I am pleased to inform you that the Coordinating Honourable Minister of Health and Social Welfare has approved the release of results of the Professional Examination in Midwifery September 2024.

2. Summary of the results indicated that four thousand, seven hundred and Fifty-three (4,753) candidates were successful representing 88% with the breakdown as follows:

a) Post Basic Midwifery: Two thousand, one hundred and thirty-seven (2,137) candidates were successful, representing 92% pass

b) i. Basic Midwifery: One thousand, eight hundred and thirty-five (1,835) candidates were successful, representing 72% pass..

ii. Basic Midwifery (Refresher): Sixteen (16) candidates were successful, representing 100% pass

c) Community Midwifery: Seven hundred and sixty-five (765) candidates were successful, representing 89% pass.

3. Heads of the training institutions are hereby directed to check the result of their institution(s) on-line as from Monday 16th September, 2024.
4. Successful candidates are hereby directed to visit the Nursing and Midwifery Council of Nigeria Portal (portal.nmen.gov.ng) to apply on-line for registration and licensing with effect from 16th September, 2024
5. Please note that on-line registration formalities including payment of registration fee should be completed within ninety (90) days. Furthermore, any application for registration initiated and not completed within thirty (30) days will be automatically deleted by the portal
6. Late registration attracts a penalty fee of Sixteen thousand, two hundred and fifty Naira (16,250.00) only, per applicant after ninety (90) days. Additionally, a penalty fee of six thousand, five hundred and sixty-two Naira (N6,562.00) only will be charged per year in default of first licensing.
7. The next Professional Examination in Midwifery is to he held from Tuesday 11 Friday 14th March, 2025.
8. Heads of nursing training institutions are hereby requested to send statistics of eligible candidates for March, 2025 Professional Examination in Midwifery to exams@nmen.gov.ng on or before 31st December, 2024 using Examination Application Checklist (EAC). Kindly note that Examination Application Checklist received after this date will be rejected outrightly.
9. Please acknowledge receipt of the result and contact the Registrar/CEO immediately for rectification of any error. Council will not entertain any complaint after thirty (30) days of release of result.
10. All correspondences should be addressed to the Registrar/CEO, Nursing and Midwifery Council of Nigeria, Headquarters Office, Plot 713, Cadastral Zone, Life Camp, Abuja.
11. On behalf of the Management of the Nursing and Midwifery Council of

Nigeria, I extend our sincere congratulations to all successful candidates and

wish them success in their future endeavor.

12. Thank you for your support and cooperation in promoting and maintaining Excellence in Nursing Education and Practice in Nigeria in line with global best practices.

Release Of Results Of The Professional Examinations In Midwifery, November 2024.

Click below to check your November Professional Examination Results.

1 The nurse is assessing the motor function of an unconscious client. The nurse should plan to use which technique to test the client’s peripheral response to pain?

1. Sternal rub

2. Nail Bed Pressure

3. Pressure on orbital rim

4. Squeezing of the sternocleidomastoid muscle

2. Nail Bed Pressure

Ans

2 The nurse is caring for the client with increased intracranial pressure. The nurse would note which trend in VS if the intracranial pressure is rising?

1. Increasing temperature, increasing pulse, increasing respirations, decreasing BP

2. Increasing temperature, decreasing pulse, decreasing respirations, increasing BP

3. Decreasing temperature, decreasing pulse, increasing respirations, decreasing BP

4. Decreasing temperature, increasing pulse, decreasing respirations, increasing BP

Ans

2. Increasing temperature, decreasing pulse, decreasing respirations, increasing BP

3 A client recovering from a head injury is participating in care. The nurse determines that the client understands measures to prevent elevations in intracranial pressure if the nurse observes the client doing the activity?

1. Blowing the nose

2. Isometric exercises

3. Coughing vigorously

4. Exhaling during repositioning

Ans

4. Exhaling during repositioning

4 A client has clear liquid leaking from the nose following a basilar skull fracture. Which findings would alert the nurse that cerebrospinal fluid is present?

1. Fluid is clear and tests negative for glucose.

2. Fluid is grossly bloody in appearance and has a pH of 6.

3. Fluid clumps together on the dressing and has a pH of 7.

4. Fluid separates into concentric rings and tests positive for glucose.

Ans

4. Fluid separates into concentric rings and tests positive for glucose.

5 A client with a spinal chord injury is prone to experiencing autonomic dysreflexia. The nurse should avoid which measure to minimize the risk of occurrence? 

1. Strict adherence to a bowel retraining program

2 Keeping the linen wrinkle-free under the client

3. Preventing unnecessary pressure on the lower limbs

4. Limiting bladder catheterization to once ever 12 hours

Ans

4. Limiting bladder catheterization to once ever 12 hours

6 The nurse is evaluating the neurological signs of a client in spinal shock following spinal chord injury. Which observation indicates that spinal shock persists?

1. Hyperreflexia

2. Positive reflexes

3. Flaccid paralysis

4. Reflex emptying of the bladder

Ans

3. Flaccid paralysis

7 The nurse is caring for a client who begins to experience seizure activity while in bed. Which action by the nurse is contraindicated?

1. Loosening restrictive clothing

2. Restraining the client’s limbs

3. Removing the pillow and raising padded side rails

4. Positioning the client to the side, if possible, with the head flexed forward

Ans

2. Restraining the client’s limbs

8 The nurse has instructed the family of a client with stroke (brain attack) who has homonymous hemianopsia about measures to help the client overcome the deficit. Which statement suggests that the family understands the measures to help when caring for the client? 

1. “We need to discourage him from wearing eyeglasses.”

2. “We need to place objects in his impaired field of vision.”

3. “We need to approach him from the impaired field of vision.”

4. “We need to remind him to turn his head to scan the lost visual field.”

Ans

4. “We need to remind him to turn his head to scan the lost visual field.”

9 The nurse is assessing the adaption of a client to changes in functional status after a stroke (brain attack). Which observation indicates to the nurse that the client is adapting most successfully?

1. Gets angry with the family if they interrupt a task

2. Experiences bouts of depression and irritability 

3. Has difficulty with using modified feeding utensils

4. Consistently uses adaptive equipment in dressing self

Ans

4. Consistently uses adaptive equipment in dressing self

10 The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. Which client activity suggests that teaching is most effective?

1. Eating large, well-balanced meals

2. Doing muscle-strengthening exercises 

3. Doing all chores early in the day while less fatigued

4. Taking medications on time to maintain therapeutic blood levels

Ans

4. Taking medications on time to maintain therapeutic blood levels

11 The nurse has given instructions to a client with Parkinson’s Disease about maintaining mobility. Which action demonstrates that the client understands the directions?

1. Sits in soft, deep chairs to promote comfort.

2. Exercises in the evening to combat fatigue.

3. Rocks back and forth to start movement with bradykinesia.

4. Buys clothes with many buttons to maintain finger dexterity.

Ans 

3. Rocks back and forth to start movement with bradykinesia.

12 The nurse has given suggestions to a client with trigeminal neuralgia about strategies to minimize episodes of pain. The nurse determines that the client needs further education if the client makes which statement?

1. “I will wash my face with cotton pads.”

2. “I’ll have to start chewing on my unaffected side.”

3. “I’ll try to eat my food either very warm or very cold.”

4. “I should rinse my mouth if toothbrushing is painful.”

Ans

3. “I’ll try to eat my food either very warm or very cold.”

13 The client is admitted to the hospital with a dx of Guillian-Barre syndrome. Which past medical history finding makes the client most at risk for the disease?

1. Meningitis or encephalitis during the last 5 years

2. Seizures or trauma to the brain within the last year

3. Back injury or trauma to the spinal chord during the last 2 years

4. Respiratory or gastrointestinal infection during the previous month

Ans

4. Respiratory or gastrointestinal infection during the previous month

14 A client with Guillian-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which strategy should the nurse incorporate in the plan of care to help the client cope with this illness?

1. Giving client full control over care decisions and restricting visitors

2. providing positive feedback and encouraging active range of motion

3. Providing information, giving positive feedback, and encouraging relaxation

4. Providing IV administered sedatives, reducing distractions, and limiting visitors

Ans

3. Providing information, giving positive feedback, and encouraging relaxation

15 A client has a neurological deficit involving the limbic system. Which assessment finding is specific to this type of deficit?

1. Is disoriented to person, place, and time

2. Affect is flat, with periods of emotional lability

3. Cannot recall what was eaten for breakfast today

4. Demonstrates inability to add and subtract; does not know who is the president of the United States.  

2. Affect is flat, with periods of emotional lability

16  The nurse is evaluating the status of a client who had a craniotomy 3 days ago. Which assessment finding would indicate that the client is developing meningitis as a complication of surgery?

1. A negative Kernig sign

2. Absence of nuchal rigidity

3. A positive Brudzinski sign

4. A Glasgow Coma Scale score of 15

Ans

3. A positive Brudzinski sign

17 The nurse has completed discharge instructions for a client with application of a halo device. Which action indicates that the client needs further clarification of the instructions?

1. Uses a straw for drinking

2. Drives only during the daytime

3. Uses caution because the device alters balance

4. Washes the skin daily under the lamb’s wool liner of the vest

Ans

2. Drives only during the daytime

18 The nurse is admitting a client with Guillain-Barre syndrome to the nursing unit. The client has ascending paralysis to the level of the waist. Knowing the complications of the disorder, the nurse should bring most essential items into the client’s room?

1. Nebulizer and pulse oximeter

2. Blood pressure cuff and flashlight

3. Flashlight and incentive spirometer

4. Electrocardiographic monitoring electrodes and intubation tray

Ans

4. Electrocardiographic monitoring electrodes and intubation tray

SECTION 5

1. Which of the following neurotransmitter is known to be associated with sleep, mood and appetite?

A. Acetylcholine

B. Dopamine

C. Serotonin

D. GABA

Answer Key C

2. The neurons of motor pathway control:

A. Stress reaction

B. Organs and glands

C. Involuntary muscles

D. Voluntary muscles

Answer Key D

3. Which of the following would be active when the person is sleeping?

A. Sympathetic nervous system

B. Parasympathetic nervous system

C. Central nervous system

D. Somatic system

Answer Key D

4. The area of the brain which is involved in the understanding of meaning is:

A. Broca’s area

B. Association areas

C. Wernicke’s area

D. Motor speech area

Answer Key C

5. Which is the neurotransmitter believed to be decreased in cognitive disorders, such as Alzheimer’s disease?

A. Acetylcholine

B. Dopamine

C. Serotonin

D. GABA

Answer Key A

6. The neurotransmitter serotonin is derived from which precursor amino acid?

A. Dopamine

B. Tyrosine

C. Tryptophan

D. Glutamine

Answer Key C

7. The location of the blood-brain barrier is considered to be;

A. At the level of the brain capillaries

B. At the level of glia

C. At the level of neurons

D. At the level of dendrites

Answer Key A

8. Identify the major excitatory neurotransmitter system in the mammalian CNS.

A. Aminobutyric acid

B. Histamine

C. Substance P

D. Glutamate/aspartate

Answer Key D

9. Agents that potentiate the actions of GABA in the brain will likely have which of the following effects?

A. Elevate blood pressure

B. Provide sedation

C. Cause seizures

D. Relieve pain

Answer Key B

10. Basal ganglia or neostriatum include the following areas, EXCEPT:

A. Caudate nucleus

B. Putamen

C. Globus pallidus

D. Amygdala

Answer Key D

11. The most common cause of dementia in the general population is

A. Epilepsy

B. Vascular disease

C. Alzheimer’s disease

D. Parkinson’s disease

E. Head trauma

Answer Key C

12. Which of the following medications may retard the progress of Alzheimer’s disease deterioration?

A. Donepezil

B. L-dopa

C. Prednisone

D. Vitamin B12

Answer Key A

13. Spike-and-wave discharges in EEG record is typical of :

A. Parkinson’s disease

B. Alzheimer’s disease

C. Delirium

D. Epilepsy

Answer Key D

14. In the dementia associated with Alzheimer’s disease, the EEG will

usually show:

A. Spike-and-wave discharges

B. Periodic frontal lobe discharges

C. Focal slowing

D. Generalized background slowing

Answer Key D

15. The normal EEG rhythm of an awake adult is

A. Beta waves

B. Alpha waves

C. Delta waves

D. Theta waves.

Answer Key B

16. Parkinson’s disease, is caused by the degeneration of neurons in an

area of the brain called the:

A. substantia nigra

B. Basal ganglia

C. Cerebellum

D. Corpus callosum

Answer Key A

17. The ability to constantly change both structure and function of many cells in the brain in response to experience and trauma is termed as:

A. spasticity

B. neural plasticity.

C. arousal

D. deep lesioning

Answer Key B

18. The division of nervous system which controls the involuntary muscles, organs, and glands is:

A. Somatic nervous system

B. Autonomic nervous system

C. Central nervous system

D. The motor pathway of the CNS.

Answer Key B

19. Parasympathetic system is also called:

A. fight-or-flight system.

B. eat-drink-and-rest system

C. autonomic nervous system

D. somatic nervous system

Answer Key B

20. A condition, causing the affected person to be unable to understand or comprehend the language (poor comprehension) with intact repetition (fluent output) is termed as:

A. Broca’s aphasia

B. Global aphasia

C. Wernicke’s aphasia

D. Conduction aphasia

Answer key  C

SECTION F

1. The nurse is about to administer a contrast medium to the client undergoing diagnostic testing. Which question does the nurse first ask the client?

a. “Are you in pain?”

b. “Are you taking ibuprofen daily

c. “Are you wearing any metal?”

d. “Do you know what this test is for?”

B

2. The nurse is caring for a client who is scheduled to have a transcranial Doppler (TCD). What does this diagnostic test evaluate?

a. Cerebral vasospasm

b. Cerebrospinal fluid

c. Evoked potentials

d. Intracranial pressure

A

3. Which task does the nurse plan to delegate to the unlicensed assistive personnel (UAP) caring for a group of clients in the neurosurgical unit?

a. Assist the health care provider in performing a lumbar puncture on a confused client

b. Attend to the care needs of a client who has had a transcranial Doppler study

c. Educate a client about what to expect during an electroencephalogram (EEG)

d. Prepare a client who is going to radiology for a cerebral arteriogram

B

4. Which information is most important for the nurse to communicate to the primary care provider (PCP) about a client who is scheduled for CT angiography?

a. Allergy to penicillin

b. History of bacterial meningitis

c. Poor skin turgor and dry mucous membranes

d. The client’s dose of metformin (Glucophage) held today

C

5. The nurse has just received report on a group of clients on the neurosurgical unit. Which client is the nurse’s first priority?

a. Client whose deep tendon reflexes have become hyperactive

b. Client who displays plantar flexion when the bottom of the foot is stroked

c. Client who consistently demonstrates decortication when stimulated

d. Client whose Glasgow Coma Scale (GCS) has changed from 15 to 13.

D

6. The nurse is performing a neurologic assessment on an 81-year-old client. Which physiologic change does the nurse expect to find because of the client’s age?

a. Decreased coordination

b. Increased sleeping during the night

c. Increased touch sensation

d. Nightly confusion

A

7. Which cranial nerve allows a person to feel a light breeze on the face?

a. I (olfactory)

b. III (oculomotor)

c. V (trigeminal)

d. VII (facial)

C

8. The nurse has just received report on a group of clients. Which client does the nurse assess first?

a. Client who was in a car accident and has a Glasgow Coma Scale score of 14

b. Client who had a cerebral arteriogram and has a cool, pale leg

c. Client who has a headache after undergoing a lumbar puncture

d. Client who has expressive aphasia after a left-sided stroke

B

9. The nurse has just received change-of-shift report about a group of clients on the neurosurgical unit. Which client does the nurse attend to first?

a. Adult postoperative left craniotomy client whose hand grip is weaker on the right

b. Middle-aged adult client who had a cerebral aneurysm clipping and is becoming increasingly confused

c. Older adult client who had a carotid endarterectomy and is unable to state the day of the week

d. Young adult client involved in a motor vehicle crash (MVC) who is yelling obscenities at the nursing staff

B

10. An older client presents to the clinic after a ground level fall at home. What statement by the client indicates the need for more injury prevention education?

a. “I always take my medicine as directed.”

b. “I only eat little snacks so I don’t gain weight.”

c. “I will make sure I drink enough water.”

d. “I make sure to get as much sleep as I used to.”

B

11. A client is scheduled for an electroencephalogram (EEG) in the morning. Which instruction does the nurse give the client?

a. “Do not take any sedatives 12-24 hours before the test.”

b. “Please do not have anything to eat or drink after midnight.”

c. “You may bring some music to listen to for distraction.”

d. “You will need to have someone to drive you home.”

A

12. The nurse prepares to assess a client with diabetes mellitus for sensory loss. Which equipment is the best choice for the nurse use to perform this assessment?

a. Cotton-tipped applicator

b. Glucometer

c. Hammer

d. Safety pin

A

13. The nurse is assessing a client with a neurologic condition who is reporting difficulty chewing when eating. The nurse suspects that which cranial nerve has been affected?

a. Abducens (CN VI)

b. Facial (CN VII)

c. Trigeminal (CN V)

d. Trochlear (CN IV)

C

14. Which client diagnosed with neurologic injury is typically at highest risk for depression?

a. Older man with a mild stroke

b. Older woman with a seizure

c. Young man with a spinal cord injury

d. Young woman with a minor closed head injury

C

15. A client has just returned from cerebral angiography. Which symptom does the client display that causes the nurse to act immediately?

a. Bleeding

b. Increased temperature

c. Severe headache

d. Urge to void

A

16. Which client will the neurologic unit charge nurse assign to a registered nurse who has floated from the labor/delivery unit for the shift?

a. Adult client who has just returned from having a cerebral arteriogram and needs vital sign checks every 15 minutes.

b. Older adult client who was just admitted with a stroke and needs an admission assessment.

c. Young adult client who has had a lumbar puncture and reports, “Light hurts my eyes.”

d. Middle-aged client who has a possible brain tumor and has questions about the scheduled magnetic resonance imaging.

A

17. The nurse is performing a rapid neurologic assessment on a trauma client. Which assessment findings are normal? Select all that apply.

a. Decerebrate posturing

b. Glasgow Coma Score (GCS) 15

c. Lethargy

d. Minimal response to stimulation

e. Pupil constriction to light

B, D

SECTION 6

1 The sympathetic nervous system postganglionic neuron releases what neurotransmitter?

A. Acetylcholine

B. Norepinephrine

C. Both Acetylcholine and Norepinephrine

D. Arginine

The answer is B. Norepinephrine

2 The sympathetic nervous system preganglionic neuron releases what neurotransmitter?

A. Serotonin

B. Acetylcholine

C. Norepinephrine

D. Arginine

The answer is B. Acetylcholine

3 In the sympathetic nervous system ganglia are found? Select all that apply:

A. Thoracic

B. Brain stem

C. Sacral

D. Lumbar

The answers are A and D, thoracic and Lumbar

4 In the parasympathetic nervous system the ganglia are found? Select all that apply:

A. Cervical

B. Brain Stem

C. Lumbar

D. Sacral

The answers are B and D, the brain stem and sacral

5 The postganglionic neuron releases what neurotransmitter in the parasympathetic nervous system?

A. Arginine

B. Norepinephrine

C. Dopamine

D. Acetylcholine

The answer is D. Acetylcholine

6 Select all the signs and symptoms a patient can experience with the stimulation of the sympathetic nervous system: select all that apply:

A. Tachycardia

B. Hypotension

C. Hyperglycemia

D. Dilated pupils

E. Urinary incontinence

F. Bronchodilation

G. Cold and clammy

H. Excessive salivation

I. Sweating

The answers are A, C, D, F, and I. Tachycardia, Hyperglycemia, Dilated pupils, Bronchodilation, and sweating

7 Select all the signs and symptoms a patient can experience with the stimulation of the parasympathetic nervous system: select all that apply:

A. Bradycardia

B. Dilated pupils

C. Bronchoconstriction

D. Constrict pupils

E. Bladder contraction

F. Dry mouth

G. Slow digestion

H. Hypertension

The answers are A, C, D, and E. Bradycardia, Bronchoconstriction, Constrict pupils, and Bladder contraction

8 The __________ nervous system stimulates cranial nerve __________, which is responsible for slowing the heart rate, constricting the airway, and stimulating digestion.

A. Parasympathetic, X

B. Sympathetic, V

C. Parasympathetic, III

D. Sympathetic, VII

The answer is A. Parasympathetic and X, the vagus nerve

9 A patient is started on a norepinephrine drip. What side effects can this medication cause? Select all that apply:

A. Tachycardia

B. Hypoglycemia

C. Hypertension

D. Bronchoconstriction

The answers are A and C. 

10 A patient with myasthenia gravis is started on Pyridostigmine. What assessment finding demonstrates the drug is working correctly?

A. The patient experiences dilation of the pupils.

B. The patient experiences a relaxed bladder

C. The patient experiences Bronchodilation

D. The patient experiences normal muscle function in the face and eyes.

The answer is D. 

11 Select the drugs below that are considered anticholinergic drugs (also called parasympatholytic)

A. Pyridostigmine

B. Atropine

C. Ipratropium

D. Propranolol

The answers are B and C, Atropine and Ipratropium are both anticholinergic drugs

12 What are some side effects of adrenergic antagonist drugs (sympatholytic): select all that apply:

A. Tachycardia

B. Bradycardia

C. Bronchoconstriction

D. Bronchodilation

The answers are B and C. Bradycardia and Cronchoconstriction

13 Select the drugs below that are considered sympathomimetic drugs:

A. Albuterol

B. Dopamine

C. Epinephrine

D. Propranolol

The answers are A, B, and C. Albuteral, Dopamine, and Epinephrine are all drugs that can mimic the sympathetic nervous system.

ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM 

SECTION 1

1. Question

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to:

A. Promote expectoration.

B. Suppress the cough.

C. Relax smooth muscles of the bronchial airway.

D. Prevent infection.

Incorrect

Correct Answer: C. Relax smooth muscles of the bronchial airway.

2. Question

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication?

