NCLEX Practice Exam for Respiratory System 3

1.    A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen?

1. Limiting fluid
2. Having the client take deep breaths
3. Asking the client to spit into the collection container
4. Asking the client to obtain the specimen after eating

2.    Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician?

1. Dry cough
2. Hermaturia
3. Bronchospasm
4. Blood-streaked sputum

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

1. 1 minute
2. 5 seconds
3. 10 seconds
4. 30 seconds

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

1. Continue to suction
2. Notify the physician immediately
3. Stop the procedure and reoxygenate the client
4. Ensure that the suction is limited to 15 seconds

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

1. Dyspnea
2. Bradypnea
3. Bradycardia
4. Decreased respirations

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

1. Resonant sounds.
2. Hyperresonant sounds.
3. Dull sounds.
4. Flat sounds.

7.    A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should:

1. Question the order because it’s too low.
2. Question the order because it’s too high.
3. Set the pump at 45 ml/hour.
4. Stop the infusion and have the laboratory repeat the theophylline measurement.

8.    The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?

1. Make inhalation longer than exhalation.
2. Exhale through an open mouth.
3. Use diaphragmatic breathing.
4. Use chest breathing.

9.    Which phrase is used to describe the volume of air inspired and expired with a normal breath?

1. Total lung capacity
2. Forced vital capacity
3. Tidal volume
4. Residual volume

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

1. Simple mask
2. Non-rebreather mask
3. Face tent
4. Nasal cannula

11.    A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?

1. Impaired color discrimination
2. Increased urinary frequency
3. Decreased hearing acuity
4. Increased appetite

12.    A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the:

1. Area of redness is measured in 3 days and determines whether tuberculosis is present.
2. Skin test doesn’t differentiate between active and dormant tuberculosis infection.
3. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.
4. Test stimulates a reddened response in some clients and requires a second test in 3 months.

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

1. 15 to 60 seconds.
2. 5 to 20 minutes.
3. 30 to 40 minutes.
4. 45 to 60 minutes.

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

1. The system is functioning normally
2. The client has a pneumothorax.
3. The system has an air leak.
4. The chest tube is obstructed.

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

1. Lips.
2. Mucous membranes.
3. Nail beds.
4. Earlobes.

16.    For a male client with an endotracheal (ET) tube, which nursing action is most essential?

1. Auscultating the lungs for bilateral breath sounds
2. Turning the client from side to side every 2 hours
3. Monitoring serial blood gas values every 4 hours
4. Providing frequent oral hygiene

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

1. Diaphragmatic breathing
2. Use of accessory muscles
3. Pursed-lip breathing
4. Controlled breathing

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

1. Lung vibrations.
2. Vocal sounds.
3. Breath sounds.
4. Chest movements.

19.    A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client’s history and physical findings, the physician suspects legionnaires’ disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What is the drug of choice for treating legionnaires’ disease?

1. Erythromycin (Erythrocin)
2. Rifampin (Rifadin)
3. Amantadine (Symmetrel)
4. Amphotericin B (Fungizone)

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

1. Pleural effusion.
2. Pulmonary edema.
3. Atelectasis.
4. Oxygen toxicity.

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

1. It helps prevent early airway collapse.
2. It increases inspiratory muscle strength.
3. It decreases use of accessory breathing muscles.
4. It prolongs the inspiratory phase of respiration.

22.    After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, “How long will it take for this drug to work?” How should the nurse respond?

1. In 30 minutes
2. In 1 hour
3. In 2.5 hours
4. In 4 hours

23.    A male client suffers adult respiratory distress syndrome as a consequence of shock. The client’s condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

1. Kinking of the ventilator tubing
2. A disconnected ventilator tube
3. An ET cuff leak
4. A change in the oxygen concentration without resetting the oxygen level alarm

24.    A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD?

1. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.
2. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator.
3. It stimulates adenosine receptors, causing bronchodilation.
4. It alters diaphragm movement, increasing chest expansion and enhancing the lung’s capacity for gas exchange.

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

1. Inflamed lung tissue
2. Sudden onset
3. Responsiveness to penicillin.
4. Elevated white blood cell (WBC) count

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

1. pH, 5.0; PaCO2 30 mm Hg
2. pH, 7.40; PaCO2 35 mm Hg
3. pH, 7.35; PaCO2 40 mm Hg
4. pH, 7.25; PaCO2 50 mm Hg

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

1. Apnea
2. Anginal pain
3. Respiratory alkalosis
4. Metabolic acidosis

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

1. Alprazolam (Xanax).
2. Propranolol (Inderal)
3. Morphine.
4. Albuterol (Proventil).

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

1. Heightened alertness
2. Increased heart rate
3. Numbness and tingling of the extremities
4. Respiratory depression

30.    The nurse in charge  formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:

1. Drinking more than 1,500 ml of fluid daily.
2. Being overweight.
3. Eating a high-protein snack at bedtime.
4. Eating more than three large meals a day.

