4.

A client is in need of an emergency

tracheostomy. Which of the following
NAME: Joshua R. Canja
scenarios does this involve?
NR-42 a. A puncture is made through the
cricothyroid cartilage
1. A nurse checks a client’s oxygen b. A tube is passed into the mouth
saturation by using a bedside sensory and through the larynx
probe. The client has pneumonia that is c. A surgical incision is made into the
currently being treated with antibiotics. trachea
When the nurse places the pulse d. A tube is passed through the nose
oximeter probe on the client, the first and into the trachea
reading she notes is 89 percent. Which 5. A nurse walks into a client’s room and
of the following actions should the discovers that the client is in respiratory
nurse perform first? distress. The client has tracheal
a. Raise the head of the bed and ask the deviation to the right side. The nurse
client to take a deep breath knows to prepare for which of the
b. Assess the probe site to ensure an following emergent procedures?
accurate reading a. Chest tube insertion on the right
c. Contact the provider for a chest x-ray side
d. Administer 100 percent oxygen and b. Chest tube insertion on the left
monitor the pulse oximetry until it side
reaches 95 percent c. Intubation
d. Tracheostomy
2. A nurse is caring for a client with a 6. Which best describes the purpose of
diagnosis of respiratory alkalosis. Which pursed-lip breathing in the client with
pH finding would be consistent with this COPD?
diagnosis? a. To reduce the over-all work of
a. 7.49 breathing
b. 7.45 b. To strengthen the muscles of the
c. 7.35 ribs
d. 7.29 c. To balance the effects of carbon
3. A nurse is caring for a client who is dioxide and oxygen in the
recovering from a chest injury. The bloodstream
provider orders arterial blood gases for d. To exercise the muscles of the
the client. The results are pH 7.26, diaphragm
pCO2 52 mmHg, HCO3 25 mmHg, and
oxygen saturation 92 percent. Which of
7. A female client has a tracheostomy
the following best describes this client’s
but doesn't require continuous
condition?
mechanical ventilation. When
a. Respiratory alkalosis
weaning the client from the
b. Metabolic acidosis
tracheostomy tube, the nurse
c. Metabolic alkalosis
initially should plug the opening in
d. Respiratory acidosis
the tube for:
 a. 5 to 60 seconds 11. Which of the following is an
b. 5 to 20 seconds abnormal finding on taking vital
c. 30 to 40 minutes signs and inspection of the
d. 45 to 60 minutes respiratory system?
a. Chest is wider than it is deep
8. The amount of air inspired and b. Breathing with little effort
expired with each breath is called: c. Respiratory rate of 10 breaths
a. Tidal volume. per minute
b. Residual volume. d. Oxygen saturation of 94%
c. Vital capacity.
d. Dead-space volume. 12. Which of the following findings on
respiratory system palpation
9. Which of the following would be indicates an area of consolidation?
most appropriate for a male client a. Decreased tactile fremitus
with an arterial blood gas (ABG) of b. Increased tactile fremitus
pH 7.5, PaCO2 26 mm Hg, O2 c. Increased crepitus
saturation 96%, HCO3 24 mEq/L, d. Decreased crepitus
and PaO2 94 mm Hg?
a. Administer a prescribed 13. A home health nurse is visiting a
decongestant. client with severe chronic
b. Instruct the client to breathe obstructive pulmonary disease
into a paper bag. (COPD) who is complaining of
c. Offer the client fluids frequently. increased shortness of air. The client
d. Administer prescribed is on home oxygen at 2 L/min via an
supplemental oxygen. oxygen concentrator with a
respiratory rate of 23 breaths/min.
10. Nurse Eve formulates a nursing The most appropriate nursing action
diagnosis of Activity intolerance is to
related to inadequate oxygenation a. Call emergency services to come
and dyspnea for a client with chronic to the home.
bronchitis. To minimize this b. Conduct further assessment of
problem, the nurse instructs the the client’s respiratory status.
client to avoid conditions that c. Consider increasing the oxygen
increase oxygen demands. Such to 4 L/min during the home visit.
conditions include: d. Reassure the client of being
A. Drinking more than 1,500 ml of unnecessarily anxious.
fluid daily.
B. Being overweight. 14. The nurse is admitting a client with
C. Eating a high-protein snack at suspected tuberculosis (TB) to the
bedtime. acute care unit. The nurse places the
D. Eating more than three large client in airborne precautions until a
meals a day. confirmed diagnosis of active TB can
be made. Which of the following
 tests is a priority to confirm the a. Bronchitis.
diagnosis? b. Pneumoconiosis.
c. Asthma.
a. Sputum culture positive for
d. Pneumonia.
Mycobacterium Tuberculosis
b. Positive purified protein derivative
(PPD) test
18. The nurse is admitting a client who
c. Chest x-ray that is positive for lung
complains of fever, chills, chest pain,
lesions
and dyspnoea. The client has a heart
d. Sputum positive for blood
rate of 110, respiratory rate of 28,
(haemoptysis)
and a nonproductive hacking cough.
A chest x-ray confirms a diagnosis of
15. A registered nurse is planning the
left lower lobe pneumonia. Upon
schedule for the day. Which of the
auscultation of the left lower lobe,
following nursing tasks may the
the nurse documents which of the
nurse delegate to a licensed
following breath sounds?
practical nurse?
a. Vesicular
a. Clarify an order with the physician