A. Constipation

B. Diarrhea

C. Bradycardia

D. Tachycardia

Correct

Correct Answer: D. Tachycardia

3. Question

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?

A. Removes the cap and shakes the inhaler well before use.

B. Press the canister down with your finger as he breathes in.

C. Inhales the mist and quickly exhales.

D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

Incorrect

Correct Answer: C. Inhales the mist and quickly exhales.

4. Question

A female client is scheduled to have a chest radiograph. Which of the following questions is of most importance to the nurse assessing this client?

A. “Is there any possibility that you could be pregnant?”

B. “Are you wearing any metal chains or jewelry?”

C. “Can you hold your breath easily?”

D. “Are you able to hold your arms above your head?”

Incorrect

Correct Answer: A. “Is there any possibility that you could be pregnant?”

5. Question

A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?

A. Encouraging additional fluids for the next 24 hours

B. Ensuring the return of the gag reflex before offering foods or fluids

C. Administering atropine intravenously

D. Administering small doses of midazolam (Versed).

Incorrect

Correct Answer: B. Ensuring the return of the gag reflex before offering foods or fluids

6. Question

A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the:

A. Brachial and radial arteries, and then releases them and observes the circulation of the hand.

B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.

C. Radial artery and observes for color changes in the affected hand.

D. Ulnar artery and observes for color changes in the affected hand.

Incorrect

Correct Answer: B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.

7. Question

A nurse is assessing a client with chronic airflow limitation and notes that the client has a “barrel chest.” The nurse interprets that this client has which of the following forms of chronic airflow limitation?

A. Chronic obstructive bronchitis

B. Emphysema

C. Bronchial asthma

D. Bronchial asthma and bronchitis

Incorrect

Correct Answer: B. Emphysema

8. Question

A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse concludes that the medication is having the intended effect if the client experiences:

A. Decreased anxiety level.

B. Increased comfort level.

C. Reduction of N/V.

D. Decreased frequency and intensity of cough.

Correct

Correct Answer: D. Decreased frequency and intensity of cough.

9. Question

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will:

A. Maintain a fluid intake of 800 ml every 24 hours.

B. Experience chills only once a day.

C. Cough productively without chest discomfort.

D. Experience less nasal obstruction and discharge.

Correct

Correct Answer: D. Experience less nasal obstruction and discharge.

10. Question

Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination?

A. A 60-year-old man with a hiatal hernia.

B. A 36-year-old woman with 3 children.

C. A 50-year-old woman caring for a spouse with cancer.

D. A 60-year-old woman with osteoarthritis.

Incorrect

Correct Answer: C. A 50-year-old woman caring for a spouse with cancer.

11. Question

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client?

A. “Use your nasal decongestant spray regularly to help clear your nasal passages.”

B. “Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.”

C. “It is important to increase your activity. A daily brisk walk will help promote drainage.”

D. “Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks.”

Incorrect

Correct Answer: D. “Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks.”

12. Question

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings?

A. It is likely that the client is developing a secondary bacterial pneumonia.

B. The assessment findings are consistent with influenza and are to be expected.

C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions

D. The client has not been taking her decongestants and bronchodilators as prescribed.

Incorrect

Correct Answer: A. It is likely that the client is developing a secondary bacterial pneumonia.

13. Question

Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose? Fill in the blank and record your final answer using one decimal place.

Answer:  mL

Correct

Correct Answer: 7.5 ml

14. Question

Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug?

A. Constipation

B. Bradycardia

C. Diplopia

D. Restlessness

Correct

Correct Answer: D. Restlessness

15. Question

A client with COPD reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?

A. Altered nutrition: Less than body requirements related to fatigue.

B. Activity intolerance related to dyspnea.

C. Weight loss related to COPD.

D. Ineffective breathing pattern related to alveolar hypoventilation.

Incorrect

Correct Answer: A. Altered nutrition: Less than body requirements related to fatigue.

16. Question

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following?

A. Develop infections easily.

B. Maintain current status.

C. Require less supplemental oxygen.

D. Show permanent improvement.

Incorrect

Correct Answer: A. Develop infections easily.

17. Question

Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client:

A. Promises to do pursed lip breathing at home.

B. States actions to reduce pain.

C. States that he will use oxygen via a nasal cannula at 5 L/minute.

D. Agrees to call the physician if dyspnea on exertion increases.

Correct

Correct Answer: D. Agrees to call the physician if dyspnea on exertion increases.

18. Question

Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD?

A. Increased anteroposterior chest diameter.

B. Underdeveloped neck muscles.

C. Collapsed neck veins.

D. Increased chest excursions with respiration.

Incorrect

Correct Answer: A. Increased anteroposterior chest diameter.

19. Question

Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?

A. To promote oxygen intake.

B. To strengthen the diaphragm.

C. To strengthen the intercostal muscles.

D. To promote carbon dioxide elimination.

Correct

Correct Answer: D. To promote carbon dioxide elimination.

20. Question

Which of the following is a priority goal for the client with COPD?

A. Maintaining functional ability.

B. Minimizing chest pain.

C. Increasing carbon dioxide levels in the blood.

D. Treating infectious agents.

Incorrect

Correct Answer: A. Maintaining functional ability

21. Question

A client’s arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms would the nurse expect?

A. Cyanosis

B. Flushed skin

C. Irritability

D. Anxiety

Incorrect

Correct Answer: B. Flushed skin

22. Question

When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects:

A. While inhaling through an open mouth.

B. While exhaling through pursed lips.

C. After exhaling but before inhaling.

D. While taking a deep breath and holding it.

Incorrect

Correct Answer: B. While exhaling through pursed lips.

23. Question

The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan?

A. Clubbing of nail beds

B. Hypertension

C. Peripheral edema

D. Increased appetite

Incorrect

Correct Answer: C. Peripheral edema

24. Question

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected?

Normal breath sounds

A. Normal breath sounds

B. Prolonged inspiration

C. Normal chest movement

D. Coarse crackles and rhonchi

Incorrect

Correct Answer: D. Coarse crackles and rhonchi

25. Question

Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD?

A. Increased PaCO2

B. Increased PaO2

C. Increased pH

D. Increased oxygen saturation

Incorrect

Correct Answer: A. Increased PaCO2

26. Question

Which of the following diets would be most appropriate for a client with COPD?

A. Low fat, low cholesterol

B. Bland, soft diet

C. Low-Sodium diet

D. High calorie, high-protein diet

Correct

Correct Answer: D. High-calorie, high-protein diet

27. Question

The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included?

A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

B. Lie flat on back, splint the thorax, take two deep breaths and cough.

C. Take several rapid, shallow breaths and then cough forcefully.

D. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

Incorrect

Correct Answer: A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

28. Question

A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client?

A. Initiate oxygen therapy and reassess the client in 10 minutes.

B. Draw blood for an ABG analysis and send the client for a chest x-ray.

C. Encourage the client to relax and breathe slowly through the mouth.

D. Administer bronchodilators.

Incorrect

Correct Answer: D. Administer bronchodilators.

29. Question

The nurse would anticipate which of the following ABG results in a client experiencing a prolonged, severe asthma attack?

A. Decreased PaCO2, increased PaO2, and decreased pH.

B. Increased PaCO2, decreased PaO2, and decreased pH.

C. Increased PaCO2, increased PaO2, and increased pH.

D. Decreased PaCO2, decreased PaO2, and increased pH.

Incorrect

Correct Answer: B. Increased PaCO2, decreased PaO2, and decreased pH.

30. Question

A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma?

A. Corticosteroids promote bronchodilation.

B. Corticosteroids act as an expectorant.

C. Corticosteroids have an anti-inflammatory effect.

D. Corticosteroids prevent development of respiratory infections.

Incorrect

Correct Answer: C. Corticosteroids have an anti-inflammatory effect.

31. Question

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply.

A. The inhaler is held upright.

B. Head is tilted down while inhaling the medication.

C. Client waits 5 minutes between puffs.

D. Mouth is rinsed with water following administration.

E. Client lies supine for 15 minutes following administration.

Incorrect

Correct Answers: A & D.

32. Question

A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to report side effects. Which of the following are potential side effects of metaproterenol?

A. Irregular heartbeat

B. Constipation

C. Pedal edema

D. Decreased heart rate.

Correct Answer: A. Irregular heartbeat

33. Question

A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most appropriate?

A. “This is an anticipated side-effect of your medication. It should go away in a couple of weeks.”

B. “You are using your inhaler too much and it has irritated your mouth.”

C. “You have developed a fungal infection from your medication. It will need to be treated with an antifungal.”

D. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”

Incorrect

Correct Answer: C. “You have developed a fungal infection from your medication. It will need to be treated with an antifungal.”

34. Question

Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma?

A. Incorporate physical exercise as tolerated into the treatment plan.

B. Monitor peak flow numbers after meals and at bedtime.

C. Eliminate stressors in the work and home environment.

D. Use sedatives to ensure uninterrupted sleep at night.

Incorrect

Correct Answer: A. Incorporate physical exercise as tolerated into the treatment plan.

35. Question

The client with asthma should be taught which of the following is one of the most common precipitating factors of an acute asthma attack?

A. Occupational exposure to toxins.

B. Viral respiratory infections.

C. Exposure to cigarette smoke.

D. Exercising in cold temperatures.

Incorrect

Correct Answer: B. Viral respiratory infections.

36. Question

A female client comes into the emergency room complaining of SOB and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 110, R 40. The physician orders ABG’s, results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L; SaO2 86%. Considering these results, the first intervention is to:

A. Begin mechanical ventilation.

B. Place the client on oxygen.

C. Give the client sodium bicarbonate.

D. Monitor for pulmonary embolism.

Incorrect

Correct Answer: B. Place the client on oxygen

37. Question

Basilar crackles are present in a client’s lungs on auscultation. The nurse knows that these are discrete, non continuous sounds that are:

A. Caused by the sudden opening of alveoli.

B. Usually more prominent during expiration.

C. Produced by airflow across passages narrowed by secretions.

D. Found primarily in the pleura.

Incorrect

Correct Answer: A. Caused by the sudden opening of alveoli

38. Question

A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first nursing action would be to:

A. Wait until the client’s lab work is done.

B. Not administer oxygen unless ordered by the physician.

C. Administer oxygen at 2 L flow per minute.

D. Administer oxygen at 10 L flow per minute and check the client’s nail beds.

Incorrect

Correct Answer: C. Administer oxygen at 2 L flow per minute.

39. Question

Immediately following a thoracentesis, which clinical manifestations indicate that a complication has occurred and the physician should be notified?

A. Serosanguineous drainage from the puncture site.

B. Increased temperature and blood pressure.

C. Increased pulse and pallor.

D. Hypotension and hypothermia.

Incorrect

Correct Answer: C. Increased pulse and pallor

40. Question

If a client continues to hypoventilate, the nurse will continually assess for a complication of:

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

Correct Answer: A. Respiratory acidosis

41. Question

A client is admitted to the hospital with acute bronchitis. While taking the client’s VS, the nurse notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in chronic respiratory distress are usually the result of:

A. Respiratory acidosis

B. A build-up of carbon dioxide

C. A build-up of oxygen without adequate expelling of carbon dioxide.

D. An acute respiratory infection.

Incorrect

Correct Answer: B. A build-up of carbon dioxide.

