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Worksheets2121 exam 1 pt.6
Total questions: 100
Worksheet time: 50mins
A client with allergic rhinitis takes diphenhydramine and drinks alcohol nightly. What is the priority teaching?
Alcohol prevents nasal inflammation
Combining them can cause dangerous sedation and impaired breathing/alertness
Alcohol increases the antihistamine’s benefit safely
Diphenhydramine prevents pneumonia
A client with acute sinusitis reports severe facial pressure that worsens when leaning forward and thick purulent drainage. Which finding most supports bacterial sinusitis?
Clear rhinorrhea and itchy eyes
Symptoms improved within 24 hours
Symptoms persist >10 days or “double-worsening” after initial improvement
Fever absent and drainage watery only
A client asks why a CT scan may be ordered for sinusitis complications. The best explanation is:
It measures lung airflow (FEV1)
It confirms influenza strain type
It measures oxygen saturation continuously
It can show sinus anatomy/abscess/extension when complications are suspected
A child with tonsillitis is suspected of having Group A strep. Which diagnostic test is most appropriate?
Rapid antigen detection test and/or throat culture
Chest x-ray
Peak flow meter
Tympanometry
A child with confirmed strep throat started antibiotics. When can they usually return to school/daycare if improving and afebrile?
Immediately after first dose
After 24 hours of antibiotics
Only after finishing the full course
Only after a repeat throat culture is negative
A 6-hour post-tonsillectomy child has frequent swallowing and throat clearing. What is the priority concern?
Normal scab formation
Mild dehydration
Hemorrhage
Expected referred ear pain only
Post-tonsillectomy teaching: which drink should be avoided initially because it can hide bleeding?
Cool water
Ice chips
Clear non-red popsicle
Red-colored liquids
A client with laryngitis says, “I’ve been whispering so I don’t strain my voice.” What is the best teaching?
Avoid whispering; use complete voice rest/humidification and fluids as instructed
Whispering is safest because it rests the cords
Start antibiotics immediately
Use decongestants every 2 hours
Which teaching best helps prevent viral nasopharyngitis transmission?
Share drinks to “build immunity”
Hand hygiene + covering cough/sneeze + avoid close contact when symptomatic
Antibiotics for everyone in the household
Only wear gloves at home
A client has influenza symptoms that started 18 hours ago and is high risk for complications. Which medication is most appropriate?
Broad-spectrum antibiotic
Diphenhydramine only
Oseltamivir
Montelukast
Which statement about oseltamivir is correct?
It cures influenza instantly
It treats bacterial pneumonia
It works best if started after fever resolves
It is most effective when started within 24–48 hours of symptom onset
A newborn is hospitalized with RSV bronchiolitis. Which nursing action is priority?
Support oxygenation and hydration and monitor for increasing work of breathing
Give aspirin for fever
Encourage forceful coughing every hour
Restrict fluids to reduce secretions
A parent asks what nirsevimab is. Best answer:
A live vaccine
A monoclonal antibody used to help prevent severe RSV disease
A broad-spectrum antibiotic
A bronchodilator used daily for asthma
A toddler with RSV has nasal flaring and retractions. Which finding is most concerning?
Clear runny nose only
Mild cough only
Poor feeding with worsening retractions and decreased oxygen saturation
Sneezing without distress
A high-risk infant is receiving RSV prevention education. Which statement is correct?
“Antibiotics prevent RSV.”
“Decongestants prevent RSV.”
“CPAP prevents RSV.”
“Monoclonal antibody prophylaxis may be recommended for some infants.”
A client with chronic nasal obstruction, reduced smell, and “grape-like” tissue in nares likely has:
Nasal polyps
Strep pharyngitis
Acute laryngitis
COPD exacerbation
A client with nasal polyps also has asthma and sensitivity to aspirin/NSAIDs. This combination most suggests:
Ménière’s disease
Aspirin-exacerbated respiratory disease (AERD)
Acute angle-closure glaucoma
Hemolytic transfusion reaction
Which medication is most appropriate for short-term relief of nasal congestion in rhinitis (with safety screening)?
Inhaled LABA
Inhaled steroid once ever
Decongestant (e.g., pseudoephedrine/phenylephrine) with precautions
IV antiviral
A client with uncontrolled hypertension asks about pseudoephedrine. The best response is:
“It’s safe for everyone.”
“It lowers blood pressure.”
“It prevents pneumonia.”
“Avoid it unless your provider approves; it can raise blood pressure and heart rate.”
