Fluid and Electrolytes NCLEX Questions (81-85)

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81. The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Pco 2 of 30 mm Hg, and of 20 mEq/L. The nurse analyzes these results as indicating which condition?

a) Metabolic acidosis, compensated
b) Respiratory alkalosis, compensated
c) Metabolic alkalosis, uncompensated
d) Respiratory acidosis, uncompensated

82. The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder?

a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis

83. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding?

a) A decreased pH and an increased CO 2
b) An increased pH and a decreased CO 2
c) A decreased pH and a decreased
d) An increased pH with an increased

84. The nurse caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder?

a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis

85. The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul’s respirations. On the basis of this documentation, which pattern did the nurse observe?

a) Respirations that cease for several seconds
b) Respirations that are regular but abnormally slow
c) Respirations that are labored and increased in depth and rate
d) Respirations that are abnormally deep, regular, and increased in rate



Fluid and Electrolytes NCLEX Questions
Answers and Rationale

81) B
- The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Pco 2 . In this situation, the pH is at the high end of the normal value and the Pco 2 is low. In an alkalotic condition, the pH is elevated. Therefore the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred.

82) B
- Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations.

 83) D
- Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and to increase. Symptoms experienced by the client would include hypoventilation and tachycardia. Option A reflects a respiratory acidotic condition. Option B reflects a respiratory alkalotic condition, and option C reflects a metabolic acidotic condition.

84) A
- Metabolic acidosis is defined as a total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration. This results from loss of buffer bases or retention of too many acids without sufficient bases, and occurs in conditions such as kidney disease; diabetic ketoacidosis; high fat diet; insufficient metabolism of carbohydrates; malnutrition; ingestion of toxins, such as acetylsalicylic acid (aspirin); malnutrition; or severe diarrhea. Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes, an ileostomy, or diarrhea. These conditions result in metabolic acidosis. The remaining options are incorrect interpretations and are not associated with the client with an ileostomy.

 85) D
- Kussmaul’s respirations are abnormally deep, regular, and increased in rate. Apnea is described as respirations that cease for several seconds. In bradypnea, respirations are regular but abnormally slow. In hyperpnea, respirations are labored and increased in depth and rate.


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Fluid and Electrolytes NCLEX Questions (1-6)


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Respiratory NCLEX Questions with Rationale 1-9

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Chest Tube NCLEX (76-80)

Welcome to Chest Tube NCLEX. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. 

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76. A client is prescribed rifampin (Rifadin), 600 mg P.O. daily. Which statement about rifampin is true?

a) It's usually given alone.
b) Its exact mechanism of action is unknown.
c) It's tuberculocidal, destroying the offending bacteria.
d) It acts primarily against resting bacteria

77. 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.

78. A recent immigrant from Vietnam is diagnosed with pulmonary tuberculosis (TB). Which intervention is most important for the nurse to implement with this client?

a) Client teaching about the cause of TB
b) Reviewing the risk factors for TB
c) Developing a list of people with whom the client has had contact
d) Client teaching about the importance of TB testing

79. After undergoing a left thoracotomy, a client has a chest tube in place. When caring for this client, the nurse must:

a) report fluctuations in the water-seal chamber.
b) clamp the chest tube once every shift.
c) encourage coughing and deep breathing.
d) milk the test tube every 2 hours.

80. The home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met?

a) Decreased oxygen requirements
b) Increased sputum production
c) Decreased activity tolerance
d) Normothermia




Chest Tube NCLEX
Answers and Rationale

76) C
- Rifampin may be tuberculocidal or tuberculostatic against the Mycobacterium tuberculosis bacteria. It's usually given with other antitubercular drugs to prevent or delay resistance. The drug impairs ribonucleic acid synthesis of bacteria. It acts against, active not resting, bacteria.

77) A
- Tidal volume is the amount of air inspired and expired with each breath. Residual volume is the amount of air remaining in the lungs after forcibly exhaling. Vital capacity is the maximum amount of air that can be moved out of the lungs after maximal inspiration and expiration. Dead-space volume is the amount of air remaining in the upper airways that never reaches the alveoli. In pathologic conditions, dead space may also exist in the lower airways.

78) C
- To lessen the spread of TB, everyone who had contact with the client must undergo a chest X-ray and TB test skin. Testing will help determine if the client infected anyone else. The remaining options are important areas to address when educating high-risk populations about TB is prior to its development.

79) C
- When caring for a client who's recovering from a thoracotomy, the nurse should encourage coughing and deep breathing to prevent pneumonia. Fluctuations in the water-seal chamber are normal. Clamping the chest tube could cause a tension pneumothorax. Chest tube milking is controversial and should be done only to remove blood clots that obstruct the flow of drainage.

80) A
- A client who is free from infection will most likely have decreased oxygen requirements. A client with infection will display increased sputum production, fever, shortness of breath, decreased activity tolerance, and increased oxygen requirements.


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Chest Tube NCLEX (1-6)


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Respiratory NCLEX Practice Questions (71-75)

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

a) Fluid intake for the past 24 hours
b) Baseline arterial blood gas (ABG) levels
c) Prior outcomes of weaning
d) Electrocardiogram (ECG) results

72. The nurse is assessing the puncture site of the client who has received a purified protein derivative test. Which finding indicates a need for further evaluation?

a) 15-mm induration
b) Reddened area
c) 10-mm induration
d) Blister

73. A client who under went surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first

a) Initiate oxygen therapy.
b) Administer a heparin bolus and begin an infusion at 500 units/hour.
c) Administer analgesics as ordered.
d) Perform nasopharyngeal suctioning.

74. A client with colorectal carcinoma is devastated after learning that the cancer has spread to the liver and lungs and the client has only a 5% chance surviving for 5 years. Which comment by the nurse would best help the client cope with this news?

a) "I've seen clients in your situation who have lived almost 20 years."
b) "It must be hard to hear that prognosis. Would it help you to talk to me or the chaplain?"
c) "This might be a good time to think about an advance directive in case you run into problems while you're here."
d) "Those are just numbers. You have to live each day fully and not worry about dying."