b. Bronchial
b. Instruct a client on a bronchoscopy
c. Broncho vesicular
c. Administer a purified protein
d. Absent breath sounds
derivative (PPD) to a client
d. Develop instructions for the client
19. The nurse is preparing a client with
on pursed-lip breathing
empyema for a thoracentesis. Which
of the following should the nurse
16. The nurse assesses fluctuations in
have available in the event that the
the water seal chamber of a client’s
procedure is ineffective?
closed chest drainage system. The
a. A ventilator
nurse evaluates this finding as
b. An intubation tray
indicating
c. A crash cart
a. The system is functioning
d. A chest tube insertion kit
properly.
b. An air leak is present.
20. The nurse is reviewing the normal
c. The tubing is kinked.
limits for a head and neck
d. The lung has re-expanded.
assessment. Which of the following
findings would indicate the need for
17. The nurse assesses a college-age
additional investigation?
client complaining of shortness of
a. The trachea is to the right of the
breath after jogging and tightness in
suprasternal notch
his chest. Upon further questioning,
b. The muscles of the neck are
the client denies a sore throat,
symmetrical
fever, or productive cough. The
c. A small, discrete, movable lymph
nurse notifies the physician that this
node
client’s clinical manifestations are
d. A thyroid gland that is not
most likely related to
visible or palpable
 this client MUST have what type of
21. The nurse is performing an dressing?
assessment of the thorax and lungs a. Non-adhesive
on a 30-year-old client. Which of the b. Debriding
following assessments does the c. Occlusive
nurse evaluate to be a normal adult d. Transparent
finding?
a. The accessory muscles are 25. A client in respiratory distress is
used during inspiration and admitted with arterial blood gas
expiration results of: PH 7.30; PO2 58, PCO 34;
b. The costal margin is greater and HCO3 19. The nurse determines
than 90° that the client is in?
c. The ribs articulate at a 45° a. Metabolic alkalosis
angle with the sternum b. Respiratory acidosis
d. The thorax is barrel shaped c. Metabolic acidosis
22. When preparing a client to collect a d. Respiratory alkalosis
sputum specimen, it would be
essential for the nurse to explain 26. The nurse is caring for a client with a
which of the following aspects of the pneumothorax. The nurse expects
procedure? the client to have a chest tube
a. Restrict fluids prior to inserted because?
expectorating sputum a. It will increase the intrathoracic
b. Collect the specimen pressure, restoring it back to
before bedtime normal
c. Avoid mouth care prior b. It will drain air out of the thorax,
to collecting the restoring normal intrathoracic
specimen pressure
d. Breathe deeply followed c. It will drain the purulent
by coughing up sputum drainage from the empyema
23. The nurse is caring for a client with that caused it
COPD who becomes dyspneic. The d. It is the appropriate post-
nurse should? operative treatment for a
a. Administer oxygen at 6L/minute pneumothorax
via nasal cannula
b. Assist the client with pursed lip 27. The nurse is caring for a client with a
breathing hemopneumothorax. The client has
c. Instruct the client to breathe a chest tube. The nurse would
into a paper bag EXPECT which of the following color
d. Place the client in a high of drainage?
Fowler’s position a. Red
b. Yellow
c. Clear
24. The nurse is caring for a client with a d. Brown
chest tube. The nurse knows that
28. When teaching a client with chronic recovering from a myocardial
obstructive pulmonary disease infarction.
about oxygen by cannula, the nurse b. 55 year old female with a health
should also instruct the client’s history of asthma and
family to hypoparathyroidism.
a. Avoid smoking near the client c. 30 year old male with a history
b. Remind the client to keep of endocarditis and has severe
mouth closed mitral stenosis.
c. Turn off oxygen during meals d. 45 year old female with lung
d. Adjust the liter flow to 10 as cancer stage 2.
needed e. 58 year old female with
uncontrolled hypertension and is
29. Before using a bronchoscope from being treated for influenza.
one client to the next, the
bronchoscope must be cleaned. The 32. . A patient is being discharged home
nurse knows that minimal cleaning after hospitalization of left
of the bronchoscope includes: ventricular systolic dysfunction. As
a. High-level disinfection. the nurse providing discharge
b. Low-level disinfection. teaching to the patient, which
c. Sterilization. statement is NOT a correct
d. Washing with soap and water. statement about this condition?*
a. "Signs and symptoms of this type
of heart failure can include:
30. A female client is scheduled to have dyspnea, persistent cough,
a chest radiograph. Which of the difficulty breathing while lying
following questions is of most down, and weight gain."
importance to the nurse assessing b. "It is important to monitor your
this client? daily weights, fluid and salt
intake."
a. “Is there any possibility that you c. "Left-sided heart failure can lead
could be pregnant?” to right-sided heart failure, if left
b. “Are you wearing any metal untreated."
chains or jewelry?” d. "This type of heart failure can
c. “Can you hold your breath build up pressure in the hepatic
easily?” veins and cause them to become
d. “Are you able to hold your arms congested with fluid which leads
above your head?” to peripheral edema."