A trach client suddenly cannot breathe and the trach is dislodged. What is the priority action?
Call dietary
Apply oxygen and replace the trach immediately per emergency protocol while calling for help
Give oral fluids
Place the client flat and wait
A nurse is suctioning a tracheostomy. Which practice is safest?
Suction continuously for 60 seconds
Instill large saline routinely before every pass
Use sterile technique and limit each suction pass to reduce hypoxia
Keep the client supine to prevent coughing
A cuffed trach client is receiving tube feeding and coughing frequently. What is the priority concern?
Increased IOP
Hypercalcemia
Viral rhinitis
Aspiration risk; assess cuff, positioning, and swallow/feeding safety per orders
A client with asthma says, “My chest feels tight, but I’m not wheezing now.” Which finding is most concerning for status asthmaticus?
Diminished/absent breath sounds (“silent chest”) with fatigue
Loud wheezing throughout both lungs
RR 18/min and SpO2 98%
Symptoms fully relieved after one SABA puff
A client in severe asthma exacerbation has increasing CO2 and decreasing level of consciousness. What is the priority?
Give a decongestant
Prepare for airway support/ventilation and escalate care immediately
Encourage pursed-lip breathing only
Delay treatment until peak flow is measured
A client with asthma asks which inhaler is the rescue medication.
Inhaled corticosteroid
LABA
Short-acting beta2 agonist (albuterol)
Montelukast
Teaching for LABA (salmeterol) in asthma: which is correct?
Use it PRN for sudden attacks
Use it alone as asthma control
Replace your rescue inhaler
Use it with an inhaled corticosteroid for maintenance, not as rescue
Which adverse effect is most expected with albuterol?
Tremors and tachycardia
Bradycardia and hypotension
Respiratory depression
Severe constipation
A client on inhaled corticosteroids reports mouth soreness and white patches. Best teaching?
Stop the steroid forever
Rinse mouth after use (and use spacer if prescribed) to reduce thrush
Take the steroid only during attacks
Switch to antibiotics for asthma control
A client with allergic asthma asks how cromolyn helps. Best answer:
It stabilizes mast cells to prevent mediator release (prevention, not rescue)
It relaxes airway smooth muscle immediately
It kills influenza virus
It replaces inhaled steroids
A COPD client is prescribed ipratropium. What is its main mechanism?
Breaks down mucus
Blocks acetylcholine to reduce bronchoconstriction and secretions
Stimulates beta2 receptors strongly
Shrinks nasal blood vessels only
A COPD client asks why they need a “controller” even when they feel okay. Best response:
Controllers prevent all infections permanently
Controllers cure emphysema
Controllers reduce baseline inflammation/bronchospasm and help prevent flare-ups
Controllers are only for strep throat
A COPD client has worsening SOB and thick secretions. Which intervention best supports secretion clearance (if not contraindicated)?
Restrict fluids to 1 L/day
Avoid humidification
Give antitussives around the clock
Hydration + humidification + expectorant as ordered to thin secretions
A COPD client’s chest x-ray shows a flattened diaphragm. This most indicates:
Hyperinflation typical of emphysema/COPD
Acute bacterial tonsillitis
Acute angle-closure glaucoma
Middle ear effusion
A COPD client’s provider orders alpha-1 antitrypsin level. Why?
To confirm influenza
To evaluate for inherited alpha-1 antitrypsin deficiency causing early emphysema
To diagnose strep throat
To measure kidney function
A COPD client has dependent edema, JVD, and hepatomegaly. What complication is most likely?
SIADH
Left-sided heart failure from valve disease
Cor pulmonale (right-sided HF from pulmonary hypertension)
Acute otitis media
Best teaching for cor pulmonale prevention in COPD is:
Avoid oxygen forever
Increase sodium intake
Stop all inhalers
Control hypoxia and COPD exacerbations to reduce pulmonary strain
A client with suspected pneumonia is ordered sputum culture. When should it be obtained if possible?
Before the first antibiotic dose
After 72 hours of antibiotics
Only if fever is gone
After discharge
A nurse is explaining why chest x-ray is ordered for pneumonia. Best explanation:
It measures airflow obstruction (FEV1)
It confirms RSV strain type
It measures arterial pH
It identifies lung infiltrates/extent of consolidation and complications
A client with severe pneumonia has pleural fluid suspected. Which procedure both removes fluid and can obtain a specimen?
Thoracentesis
Audiometry
Tympanometry
A client has aspiration pneumonia risk. Which history finding is most important?
