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Q2 Respiratory

Total questions: 80

Worksheet time: 2hrs 0mins

Name
Class
Date
1.

A nurse is caring for a client who is complaining of chest pain after a motor vehicle collision. What finding would cause the most concern?

a)

Equal rise of chest wall

b)

Bruising on ribs

c)

Pain on inspiration

d)

The ribs do not appear to be moving together

2.

A nurse is caring for a client with a chest tube who reports increasing shortness of breath. What is the priority action?

a)

Increase suction

b)

Reposition the client

c)

Check for occlusions in the tubing

d)

Administer oxygen

3.

A nurse is caring for a client being mechanically ventilated. The high-pressure alarm sounds, with no obvious cause. What is the priority intervention?

a)

Suction the client

b)

Call the provider

c)

Manually ventilate the client with the ambu-bag

d)

Silence the alarm

4.

A client with a history of hemorrhagic stroke has a massive pulmonary embolism and is hypotensive. What is the best treatment option?

a)

Thrombolytics

b)

Heparin drip

c)

IVC filter

d)

Pulmonary embolectomy

5.

The nurse is caring for a client with ARDS who becomes hypotensive. What is the most likely cause?

a)

Increased cardiac output due to hypoxia

b)

Cardiac tamponade

c)

Hypovolemia due to fluid leaking into the interstitial spaces

d)

Left ventricular failure

6.

A client with ARDS is intubated and receiving oxygen at 40% (FiO2 0.4). What is the priority lab value to report to the healthcare provider?

a)

PaO2, 85

b)

PaO2, 72

c)

PaO2, 62

d)

HCO3, 26

7.

What actions should the nurse take when caring for a client receiving mechanical ventilation?

a)

Check the ventilator settings throughout the shift

b)

Ensure there is a manual resuscitation bag at the bedside

c)

Assess the client’s respiratory status every two hours

d)

Collaborate with the respiratory therapist

8.

A client was involved in a motor vehicle accident 36 hours ago. The nurse monitors frequently to assess for which high-risk complication?

a)

Pneumothorax

b)

Cardiac tamponade

c)

Acute respiratory distress syndrome (ARDS)

d)

Aspiration pneumonia

9.

The family of a client with ARDS asks if their loved one is going to die. What is the best way to address their concerns?

a)

We can’t predict that.

b)

They are getting the best care.

c)

Support the family and help them understand the realistic expectation of the client’s chance of survival

d)

Please talk to the physician.

10.

A client has an oral endotracheal tube (ETT) placed. What is the nurse’s first responsibility immediately following placement?

a)

Tape the tube securely

b)

Assess for bilateral breath sounds

c)

Check for end-tidal CO2

d)

Order chest x-ray

11.

A client with PE has SpO2 that drops from 94% to 88%. What should the nurse do?

a)

Call rapid response

b)

Start CPR

c)

Increase the oxygen flow rate

d)

Elevate the head of the bed

12.

What is the first intervention after confirming an arterial oxygen saturation of 54% on 10L O2 in a client with ARDS?

a)

Notify provider

b)

Prepare for intubation

c)

Increase FiO2

d)

Suction airway

13.

A patient with respiratory failure has RR of 6 breaths/min and SpO2 78%. The client is lethargic. What intervention will the nurse anticipate?

a)

Nasal cannula

b)

CPAP

c)

Endotracheal intubation and positive-pressure ventilation

d)

Albuterol nebulizer

14.

The ventilator alarm sounds and the client’s SpO2 drops to 80%. What is the first action the nurse should take?

a)

Increase FiO2

b)

Notify HCP

c)

Auscultate bilateral breath sounds

d)

Reposition the client

15.

The nurse hears a ventilated client speaking. What is the most likely cause?

a)

Overinflated cuff

b)

Disconnected tubing

c)

Inadequate inflation of the cuff on the tracheostomy tube

d)

Normal finding

16.

A client with PE is undergoing a chest x-ray and CT scan. The nurse notices hemoptysis and dyspnea. What condition is this likely confirming?

a)

Asthma

b)

CHF

c)

Pulmonary embolism

d)

Pneumonia

17.

The nurse is preparing for chest tube removal. What should the client be instructed to do?

a)

Exhale and hold

b)

Inhale deeply

c)

Take a deep breath and hold it while bearing down (Valsalva maneuver)

d)

Breathe normally

18.

A client with blunt chest trauma has muffled heart sounds, JVD, and hypotension. What is the priority nursing action?

a)

Administer fluids

b)

Reassess in 15 minutes

c)

Prepare for emergent pericardiocentesis

d)

Position in high Fowler’s

19.

SATA — Which are symptoms of pulmonary embolism (PE)?

a)

Nausea

b)

Hemoptysis

c)

Low-grade fever

d)

Cough with sputum

20.