42. Question

Auscultation of a client’s lungs reveals crackles in the left posterior base. The nursing intervention is to:

A. Repeat auscultation after asking the client to deep breathe and cough.

B. Instruct the client to limit fluid intake to less than 2000 ml/day.

C. Inspect the client’s ankles and sacrum for the presence of edema.

D. Place the client on bedrest in a semi-Fowler’s position.

Incorrect

Correct Answer: A. Repeat auscultation after asking the client to deep breathe and cough.

43. Question

The most reliable index to determine the respiratory status of a client is to:

A. Observe the chest rising and falling.

B. Observe the skin and mucous membrane color.

C. Listen and feel the air movement.

D. Determine the presence of a femoral pulse.

Incorrect

Correct Answer: C. Listen and feel the air movement.

44. Question

A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan of care because of the polycythemia?

A. Fluid volume deficit related to blood loss.

B. Impaired tissue perfusion related to thrombosis.

C. Activity intolerance related to dyspnea.

D. Risk for infection related to suppressed immune response.

Correct Answer: B. Impaired tissue perfusion related to thrombosis.

45. Question

The physician has scheduled a client for a left pneumonectomy. The position that will most likely be ordered postoperatively for his is the:

A. Nonoperative side or back

B. Operative side or back

C. Back only

D. Back or either side.

Correct Answer: B. Operative side or back

46. Question

Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find:

A. A flushed face.

B. Dyspnea and pain.

C. Decreased temperature.

D. Severe cough and no pain.

Incorrect

Correct Answer: B. Dyspnea and pain

47. Question

A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first intervention in completing this procedure would be to:

A. Change the tracheostomy dressing.

B. Provide humidity with a trach mask.

C. Apply oral or nasal suction.

D. Deflate the tracheal cuff.

Correct Answer: C. Apply oral or nasal suction.

48. Question

A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that the tidal volume is the amount of air:

A. Exhaled forcibly after a normal expiration.

B. Exhaled after there is a normal inspiration.

C. Trapped in the alveoli that cannot be exhaled.

D. Forcibly inspired over and above a normal respiration.

Incorrect

Correct Answer: B. Exhaled after there is a normal inspiration.

49. Question

An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by:

A. A decreasing oxygen pressure in the blood.

B. An increasing carbon dioxide pressure in the blood.

C. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.

D. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood.

Incorrect

Correct Answer: C. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.

50. Question

The best method of oxygen administration for client with COPD uses:

A. Cannula

B. Simple Face mask

C. Non-rebreather mask

D. Venturi mask

Correct Answer: D. Venturi mask

SECTION 2

1. Question

Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnosed asthma. When teaching the patient about this drug, the nurse should explain that it may cause:

A. Nasal congestion

B. Nervousness

C. Lethargy

D. Hyperkalemia

Incorrect

Correct Answer: B. Nervousness

2. Question

Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is:

A. Yellow

B. Green

C. Clear

D. Gray

Incorrect

Correct Answer: C. Clear

3. Question

A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A. Nausea or vomiting

B. Abdominal pain or diarrhea

C. Hallucinations or tinnitus

D. Lightheadedness or parenthesis 

Correct Answer: D. Lightheadedness or paresthesia

4. Question

Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for:

A. Patients with an acute asthma attack.

B. Patients with narcolepsy.

C. Patients under age

D. Elderly patients.

Correct Answer: D. Elderly patients

5. Question

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

A. Kinking of the ventilator tubing.

B. A disconnected ventilator tube.

C. An endotracheal cuff leak.

D. A change in the oxygen concentration without resetting the oxygen level alarm.

Correct Answer: A. Kinking of the ventilator tubing.

6. Question

A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?

Leg movement

A. Leg movement

B. Finger movement

C. Lip movement

D. Fighting the ventilator

Correct Answer: D. Fighting the ventilator

7. Question

On auscultation, which finding suggests a right pneumothorax?

A. Bilateral inspiratory and expiratory crackles.

B. Absence of breaths sound in the right thorax.

C. Inspiratory wheezes in the right thorax.

D. Bilateral pleural friction rub.

Incorrect

Correct Answer: B. Absence of breaths sound in the right thorax

8. Question

Rhea, confused and short breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses see many abbreviations. What does a lowercase “a” in ABG value present?

A. Acid-base balance

B. Arterial Blood

C. Arterial oxygen saturation

D. Alveoli

Correct Answer: B. Arterial Blood

9. Question

A male patient is admitted to the healthcare facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?

A. Activity intolerance related to fatigue.

B. Anxiety related to actual threat to health status.

C. Risk for infection related to retained secretions.

D. Impaired gas exchange related to airflow obstruction.

Correct Answer: D. Impaired gas exchange related to airflow obstruction.

10. Question

Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:

A. Contralateral side in a simple pneumothorax.

B. Affected side in a hemothorax.

C. Affected side in a tension pneumothorax.

D. Contralateral side in hemothorax.

Correct Answer: D. Contralateral side in hemothorax.

11. Question

After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

A. Monitor fluctuations in the water-seal chamber.

B. Clamp the chest tube once every shift.

C. Encourage coughing and deep breathing.

D. Milk the chest tube every 2 hours.

Incorrect

Correct Answer: C. Encourage coughing and deep breathing

12. Question

When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:

A. Encourage oral feeding as soon as possible.

B. Develop an alternative communication method.

C. Keep the tracheostomy cuff fully inflated.

D. Keep the patient flat in bed.

Correct Answer: B. Develop an alternative communication method.

13. Question

A male patient has a sucking stab wound to the chest. Which action should the nurse take first?

A. Drawing blood for a hematocrit and hemoglobin level.

B. Applying a dressing over the wound and taping it on three sides.

C. Preparing a chest tube insertion tray.

D. Preparing to start an I.V. line.

Correct Answer: B. Applying a dressing over the wound and taping it on three sides.

14. Question

For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A. Encouraging the patient to drink three glasses of fluid daily.

B. Keeping the patient in semi-Fowler’s position.

C. Using a high-flow venturi mask to deliver oxygen as prescribed.

D. Administering a sedative, as prescribed.

Correct Answer: C. Using a high-flow venturi mask to deliver oxygen as prescribe

15. Question

A male patient’s X-ray result reveals bilateral white-outs, indicating acute respiratory distress syndrome (ARDS). This syndrome results from:

A. Cardiogenic pulmonary edema

B. Respiratory alkalosis

C. Increased pulmonary capillary permeability

D. Renal failure

Correct Answer: C. Increased pulmonary capillary permeability

16. Question

For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?

A. Restricting fluid intake to 1,000 ml per day.

B. Enforcing absolute bed rest.

C. Teaching the patient how to perform controlled coughing.

D. Administering prescribed sedatives regularly and in large amounts.

Correct Answer: C. Teaching the patient how to perform controlled coughing.

17. Question

Nurse Lei, caring for a client with a pneumothorax and who has had a chest tube inserted, continues gentle bubbling in the suction control chamber. What action is appropriate?

A. Do nothing, because this is an expected finding.

B. Immediately clamp the chest tube and notify the physician.

C. Check for an air leak because the bubbling should be intermittent.

D. Increase the suction pressure so that the bubbling becomes vigorous.

Correct Answer: A. Do nothing, because this is an expected finding.

18. Question

Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?

A. Inform the physician.

B. Continue to monitor the client.

C. Reinforce the occlusive dressing.

D. Encourage the client to deep breathe.

Correct Answer: B. Continue to monitor the client.

19. Question

Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:

A. Call the physician.

B. Place the tube in a bottle of sterile water.

C. Immediately replace the chest tube system.

D. Place a sterile dressing over the disconnection site.

Correct Answer: B. Place the tube in a bottle of sterile water.

20. Question

A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:

A. Exhale slowly

B. Stay very still

C. Inhale and exhale quickly

D. Perform the Valsalva maneuver

Correct Answer: D. Perform the Valsalva maneuver.

21. Question

While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged. The initial nursing action is to:

A. Call the physician to reinsert the tube.

B. Grasp the retention sutures to spread the opening.

C. Call the respiratory therapy department to reinsert the tracheotomy.

D. Cover the tracheostomy site with a sterile dressing to prevent infection.

Correct Answer: B. Grasp the retention sutures to spread the opening.

22. Question

Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?

A. Stridor

B. Occasional pink-tinged sputum

C. A few basilar lung crackles on the right

D. Respiratory rate 24 breaths/min

Correct Answer: A. Stridor

23. Question

An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

A. A low respiratory rate.

B. Diminished breath sounds.

C. The presence of a barrel chest.

D. A sucking sound at the site of injury.

Correct Answer: B. Diminished breath sounds.

24. Question

Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?

A. Hypocapnia

B. A hyperinflated chest noted on the chest x-ray.

C. Increased oxygen saturation with exercise.

D. A widened diaphragm noted on the chest x-ray.

Correct Answer: B. A hyperinflated chest noted on the chest x-ray.

25. Question

An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?

A. Face tent

B. Venturi mask

C. Aerosol mask

D. Tracheostomy collar

Correct Answer: B. Venturi mask

26. Question

Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:

A. Dyspnea

B. Chest pain

C. A bloody, productive cough.

D. A cough with the expectoration of mucoid sputum.

Correct Answer: D. A cough with the expectoration of mucoid sputum

27. Question

A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis?

A. Bronchoscopy

B. Sputum culture

C. Chest x-ray

D. Tuberculin skin test

I

Correct Answer: B. Sputum culture

28. Question

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:

A. 1 L/min

B. 2 L/min

C. 6 L/min

D. 10 L/min

Correct Answer: B. 2 L/min

29. Question

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:

A. Promote oxygen intake.

B. Strengthen the diaphragm.

C. Strengthen the intercostal muscles.

D. Promote carbon dioxide elimination.

Correct Answer: D. Promote carbon dioxide elimination.

30. Question

A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client?

A. Pallor

B. Low arterial PaO2

C. Elevated arterial PaO2

D. Decreased respiratory rate

Correct Answer: B. Low arterial PaO2

31. Question

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

A. Limiting fluid.

B. Having the client take deep breaths.

C. Asking the client to spit into the collection container.

D. Asking the client to obtain the specimen after eating.

Correct Answer: B. Having the client take deep breaths.

32. Question

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?

A. Dry cough

B. Hematuria

C. Bronchospasm

D. Blood-streaked sputum

Correct Answer: C. Bronchospasm

33. Question

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:

A. 1 minute

B. 5 seconds

C. 10 seconds

D. 30 seconds

Correct Answer: C. 10 seconds

34. Question

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?

A. Continue to suction.

B. Notify the physician immediately.

C. Stop the procedure and reoxygenate the client.

D. Ensure that the suction is limited to 15 seconds.

Correct Answer: C. Stop the procedure and reoxygenate the client.

35. Question

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

A. Dyspnea

B. Bradypnea

C. Bradycardia

D. Decreased respirations

Correct Answer: A. Dyspnea

36. Question

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:

A. Resonant sounds.

B. Hyperresonant sounds.

C. Dull sounds.

D. Flat sounds.

Correct Answer: A. Resonant sounds.