75. Inspiratory and expiratory stridor may be heard in a client who:

a) is experiencing an exacerbation of goiter
b) is experiencing an acute asthmatic attack.
c) has aspirated a piece of meat
d) has severe laryngotracheitis




Respiratory NCLEX Practice Questions
Answers and Rationale

71) B
- Before weaning a client from mechanical ventilation, it's most important to have a baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client's record, and the nurse can refer to them before the weaning process begins.

72) A
- A 10-mm induration strongly suggests a positive response in this tuberculosis screening test; a 15-mm induration clearly requires further evaluation. The other options aren't positive reactions to the test and require no further evaluation.

73) A
- The client's signs and symptoms suggest pulmonary embolism. therefore, maintaining respiratory function takes priority. The nurse should first initiate oxygen therapy and then notify the physician immediately. The physician will most likely prescribe an anticoagulant, such as heparin, or an antithrombolytic to dissolve the thrombus. Analgesics can be administered to decrease pain and anxiety but administering oxygen takes priority. Suctioning typically isn't necessary with pulmonary embolism.

74) B
- This response is most therapeutic because it encourages the client to express feelings and concerns. Options A and D offer false hope and reflect the nurse's empirical observations, not statistics. Option C is inappropriate because an informed person who isn't a member of the health care team should discuss (at the client's request) which level of care the client wishes to receive in case of an emergency.

75) C
- Inspiratory and expiratory stridor is a low-pitched crowing sound heard in client who have a foreign body obstructing the trachea or mainstem bronchi. Acute asthmatic attacks are characterized by wheezing. Goiter attacks and severe laryngotracheitis are associated with inspiratory  stridor only.


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Respiratory NCLEX Practice Questions (1-6)


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Respiratory NCLEX Practice Questions (76-80)

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Respiratory NCLEX Practice Questions (66-70)

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66. A client with end-stage chronic obstructive pulmonary disease requires bi-level positive airway pressure (BiPAP). While caring for the client, the nurse determines that bilateral wrist restraints are required to prevent compromised care. Which client care outcome is associated with restraint use in the client who requires BiPAP?

a) The client will remain infection-free

b) The client will maintain adequate oxygenation.

c) The client will maintain adequate urine output

d) The client will remain pain-free

67. A 52-year-old client who just emigrated from Mexico is admitted with tuberculosis. The client explains to the nurse through an interpreter that he's concerned about paying for his medications after discharge. The nurse should collaborate with which health care team member about the client's financial concerns?

a) Public health worker

b) Home health nurse

c) Physician

d) Social worker

68. During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect

a) The client's pupils to become dilated

b) The client to experience bronchodilation

c) A decrease in the client's gastric secretions.

d) A drop in the client's heart rate.

69. A client with chronic sinusitis comes to the outpatient department complaining of headache, malaise, and a nonproductive cough. When examining the client's paranasal sinuses, the nurse detects tenderness. To evaluate this finding further, the nurse should transilluminate the:

a) frontal sinuses only

b) sphenoidal sinuses only

c) frontal and maxillary sinuses

d) sphenoidal and ethmoidal sinuses.

70. A client with severe acute respiratory syndrome (SARS) privately informs the nurse that he doesn't want to be placed on a ventilator if his condition worsens. The client's wife and children have repeatedly expressed their desire that everything be done for the client. The most appropriate action by the nurse would be to.

a) inform the family of the client's wishes.

b) assure the family that everything possible will be done.

c) support the client's decision

d) assure the client that everything possible will be done.

Respiratory NCLEX Practice Questions

Answers and Rationale

66) B

- BiPAP is a type of continuous positive airway pressure in which both inspiratory and expiratory pressures are set above atmospheric pressure. This type of ventilatory support assists clients with chronic obstructive pulmonary disease who retain PaCO2. Restrains are necessary in this client to maintain BiPAP therapy if the client attempts to dislodge the mask despite instruction no to do so. Maintaining  oxygenation is the expected outcome in this client. Options A, C, and D aren't direct outcomes of the client requiring BiPAP who needs restraints to maintain client safety.

67) D

- The nurse should collaborate with the social worker about the client's financial concerns. This collaboration can be done independently without a physician's order. The physician must only notify the public health department of the client's diagnoses. The physician and home health nurse are also involved in the client's care but aren't typically involved with the client's financial concerns until after the client is discharged

 68) D

- During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it, in turn, may cause stimulation vagus nerve. The client may, therefore, experience a sudden drop in heart rate leading to syncope. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation, Stimulation of the vagus nerve increases gastric secretions.

69) C

- After detecting tenderness of the paranasal sinuses, the nurse should transilluminate both frontal and maxillary sinuses; lack of illumination may indicate sinus congestion and pus accumulation. The sphenoidal and ethmoidal sinuses can't be transilluminated because of their location.

70) C

- The nurse is obligated to act as client advocate. The nurse shouldn't discuss the issue with the client's family unless the client gives permission. Answers B and D oppose the client's wishes and don't demonstrate client advocacy

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Respiratory NCLEX Practice Questions (1-6)


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Respiratory NCLEX Practice Questions (71-75)

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NCLEX Review Respiratory Questions (61-65)

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61. A client scheduled for pneumonectomy tells the nurse that a friend of his had lung surgery and had chest tubes. The client asks the nurse about how long his chest tubes will be in place after surgery. The nurse responds that:

a) they will be removed after 3 to 4 days
b) they will be in place for 24 to 48 hours
c) they usually remain in place for a full week after surgery
d) most likely, there will be no chest tubes in place after surgery

62. A nurse is caring for a client with active tuberculosis who has started medication therapy that includes rifampin (Rifadin). The nurse instructs the client to expect which side effect of this medication?

a) bilious urine
b) yellow sclera
c) orange secretions
d) clay-colored stools

63. The nurse sends a sputum specimen to the laboratory for culture from a client with suspected active tuberculosis (TB). The results report that Mycobacterium tuberculosis is cultured. How would the nurse correctly analyze these results?

