rate and depth, or if the patient has lost the respiratory
drive, a manual rescucitation bag (Ambu bag)may be used to deliver oxygen until the patient is
resuscitated or can be intubated with an endotracheal tube.

30.Which dietary guideline would be appropriate for the older adult homebound client with advanced
respiratory disease who informs the nurse that she has no energy to eat?
a) Eat one large meal at noon.
b) Snack on high-carbohydrate foods frequently.
c) Eat smaller meals that are high in protein.
d) Contact the physician for nutrition shake.
C

31.The nurse is informed while receiving a nursing report that the client has been hypoxic during the
evening shift. Which assessment finding is consistent with hypoxia?

a) Confusion
b) Decreased blood pressure
c) Decreased respiratory rate
d) Hyperactivity
A
32. A physician has ordered an arterial blood gas test for a client with a respiratory disorder. What is
the most common role of the nurse in performing the arterial blood gas test?

a) Implement measures to prevent complications after arterial puncture.

b) Measure the partial pressure of oxygen dissolved in plasma.
c) Measure the percentage of hemoglobin saturated with oxygen.
d) Perform the arterial puncture to obtain the specimen.
A

33.The nurse is caring for a postoperative client who has a prescription for meperidine (Demerol) 7
5mg intramuscularly (IM) every 4 hours as needed for pain. Before and after administering Demerol,
the nurse would assess which most important sign?

a) Respiratory rate and depth

b) Urinary intake and output
c) Orthostatic blood pressure
d) Apical pulse
A

34.Which diagnostic procedure measures lung size and airway patency, producing graphic
representations of lung volumes and flows?

a) Pulmonary function tests

b) Chest x-ray
c) Skin tests
d) Bronchoscopy
A
35.A newly hired nurse is performing a focused respiratory assessment. The nurse mentor will
intervene if which action by the newly hired nurse is noted?

a) The newly hired nurse palpates the point of maximal impulse (PMI).
b) The newly hired nurse auscultates breath sounds as the client breathes through the nose.
c) The newly hired nurse attaches a pulse oximetry to the client's index finger.
d) The newly hired nurse explains the assessment procedure before performing it.
B

36.The nurse is caring for a client with emphysema. A review of the client's chart reveals pH 7.36,
paO2 73 mm Hg, PaCO2 64 mm Hg, and HCO3 35 mEq/L. The nurse would question which
prescription, if prescribed by the health care practitioner?

a) Pulse oximetry
b) 4 L/minute O2 nasal cannula
c) High-Fowler's position
d) Increase fluid intake to 3 L/day
B
The client with chronic lung disease, such as emphysema, becomes insensitive to carbon dioxide and
responds to hypoxia to stimulate breathing. If given excessive oxygen (4 L/minute), the stimulus to
breathe is removed. Clients with emphysema are most comfortable in high-Fowler's position because
it aids in the use of the accessory muscles to promote respirations. Increasing fluid intake helps keep
the client's secretions thin. Pulse oximetry monitors the client's arterial oxyhemoglobin saturation
while receiving oxygen therapy.

37.The nurse is caring for a client who has a compromised cardiopulmonary system and needs to
assess the client's tissue oxygenation. The nurse would use which appropriate method to assess this
client's oxygenation?

a) Arterial blood gas

b) Hemoglobin levels
c) Hematocrit values
d) Pulmonary function
A
Arterial blood gases include the levels of oxygen, carbon dioxide, bicarbonate, and pH. Blood gases
determine the adequacy of alveolar gas exchange and the ability of the lungs and kidneys to maintain
the acid-base balance of body fluids.

38.A nurse is delivering 3 L/min oxygen to a patient via nasal cannula. What percentage of delivered
oxygen is the patient receiving?

a) 32%
b) 28%
c) 47%
d) 23%
A
A nasal cannula is used to deliver from 1 L/minute to 6 L/minute of oxygen. 1 L/minute = 24%, 2
L/minute = 28%, 3 L/minute = 32%, 4 L/minute = 36%, 5 L/minute = 40%, and 6 L/minute = 44%

39.What structural changes to the respiratory system should a nurse observe when caring for older
adults?

a) increased use of accessory muscles for breathing

b) respiratory muscles become weaker
c) increased mouth breathing and snoring
d) diminished coughing and gag reflexes
B
One of the structural changes affecting the respiratory system that a nurse should observe in an older
adult is respiratory muscles becoming weaker. The nurse should also observe other structural
changes: the chest wall becomes stiffer as a result of calcification of the intercostals cartilage,
kyphoscoliosis, and arthritic changes to costovertebral joints; the ribs and vertebrae lose calcium; the
lungs become smaller and less elastic; alveoli enlarge; and alveolar walls become thinner.
Diminished coughing and gag reflexes, increased use of accessory muscles for breathing, and
increased mouth breathing and snoring are functional changes to the respiratory system in older
adults.