31. . Which of the following patients are 33. Which of the following are NOT
MOST at risk for developing heart typical signs and symptoms of right-
failure? Select-all-that-apply:* sided heart failure? Select-all-that-
a. 69 year old male with a history apply:*
of alcohol abuse and is
 a. Jugular venous distention f. Options A, B, and C are all
b. Persistent cough correct
c. Weight gain
d. Crackles 37. Patients with heart failure can
e. Nocturia experience episodes of
f. Orthopnea exacerbation. All of the patients
below have a history of heart failure.
34. A patient is diagnosed with left- Which of the following patients are
sided systolic dysfunction heart at MOST risk for heart failure
failure. Which of the following are exacerbation?*
expected findings with this a. A 55 year old female who limits
condition?* sodium and fluid intake
a. Echocardiogram shows an ejection regularly.
fraction of 38%. b. A 73 year old male who reports
b. Heart catheterization shows an not taking Amiodarone for one
ejection fraction of 65%. month and is experiencing atrial
c. Patient has frequent episodes of fibrillation.
nocturnal paroxysmal dyspnea. c. A 67 year old female who is
d. Options A and C are both expected being discharged home from
findings with left-sided systolic heart valve replacement surgery.
dysfunction heart failure. d. A 78 year old male who has a
health history of eczema and
35. True or False: Patients with left- cystic fibrosis.
sided diastolic dysfunction heart
failure usually have a normal 38. A 74 year old female presents to the
ejection fraction.* ER with complaints of dyspnea,
a. True persistent cough, and unable to
b. False sleep at night due to difficulty
breathing. On assessment, you note
36. A patient has a history of heart crackles throughout the lung fields,
failure. Which of the following respiratory rate of 25, and an
statements by the patient indicates oxygen saturation of 90% on room
the patient may be experiencing air. Which of the following lab
heart failure exacerbation?* results confirm your suspicions of
a. “I’ve noticed that I’ve gain 6 lbs heart failure?*
in one week.” A. K+ 5.6
b. B. “While I sleep I have to prop B. BNP 820
myself up with a pillow so I can C. BUN 9
breathe.” D. Troponin <0.02
c. “I haven’t noticed any swelling in
my feet or hands lately.” 39. Which of the following
d. Options B and C are correct. tests/procedures are NOT used to
e. Options A and B are correct. diagnose heart failure?*
 a. Echocardiogram b. "I will be sure to incorporate
b. Brain natriuretic peptide blood canned vegetables and fish into
test my diet."
c. Nuclear stress test c. "I'm glad I can still eat
d. Holter monitoring sandwiches because I love
bologna and cheese
40. What type of heart failure does this sandwiches."
statement describe? The ventricle is d. "I will limit my consumption of
unable to properly fill with blood frozen meals."
because it is too stiff. Therefore,
blood backs up into the lungs 43. Select all the correct statements
causing the patient to experience about educating the patient with
shortness of breath.* heart failure:*
a. Left ventricular systolic a. It is important patients with
dysfunction heart failure notify their
b. B. Left ventricular ride-sided physician if they gain more than
dysfunction 6 pounds in a day or 10 pounds
c. Right ventricular diastolic in a week.
dysfunction b. Patients with heart failure
d. Left ventricular diastolic should receive an annual
dysfunction influenza vaccine and be up-to-
date with the pneumonia
41. A patient with left-sided heart vaccine.
failure is having difficulty breathing. c. Heart failure patients should
Which of the following is the most limit sodium intake to 2-3 grams
appropriate nursing intervention?* per day.
a. Encourage the patient to cough d. Heart failure is exacerbated by
and deep breathe. illness, too much fluid or sodium