a) results are positive for active tuberculosis
b) results indicate a less virulent  strain of tuberculosis
c) results are inconclusive until a repeat sputum is sent
d) results are unreliable unless the client has also had positive Mantoux test

64. A client with a history of respiratory disease is ambulating with the nurse to the doorway of the hospital room. The client becomes pale and dyspneic. The nurse has the client sit and takes the client's vital signs. The client's respiratory rate is 32 breaths per minute, oxygen saturation is 90%, and the heart rate has increased from 76 to 98 beats per minute. The nurse interprets that this client is experiencing:

a) activity intolerance
b) impaired physical mobility
c) ineffective airway clearance
d) ineffective breathing pattern

65. The ambulatory care nurse is assessing a client with chronic sinusitis. The nurse determines that which manifestation reported by the client is unrelated to this problem?

a) anosmia
b) chronic cough
c) purulent nasal discharge
d) headache more pronounced in the evening






NCLEX Review Respiratory Questions
Answers and Rationale

61) D
- Pneumonectomy involves removal of the entire lung, usually caused by extensive disease such as bronchogenic carcinoma, unilateral tuberculosis, or lung abscess. Chest tubes are not inserted because the cavity is left to fill with serosanguineous fluid, which later solidifies. Therefore, options A,B, and C are incorrect.

62) C
- Secretions will become orange in color as a result of the rifampin. The client should be instructed that this side effect will likely occur and should be told that soft contact lenses, if used by the client, will become permanently discolored. Options A, B, and D are not expected effects.

63) A
- Culture of Mycobacterium tuberculosis from sputum or other body secretions or tissue is the only method of confirming the diagnosis. Options B and C are incorrect statements. The Mantoux test is performed to assist in diagnosing TB but does not confirm active disease.

64) A
- Activity intolerance is characterized by exertional dyspnea, adverse changes in blood pressure or heart rate with activity, and fatigue. Ineffective breathing pattern occurs when the rate, timing, depth, or rhythm of breathing is insufficient to maintain optimal ventilation. Ineffective airway clearance occurs when the client is unable to clear his or her own secretions from the airway. Impaired physical mobility occurs when the client is limited in physical movement and has limited muscle strength, range of motion, or coordination.

65) D
- Chronic sinusitis is characterized by persistent purulent nasal discharge, a chronic cough resulting from nasal discharge, anosmia (loss of smell), nasal stuffiness, and headache that is worse upon arising after sleep.



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NCLEX Review Respiratory Questions (1-6)


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NCLEX Review Respiratory Questions (66-70)

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NCLEX Review Respiratory Questions (56-60)

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56. A client has a left pleural effusion that has not yet been treated. The nurse plans to have which of the following items available for immediate use?

a) intubation tray
b) paracentesis tray
c) thoracentesis tray
d) central nervous line insertion tray

57. A client with acute respiratory distress syndrome has an order to be placed on a continuous positive airway pressure (CPAP) face mask. The nurse implements which of the following for this procedure to be most effective?

a) obtains baseline arterial blood gases
b) obtains baseline pulse oximetry levels
c) applies the mask to the face with a snug fit
d) encourages the client to remove the mask frequently for coughing and deep breathing exercises

58. The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) how to do pursed-lip breathing. Evaluation of understanding is evident if the client demonstrates which of the following?

a) breathes in and then holds the breath for 30 seconds
b) loosens the abdominal muscles while breathing out
c) breathes so that expiration is three times as long as inspiration
d) inhales with pursed lips and exhales with the mouth open wide

59. A physician is inserting a chest tube. The nurse selects which of the following materials to be used as the first layer of the dressing at the chest tube insertion site?

a) sterile 4x4 gauze pad
b) petrolatum jelly gauze
c) absorbent gauze dressing
d) gauze impregnated with povidone-iodine

60. A client being seen in the physician's office for follow-up 2 weeks after pneumonectomy complains of numbness and tenderness at the surgical site. The nurse tells the client that this is:

a) not likely to be permanent, but may last for some months
b) a severe problem and the client will probably be rehospitalized
c) probably caused by permanent nerve damage as a result of surgery
d) often the first sign of a wound infection and checks the client's temperature






NCLEX Review Respiratory Questions
Answers and Rationale

56) C
- The client with a significant pleural effusion is usually treated by thoracentesis. This procedure allows drainage of the fluid, which may then be analyzed to determine the precise cause of the effusion. The nurse ensures that a thoracentesis tray is readily available in case the client's symptoms should rapidly become more severe. A paracentesis tray is needed for the removal of abdominal effusion. Options A and D are not specifically indicated for this procedure.

57) C
- The face mask must be applied over the nose and mouth with a snug fit, which is necessary to maintain positive pressure in the client's airways. The nurse obtains baseline respiratory assessments and arterial blood gases to evaluate the effectiveness of therapy, but these are not done to increase the effectiveness of the procedure. A disadvantage of the CPAP face mask is that the client must remove it for coughing, eating, or drinking. This removes the benefit of positive pressure in the airway each time it is removed.

58) C
- Prolonging expiration time reduces air trapping caused by airway narrowing that occurs in COPD. Tightening (not loosening) the abdominal muscles aids in expelling air. Exhaling through pursed lips (not with the mouth wide open) increases the intraluminal pressure and prevents the airways from collapsing. The client is not instructed to breathe in and hold the breath for 30 seconds; this action has no useful purpose for the client with COPD.

59) B
- The first layer of the chest tube dressing is petrolatum gauze, which allows for an occlusive seal at the chest tube insertion site. Additional layers of gauze cover this layer, and the dressing is secured with a strong adhesive tape or Elastoplast tape.

60) A
- Clients who undergo pneumonectomy may experience numbness, altered sensation, or tenderness in the area that surrounds the incision. These sensations may last for months. It is not considered to be a severe problem and is not indicative of a wound infection.