37. Question

A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophylline) (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:

A. Question the order because it’s too low.

B. Question the order because it’s too high.

C. Set the pump at 45 ml/hour.

D. Stop the infusion and have the laboratory repeat the theophylline measurement.

Correct Answer: A. Question the order because it’s too low.

38. Question

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

A. Make inhalation longer than exhalation.

B. Exhale through an open mouth.

C. Use diaphragmatic breathing.

D. Use chest breathing.

Correct Answer: C. Use diaphragmatic breathing.

39. Question

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

A. Total lung capacity

B. Forced vital capacity

C. Tidal volume

D. Residual volume

Correct Answer: C. Tidal volume

40. Question

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?

A. Simple mask

B. Non-rebreather mask

C. Face tent

D. Nasal cannula

Correct Answer: B. Non-rebreather mask

41. Question

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

A. Impaired color discrimination

B. Increased urinary frequency

C. Decreased hearing acuity

D. Increased appetite

Correct Answer: C. Decreased hearing acuity

42. Question

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:

A. Area of redness is measured in 3 days and determines whether tuberculosis is present.

B. Skin test doesn’t differentiate between active and dormant tuberculosis infection.

C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.

D. Test stimulates a reddened response in some clients and requires a second test in 3 months.

Correct Answer: B. Skin test doesn’t differentiate between active and dormant tuberculosis infection.

43. Question

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:

A. 15 to 60 seconds.

B. 5 to 20 minutes.

C. 30 to 40 minutes.

D. 45 to 60 minutes.

Correct Answer: B. B. 5 to 20 minutes.

44. Question

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

A. The system is functioning normally.

B. The client has a pneumothorax.

C. The system has an air leak.

D. The chest tube is obstructed.

Correct Answer: C. The system has an air leak.

45. Question

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:

A. Lips

B. Mucous membranes

C. Nail beds

D. Earlobes

Correct Answer: B. Mucous membranes

46. Question

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

A. Auscultating the lungs for bilateral breath sounds.

B. Turning the client from side to side every 2 hours.

C. Monitoring serial blood gas values every 4 hours.

D. Providing frequent oral hygiene.

Correct Answer: A. Auscultating the lungs for bilateral breath sounds.

47. Question

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

A. Diaphragmatic breathing

B. Use of accessory muscles

C. Pursed-lip breathing

D. Controlled breathing

Correct Answer: B. Use of accessory muscles

48. Question

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:

A. Lung vibrations

B. Vocal sounds

C. Breath sounds

D. Chest movements.

Correct Answer: D. Chest movements

49. Question

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?

A. erythromycin (Erythrocin)

B. rifampin (Rifadin)

C. amantadine (Symmetrel)

D. amphotericin B (Fungizone)

Correct Answer: A. Erythromycin (Erythrocin)

50. Question

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:

A. Pleural effusion

B. Pulmonary edema

C. Atelectasis

D. Oxygen toxicity

Correct Answer: C. Atelectasis

SECTION 3

1. Question

An elderly client with pneumonia may appear with which of the following symptoms first?

A. Altered mental status and dehydration

B. Fever and chills

C. Hemoptysis and dyspnea

D. Pleuritic chest pain and cough

Correct Answer: A. Altered mental status and dehydration

2. Question

Which of the following pathophysiological mechanisms that occur in the lung parenchyma allows pneumonia to develop?

A. Atelectasis

B. Bronchiectasis

C. Effusion

D. Inflammation

Correct Answer: D. Inflammation

3. Question

A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following?

A. Acute asthma

B. Bronchial pneumonia

C. Chronic obstructive pulmonary disease (COPD)

D. Emphysema

Correct Answer: A. Acute asthma

4. Question

Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder?

A. Circumoral cyanosis

B. Increased forced expiratory volume

C. Inspiratory and expiratory wheezing

D. Normal breath sounds

Incorrect

Correct Answer: C. Inspiratory and expiratory wheezing

5. Question

Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection?

A. Emotional

B. Extrinsic

C. Intrinsic

D. Mediated

Incorrect

Correct Answer: C. Intrinsic

6. Question

A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away?

A. Beta-adrenergic blockers

B. Bronchodilators

C. Inhaled steroids

D. Oral steroids

Correct Answer: B. Bronchodilators

7. Question

A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first?

A. Take a full medication history.

B. Give a bronchodilator by nebulizer.

C. Apply a cardiac monitor to the client.

D. Provide emotional support to the client.

Correct Answer: B. Give a bronchodilator by nebulizer.

8. Question

A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions?

A. Adult respiratory distress syndrome (ARDS)

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: C. Chronic obstructive bronchitis

9. Question

The term “blue bloater” refers to which of the following conditions?

A. Adult respiratory distress syndrome (ARDS)

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: C. Chronic obstructive bronchitis

10. Question

The term “pink puffer” refers to the client with which of the following conditions?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct

Correct Answer: D. Emphysema

11. Question

A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: D. Emphysema

12. Question

It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons?

A. All clients are recommended to have these vaccines.

B. These vaccines produce bronchodilation and improve oxygenation.

C. These vaccines help reduce the tachypnea these clients experience.

D. Respiratory infections can cause severe hypoxia and possibly death in these clients.

Correct Answer: D. Respiratory infections can cause severe hypoxia and possibly death in these clients.

13. Question

Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?

A. It enhances cardiovascular fitness.

B. It improves respiratory muscle strength.

C. It reduces the number of acute attacks.

D. It worsens respiratory function and is discouraged.

Correct Answer: A. It enhances cardiovascular fitness.

14. Question

Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why?

A. Reducing fluid volume reduces oxygen demand.

B. Reducing fluid volume improves clients’ mobility.

C. Restricting fluid volume reduces sputum production.

D. Reducing fluid volume improves respiratory function.

Incorrect

Correct Answer: A. Reducing fluid volume reduces oxygen demand.

15. Question

A 69-year-old client appears thin and cachectic. He’s short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: D. Emphysema

16. Question

A client with emphysema should receive only 1 to 3 L/minute of oxygen if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?

A. The client doesn’t notice he needs to breathe.

B. The client breathes only when his oxygen levels climb above a certain point.

C. The client breathes only when his oxygen levels dip below a certain point.

D. The client breathes only when his carbon dioxide level dips below a certain point.

Incorrect

Correct Answer: C. The client breathes only when his oxygen levels dip below a certain point.

17. Question

Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics?

A. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.

B. How to increase his oxygen therapy.

C. How to treat respiratory infections without going to the physician.

D. How to recognize the signs of an impending respiratory infection.

Correct Answer: D. How to recognize the signs of an impending respiratory infection.

18. Question

Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery?

A. Atelectasis

B. Bronchitis

C. Pneumonia

D. Pneumothorax

Correct Answer: A. Atelectasis

19. Question

Which of the following measures can reduce or prevent the incidence of atelectasis in a postoperative client?

A. Chest physiotherapy

B. Mechanical ventilation

C. Reducing oxygen requirements

D. Use of an incentive spirometer.

Correct Answer: D. Use of an incentive spirometer.

20. Question

Emergency treatment of a client in status asthmaticus includes which of the following medications?

A. Inhaled beta-adrenergic agents

B. Inhaled corticosteroids

C. I.V. beta-adrenergic agents

D. Oral corticosteroids

Correct Answer: A. Inhaled beta-adrenergic agents

21. Question

Which of the following treatment goals is best for the client with status asthmaticus?

A. Avoiding intubation.

B. Determining the cause of the attack.

C. Improving exercise tolerance.

D. Reducing secretions.

Correct Answer: A. Avoiding intubation

22. Question

Dani was given Dilaudid for pain. She’s sleeping and her respiratory rate is 4 breaths/minute. If action isn’t taken quickly, she might have which of the following reactions?

A. Asthma attack

B. Respiratory arrest

C. Improve cardiac output

D. Constipation

Correct Answer: B. Respiratory arrest

23. Question

Which of the following additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 4 breaths/minute?

A. Arterial blood gas (ABG) and breath sounds.

B. Level of consciousness and a pulse oximetry value.

C. Breath sounds and reflexes.

D. Pulse oximetry value and heart sounds.

Correct Answer: B. Level of consciousness and a pulse oximetry value.

24. Question

A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect PaCO2 to be which of the following values?

A. 15 mm Hg

B. 30 mm Hg

C. 40 mm Hg

D. 80 mm Hg

Correct Answer: D. 80 mm Hg

25. Question

A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and becomes short of breath and tachypnea. He has a decreased level of consciousness. These signs indicate which of the following conditions?

A. Asthma attack

B. Pulmonary embolism

C. Respiratory failure

D. Rheumatoid arthritis

Correct Answer: C. Respiratory Failure

26. Question

Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first?

A. Administering oxygen.

B. Inserting an I.V. catheter.

C. Obtaining a complete blood count (CBC).

D. Taking vital signs.

Correct Answer: A. Administering oxygen.

27. Question

Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should take which of the following steps next?

A. Administer beta-adrenergic blockers.

B. Administer bronchodilators.

C. Obtain serum electrolyte levels.

D. Have the client lie flat in the bed.

Correct Answer: B. Administer bronchodilators.

28. Question

A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

Correct Answer: C. Respiratory acidosis

29. Question

A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience what type of acid-base imbalance?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

Correct Answer: A. Respiratory acidosis

30. Question

A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition?

A. Sodium level of 145 mEq/L

B. Potassium level of 3.0 mEq/L

C. Magnesium level of 2.0 mg/L

D. Phosphorus level of 4.0 mg/dl

Correct Answer: B. Potassium level of 3.0 mEq/L

SECTION 4 

1. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?  

A. 

Place the end of the chest tube in a container of sterile saline.

B. 

Apply an occlusive dressing and notify the physician.

C. 

Clamp the chest tube immediately.

D. 

Secure the chest tube with tape.

Correct Answer

A. Place the end of the chest tube in a container of sterile saline.

2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza?

A. Septicemia

B. Pneumonia

C. Meningitis

D. Pulmonary edema

Correct Answer

B. Pneumonia

3. A female 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:

A. 5 to 60 seconds.

B. 5 to 20 minutes.

C. 30 to 40 minutes.

D. 45 to 60 minutes.

Correct Answer

B. 5 to 20 minutes.

4. Gina, a home health nurse, is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?

A. Hypoxia

B. Delirium

C. Hyperventilation

D. Semiconsciousness

Correct Answer

A. Hypoxia

5. A male 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?

A. PH 5.0; PaCO2 30 mm Hg

B. PH 7.40; PaCO2 35 mm Hg

C. PH 7.35; PaCO2 40 mm Hg

D. PH 7.25; PaCO2 50 mm Hg

Correct Answer

D. PH 7.25; PaCO2 50 mm Hg

6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience:

A. Hyperglycemia and glycosuria.

B. Acute adrenocortical insufficiency.

C. GI bleeding.

D. Restlessness and seizures.

Correct Answer

B. Acute adrenocortical insufficiency.

7. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?

A. Activity intolerance related to fatigue.

B. Anxiety related to actual threat to health status.

C. Risk for infection related to retained secretions.

D. Impaired gas exchange related to airflow obstruction.

Correct Answer

D. Impaired gas exchange related to airflow obstruction.

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

A. Simple mask

B. Non-rebreather mask

C. Face tent

D. Nasal cannula

Correct Answer

B. Non-rebreather mask

9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure?