Answers and Rationales

1. Answer B. To obtain a sputum specimen, the client should rinse the mouth to reduce contamination, breathe deeply, and then cough into a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.
2. Answer D. If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.
3. Answer C. Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells in the heart. A vasovagal response may occur, causing bradycardia. The nurse must preoxygenate the client before suctioning and limit the suctioning pass to 10 seconds.
4. Answer C. During suctioning, the nurse should monitor the client closely for side effects, including hypoxemia, cardiac irregularities such as a decrease in heart rate resulting from vagal stimulation, mucosal trauma, hypotension, and paroxysmal coughing. If side effects develop, especially cardiac irregularities, the procedure is stopped and the client is reoxygenated.
5. Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain.
6. Answer A. When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.
7. Answer A. A therapeutic theophylline level is 10 to 20 mcg/ml. The client is currently receiving 0.5 mg/kg/hour of aminophylline. Because the client’s theophylline level is sub-therapeutic, reducing the dose (which is what the physician’s order would do) would be inappropriate. Therefore, the nurse should question the order.
8. Answer C. In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
9. Answer C. Tidal volume refers to the volume of air inspired and expired with a normal breath. Total lung capacity is the maximal amount of air the lungs and respiratory passages can hold after a forced inspiration. Forced vital capacity is the vital capacity performed with a maximally forced expiration. Residual volume is the maximal amount of air left in the lung after a maximal expiration.
10. Answer B. A non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO₂) as high as 100%. Other modes — simple mask, face tent, and nasal cannula — deliver lower levels of FIO₂.
11. Answer C. Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin therapy. The client should notify the physician immediately if it occurs so that streptomycin can be discontinued and an alternative drug can be prescribed. The other options aren’t associated with streptomycin. Impaired color discrimination indicates color blindness; increased urinary frequency and increased appetite accompany diabetes mellitus.
12. Answer B. The Mantoux test doesn’t differentiate between active and dormant infections. If a positive reaction occurs, a sputum smear and culture as well as a chest X-ray are necessary to provide more information. Although the area of redness is measured in 3 days, a second test may be needed; neither test indicates that tuberculosis is active. In the Mantoux test, an induration 5 to 9 mm in diameter indicates a borderline reaction; a larger induration indicates a positive reaction. The presence of a wheal within 2 days doesn’t indicate active tuberculosis.
13. Answer B. Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, then gradually lengthen this interval according to the client’s respiratory status. A client who doesn’t require continuous mechanical ventilation already is breathing without assistance, at least for short periods; therefore, plugging the opening of the tube for only 15 to 60 seconds wouldn’t be long enough to reveal the client’s true tolerance to the procedure. Plugging the opening for more than 20 minutes would increase the risk of acute respiratory distress because the client requires an adjustment period to start breathing normally.
14. Answer C. Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.
15. Answer B. Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin color.
16. Answer A. For a client with an ET tube, the most important nursing action is auscultating the lungs regularly for bilateral breath sounds to ensure proper tube placement and effective oxygen delivery. Although the other options are appropriate for this client, they’re secondary to ensuring adequate oxygenation.
17. Answer B.  The use of accessory muscles for respiration indicates the client is having difficulty breathing. Diaphragmatic and pursed-lip breathing are two controlled breathing techniques that help the client conserve energy.
18. Answer D. The nurse observes respiratory excursion to help assess chest movements. Normally, thoracic expansion is symmetrical; unequal expansion may indicate pleural effusion, atelectasis, pulmonary embolus, or a rib or sternum fracture. The nurse assesses vocal sounds to evaluate air flow when checking for tactile fremitus; after asking the client to say “99,” the nurse palpates the vibrations transmitted from the bronchopulmonary system along the solid surfaces of the chest wall to the nurse’s palms. The nurse assesses breath sounds during auscultation.
19. Answer A. Erythromycin is the drug of choice for treating legionnaires’ disease. Rifampin may be added to the regimen if erythromycin alone is ineffective; however, it isn’t administered first. Amantadine, an antiviral agent, and amphotericin B, an antifungal agent, are ineffective against legionnaires’ disease, which is caused by bacterial infection.
20. Answer C. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn’t cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn’t one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.
21. Answer A. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)
22. Answer A. Codeine’s onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life, in 2.5 hours; and its duration of action is 4 to 6 hours.
23. Answer A. Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm or pulmonary embolus, mucus plugging, water in the tube, coughing or biting on the ET tube, and the client’s being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm.
24. Answer A.  Anhydrous theophylline and other methylxanthine agents make the central respiratory center more sensitive to CO₂ and stimulate the respiratory drive. Inhibition of phosphodiesterase is the drug’s mechanism of action in treating asthma and other reversible obstructive airway diseases — not COPD. Methylxanthine agents inhibit rather than stimulate adenosine receptors. Although these agents reduce diaphragmatic fatigue in clients with chronic bronchitis or emphysema, they don’t alter diaphragm movement to increase chest expansion and enhance gas exchange.
25. Answer A. The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. Antibiotic therapy is the primary treatment for most types of pneumonia; however, the antibiotic must be specific for the causative agent, which may not be responsive to penicillin. A few types of pneumonia, such as viral pneumonia, aren’t treated with antibiotics. Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, don’t.
26. Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO₂) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO₂ value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO₂value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange in the lungs.
27. Answer A. Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High oxygen concentrations don’t cause metabolic acidosis.
28. Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client’s greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta₂ adrenergic agonist, which causes dilation of the bronchioles. It’s given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client’s breathing. Propranolol is contraindicated in a client who’s wheezing because it’s a beta₂ adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation.
29. Answer D. Respiratory depression is the most serious complication of epidural analgesia. Other potential complications include hypotension, decreased sensation and movement of the extremities, allergic reactions, and urine retention. Typically, epidural analgesia causes central nervous system depression (indicated by drowsiness) as well as a decreased heart rate and blood pressure.
30. Answer B. Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult; however, it doesn’t increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six a day).