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NCLEX Review Respiratory Questions (1-6)


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NCLEX Review Respiratory Questions (61-65)

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NCLEX Review Respiratory Questions (51-55)

51. A nurse 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 of 24 bpm

52. A nurse is assessing the functioning of a chest tube drainage system in a client who has just returned from the recovery room following a thoracotomy with wedge resection. Select all expected assessment findings

a) excessive bubbling in the water seal chamber
b) vigorous bubbling in the suction control chamber
c) 50 ml of drainage in the drainage collection chamber
d) drainage system maintained below the client's chest
e) occlusive dressing in place over the chest tube insertion site
f) fluctuation of water in the tube in the water seal chamber during inhalation and exhalation

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NCLEX Review Respiratory Questions (46-50)

NCLEX Review Respiratory Questions

46. Which of the following assessment findings in a client with a closed chest tube drainage should concern the nurse most?

a) continuous, vigorous bubbling in the suction control chamber
b) continuous, gentle bubbling in the suction control chamber
c) continuous fluctuations of fluid along the tube in the water-seal chamber
d) absence of bubbling in the water-seal chamber

47. A 4-year old female client is brought to the emergency room after waking up with bark-like cough and stridor. On arrival to the ER, she has respiratory distress and is afebrile. The diagnosis is croup. What instruction should you give the parents?

a) perform percussion and postural drainage before putting the child to bed and before meals
b) run a cool mist vaporizer in patient's room during the day
c) encourage the child to do coughing and deep breathing exercises
d) bring the child to the bathroom and have the tap run with warm water during acute episodes of cough  

48. Which of the following teachings should be given to the mother when her child is in a mist tent for liquefication of secretions?

a) give the child a stuff toy inside the mist tent
b) avoid nylon blanket inside the mist tent
c) advise mother to let the child stay in the mist tent
d) give the child coloring book inside the mist tent

49. A nurse assesses a client with a chest tube who is restless and diaphoretic, and has a temperature of 101.2 F. The client reports pain at the chest tube site. Which action should the nurse take first?

a) administer pain medication
b)auscultate the client's lungs
c) check the client's blood pressure and pulse
d) check the chest tube dressing and tubing

50. A nurse 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





NCLEX Review Respiratory Questions:
ANSWERS AND RATIONALE

46) A
- vigorous bubbling in the suction control chamber indicates that the pressure of suction is very high. This may cause trauma to the pleura, and should concern the nurse. Options B, C, and D are normal findings.

47) B
- cool mist vaporizer will relieve spasm of airways. This will promote easy breathing of the child with croup.

48) C
- a child should stay inside the mist tent to liquefy mucous secretions and facilitate breathing. Toys that absorb moisture like stuff toys and coloring book should be avoided. Dampness lowers resistance to infection.

49) B
- assessment of the respiratory status is a priority among clients with chest tube.

50) B
- the presence of fluctuation of the fluid level in the water seal chamber indicates a patent drainage system. With normal breathing, the water level rises with inspiration and falls with expiration. Fluctuation stops if the tube is obstructed, if a dependent loop exists. If the suction is not working properly, or if the lung has re-expanded. Option A, C, and D are incorrect. 


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Online Nursing Practice Test about Respiratory Diseases (41-45)

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41. High pressure alarm still alarms after suctioning the client. What should the nurse do next?

a) disconnect the client from mechanical ventilation and do manual resuscitation
b) call the respiratory therapist
c) call another nurse to be with the client while the nurse calls for the physician
d) turn off the alarm

42. Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall?

a) pneumococcal pneumonia
b) legionaire's pneumonia
c) viral pneumonia
d) mycoplasma pneumonia

43. A client is admitted to an acute care facility with a tentative diagnosis of PCP (pneumocystis carinii pneumonia). She had lost 25 lbs. over the past 2 months and complains of anorexia. At this point, the highest priority goal is that the patient will

a) increase nutrient intake
b) have no further weight loss
c) be free from infection
d) maintain cardiopulmonary functioning

44. A patient underwent a pneumonectomy and developed tension pneumothorax. Which of the following is an early indication of tension pneumothorax

a) frothy, blood-tinged sputum
b) trachea shifts toward unaffected side of the chest
c) development of subcutaneous emphysema
d) open, sucking chest wound

45. The nurse is caring for a client on mechanical ventilator. The low-pressure alarm of the ventilator turns on. The most important nursing action is:

a) prepare to suction the client
b) check air leak from endotracheal tube
c) check if the tube is kinked
d) turn off the alarm



ANSWERS AND RATIONALE

41) A
- oxygenation and ventilation are the priority among clients on mechanical ventilation

42) B
- legionaire's pneumonia is the highest in incidence during summer. Whereas, pneumococcal pneumonia is most common during winter.

43) D
- cardiopulmonary functioning is a priority in the patient with pneumocystis carinii pneumonia.

44) B
- mediastinal shift indicates pneumothorax. This causes airway obstruction.

45) B
- when the low-pressure alarm turns on, this indicates disconnection of tubings. So, appropriate nursing action is to check for air leak. When the high pressure alarm turns on, this indicates obstruction. It may be due to accumulation of mucous secretions, kinks along the tubing, or the client is biting the endotracheal tube.



Related Topics:

• Fundamentals of Nursing  Concepts
• Medical-Surgical Concepts
• Maternal and Child Concepts

• Online Nursing Practice Test about Respiratory Diseases (46-50)
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Online Nursing Practice Test about Respiratory Diseases (36-40)

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36. Which of the following findings should be reported to the physician?

a) vesicular breath sounds at the peripheral areas of the lungs
b) bronchovesicular breath sounds heard over the mainstem bronchi
c) bronchial breath sounds heard over the trachea
d) adventitious breath sounds heard all over the lungs

37. The client with chronic obstructive pulmonary disease (COPD) is receiving Aminophylline. Which of the following manifestations indicate that the client is experiencing an adverse effect of the drug?

a) elevated temperature
b) bradycardia
c) restlessness
d) tachycardia

38. The client has closed chest drainage. Which of the following observations need prompt reporting to the physician?

a) the water in the water-seal drainage is constantly bubbling
b) there is continuous bubbling in the suction control chamber
c) fluctuation of fluids is noted in the water seal chamber if suction is not applied
d) the suction control chamber is filled with 20 cm of sterile NSS

39. The client is diagnosed to have COPD (Chronic Obstructive Pulmonary Disease). Which of the following signs and symptoms needs priority intervention by the nurse?

a) temperature of 37.5 C
b) tachycardia
c) cough
d) 91% oxygen saturation

40. A client who had vehicular accident was admitted to the emergency department. His trachea is deviated to the left. What does the nurse anticipate to be done to the client?

a) the client will have endotracheal intubation
b) the client will have emergency tracheotomy
c) the client will have oxygen by mask
d) the client will have thoracentesis



ANSWERS AND RATIONALE

36) D
- adventitious breath sounds are abnormal breath sounds and should be reported to the physician. Vesicular, bronchovesicular, and bronchial breath sounds are normal breath sounds.