A. Immediately before a meal

B. At least 2 hours after a meal

C. When bronchospasms occur

D. When secretions have mobilized

Correct Answer

B. At least 2 hours after a meal

10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client’s arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values?

A. Fever

B. Tachypnea

C. Tachycardia

D. Hypotension

Correct Answer

D. Hypotension

11. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is:

A. Helping him communicate

B. Keeping his airway patent

C. Encouraging him to perform activities of daily living

D. Preventing him from developing an infection

Correct Answer

B. Keeping his airway patent

12. 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

Correct Answer

C. Teaching the client how to perform controlled coughing

13. The amount of air inspired and expired with each breath is called:

A. Tidal volume.

B. Residual volume.

C. Vital capacity.

D. Dead-space volume.

Correct Answer

A. Tidal volume.

14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He’s placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than:

A. 0.21

B. 0.35

C. 0.5

D. 0.7

Correct Answer

C. 0.5

15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true?

A. A positive reaction indicates that the client has active tuberculosis (TB).

B. A positive reaction indicates that the client has been exposed to the disease.

C. A negative reaction always excludes the diagnosis of TB.

D. The PPD can be read within 12 hours after the injection.

Correct Answer

B. A positive reaction indicates that the client has been exposed to the disease.

16. Nurse Murphy administers albuterol (Proventil), as prescribed to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

A. Respiratory rate of 22 breaths/minute.

B. Dilated and reactive pupils.

C. Urine output of 40 ml/hour.

D. Heart rate of 100 beats/minute.

Correct Answer

A. Respiratory rate of 22 breaths/minute.

17. What is the normal pH range for arterial blood?

A. 7 to 7.49

B. 7.35 to 7.45

C. 7.50 to 7.60

D. 7.55 to 7.65

Correct Answer

B. 7.35 to 7.45

18. Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review?

A. Fluid intake for the last 24 hours.

B. Baseline arterial blood gas (ABG) levels.

C. Prior outcomes of weaning.

D. Electrocardiogram (ECG) results.

Correct Answer

B. Baseline arterial blood gas (ABG) levels.

19. Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?

A. Administer a prescribed decongestant.

B. Instruct the client to breathe into a paper bag.

C. Offer the client fluids frequently.

D. Administer prescribed supplemental oxygen.

Correct Answer

B. Instruct the client to breathe into a paper bag.

20. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?

A. PH

B. Bicarbonate (HCO3–)

C. Partial pressure of arterial oxygen (PaO2)

D. Partial pressure of arterial carbon dioxide (PaCO2)

Correct Answer

C. Partial pressure of arterial oxygen (PaO2)

21. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following interventions will most likely lower the client’s arterial blood oxygen saturation?

A. Endotracheal suctioning.

B. Encouragement of coughing.

C. Use of a cooling blanket.

D. Incentive spirometry.

Correct Answer

A. Endotracheal suctioning.

22. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the plan of care?

A. Measuring and documenting the drainage in the collection chamber.

B. Maintaining continuous bubbling in the water-seal chamber.

C. Keeping the collection chamber at chest level.

D. Stripping the chest tube every hour.

Correct Answer

A. Measuring and documenting the drainage in the collection chamber.

23. Nurse Eve 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:

A. Drinking more than 1,500 ml of fluid daily.

B. Being overweight.

C. Eating a high-protein snack at bedtime.

D. Eating more than three large meals a day.

Correct Answer

B. Being overweight.

24. A black male 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:

A. Lips

B. Mucous membranes

C. Nail beds

D. Earlobes

Correct Answer

B. Mucous membranes

25. A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client’s serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range?

A. 1 to 2 mcg/ml

B. 2 to 5 mcg/ml

C. 5 to 10 mcg/ml

D. 10 to 20 mcg/ml

Correct Answer

D. 10 to 20 mcg/ml

26. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind that:

A. Vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.

B. Vancomycin may cause irreversible neutropenia.

C. Vancomycin should be administered rapidly in a large volume of fluid.

D. Vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.

Correct Answer

A. Vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.

27. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client’s medical history. Which condition is a predisposing factor for respiratory alkalosis?

A. Myasthenia gravis.

B. Type 1 diabetes mellitus.

C. Extreme anxiety.

D. Narcotic overdose.

Correct Answer

C. Extreme anxiety.

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:

A. Alprazolam (Xanax)

B. Propranolol (Inderal)

C. Morphine

D. Albuterol (Proventil)

Correct Answer

D. Albuterol (Proventil)

29. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A. Encouraging the client to drink three glasses of fluid daily.

B. Keeping the client in semi-Fowler’s position.

C. Using a high-flow Venturi mask to deliver oxygen as prescribed.

D. Administering a sedative as prescribed.

Correct Answer

C. Using a high-flow Venturi mask to deliver oxygen as prescribed.

30. Nurse Joana 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?

A. It increases inspiratory muscle strength.

B. It decreases use of accessory breathing muscles.

C. It prolongs the inspiratory phase of respiration.

D. It helps prevent early airway collapse.

Correct Answer

D. It helps prevent early airway collapse.

SECTION 5

1.A male patient has a sucking stab wound to the chest. Which action should the nurse take first?

ADrawing blood for a hematocrit and hemoglobin level

BApplying a dressing over the wound and taping it on three sides

CPreparing a chest tube insertion tray

DPreparing to start an I.V. line

B

2.A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?

AActivity intolerance related to fatigue

BAnxiety related to actual threat to health status

CRisk for infection related to retained secretions

DImpaired gas exchange related to airflow obstruction

D

3.A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A Nausea or vomiting

BAbdominal pain or diarrhea

CHallucinations or tinnitus

DLightheadedness or parenthesis 

D

4.Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for:

A Patients with an acute asthma attack

B Patients with narcolepsy

C Patients under age 6

D Elderly patients

D

5.A female patient suffers adult respiratory distress syndrome as a consequence of shock. The patient’s condition deteriorates rapidly, and endotracheal 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?

A Kinking of the ventilator tubing

B A disconnected ventilator tube

C An endotracheal cuff leak

D A change in the oxygen concentration without resetting the oxygen level alarm

A

6. A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?

A Leg movement

B Finger movement

C Lip movement

D Fighting the ventilator

D

7.On auscultation, which finding suggests a right pneumothorax?

A Bilateral inspiratory and expiratory crackles

B Absence of breaths sound in the right thorax

C Inspiratory wheezes in the right thorax

D Bilateral pleural friction rub

B

8.Rhea, confused and short breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses sees many abbreviations. What does a lowercase “a” in ABG value present?

A Acid-base balance

B Arterial Blood

C Arterial oxygen saturation

D Alveol

B.

9. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:

A Contralateral side in a simple pneumothorax

B Affected side in a hemothorax

C Affected side in a tension pneumothorax

D Contralateral side in hemothorax

D. 

10. After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

A Monitor fluctuations in the water-seal chamber

B Clamp the chest tube once every shift

C Encourage coughing and deep breathing

D Milk the chest tube every 2 hours

C

11. For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A Encouraging the patient to drink three glasses of fluid daily

B Keeping the patient in semi-fowler’s position

C Using a high-flow venturi mask to deliver oxygen as prescribe

D Administering a sedative, as prescribe

C

12. A male patient’s X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from:

A Cardiogenic pulmonary edema

B Respiratory alkalosis

C Increased pulmonary capillary permeability

D Renal failure

C

13. Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. What action is appropriate?

A Do nothing, because this is an expected finding

B Immediately clamp the chest tube and notify the physician

C Check for an air leak because the bubbling should be intermittent

D Increase the suction pressure so that the bubbling becomes vigorous

A

14 .Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?

A Inform the physician

B Continue to monitor the client

C Reinforce the occlusive dressing

D Encourage the client to deep-breathe

B

15. Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:

A Call the physician

B Place the tube in bottle of sterile water

C Immediately replace the chest tube system

D Place a sterile dressing over the disconnection site

B

16.A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:

A Exhale slowly

B Stay very still

C Inhale and exhale quickly

D Perform the Valsalva maneuver

D

17. While changing the tapes on a tracheostomy tube, the male client coughs and tube is dislodged. The initial nursing action is to:

A Call the physician to reinsert the tube

B Grasp the retention sutures to spread the opening

C Call the respiratory therapy department to reinsert the tracheotomy

D Cover the tracheostomy site with a sterile dressing to prevent infection

B

18. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?

A Stridor

B Occasional pink-tinged sputum

C A few basilar lung crackles on the right

D Respiratory rate 24 breaths/min

A

19. An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

A A low respiratory rate

B Diminished breath sounds

C The presence of a barrel chest

D A sucking sound at the site of injury

B

20.Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?

A Hypocapnia

B A hyperinflated chest noted on the chest x-ray

C Increased oxygen saturation with exercise

D A widened diaphragm noted on the chest x-ray

B

21.An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?

A Face tent

B Venturi mask

C Aerosol mask

D Tracheostomy collar

B

22.Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:

A Dyspnea

B Chest pain

C A bloody, productive cough

D A cough with the expectoration of mucoid sputum

D

23. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis?

A Bronchoscopy

B Sputum culture

C Chest x-ray

D Tuberculin skin test

B

23.A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:

A 1 L/min

B 2 L/min

C 6 L/min

D 10 L/min

B

24. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:

A Promote oxygen intake

B Strengthen the diaphragm

C Strengthen the intercostal muscles

D Promote carbon dioxide elimination

D

25. A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client?

A Pallor

B Low arterial PaO2

C Elevated arterial PaO2

D Decreased respiratory rate

B

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

ALimiting fluid

BHaving the client take deep breaths

CAsking the client to spit into the collection container

DAsking the client to obtain the specimen after eating

B

27. 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?

A Dry cough

B Hematuria

CBronchospasm

DBlood-streaked sputum

C

28. 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:

A1 minute

B5 seconds

C10 seconds

D30 seconds

C

29. 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?

AContinue to suction

BNotify the physician immediately

C Stop the procedure and reoxygenate the client

DEnsure that the suction is limited to 15 seconds

C

30. 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?

A Dyspnea

B Bradypnea

C Bradycardia

D Decreased respirations

A

31. 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:

A Resonant sounds

B Hyperresonant sounds

C Dull sounds

D Flat sounds

A 

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

Tidal volume

33. 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?

A Simple mask

B Non-rebreather mask

C Face tent

D Nasal cannula

B

34. 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?

A Impaired color discrimination

B Increased urinary frequency

C Decreased hearing acuity

D Increased appetite

C

35. 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:

A Area of redness is measured in 3 days and determines whether tuberculosis is present.

B Skin test doesn’t differentiate between active and dormant tuberculosis infection.

C Presence of a wheal at the injection site in 2 days indicates active tuberculosis.

D Test stimulates a reddened response in some clients and requires a second test in 3 months.