High potassium diet
Dysphagia after stroke with coughing during meals
Seasonal allergies only
Presbycusis
A hospitalized client develops pneumonia after 48 hours of admission. This is classified as:
CAP
HCAP
HAP
VAP
A client develops pneumonia after 48 hours of mechanical ventilation. This is:
CAP
HAP
HCAP
VAP
Broad-spectrum antibiotics are most appropriate when:
Cultures are pending and the organism is unknown in a seriously ill client
Viral infection is suspected and mild
The organism is known and sensitive to narrow therapy
Symptoms are minimal and improving
Before starting broad-spectrum antibiotics for suspected bacterial pneumonia, what is the best nursing action when feasible?
Delay antibiotics until fever resolves
Obtain ordered blood/sputum cultures first
Give antihistamines first
Restrict fluids to reduce coughing
A client with pneumonia suddenly has severe dyspnea and pleuritic pain. The provider suspects pulmonary embolism. Which diagnostic test is most direct for PE evaluation?
Peak flow
Spirometry
CT pulmonary angiography (CTPA) as ordered
Throat culture
A nurse is teaching spirometry results in obstructive disease. Which pattern is most expected in COPD?
Increased FEV1/FVC ratio
Normal FEV1 with high ratio
Increased tidal volume only
Decreased FEV1 and decreased FEV1/FVC ratio
A client is taught peak flow "zones." Which is correct?
Green zone is usually 80–100% of personal best
Green zone is 50–80% of personal best
Yellow zone means "no action needed"
Red zone means "continue routine meds only"
A client with asthma has peak flow in the red zone. What is the priority action?
Schedule a routine follow-up next month
Follow the action plan: use rescue meds and seek urgent/emergency care as directed
Stop all meds to "reset" lungs
Drink fluids only
A client has suspected lung cancer. Which risk factor is most important to assess?
Pack-year smoking history
Daily water intake
Red meat intake
Nail polish exposure
Which diagnostic test is commonly used to evaluate metabolic activity and staging in lung cancer?
Tympanometry
PET scan
Rinne test
Peak flow
A provider suspects mediastinal lymph node involvement in lung cancer. Which procedure is most associated with sampling mediastinal nodes?
Thoracentesis
Spirometry
Mediastinoscopy
Throat culture
A client has a pleural effusion and suspected malignancy. Which procedure can obtain pleural fluid and allow biopsy depending on findings?
Audiometry
Chest percussion only
Pulse oximetry
Thoracoscopy (VATS) as ordered
A post-lobectomy client has sudden dyspnea and copious serosanguinous drainage from chest tube with air leak. Which complication is most concerning?
Bronchopleural fistula
Otitis externa
Allergic rhinitis
Presbycusis
A client with pneumonia deteriorates and imaging shows pus in the pleural space. This complication is called:
Atelectasis
Empyema
Cor pulmonale
Sinusitis
A client’s lung cancer is suspected to have spread to the brain due to new neuro symptoms. Which imaging is most appropriate?
Peak flow
Chest x-ray
MRI brain as ordered
Tympanometry
A client asks why bronchoscopy is used in lung cancer workup. Best answer:
It measures oxygen saturation
It treats influenza
It confirms rhinitis
It visualizes airways and can obtain tissue/brushings for diagnosis
A client is ordered a CT chest for a new mass. Why CT instead of chest x-ray alone?
CT provides more detailed anatomy and can better characterize masses/lymph nodes
CT measures ABG pH
CT cures pneumonia
CT prevents RSV
A client has suspected community-acquired pneumonia and is stable. Which treatment principle is most appropriate?
Withhold antibiotics until day 10
Use narrowest effective antibiotic once organism is known; start empiric therapy as ordered
Always use broadest antibiotics for all pneumonia
Use only antihistamines
A client with severe allergic rhinitis takes an antihistamine and reports urinary retention. Which class is most associated with anticholinergic effects?
First-generation antihistamines (e.g., diphenhydramine)
LABAs
Antivirals
Monoclonal antibodies
A client uses oxymetazoline nasal spray daily for 2 weeks and now has worse congestion. What is happening?
Hyperkalemia
Rebound congestion (rhinitis medicamentosa)
Cor pulmonale
Pneumonia complication
Which medication class is best described as "short-acting bronchodilator for rapid relief"?
Inhaled corticosteroid
LABA
SABA
Mast cell stabilizer
A nurse is teaching a client with asthma about inhaler order when using both albuterol and an inhaled corticosteroid. Which is best?