37) D
- aminophylline causes tachycardia, restlessness, insomnia, diuresis, hypotension, and diarrhea. Tachycardia is the most common adverse effect of bronchodilators.

38) A
constant bubbling in the water-seal drainage indicates air leak. This should be reported to the physician. All the other findings are normal.

39) C
- cough in COPD is caused by copious, tenacious mucous secretions. Problems with airway should be given highest priority. In COPD, 91% oxygen saturation is considered normal, because the client is breathing due to low oxygen levels in the blood.

40) D
- this situation indicates pneumothorax. Therefore, there is a need to aspirate the air from he pleural space to prevent lung collapse.


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• Online Nursing Practice Test about Respiratory Diseases (41-45)
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Online Nursing Practice Test about Respiratory Diseases (21-28)

Situation: Mr. Tan, a 40 year old with asthmatic attack is admitted in the medical ward.

21. Mr. Tan admits to the nurse that he takes the following medications. Which medication may cause asthma attack?

a) milk of magnesia
b) pepcid ( famotidine)
c) acetylsalicylic ( aspirin)
d) benadryl ( diphenhydramine)

22. Your finding in your assessment would include the following except:

a) ability to speak words without taking deep breath
b) tachycardia, cool and moist skin
c) air hunger and presence of wheezing sound
d) tachycardia, warm and moist skin

23. With your assessment which of these symptoms would you expect to develop late?

a) nasal flaring
b) lips pursed in an effort exhale
c) cyanosis
d) use of accessory muscles for breathing

24. Which has the least tendency to precipitate or trigger asthmatic attack?

a) air pollution
b) cold climate
c) sudden changes in climate
d) molds, house dust

25. The most comfortable position for him to assume during asthmatic attack is:

a) sitting
b) orthopneic
c) fowlers
d) supine

26. Which of the following breathing patterns shows that the patient with chronic asthma has improved respiratory status?

a) a rate of exhalation twice that of inhalation
b) a rate of inhalation twice that of exhalation
c) slow, shallow inhalation
d) slow, deep exhalation

27. Which finding below would indicate the most effective response to asthma medications?

a) the ability to participate in active sports for longer periods
b) cyanosis subsides
c) peak expiratory flow rate (PEFR) within normal limits
d) patient can breathe on his own without oxygen

28. The child with asthma, has elevated WBC and eosinophils. Which of the following should be included in the nursing care plan of the client?

a) provide a private room
b) room-in the child with another child with asthma
c) room-in the child with another child with chicken pox
d) room-in the child with another child with glomerulonephritis



ANSWERS AND RATIONALE

21) C
- Common Factors Triggering an Asthmatic Attack
1. Medications:

• Aspirin and NSAID - can trigger allergic reaction, its anti-inflammatory effect decreases histamine secretion and mucus secretion causing pooling of thick mucus that obstructs the airway and triggers an asthmatic attack
• beta blockers
• cholinergic drugs - eye drops used in glaucoma (pilocarpine) and bladder contraction
• chemicals - paint, solvents, rubber, plastic - avoid engaging in tasks that involves the use of these chemicals, avoid powder detergents

2. Air pollutants - instruct to close car window and use airconditioner

3. Sudden changes in temperature

4. Cold air - exercising in cold air

5. Allergens - feather, pollen, dust, molds, animal dander - keep away from pets, remove carpets and curtains, damp dusting, stay indoor when grass cutting and when pollen count is high, close window at night, avoid garage and basements, avoid feather pillow

6. Exercise - irregular exercise schedules and excessive physical exertion

7. stress

8. Strong odors

22) A
- common assessment findings in asthma include: wheezing, chest tightness, breathlessness, coughing, anxiety, apprehension, tachypnea and tachycardia.
Patients experiencing asthmatic attack can usually speak only one or two words between breaths because of severe dyspnea, anxiety, fatigue and apprehension.

23) C
- Signs and Symptoms of Asthma

Asthma is caused by inflammatory response in the lungs triggered by any of the above mentioned allergens. When a patient comes in contact with allergens. IgE is produced which stimulate the mast cells in the lungs to release inflammatory mediators in the lungs such as histamine, prostaglandins and leokotrienes. These substances cause the following pathologic changes in the lungs that cause the signs and symptoms of asthma:

• bronchospasms which narrows airways causing wheezing, shortness of breath
• increased mucus production which blocks airways and causes nonproductive cough
• increased capillary permeability which causes edema of the airways decreasing area for gas exchange.

All these contribute to airway obstruction. In an effort to overcome the airway obstruction, the patient must exert much respiratory effort when breathing such as nasal flaring, pursed lip breathing and use of accessory muscles. Cyanosis is a late sign in asthma. It indicates impaired gas exchange and that the tissues are no longer receiving adequate oxygen supply. Auscultation reveals wheezing especially on expiration. The absence of wheezing is a dangerous sign that indicates that the small airways are too constricted to allow air to pass through.

24) B
- cold climate does not trigger asthmatic attack but it is the sudden changes in environmental temperature or sudden weather changes that does. However, exercising in cold weather usually trigger asthma.