What is the mechanism behind hypoxia in large pulmonary embolism?

a)

Decreased RBC production

b)

Alveolar rupture

c)

Ventilation-perfusion mismatch

d)

Hyperinflation

21.

A nurse is caring for a mechanically ventilated client with sudden agitation and high respiratory rate. What is the best action?

a)

Increase FiO2

b)

Call the provider

c)

Increase sedation

d)

Administer bronchodilator

22.

What is the purpose of PEEP in clients with ARDS?

a)

Decrease cardiac output

b)

Lower airway resistance

c)

Keep alveoli open and improve oxygenation

d)

Stimulate spontaneous breathing

23.

A nurse notes continuous bubbling in the water-seal chamber of a chest tube. What should the nurse do?

a)

Clamp the chest tube

b)

Strip the tubing

24.

What is the first nursing action when a ventilator’s high-pressure alarm sounds and breath sounds are diminished on the right?

a)

Check for mucus plug

b)

Increase oxygen

c)

Assess the position of the endotracheal tube

d)

Suction the client

25.

A nurse notes muffled heart sounds, distended neck veins, and hypotension in a trauma client. Which complication is suspected?

a)

Pulmonary embolism

b)

Cardiac tamponade

c)

Tension pneumothorax

d)

Hemothorax

26.

What ventilator mode delivers a set tidal volume at a set rate, but allows the client to initiate breaths?

a)

CPAP

b)

PSV

c)

Assist Control (AC)

d)

SIMV

27.

What are possible complications of mechanical ventilation?

a)

Hypotension

b)

Ventilator-associated pneumonia

c)

Barotrauma

d)

Stress ulcers

28.

What finding would indicate barotrauma in a client on positive pressure ventilation?

a)

Pulmonary infiltrates

b)

Crepitus and subcutaneous emphysema

c)

Bradycardia

d)

Decreased urine output

29.

A client with ARDS is on a ventilator. FiO2 is 100%, but PaO2 remains critically low. What intervention may be used to improve oxygenation?

a)

Increase respiratory rate

b)

Elevate head of bed

c)

Place client in prone position

d)

Lower FiO2 gradually

30.

After chest tube insertion, the nurse notes no tidaling in the water-seal chamber. What is the most appropriate action?

a)

Increase suction

b)

Strip the tubing

c)

Check for occlusion or kinks in the tubing

d)

Document as normal

31.

A patient with ARDS continues to require increased PEEP. What complication should the nurse assess for?

a)

Pneumonia

b)

Fluid overload

c)

Hypotension due to decreased venous return

d)

Hyperkalemia

32.

A client with a new tracheostomy is attempting to talk. What does this most likely indicate?

a)

Cuff is underinflated

b)

Tube is well placed

c)

Sedation is too light

d)

Client is delirious

33.

A client with ARDS has a PaO2/FiO2 ratio of 95. How should the nurse interpret this?

a)

Normal

b)

Mild ARDS

c)

Moderate ARDS

d)

Severe ARDS

34.

What assessment would the nurse expect in a client with a flail chest?

a)

Retractions

b)

Grunting

c)

Paradoxical chest wall movement

d)

Tracheal deviation

35.

Which ventilator setting allows the client to breathe spontaneously, but augments each breath with preset pressure?

a)

Pressure Support Ventilation (PSV)

b)

SIMV

c)

Assist Control

d)

CPAP

36.

SATA — Which findings are consistent with pulmonary embolism?

a)

Low-grade fever

b)

Hemoptysis

c)

Chest wall bruising

d)

Sudden dyspnea

37.

Which test result confirms the diagnosis of pulmonary embolism?

a)

EKG

b)

ABG

c)

Chest x-ray

d)

CT scan of the chest

38.

A trauma patient develops absent breath sounds on one side and tracheal deviation. What is the nurse’s priority intervention?

a)

Apply oxygen and wait for x-ray

b)

Notify the provider for immediate needle decompression

c)

Administer analgesics

d)

Encourage deep breathing

39.

A nurse is preparing a client for thoracentesis. What position should the client be placed in?

a)

Supine with pillow under knees

b)

Lateral recumbent

c)

Sitting upright leaning forward on bedside table

d)

Trendelenburg position

40.

A client receiving PEEP therapy for ARDS begins to show hypotension and decreased urine output. What is the likely cause?

a)

PEEP-induced reduction in venous return and cardiac output

b)

Fluid overload

c)

Pulmonary edema

d)

Infection

41.

What finding would confirm that a client is experiencing refractory hypoxemia due to ARDS?

a)

PaO2 returns to normal with 100% oxygen

b)

SaO2 improves after suctioning

c)

Oxygen saturation remains low despite increased FiO2

d)

Wheezing and stridor present

42.