Steroid first always
Use them at the exact same time
Steroid replaces albuterol
Use albuterol first to open airways, then steroid as prescribed
A client with COPD asks why PFTs are ordered. Best explanation:
They measure airflow limitation and severity (e.g., FEV1) and response to bronchodilators
They diagnose strep throat
They measure inner ear pressure
They confirm glaucoma
A COPD client has an ABG showing chronic CO2 retention with near-normal pH and elevated HCO3−. This most indicates:
Acute respiratory alkalosis
Compensated respiratory acidosis
Uncompensated metabolic alkalosis
Mixed acidosis only
A client with suspected bacterial pneumonia is started on broad-spectrum antibiotics while cultures are pending. Which nursing action is priority to reduce resistance once results return?
Stop antibiotics immediately regardless
Switch to antiviral therapy
De-escalate to narrow-spectrum therapy based on culture/sensitivity
Continue broad-spectrum for 30 days always
A client with severe influenza develops sudden worsening respiratory distress and bilateral infiltrates. Which complication is most concerning?
Acute otitis media
Sinus headache
Laryngitis
ARDS/respiratory failure
A client with suspected lung cancer has pleural effusion. What finding most suggests malignant pleural involvement?
Recurrent unilateral pleural effusions with weight loss and persistent cough
Seasonal itching and sneezing only
Improvement within 24 hours of antihistamine
Only sore throat and strawberry tongue
A client asks what a "biopsy" is. Best explanation:
It measures oxygen in blood
It removes a tissue sample so it can be examined for cancer/diagnosis
It measures FEV1
It measures ear conduction
A trach client has thick secretions. Which intervention is most helpful to prevent mucus plugging?
Adequate humidification and hydration as ordered + suctioning as needed
Restrict fluids strictly
Avoid suctioning entirely
Use antihistamines to dry everything out
A nurse is assessing for trach cuff complications. Which finding is most concerning?
Mild sore throat
Tracheal mucosal damage risk from high cuff pressure
Improved voice volume
Increased appetite
A client with suspected pneumonia has crackles and O2 sat 88%. What is the priority first action?
Get peak flow reading
Obtain throat culture
Apply oxygen per order and reassess respiratory status
Give decongestant
A client with asthma says, "I’m using my LABA inhaler when I’m tight." Best response:
Correct—LABA is fastest rescue
LABA replaces albuterol
LABA is best for sudden attacks
LABA is maintenance; use SABA for acute symptoms and follow the plan
A client with influenza is asking if antibiotics will cure it. Best response:
Antibiotics treat bacteria, not viruses; antivirals may be used early for influenza
Antibiotics cure all viruses
Antibiotics prevent all complications
Antibiotics replace vaccines
A client with asthma is on inhaled steroids and reports hoarseness. Which teaching is best?
Take steroids only PRN
Use a spacer and rinse/gargle after inhalation to reduce local effects
Stop all controller meds
Switch to decongestants
A client with severe asthma exacerbation is receiving continuous nebulized bronchodilators and IV steroids. Which sign suggests improvement?
Increasing PaCO2 with drowsiness
“Silent chest”
Peak flow increases toward personal best and work of breathing decreases
Cyanosis worsens
A client with pneumonia has pleuritic pain and decreased breath sounds on one side; ultrasound shows a large pleural effusion. What is the best next step?
Start decongestants only
Give antihistamines only
Encourage vigorous coughing only
Prepare for thoracentesis per order and monitor respiratory status
A client with suspected lung cancer has new clubbing of fingers and unexplained weight loss. Which priority screening question is most important?
Smoking history and occupational exposures (asbestos/radon)
Favorite fruit intake
Daily water flavorings
Shoe size
A client asks why "sputum cytology" might be ordered in lung cancer evaluation. Best answer:
It measures nasal swelling
It can detect abnormal/cancer cells shed into sputum in some cases
It measures FEV1 only
It treats infection
A client with conductive vs sensorineural hearing questions is mistakenly scheduled for bronchoscopy. Which test actually measures hearing thresholds?
Audiometry
Chest x-ray
A client with suspected bacterial pneumonia asks why CT chest may be ordered if x-ray is unclear. Best answer:
CT is the same as x-ray
CT provides more detailed imaging to evaluate complications/masses when needed
CT measures oxygen saturation
CT measures potassium
A client with COPD has early-onset emphysema and minimal smoking history. Which lab supports a genetic cause?