25) B
- the ideal position for a patient with asthma is the orthopneic position in which the patient is in high fowler's position with the head and arms resting on the over bed table. This position promotes lung expansion and facilitates breathing

26) A

27) C
- PERF and Drugs used in Asthma

PERF refers to amount of air inspired. If the PERF is below the amount of air inspired, it means that air is trapped in the alveoli and bronchioles because of bronchial spasms and blockage by accumulated secretions, this prevents proper exchange of oxygen and carbon dioxide and leads to hypoxia and acidosis. Peak flow meters measures PERF. If medication used to relax and dilate bronchioles is effective, effective gas exchange will be manifested by an improved PERF because air will be able to freely enter and leave the lungs and normal gas exchange will be able to take place.

Drugs used in asthma include:

1. Bronchodilators - relieve bronchospasms

• epinephrine/ephedrine/terbutaline
• theophylline
• albuterol (ventalin and proventil)
• isoproterenol (isuprel)/metaproterenol (metaprel and alupent)
• give the inhaled bronchodilator before the ant-inflammatory steroids

2. Anti-inflammatory - prevent histamine and decrease mucus

• hydrocortisone/dexamethasone/beclomethasone

3. Prophylactic therapy to prevent future attacks

• cromolyn sodium (intal)

28) A
- elevated WBC indicates that the child is experiencing infection. Therefore, the child should not be roomed-in with another child. Provide a private room for this child.


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Online Nursing Practice Test about Respiratory Diseases (29-35)

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29. The client had undergone thoracentesis. Which of the following is a correct action by the LVN (Licensed Vocational Nurse) immediately after the procedure?

a) she turns the client towards the affected side
b) she turns the client towards the unaffected side
c) she places the client in a supine position
d) she places the client in semi-fowler's position

30. The client is diagnosed to have advanced chronic obstructive pulmonary disease (COPD). Which of the following nursing action would best promote adequate gas exchange?

a) administering sedative as prescribed
b) placing the client in upright position
c) using high-flow venturi mask to deliver oxygen
d) encourage client to drink 6 glasses of fluid daily

31. A 48-year old man with tuberculosis is taking INH with pyridoxine (Vit. B6). The client asks why it is necessary for him to take pyridoxine. Which of the following is the most appropriate response by the nurse?

a) it increases INH absorption
b) it prevents INH-associated neuritis
c) it decreases toxicity of INH
d) it increases the effectiveness of INH

32. The child with croup is in a mist tent. Which of the following toys will be appropriate for the child?

a) stuffed toys
b) drawing book
c) plastic ball
d) coloring book

33. The client had been subjected to thoracentesis without written consent. What offense are the health care providers liable for?

a) assault
b) battery
c) manslaughter
d) invasion of privacy

34. The client with acute asthmatic attack is receiving Theophylline (Aminophylline) drip. Which of the following nursing actions should be included in the nursing care plan of the client?

a) note for decreased urine output
b) observe for elevated temperature
c) be alert for decreased BP
d) monitor for decreased pulse rate

35. Which of the following is the best position for a client who had undergone lobectomy?

a) side-lying position
b) supine position
c) sitting upright, leaning forward position
d) semi-fowler's position



ANSWERS AND RATIONALE

29) B
- after thoracentesis, turn the client towards unaffected side to prevent leakage of fluid into the thoracic cavity.

30) B
- upright position enhances adequate ventilation. The client with COPD is best placed in upright, leaning forward position.

31) B
- the common side effect of INH is peripheral neuritis. Vitamin B6 prevents this side effect.

32) C
- plastic ball does not absorb moisture within the mist tent. Therefore, it is the most appropriate toy for the child. Toys that may absorb moisture should be avoided because dampness may lower the child's resistance to infection.

33) B
- battery is intentional touching a person's body part without his consent.

34) C
- aminophylline causes diuresis, and therefore hypotension may occur.

35) D
- semi-fowler's position will promote maximum lung expansion. Therefore, this is the best position after a lung surgery like lobectomy.


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Online Nursing Practice Test about Respiratory Diseases (14-20)

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14. A 14-year old male is to be admitted to the unit due to high fever related to influenza. With whom among the following clients should he be placed together in the room?

a) the 12-year old male client who had undergone appendectomy
b) the 12-year old female client with flu
c) the 12-year old boy with flu
d) the 12-year old boy with leukemia

15. Why is influenza vaccine given to adults annually?

a) immunity last only for a year
b) some organisms are resistant to the vaccine
c) this is the routine procedure
d) adults have low resistance to flu virus

16. Which of the following nursing interventions should be implemented for a client with influenza?

a) instructing family members not to visit the client until the fever declines
b) instructing family members or visitors to wear surgical mask before entering the client's room
c) instructing family members that there are no special precautions needed when caring for the client
d) instructing family members to wear gown and gloves before entering the client's room

17. Which of the following should concern the nurse most, when caring for a client who will undergo bronchoscopy?

a) the client had a glass of orange juice an hour ago
b) the client has yellowish sputum
c) the client complains of thirst and dryness of mouth
d) the client says, he had removed his dentures

18. The client had undergone decortication of the right lung. The nurse needs to intervene when the unlicensed nursing assistant does which of the following?

a) instructs the client to lie on the operated side
b) instructs the client to lie on the unoperated side
c) keeps the client on supine with head of the bed elevated
d) ensures that chest tube with water-seal drainage functions properly

19. Which of the following findings should concern the nurse that the oxygen saturation monitor is not working?

a) there is no sensor light on the probe
b) oxygen saturation (Sa O2) is 92%
c) pulse rate= 58/min; Sa is 97%
d) mucous membrane in the mouth appears pinkish

20. The client had left chest injury. The nurse can feel air going in and out of injured site during breathing. Which of the following should the nurse do initially?

a) apply petrolatum jelly dressing at the site
b) turn the client to right side
c) give oxygen therapy at 2 L/min
d) transport the client to the nearest medical facility



ANSWERS AND RATIONALE

14) C
cohorts (client with the same diagnosis) can be roomed-in as long as one does not have infection which is different from the other. Age group is another consideration as well as gender of clients.