B

36. 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:

A15 to 60 seconds

B 5 to 20 minutes

C30 to 40 minutes

D 45 to 60 minutes

B

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

AThe system is functioning normally

B The client has a pneumothorax

C The system has an air leak

D The chest tube is obstructed

C

38. 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:

A Lips

B Mucous membranes

C Nail beds

D Earlobes

B

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

A Auscultating the lungs for bilateral breath sounds

B Turning the client from side to side every 2 hours

C Monitoring serial blood gas values every 4 hours

D Providing frequent oral hygiene

A

40. 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:

A Pleural effusion

B Pulmonary edema

C Atelectasis

D Oxygen toxicity

C

41. 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?

A It helps prevent early airway collapse

B It increases inspiratory muscle strength

C It decreases use of accessory breathing muscles

D It prolongs the inspiratory phase of respiration

A

42. 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?

A pH, 5.0; PaCO2 30 mm Hg

B pH, 7.40; PaCO2 35 mm Hg

C pH, 7.35; PaCO2 40 mm Hg

D pH, 7.25; PaCO2 50 mm Hg

D

PULSE

The pulse is a wave of blood created by contraction of the left ventricle of the heart. Generally, the pulse wave represents the stroke volume output or the amount of blood that enters the arteries with each ventricular contraction. Compliance of the arteries is their ability to contract and expand. When a person’s arteries lose their distensibility, as can happen with age, greater pressure is required to pump the blood into the arteries. 

Pulse rate: The number of pulsing sensations occurring in 60 seconds.

Cardiac output: This the volume of blood pumped by the heart within 60 seconds and it equals the product of HR and the ventricular SV. In an adult the heart normally pumps 5L of blood per minute.

When an adult is resting, the heart pumps about 5 liters of blood each minute. In a healthy person, the pulse reflects the heartbeat; that is, the pulse rate is the same as the rate of the ventricular contractions of the heart. However, in some types of cardiovascular disease, the heartbeat and pulse rates can differ. For example, a client’s heart may produce very weak or small pulse waves that are not detectable in a peripheral pulse far from the heart. In these instances, the nurse should assess the heartbeat and the peripheral pulse. 

A peripheral pulse is a pulse located away from the heart, for example, in the foot or wrist. The apical pulse, in contrast, is a central pulse; that is, it is located at the apex of the heart. It is also referred to as the point of maximal impulse (PMI).

FACTORS AFFECTING THE PULSE

The rate of the pulse is expressed in beats per minute (beats/min). A pulse rate varies according to a number of factors. The nurse should consider each of the following factors when assessing a client’s pulse:

• Age. As age increases, the pulse rate gradually decreases.

Variations in Pulse with Age:

                    Pulse Average                          Ranges

Newborn          130                                        80–180

1 year               120                                       80–140

5–8 years         100                                        75–120

10 years            70                                         50–90

Teen                  75                                         50–90

Adult                 80                                          60–100

• Sex. After puberty, the average male’s pulse rate is slightly lower than the female’s.
• Exercise. The pulse rate normally increases with activity. The rate of increase in the professional athlete is often less than in the average person because of greater cardiac size, strength, and efficiency.
• Fever. The pulse rate increases;

(a) in response to the lowered blood pressure that results from peripheral vasodilation associated with elevated body temperature and 

(b) because of the increased metabolic rate.

• Medications. Some medications decrease the pulse rate, and others increase it. For example, cardiotonics (e.g., digitalis preparations) decrease the heart rate, whereas epinephrine increases it.
• Hypovolemia/dehydration. Loss of blood from the vascular system increases the pulse rate. In adults, the loss of circulating volume results in an adjustment of the heart rate to increase blood pressure as the body compensates for the lost blood volume.
• Stress. In response to stress, sympathetic nervous stimulation increases the overall activity of the heart. Stress increases the rate as well as the force of the heartbeat. Fear and anxiety as well as the perception of severe pain stimulate the sympathetic system.
• Position. When a person is sitting or standing, blood usually pools in dependent vessels of the venous system. Pooling results in a transient decrease in the venous blood return to the heart and a subsequent reduction in blood pressure and increase in heart rate.
• Pathology. Certain diseases such as some heart conditions or those that impair oxygenation can alter the resting pulse rate.

Characteristics of the normal pulse which should be noted are:

1. The rate at which the heart beats

2. Rhythm; The pulse rhythm is the pattern of the beats and the intervals between the beats. Equal time elapses between beats of a normal pulse (The length of time between each beat should the same). Therefore, the Nurse\Midwife should note the regularity with which the heart beats occur. 

3. Volume or strength of the beat. It should require moderatepressure to obliterate the blood vessel.

4.Tension; The vessel should feel pliant and soft i.e. it should not feel hard and tortuous under the Nurse’s hand.

PULSE SITES

A pulse may be measured in nine sites: 

1. Temporal: Where the temporal artery passes over the temporal bone of the head. The site is superior (above) and lateral to (away from the midline of) the eye.

2. Carotid: It is located at the side of the neck where the carotid artery runs between the trachea and the sternocleidomastoid muscle.

NB: Never press both carotids at the same time because this can cause a reflex drop in blood pressure or pulse rate.

3. Apical: Located at the apex of the heart. In an adult, this is located on the left side of the chest, about 8 cm to the left of the sternum (breastbone) at the fifth intercostal space (area between the ribs). In older adults, the apex may be further left if conditions are present that have led to an enlarged heart. Before 4 years of age, the apex is left of the midclavicular line (MCL); between 4 and 6 years, it is at the MCL for a child 7 to 9 years of age, the apical pulse is located at the fourth or fifth intercostal space. 

4. Brachial: Located at the inner aspect of the biceps muscle of the arm or medially in the antecubital space. 

5. Radial: Located where the radial artery runs along the radial bone, on the thumb side of the inner aspect of the wrist. The radial site is most commonly used in adults. It is easily found in most people and readily accessible.

6. Femoral: Located where the femoral artery passes alongside the inguinal ligament. 

7. Popliteal: Located where the popliteal artery passes behind the knee. 

8. Posterior tibial: Located on the medial surface of the ankle where the posterior tibial artery passes behind the medial malleolus. 

9. Dorsalis pedis: Located where the dorsalis pedis artery passes over the bones of the foot, on an imaginary line drawn from the middle of the ankle to the space between the big and second toes. 

REASONS FOR USING SPECIFIC PULSE SITE

Radial: Readily accessible

Temporal: It is usually used when radial pulse is not accessible

Carotid: It is used during cardiac arrest/shock in adults, it can be used to determine circulation to the brain

Apical: It is routinely used for infants and children up to 3 years of age, also used to determine discrepancies with radial pulse and can be used in conjunction with some medications.

Brachial: It is used to measure blood pressure, used during cardiac arrest for infants.

Femoral: It is used in cases of cardiac arrest/shock and can be used to determine circulation to a leg

Popliteal: It is used to determine circulation to the lower leg

Posterior tibial: : It is used to determine circulation to the foot

Dorsalis pedis: It is used to determine circulation to the foot

ASSESSING THE PULSE

A pulse is commonly assessed by palpation (feeling) or auscultation (hearing). The middle three fingertips are used for palpating all pulse sites except the apex of the heart. A stethoscope is used for assessing apical pulses. A pulse is normally palpated by applying moderate pressure with the three middle fingers of the hand. The pads on the most distal aspects of the finger are the most sensitive areas for detecting a pulse. With excessive pressure, one can obliterate a pulse, whereas with too little pressure one may not be able to detect it. 

Before the nurse assesses the resting pulse, the client should assume a comfortable position. The nurse should also be aware of the following:

• Any medication that could affect the heart rate.
• Whether the client has been physically active. If so, wait 10 to 15 minutes until the client has rested and the pulse has slowed to its usual rate.
• Any baseline data about the normal heart rate for the client. For example, a physically fit athlete may have a resting heart rate below 60 beats/min.
• Whether the client should assume a particular position (e.g., sitting). In some clients, the rate changes with the position because of changes in blood flow volume and autonomic nervous system activity. When assessing the pulse, the nurse collects the following data: the rate, rhythm, volume, arterial wall elasticity, and presence or absence of bilateral equality.

Pulse volume, also called the pulse strength or amplitude, refers to the force of blood with each beat. Usually, the pulse volume is the same with each beat. It can range from absent to bounding. A normal pulse can be felt with moderate pressure of the fingers and can be obliterated with greater pressure. A forceful or full blood volume that is obliterated only with difficulty is called a full or bounding pulse. A pulse that is readily obliterated with pressure from the fingers is referred to as weak, feeble, or thready. The elasticity of the arterial wall reflects its expansibility or its deformities. A healthy, normal artery feels straight, smooth, soft, and pliable. Older adults often have inelastic arteries that feel twisted (tortuous) and irregular on palpation. When assessing a peripheral pulse to determine the adequacy of blood flow to a particular area of the body (perfusion), the nurse should also assess the corresponding pulse on the other side of the body. The second assessment gives the nurse data with which to compare the pulses. For example, when assessing the blood flow to the right foot, the nurse assesses the right dorsalis pedis pulse and then the left dorsalis pedis pulse. If the client’s right and left pulses are the same volume and elasticity, the client’s dorsalis pedis pulses are bilaterally equal. The pulse rate does not need to be counted when assessing for perfusion and equality. When a peripheral pulse is located, it indicates that pulses more proximal to that location will also be present. For example, if the dorsalis pedis, the most distal pulse of the lower extremity, cannot be felt, the nurse next palpates for the posterior tibial pulse. If it is not felt, the popliteal pulse must be assessed. If the popliteal pulse is found, it is not necessary to assess the femoral pulse since it must also be present in order for the more distal pulse to exist.

ABNORMALITIES IN PULSE

Tachycardia is an abnormally elevated heart rate i.e an increase in heart rate above 100 beats/min in an adult. This is found in certain hearty diseases, in some anaemias, and in thyrotoxicosis. Tachycardia may be continuous or paroxysmal i.e. occurring at irregular periods and for varying lengths of time.

Bradycardia is an abnormally slow heart rate, i.e. heart rate in an adult of less than 60 beats/min. It occurs in most cases of head injury, cerebral tumour and in diseases of the liver associated with jaundice etc.

Dysrhythmia or Arrhythmia is a pulse with an irregular rhythm. It may consist of random, irregular beats or a predictable pattern of irregular beats. When a dysrhythmia is detected, the apical pulse should be assessed. An electrocardiogram (ECG) is necessary to define the dysrhythmia further. 

RESPIRATIONS

Respiration is the act of breathing i.e. Inhalation and Expiration.

Inhalation or Inspiration refers to the intake of air into the lungs and exhalation or expiration refers to breathing out or the movement of gases from the lungs to the atmosphere. The apparent movement of the chest wall (the rise and fall) denotes respiration and must be counted and recorded by the midwife.

Ventilation is also used to refer to the movement of air in and out of the lungs. There are basically two types of breathing: costal (thoracic) breathing and diaphragmatic (abdominal) breathing. Costal breathing involves the external intercostal muscles and other accessory muscles, such as the sternocleidomastoid muscles. It can be observed by the movement of the chest upward and outward. By contrast, diaphragmatic breathing involves the contraction and relaxation of the diaphragm, and it is observed by the movement of the abdomen, which occurs as a result of the diaphragm’s contraction and downward movement. 