A client develops restlessness and dyspnea after trauma. What is the priority nursing action?

a)

Administer anxiolytics

b)

Monitor for fever

c)

Suspect ARDS and notify the provider

d)

Reposition the client

43.

What is the best explanation for family members when a patient is placed in the prone position during ARDS treatment?

a)

It’s to prevent blood clots.

b)

It helps with digestion and circulation.

c)

It helps open the lungs and improve oxygenation.

d)

It prevents ventilator alarms from going off.

44.

A nurse is preparing to assist with removal of a chest tube. What instruction should the client receive?

a)

Take a deep breath and blow it out hard.

b)

Hold your breath until I say stop.

c)

Take a deep breath and hold it while bearing down.

d)

Breathe slowly and deeply throughout the procedure.

45.

A nurse is caring for a client who is agitated and “fighting” the ventilator. What is the priority action?

a)

Decrease PEEP

b)

Assess sedation needs

c)

Administer naloxone

d)

Lower the head of the bed

46.

SATA — Which findings are early signs of ARDS?

a)

Cyanosis

b)

Restlessness

c)

Dyspnea

d)

Anxiety

e)

Bradycardia

47.

The nurse observes tidaling in the water-seal chamber of a client’s chest tube. What is the correct interpretation?

a)

There is an air leak in the system

b)

The system is not functioning

c)

This is a normal and expected finding

d)

Immediate suction is required

48.

The chest tube of a trauma patient is draining 400 mL of blood in 1 hour. What is the nurse’s priority action?

a)

Strip the tubing

b)

Notify the healthcare provider immediately

c)

Document and continue to monitor

d)

Elevate the head of the bed

49.

SATA — Which findings indicate possible development of barotrauma in a ventilated client?

a)

Crepitus around the neck and chest

b)

Sudden drop in SpO₂

c)

Bradycardia

d)

High-pressure alarm sounds

e)

Frothy sputum

50.

What ABG finding would support the diagnosis of respiratory acidosis in a client with respiratory failure?

a)

pH 7.45, PaCO₂ 35

b)

pH 7.48, PaCO₂ 28

c)

pH 7.31, PaCO₂ 58, HCO₃ 24

d)

pH 7.29, PaCO₂ 38, HCO₃ 19

51.

A nurse notes pink, frothy sputum in a ventilated client. What is the likely cause?

a)

Ventilator-associated pneumonia

b)

Pulmonary edema

c)

Barotrauma

d)

ARDS resolution

52.

What does a PaO₂/FiO₂ ratio < 100 indicate in a client with ARDS?

a)

Severe ARDS

b)

Mild hypoxemia

c)

Normal oxygenation

d)

Ventilator dependence only

53.

SATA — Which complications are associated with high levels of PEEP?

a)

Barotrauma

b)

Decreased venous return

c)

Hypotension

d)

Hypertension

e)

Fluid overload

54.

The nurse is reviewing a client’s ventilator settings and notes a tidal volume of 700 mL with worsening SpO₂ and crepitus. What is the best interpretation?

a)

FiO₂ is too low

b)

Tidal volume may be too high and causing barotrauma

c)

Client needs suctioning

d)

Oxygen is not needed

55.

A nurse notes that a client is hypotensive following the initiation of PEEP. What is the physiologic cause?

a)

Increased respiratory rate

b)

Decreased venous return due to increased intrathoracic pressure

c)

Infection

d)

Kidney injury

56.

What is the most appropriate treatment for ventilator-associated pneumonia (VAP)?

a)

Oral antibiotics only

b)

Prophylactic anticoagulants

c)

Broad-spectrum antibiotics and ventilator bundle compliance

d)

Cough suppressants

57.

A trauma patient presents with absent breath sounds on the left and tracheal deviation to the right. What is the likely cause?

a)

ARDS

b)

Pneumothorax

c)

Pulmonary embolism

d)

Atelectasis

58.

A client with a central venous catheter suddenly develops shortness of breath, chest pain, and decreased breath sounds on one side. What is the most likely cause?

a)

Myocardial infarction

b)

Pulmonary embolism

c)

Tension pneumothorax

d)

Pericarditis

59.

The ventilator high-pressure alarm is sounding and the client’s chest movement is unequal. What should the nurse do first?

a)

Call respiratory therapist

b)

Auscultate breath sounds and assess for obstruction or pneumothorax

c)

Silence the alarm

d)

Increase FiO2

60.

A nurse is preparing to assist with thoracentesis. Which item should be readily available at the bedside in case of complication?

a)

Blood pressure cuff

b)

Chest tube tray

c)

Nasogastric tube

d)

Foley catheter

61.