15) A
- annual influenza vaccine is required to maintain adequate protection.

16) B
- influenza requires droplet precaution. Healthcare workers and family members should wear surgical mask when entering client's room to ensure prevention of contamination.

17) A
- the client should be on NPO 6-8 hours before bronchoscopy if the client had taken anything by mouth, aspiration and airway obstruction may occur.

18) A
- the nurse should intervene when the nursing assistant instructs the client to lie on the operated side. This may inhibit expansion of the affected lung. Options B, C, and D are correct nursing interventions.

19) A
- if the O2 saturation monitor is not working, there will be no sensor light on the probe.

20) A
- cover the injured site of the chest with occlusive dressing like petrolatum jelly dressing to prevent pneumothorax and atelectasis.


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• Online Nursing Practice Test about Respiratory Diseases (21-28)
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Online Nursing Practice Test about Respiratory Diseases (11-13)

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Situation: Joey has been brought to the hospital with acute laryngotracheobronchitis. He received epinephrine in the emergency room 2 hours ago.

11. While completing discharge teaching with Joey's parents. The nurse teaches the parents that Joey may have recurrence of uncontrolled coughing. The nurse should instruct the parents that if this happened, they should first:

a) call the emergency room
b) increase his fluid intake to liquefy secretion
c) administer the prescribed dose of guaifenesin
d) sit with the child in the bathroom with a basin of hot water and the door closed

12. Joey became very upset and agitated when he is placed in a mist tent. His aunt, who is staying with him, asks the nurse, "Isn't there something we can do?" The best response for the nurse is:

a) he'll settle down once he get used of it
b) would you like to sit with him under the tent
c) he has to stay here. I'll get him some toys
d) go ahead and take him out, but let him back in the tent when you leave

13. The initial nursing action for the nurse admitting Joey to the pediatric unit is to:

a) familiarize Joey with the unit
b) assess respiratory status
c) offer fluids
d) administered oxygen as ordered


ANSWERS AND RATIONALE

11) D
- Before discharging a child who had a croup attack, the nurse should provide anticipatory guidance to the parent in case croup happens again in the future. Bring child in the bathroom with a basin of hot water to fill the room with steam. This moist warm air will help to cause bbronchodilation and relieve spasms. Another way is to fill the bath tub with hot water or let faucet run with hot water.
Laryngotracheobronchitis or croup is inflammation of the larynx, trachea and bronchi. The most common cause in children below 3 years old is viral infection and between three to six years old, it is often due to H. influenzae.

Signs and symptoms of laryngotracheobronchitis include:

begins as a mild upper respiratory infection without fever or low grade fever

child awakens during the night in respiratory distress: barking cough, inspiratory stridor, and retractions which frightens the parents who rush the child to the emergency room

emergency management in the E.R. is to give the child racemic epinephrine by nebulizer to cause bronchodilation and maintain patent airway.

12) B
- a child having croup is placed inside the mist tent to promote bronchodilation and liquefy secretions. If the child feels afraid bein inside the plastic enclosure alone, it is allowable to tuck the parent or caregiver inside the mist tent with the child to reduce child's anxiety and prevent crying.
13) B
- the major danger of croup is airway occlusion from laryngospasm, therefore it is important to check the respiratory status of the child frequently.

• the nurse should take the vital signs closely every 15 minutes. Cyanosis, child thrashing, increased respiratory and pulse rate are signs of respiratory obstruction which requires intubation to maintain airway
• in addition, the nurse should provide comfort to the child and reduce the child's anxiety or fear. She can advise parent to hold child as necessary in order to prevent crying. This is because crying can result in laryngospasm and total occlusion of the aiway
• it is also contraindicated to stimulate the gag reflex as this can also result in laryngospasm
• if the child can tolerate it, the child should be allowed to drink or sip fluid from a straw to keep secretions moist.

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Online Nursing Practice Test about Respiratory Diseases (7-10)

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Situation: Jonas, 32 year old has returned from Honk Kong and was admitted to St. John of God Hospital and was tentatively diagnosed to have SARS.

7. Jonas is expected to have which of the following symptoms

a) fever, rapid progressive respiratory compromise
b) fever and dyspnea
c) fever and productive cough
d) fever and cyanosis

8. Incubation period of SARS

a) 2-8 days
b) 5-11 days
c) 1-10 days
d) 1-5 days

9. What is the causitive agent of SARS?

a) corona virus
b) retro virus
c) rhabdo virus
d) influenza virus

10. The following countries where SARS originated includes the following except:

a) China
b) Canada
c) Philippines
d) Australia


ANSWERS AND RATIONALE

7) B
- initial manifestation of SARS includes high fever, chills, headache, body malaise and muscular aches.
After 3 to 7 days. SARS manifestations appear which include nonproductive cough, dyspnea, shortness of breath and possible hypoxemia.

8) A
- the incubation period of SARS is 2-10 days and maybe as long as 10 days in some people

9) A
- the causative agent is a newly identified corona virus which is transmitted by:

• close person to person contact
• direct contact with infected person or contaminated object
• exposure of the eyes or mucous membrane to respiratory secretions of SARS patient

Risk Factors of SARS

• close contact with person who is diagnosed or suspected with SARS
• recent travel (within 10 days before appearance of signs and symptoms) to area with suspect or confirmed community transmission of SARS

10) C
- SARS cases were first identified in ASIAN countries in 2002. Countries initially affected by SARS include China, Singapore, Hong Kong, Australia, North America and Europe. The high risk age groups are those between 25-70 years old. About 3 patients in every 100 SARS cases die of the disease.