40.A client has been placed on 6 L of humidified oxygen via nasal cannula. Which action by the nurse
is most appropriate?

a. Drain condensation back into the humidifier, maintaining a closed system.

b. Keep the water sterile by draining it from the water trap back into the humidifier.
c. Turn down the humidity when condensation begins to collect in the tubing.
d. Remove condensation in the tubing by disconnecting and emptying it appropriately.
D
Condensation often forms in the tubing when a client receives humidified high-flow oxygen. Remove
this condensation as it collects by disconnecting the tubing and emptying the water. Some humidifiers
and nebulizers have a water trap that hangs from the tubing so the condensation can be drained
without disconnecting. To prevent bacterial contamination, never drain the fluid back into the
humidifier or the nebulizer. Do not turn down the humidity because the physician has ordered it and
the client needs it. Minimize how long the tubing is disconnected because the client does not receive
oxygen during this period.
41.A client is receiving oxygen via Venturi mask at 40%. On assessment the nurse finds the client
cyanotic with labored respirations. Which action does the nurse perform first?

a. Remove bedding from around the adaptor opening.

b. Listen to lung sounds and obtain a respiratory rate.
c. Call respiratory therapy to check oxygen saturation.
d. Notify the provider or Rapid Response Team immediately.
A
The Venturi mask works by drawing in a specific amount of air to mix with the oxygen through holes
in an adaptor fitted at the bottom of the mask. Holes of different sizes allow different amounts of room
air to be entrained, changing the amount of oxygen delivered. Bedding (or clothing) wrapped around
those holes would effectively change the FiO2. The nurse should ensure that the holes remain
unobstructed. Other options are appropriate but are not the first choice, because this simple step may
be what solves the problem.

42.A client requires oxygen received via a face mask but wants to remain as mobile as possible once
discharged home. Which intervention by the home health nurse best provides the client with maximal
mobility?

a. Arrange a consultation with pulmonary rehabilitation to decrease oxygen needs.

b. Encourage the client to remove the mask occasionally to assess tolerance.
c. Add extra connecting pieces of tubing to the client's existing oxygen setup.
d. Change the face mask to a nasal cannula occasionally, such as at mealtimes.
C

43. A client has been brought in by the rescue squad to the emergency department. The client is
having an acute exacerbation of chronic obstructive pulmonary disease (COPD) and is severely short
of breath. On arrival, the client is on 15 L/min of oxygen via rebreather mask. Which action by the
nurse takes priority?

a. Immediately reduce the oxygen flow to 2 to 4 L/min via nasal cannula.

b. Perform a thorough respiratory assessment and attach pulse oximetry.
c. Call the laboratory to obtain arterial blood gases as soon as possible.
d. Obtain a stat chest x-ray, then slowly wean the client's oxygen down.
B
Oxygen-induced hypoventilation can occur in clients with chronically elevated PCO2 levels, such as
those seen in COPD. Giving oxygen can eliminate their hypoxic drive to breathe and can cause
respiratory arrest. However, hypoxemia is a greater threat to an acutely ill client than is the potential
for oxygen-induced hypoventilation, and clients should be given the amount of oxygen they require.
The nurse should perform a thorough respiratory assessment and should monitor the client for signs
of this problem, rather than automatically reducing oxygen delivery. Blood gases and a chest x-ray
will also be obtained, but they do not take priority over assessing and monitoring the client.

44.The nurse is caring for a client with orders for oxygen at 5 L/min. Approximately how much FiO2 is
the client receiving?

a. 24%
b. 28%
c. 36%
d. 40%
D

45.A client who is receiving continuous oxygen therapy by nasal cannula for an acute respiratory
problem is becoming increasingly confused. What does the nurse do first?

a. Notify the health care provider.

b. Assess the client's pulse oximetry.
c. Document the observation.
d. Raise the head of the bed.
B
Cerebral hypoxia is a cause of confusion and is a sensitive indicator that the client needs more
oxygen. Although you would want to notify the provider of the change in the client's condition, the
best action is first to assess pulse oximetry and then to increase the oxygen. You would not just
document the assessment finding without intervening. Raising the head of the bed would not help the
client oxygenate better.

46.The nurse assesses a client who is receiving oxygen via a partial rebreather mask. Which
assessment finding does the nurse intervene to correct?

a. The bag is two thirds inflated during inhalation.

b. The client's pulse oximetry reading is 93%.
c. The oxygen flow rate is 2 L/min.
d. The arterial oxygen level is 90%.
C
Flow rate should be 6 to 11 L/min. A flow rate of 2 L/min will not adequately inflate the bag. A bag that
is two thirds inflated is desired. A pulse oximetry reading of 93% and higher is adequate, as is an
arterial oxygenation of 90%.
T
47.he nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient
has been receiving high-flow oxygen therapy for an extended time. What symptoms should the nurse
anticipate if the patient were experiencing oxygen toxicity?

A) Bradycardia and frontal headache

B) Dyspnea and substernal pain
C) Peripheral cyanosis and restlessness
D) Hypotension and tachycardia
B

48.The nurse is caring for a patient who is scheduled to have a thoracotomy. When planning
preoperative teaching, what information should the nurse communicate to the patient?

A) How to milk the chest tubing

B) How to splint the incision when coughing
C) How to take prophylactic antibiotics correctly
D) How to manage the need for fluid restriction
B

49. The nurse is discussing activity management with a patient who is postoperative following
thoracotomy. What instructions should the nurse give to the patient regarding activity immediately
following discharge?

A) Walk 1 mile 3 to 4 times a week.

B) Use weights daily to increase arm strength.
C) Walk on a treadmill 30 minutes daily.
D) Perform shoulder exercises five times daily.
D