b. Place the patient in Semi- intake, and arrhythmias.
Fowler's position. e. Patients with heart failure
c. Assist the patient into High should limit exercise because of
Fowler's position. the risks.
d. Perform chest percussion
therapy. 44. A patient taking Digoxin is
experiencing severe bradycardia,
42. You're providing diet discharge nausea, and vomiting. A lab draw
teaching to a patient with a history shows that their Digoxin level is 4
of heart failure. Which of the ng/mL. What medication do you
following statements made by the anticipate the physician to order for
patient represents they understood this patient?*
the diet teaching?* a. Narcan
a. "I will limit my sodium intake to b. B. Aminophylline
5-6 grams a day." c. Digibind
 d. No medication because this is a medications do you suspect is
normal Digoxin level. causing this issue?*
a. Lisinopril
45. Which of the following is a late sign b. Losartan
of heart failure?* c. Lasix
a. Shortness of breath d. Digoxin
b. Orthopnea 49. Select all the correct statements
c. Edema about the pharmacodynamics of
d. Frothy-blood tinged sputum Beta-blockers for the treatment of
heart failure:*
46. These drugs are used as first-line a. These drugs produce a negative
treatment of heart failure. They inotropic effect on the heart by
work by allowing more blood to flow increasing myocardial
to the heart which decreases the contraction.
work load of the heart and allows b. A side effect of these drugs
the kidneys to secrete sodium. include bradycardia.
However, some patients can c. These drugs are most commonly
develop a nagging cough with these prescribed for patients with
types of drugs. This description heart failure who have COPD.
describes?* d. Beta-blockers are prescribed
a. Beta-blockers with ACE or ARBs to treat heart
b. Vasodilators failure.
c. Angiotensin II receptor blockers 50. You are assisting a patient up from
d. Angiotensin-converting-enzyme the bed to the bathroom. The
inhibitors patient has swelling in the feet and
legs. The patient is receiving
47. A patient with heart failure is taking treatment for heart failure and is
Losartan and Spironolactone. The taking Hydralazine and Isordil.
patient is having EKG changes that Which of the following is a nursing
presents with tall peaked T-waves priority for this patient while
and flat p-waves. Which of the assisting them to the bathroom?*
following lab results confirms these a. Measure and record the urine
findings?* voided.
a. Na+ 135 b. Assist the patient up slowing and
b. BNP 560 gradually.
c. K+ 8.0 c. Place the call light in the
d. K+ 1.5 patient's reach while in the
bathroom.
48. During your morning assessment of d. Provide privacy for the patient.
a patient with heart failure, the
patient complains of sudden vision 50 – 60 Draw and label its parts
changes that include seeing the three way water sealed
yellowish-green halos around the drainage bottle.
lights. Which of the following
 16. A
60 – 100 Compute the following: 17. C
18. B
1. In order to prepare 4 L of an 19. D
20. A
0.1% solution of epinephrine,
21. C
what volume of 1:20 stock
22. D
solution must be used? 23. C

2. How many grams of

potassium iodide are needed 24. C
to prepare 500 ml of a 5% 25. B
solution? 26. B
27. A
3. 300 ml 0f 10% iodine 28. A
solution contains how many 29. C
30. C
grains of iodine?
31. A,C,E
32. D
4. What is the percent 33. B,D,F
concentration of a 1:6000 ml 34. D
solution of mercuric 35. A
chloride? 36. E
37. B
38. B
Good luck ! 39. D
May the force be 40. D
41. C
with you! 42. D
43. B,C
44. C
Answer : 45.
46.
D
D
1. B 47. C
2. A 48. D
3. D 49. B,D
4. C 50. B
5. C
6. A
7. D
8. A
9. B
10. B
11. A
50-60. Adjustable vent tube
12. B
13. B
14. A
15. C
From
Patient

1.

1.Trap bottle
2. underwater seal bottle
3. Monometer bottle

To suction 60-100
1. Xml = 0.1%x4000= 20ml
2. 5g. _. g = 25g
100ml. 500ml
3. 15g
4. 0.016%