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Online Nursing Practice Test about Respiratory Diseases (1-6)

Situation: A 20 year old client is being treated for pneumonia. he has persistent cough and complained severe pain on coughing.
1. Which of the following organisms most commonly causes community acquired pneumonia in adults?

a) haemophilus influenzae
b) klebsiella pnemoniae
c) streptococcus pneumoniae
d) staphylococcus aureus

2. What type of instruction could be given to help the client reduce the discomfort he is ahving?

a) hold in your cough as much as possible
b) place the head of your bed flat to help with coughing
c) restrict fluids to help decrease the amount of sputum
d) splint your chest wall with pillow for comfort

3. A diagnosis of pneumonia is typically achieved by which of the following diagnostic test?

a) ABG analysis
b) chest x-ray
c) blood cultures
d) nutritional intake

4. The client has been treated with antibiotic therapy for left lower lobe pneumonia for 10 days. Which of the following physical findings would lead the nurse to believe it is appropriate to discharge the client?

a) continued dyspnea
b) temperature of 102 F
c) respiratory rate of 32 bpm
d) vesicular breath sounds in left base

5. A nurse is caring for a client with chest-tube drainage system. The nurse notes constant bubbling in the suction control chamber. Which of the following nursing actions is most appropriate?

a) reposition the client
b) notify the physician
c) this is normal, expected finding and no action is necessary
d) turn off suction machine

6. The nurse determines that influenza vaccine must be given regularly to clients with

a) hypertension
b) diabetes mellitus
c) urinary calculi
d) chronic illness



Try to read the latest type of cancer, it might be included in the exam --> Mesothelioma Cancer
ANSWERS AND RATIONALE

1) C
- pneumonia is inflammation of the bronchioles and alveoli that is usually accompanied by increased interstitial or alveolar fluid. Infectious pneumonia is caused by the following microorganisms:
Microorganisms that causes Pneumonia

• Streptococcus pneumoniae - most common cause of community acquied pneumonia
• Mycoplasma pneumoniae and hemophillus influenza - are other causes of community acquired pneumonia
• Pneumocystiis carinii - affects immunocompromised individuals such as those with AIDS
• Staphylococcus aureus, kleibsiella pneumoniae, P. aeruginosa and E. coli are common caused of nosochomial pneumonia.

Non-infectious pneumonia is caused by aspiration of gastric contents (aspiration pneumonia) and inhalation of toxic gases, dusts, smoke or chemicals.

2) D
- Nursing care for patients with Pneumonia includes:

• pleuritic chest pain may prevent the patient from coughing and performing deep breathing exercises effectively. To minimize the patient's discomfort the nurse can teach the patient to splint the chest wall with pillow during coughing. Pleuritic chest pain is sharp localized chest pain that occurs with breathing and coughing.
• place patient in fowler's or high fowler's position to promote lung expansion and facilitate breathing.
• change position every 2 hours in patient's who have altered level of consciousness to mobilize secretions, preferably placed in side lying to prevent aspiration with the head of the bed raised to 45 degrees.
• activity intolerance may result due to impaired oxygen and carbon dioxide exchange. Schedule patient's activity after treatment and medication. Activity of the patient should be according to tolerance
• chest physiotherapy including percussion, vibration and postural drainage is performed to reduce lung consolidation and prevent atelectasis. These activities help to mobilize secretions.
• suctioning, coughing and deep breathing to clear airways
• provide liberal fluid intake of 2,500 to 3,000 ml a day to help liquefy secretions.

Diagnostic Test used to determine Pneumonia

• Chest x-ray - is ordered to determine the extent and pattern of lung tissue involvement. On chest x-ray, areas of pneumonia appear as consolidation. On auscultation, bronchial breath sounds will be heard over consolidated areas. Presence of fluids, atelectasis and infiltrates will also be seen with x-ray.
• Sputum culture and sensitivity - not blood culture, is ordered for pneumonia to identify the infecting microorganism and determine which antibiotic would be most effective in destroying the pathogenic agent.
• ABG analysis - is ordered to assess the patient's gas exchange as areas of consolidated tissue will not be able to exchange carbon dioxide and oxygen properly with blood which could result in impaired gas exchange. The ABG is abnormal is arterial oxygen tension (PO2) is less than 80mmHg. This indicates the need to place patient under oxygen therapy.

3) B
- the major diagnostic tests used to identify the extent of the lung tissue affected by pneumonia is chest x-ray and to identify the causitive agent is sputum culture and microscopy.

4) D
- Common Manifestation of pneumonia includes fever, headache, chills, sweating, pleuritic chest pain, cough, sputum production, dyspnea, muscle pain and fatigue. On auscultation limited breath sounds crackles or rales maybe heard over the affected part of the lungs. Pleural friction rub may also be heard.

Type of Pneumonia and its Manifestations:

1. Pneumococcal pneumonia

• sudden onset of chills
  
• fever
  
• stabbing pleuritic chest pain
  
• dyspnea
• tachypnea
• high WBC
• consolidation on chest x-ray
• productive cough - rusty brown or blood streaked purulent sputum turns yellow and mucoid

2. Bronchopneumonia

• gradual onset with cough
• scattered crackles
• minimal dyspnea
• low grade fever
• patchy areas of consolidation on chest x-ray

3. Legionaires's disease

• gradual onset with chills
• fever
• body malaise
• headache
• confusion
• lack of appetite
• diarrhea
• muscle and joint pain
• dyspnea
• elevated WBC
• dry cough -scant mucoid or blood tinged sputum

4. Staphylococcal pneumonia

• sudden onset with fever
• multiple chills
• pleuritic pain
• dyspnea
• rales
• decreased breath sounds
• chest x-ray may show patcht infiltrates
  
• empyema
• abscesses and pneumothorax
• elevated WBC
• productive cough - purulent golden yellow or blood streaked sputum

5. Viral pneumonia

• sudden or gradual onset with flulike symptoms
  
• fever
• muscle aches
• normal to slightly elevated WBC
• dyspnea
• breath sounds maybe normal or with occasional wheezing and crackles
• dry cough - with scant mucoid that turns to purulent sputum

6. Pneumocystis carinii pneumonia

• abrupt onset with tachypnea
• shortness of breath
• fever
• respiratory distress
• dry cough

5) C
- Rationale: constant bubbling in the suction control bottle is normal. It indicates proper functioning of the apparatus

6) D
- Rationale: clients with chronic illness have low resistance to infection. Therefore, they should receive influenza vaccine yearly


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