BNP
Troponin
Low alpha-1 antitrypsin level
Elevated bilirubin
A client with lung cancer has a chest tube post-surgery. Sudden large, foul-smelling pleural drainage and fever suggests:
TRALI
Sinusitis
Allergic rhinitis
Empyema/infected pleural space complication
A client with allergic rhinitis asks about "second-generation" antihistamines. What benefit is most typical?
Less sedation compared with first-generation agents
Stronger sedation
Higher risk of respiratory depression with alcohol
Immediate cure of asthma
A client with asthma takes albuterol and reports palpitations. What is the best nursing response?
This means the medication is poisoning you
Tremor/tachycardia can occur; report severe symptoms and follow dosing instructions
Stop all rescue meds immediately
This proves pneumonia
A provider orders broad-spectrum antibiotics for suspected sepsis from pneumonia. Which nursing priority supports best practice?
Delay antibiotics for 24 hours
Give only antihistamines first
Obtain ordered cultures first when feasible, then administer antibiotics promptly
Give potassium before antibiotics
A client with severe OSA asks why weight loss is recommended. Best answer:
Weight loss reduces soft tissue around the airway and can reduce airway collapse
Weight loss cures influenza
Weight loss replaces CPAP immediately for everyone
Weight loss increases mucus for better clearance
A trach client is on room air but has thick secretions and frequent plugging. Which order is most helpful?
Humidified oxygen/air delivery as prescribed (humidification is key with trachs)
Restrict fluids to 500 mL/day
Avoid suctioning
Use decongestants as the main fix
A client with COPD asks why they need vaccines. Best answer:
Vaccines cure COPD
Influenza and pneumococcal vaccines reduce infection risk that can trigger exacerbations
Vaccines are avoided in COPD
Vaccines replace inhalers
A client with pneumonia has been on antibiotics for 48 hours and is worsening. Which is the priority nursing action?
Notify provider; reassess oxygenation, consider complications/resistance, and ensure cultures/results reviewed
Stop oxygen immediately
Encourage exercise only
Discharge immediately
A client with lung cancer is scheduled for PET and MRI. What is the main reason for advanced imaging?
To measure FEV1 directly
To stage cancer and evaluate spread/metastasis and treatment planning
To cure infection
To treat RSV
A client with COPD has chronic hypercapnia. Which oxygen approach is most appropriate?
No oxygen ever
15 L NRB continuously for all COPD clients
Titrate oxygen as prescribed (often low-flow/controlled) to target saturation while monitoring
Room air only regardless of saturation
A client with suspected aspiration pneumonia is most likely to have infiltrates in which lung area?
Left upper lobe always
Bilateral apices only
Right middle lobe only
Dependent lung segments (often right lower lobe), depending on position during aspiration
A client with rhinitis asks which symptom best suggests allergic rhinitis rather than viral rhinitis.
Itchy eyes/sneezing + clear watery drainage and seasonal pattern
Thick green drainage on day 1
High fever and severe body aches always
Strawberry tongue
A client with asthma is prescribed a mast cell stabilizer. When should it be used for best effect?
Only during acute attacks
Regularly before exposure/exercise as prevention, not for rescue
Only at bedtime for sleep
Only with antibiotics
A nurse is reviewing why sputum studies matter. Which is the best purpose of sputum culture?
Identify the organism and guide antibiotic choice
Measure PaO2
Diagnose glaucoma
Measure hearing thresholds
A client with status asthmaticus is receiving continuous bronchodilators and IV steroids. Which finding shows the greatest immediate danger?
RR 20 and wheezing present
SpO2 95% on room air
Mild cough with good air movement
Rising PaCO2 with decreasing mental status
A client post-lung surgery suddenly has subcutaneous emphysema, increased air leak, and respiratory distress. Which complication is most likely?
Bronchopleural fistula or significant air leak complication
Allergic rhinitis
Tonsillitis
Presbycusis
A client asks why "thoracentesis with biopsy" might be done in lung cancer workup. Best response:
It treats influenza
It removes nasal polyps
To sample pleural fluid/tissue to diagnose cancer spread or effusion cause
It cures COPD
A client asks why “thoracentesis with biopsy” might be done in lung cancer workup. Best response:
It removes nasal polyps
It can remove pleural fluid and obtain tissue/cells to help diagnose malignancy
It confirms asthma severity
It treats influenza
A client with seasonal allergic rhinitis asks which medication is best for daily prevention of sneezing/itching during pollen season.
Intranasal corticosteroid (e.g., fluticasone) used consistently
Albuterol inhaler used every morning
IV methylprednisolone once monthly
Broad-spectrum antibiotic for 10 days