A nurse is caring for a client with acute respiratory distress syndrome (ARDS). Despite FiO2 of 100%, the PaO2 remains low. What condition is this?

a)

Ventilator-associated pneumonia

b)

Refractory hypoxemia

c)

Oxygen toxicity

d)

Normal ventilation-perfusion balance

62.

What is the most appropriate initial intervention when a client with ARDS on high FiO2 becomes hypotensive?

a)

Prepare for fluid bolus

b)

Decrease PEEP

c)

Auscultate lung sounds and assess for pneumothorax

d)

Administer vasopressors

63.

SATA — Which clients are at increased risk for developing pulmonary embolism (PE)?

a)

Client with fractured pelvis

b)

Client who smokes

c)

Client with asthma

d)

Client on beta-blockers

64.

A client on a ventilator shows a sudden increase in respiratory rate and is visibly uncomfortable. What does the nurse suspect?

a)

Airway obstruction

b)

Inadequate sedation

c)

Oxygen toxicity

d)

Alkalosis

65.

The nurse is evaluating the effect of PEEP in an ARDS client. What indicates a positive response?

a)

Improved oxygenation (↑PaO2 or ↑SpO2)

b)

Decreased BP

c)

Bradycardia

d)

Loud breath sounds bilaterally

66.

A nurse reviews the PaO2/FiO2 ratio of a client receiving 70% FiO2 and PaO2 of 60 mmHg. How is this interpreted?

a)

Mild ARDS

b)

Moderate ARDS

c)

Severe hypoxemia

d)

Oxygen toxicity

67.

Which ventilator mode allows the client to breathe spontaneously while receiving support for each breath?

a)

Assist-control (AC)

b)

CPAP

c)

Pressure support ventilation (PSV)

d)

Controlled mechanical ventilation (CMV)

68.

A client is ventilated and has low PaO2 despite maximum FiO2. What non-ventilator intervention should the nurse anticipate?

a)

Diuretics

b)

Intubation

c)

Prone positioning

d)

Beta-agonist bronchodilators

69.

A client is recovering from ARDS. What ABG value suggests improving oxygenation?

a)

PaO2 54 mmHg

b)

PaO2 62 mmHg

c)

PaO₂ 85 mmHg

d)

PaO₂ 49 mmHg

70.

What is the priority concern with high PEEP settings?

a)

Bronchospasm

b)

Decreased cardiac output from reduced venous return

c)

Electrolyte imbalance

d)

Increased urine output

71.

A client is on a ventilator and the family asks, “Why is the machine making the client breathe?” What’s the best response?

a)

The machine works better than human lungs.

b)

This will allow the lungs to rest.

c)

The ventilator supports breathing until the lungs recover.

d)

It keeps the heart rate normal.

72.

What is the mechanism of oxygenation failure in ARDS?

a)

Increased carbon dioxide

b)

Loss of airway tone

c)

Alveolar collapse and decreased compliance

d)

Bronchoconstriction

73.

SATA — Which interventions reduce the risk of ventilator-associated pneumonia (VAP)?

a)

Oral care with chlorhexidine

b)

Elevate HOB 30-45°

c)

Daily sedation vacation

d)

Administer antibiotics Q4h

e)

Frequent trach suctioning even when not needed

74.

A client on mechanical ventilation becomes hypotensive after an increase in PEEP. What is the most likely cause?

a)

Sepsis

b)

Ventilator disconnection

c)

Reduced venous return to the heart

d)

Air embolism

75.

A client with PE has SpO2 85% on 6L nasal cannula and is tachypneic. What is the priority intervention?

a)

Call physician

b)

Begin CPR

c)

Increase oxygen and prepare for higher level support

d)

Give cough suppressant

76.

A nurse is preparing to assist a provider with needle decompression. What condition is this procedure used to treat?

a)

Flail chest

b)

Hemothorax

c)

Tension pneumothorax

d)

ARDS

77.

A trauma patient’s breath sounds are absent on the left. What condition does the nurse suspect?

a)

Flail chest

b)

Hemothorax

c)

Pneumothorax

d)

Atelectasis

78.

SATA — Which findings suggest development of a tension pneumothorax?

a)

Absent breath sounds on one side

b)

Tracheal deviation

c)

Bradycardia

d)

Distended neck veins (JVD)

e)

Productive cough

79.

A nurse assesses a chest tube with no fluctuation (tidaling) in the water seal chamber. What is the appropriate action?

a)

Increase suction

b)

Check for kinks or clots in tubing

c)

Notify provider immediately

d)

Document as normal

80.

A nurse prepares to insert a chest tube in a client with a pneumothorax. What is the main goal of this procedure?

a)

Reduce infection

b)

Restore fluid balance

c)

Remove air and allow lung re-expansion

d)

Prevent aspiration

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