Assessing Respirations

Resting respirations should be assessed when the client is relaxed because exercise affects respirations, increasing their rate and depth. Anxiety is likely to affect respiratory rate and depth as well. Respirations may also need to be assessed after exercise to identify the client’s tolerance to activity. Before assessing a client’s respirations, a nurse should be aware of the following:

• The client’s normal breathing pattern
• The influence of the client’s health problems on respirations
• Any medications or therapies that might affect respirations
• The relationship of the client’s respirations to cardiovascular function. The rate, depth, rhythm, quality, and effectiveness of respirations should be assessed. The respiratory rate is normally described in breaths per minute. Breathing that is normal in rate and depth is called eupnea.

FACTORS AFFECTING RESPIRATIONS

Several factors influence respiratory rate. They are:

• Exercise: It increases metabolism increases thereby increasing the rate and depth to meet the need of the body for additional oxygen and to rid the body of CO2.
• Acute Pain alters rate and rhythm of respirations; breathing becomes shallow. Patient inhibits or splints chest wall movement when pain is in area of chest or abdomen.
• Anxiety/ stress (readies the body for “fight or flight”); Increases respiration rate and depth as a result of sympathetic stimulation.
• Smoking: Chronic smoking changes pulmonary airways, resulting in increased rate of respirations at rest when not smoking.
• Body Position: A straight, erect posture promotes full chest expansion. A stooped or slumped position impairs ventilatorymovement while lying flat prevents full chest expansion. People in a supine position experience two physiological processes that suppress respiration: an increase in the volume of blood inside the thoracic cavity and compression of the chest. Consequently, clients lying on their back have poorer lung aeration, which predisposes them to the stasis of fluids and subsequent infection.
• Medications: Opioid analgesics, general anesthetics, and sedative hypnotics depress rate and depth. Amphetamines and cocaine sometimes increase rate and depth. Bronchodilators slow rate by causing airway dilation.
• Neurological Injury: Injury to brainstem impairs respiratory center and inhibits respiratory rate and rhythm.
• Hemoglobin Function: Decreased hemoglobin levels (anemia) reduce oxygen-carrying capacity of the blood, which increases respiratory rate. Increased altitude lowers amount of saturated hemoglobin, which increases respiratory rate and depth. Abnormal blood cell function (e.g., sickle cell disease) reduces ability of hemoglobin to carry oxygen, which increases respiratory rate and depth.
• Environmental temperature: Increased environmental temperature increases respiratory rate while decrease in environmental temperature decreases it.
• Age/Sex: Respiratory rate is lower in adult than in children and it is usually more slightly higher in women than in men.

Age                     Respirations Average (and Ranges) 

Newborn                          35                  30–60 

1 year                               30                   20–40 

5–8 years                         20                   15–25 

10 years                           19                   15–25 

Teen                                18                   15–20 

Adult                               16                   12–20 

Older adult                      16                    15–20

ALTERATIONS IN BREATHING PATTERN

Bradypnea: Rate of breathing is regular but abnormally slow (less than 12 breaths/min).

Tachypnea: Rate of breathing is regular but abnormally rapidwith shallow breath (greater than 20 breaths/min).

Dyspnea: Difficult and labored breathing during which the individual has a persistent, unsatisfied need for air and feels distressed

Apnea: Respirations cease for several seconds. Persistent cessation results in respiratory arrest. Hyperventilation;Overexpansion of the lungs characterized by rapid and deep breaths. Hypocarbia sometimes occurs.

Hypoventilation: Underexpansion of the lungs, characterized by shallow respirations. Respiratory rate is abnormally low, and depth of ventilation is depressed. Hypercarbia sometimes occurs.

Cheyne-Stokes Respiration: Respiratory rate and depth are irregular, characterized by alternating periods of apnea and hyperventilation. Respiratory cycle begins with slow, shallow breaths that gradually increase to abnormal rate and depth. The pattern reverses; breathing slows and becomes shallow, concluding as apnea before respiration resumes.

Kussmaul’s respiration: Respirations are abnormally deep, regular, and increased in rate. 

Biot’s respiration: Respirations are abnormally shallow for two to three breaths, followed by irregular period of apnea.

Orthopnea: Ability to breathe only in upright sitting or standing positions

BREATH SOUNDS

They are usually audible without amplification.

• Stridor—a shrill, harsh sound heard during inspiration with laryngeal obstruction
• Stertor—snoring or sonorous respiration, usually due to a partial obstruction of the upper airway
• Wheeze—continuous, high-pitched musical squeak or whistling sound occurring on expiration and sometimes on inspiration when air moves through a narrowed or partially obstructed airway
• Bubbling—gurgling sounds heard as air passes through moist secretions in the respiratory tract

CHEST MOVEMENTS

• Intercostal retraction—indrawing between the ribs
• Substernal retraction—indrawing beneath the breastbone
• Suprasternal retraction—indrawing above the clavicles

SECRETIONS AND COUGHING

• Hemoptysis—the presence of blood in the sputum
• Productive cough—a cough accompanied by expectorated secretions
• Nonproductive cough—a dry, harsh cough without secretion

 

BLOOD PRESSURE

Arterial blood pressure is a measure of the pressure exerted by the blood as it flows through the arteries. Because the blood moves in waves, there are two blood pressure measurements. The systolic pressure is the pressure of the blood as a result of contraction of the ventricles, that is, the pressure of the height of the blood wave. The diastolic pressure is the pressure when the ventricles are at rest. Diastolic pressure, then, is the lower pressure, present at all times within the arteries. The difference between the diastolic and the systolic pressures is called the pulse pressure. 

A normal pulse pressure is about 40 mmHg but can be as high as 100 mmHg during exercise. Blood pressure is measured in millimeters of mercury (mmHg) and recorded as a fraction: systolic pressure over the diastolic pressure. A typical blood pressure for a healthy adult is 120/80 mmHg (pulse pressure of 40). Because blood pressure can vary considerably among individuals, it is important for the nurse to know a specific client’s baseline blood pressure. For example, if a client’s usual blood pressure is 180/100 mmHg, and it is assessed following surgery to be 120/80 mmHg, this significant drop in pressure may indicate complications and must be reported to the primary care provider. 

DETERMINANTS OF BLOOD PRESSURE ARTERIAL BLOOD PRESSURE

Pumping action of the heart: When the pumping action of the heart is weak, less blood is pumped into arteries (lower cardiac output), and the blood pressure decreases. When the heart’s pumping action is strong and the volume of blood pumped into the circulation increases (higher cardiac output), the blood pressure increases.

Peripheral vascular resistance: This is the resistance supplied by the blood vessels through which the blood flows. Peripheral resistance can increase blood pressure. The diastolic pressure especially is affected. Some factors that create resistance in the arterial system are the capacity of the arterioles and capillaries, the compliance of the arteries, and the viscosity of the blood. The internal diameter or capacity of the arterioles and the capillaries determines in great part the peripheral resistance to the blood in the body. The smaller the space within a vessel, the greater the resistance. Normally, the arterioles are in a state of partial constriction. Increased vasoconstriction, such as occurs with smoking, raises the blood pressure, whereas decreased vasoconstriction lowers the blood pressure. If the elastic and muscular tissues of the arteries are replaced with fibrous tissue, the arteries lose much of their ability to constrict and dilate. This condition, most common in middle-aged and older adults, is known as arteriosclerosis.

Blood volume: When the blood volume decreases (for example, as a result of a hemorrhage or dehydration), the blood pressure decreases because of decreased fluid in the arteries. Conversely, when the volume increases (for example, as a result of a rapid intravenous infusion), the blood pressure increases because of the greater fluid volume within the circulatory system.

Blood viscosity: Blood pressure is higher when the blood is highly viscous (thick), that is, when the proportion of red blood cells to the blood plasma is high. This proportion is referred to as the hematocrit. The viscosity increases markedly when the hematocrit is more than 60% to 65%.

FACTORS AFFECTING BLOOD PRESSURE

• Age: Newborns have a systolic pressure of about 75 mmHg. The pressure rises with age, reaching a peak at the onset of puberty, and then tends to decline somewhat. In older adults, elasticity of the arteries is decreased, the arteries are more rigid and less yielding to the pressure of the blood. This produces an elevated systolic pressure. Because the walls no longer retract as flexibly with decreased pressure, the diastolic pressure may also be high.
• Exercise: Physical activity increases the cardiac output and hence the blood pressure. For reliable assessment of resting blood pressure, wait 20 to 30 minutes following exercise.
• Stress: Stimulation of the sympathetic nervous system increases cardiac output and vasoconstriction of the arterioles, thus increasing the blood pressure reading; however, severe pain can decrease blood pressure greatly by inhibiting the vasomotor center and producing vasodilation.
• Race: African Americans older than 35 years tend to have higher blood pressures than European Americans of the same age although the exact reasons for these differences are unclear
• Sex: After puberty, females usually have lower blood pressures than males of the same age; this difference is thought to be due to hormonal variations. After menopause, women generally have higher blood pressures than before.
• Medications: Many medications, including caffeine, may increase or decrease the blood pressure.
• Obesity: Both childhood and adult obesity predispose to hypertension.
• Diurnal variations: Pressure is usually lowest early in the morning, when the metabolic rate is lowest, then rises throughout the day and peaks in the late afternoon or early evening.
• Medical conditions. Any condition affecting the cardiac output, blood volume, blood viscosity, and/or compliance of the arteries has a direct effect on the blood pressure.
• Temperature: Because of increased metabolic rate, fever can increase blood pressure. However, external heat causes vasodilation and decreased blood pressure. Cold causes vasoconstriction and elevates blood pressure.

ABNORMALITIES IN BLOOD PRESSURE

HYPERTENSION: A blood pressure that is persistently above normal is called hypertension. A single elevated blood pressure reading indicates the need for reassessment. Hypertension cannot be diagnosed unless an elevated blood pressure is found when measured twice at different times. It is usually asymptomatic and is often a contributing factor to myocardial infarctions (heart attacks). An elevated blood pressure of unknown cause is called primary hypertension.

An elevated blood pressure of known cause is called secondary hypertension. Hypertension is a widespread health problem. Individuals with diastolic blood pressures of 80 to 89 mmHg or systolic blood pressures of 120 to 139 mmHg should be considered prehypertensive and, without intervention, may develop cardiac disease. Hypertension is when either the systolic BP is higher than 140 mmHg or when the diastolic blood pressure (BP) is 90 mmHg or higher 

Factors associated with hypertension include thickening of the arterial walls, which reduces the size of the arterial lumen, and inelasticity of the arteries as well as such lifestyle factors as cigarette smoking, obesity, heavy alcohol consumption, lack of physical exercise, high blood cholesterol levels, and continued exposure to stress. 

HYPOTENSION: Hypotension is a blood pressure that is below normal, that is, a systolic reading consistently between 85 and 110 mmHg in an adult whose normal pressure is higher than this. Orthostatic hypotension is a blood pressure that decreases when the client sits or stands. It is usually the result of peripheral vasodilation in which blood leaves the central body organs, especially the brain, and moves to the periphery, often causing the person to feel faint.

Hypotension can also be caused by analgesics such as meperidine hydrochloride (Demerol), bleeding, severe burns, and dehydration. It is important to monitor hypotensive clients carefully to prevent falls.