practice questions (TB)

Question 1

A nurse assesses several clients who have a history of asthma. Which client should the nurse assess first?

a. A 66-year-old client with a barrel chest and clubbed fingernails
b. A 48-year-old client with an oxygen saturation level of 92% at rest
c. A 35-year-old client who has a longer expiratory phase than inspiratory phase
d. A 27-year-old client with a heart rate of 120 beats/min

Answer 1

D - Tachycardia can indicate hypoxemia. The rest are expected findings or not emergent.

Question 2

A nurse cares for a client with arthritis who reports frequent asthma attacks. Which action should the nurse take first?

a. Review the client’s pulmonary function test results.
b. Ask about medications the client is currently taking.
c. Assess how frequently the client uses a bronchodilator.
d. Consult the provider and request arterial blood gases.

Answer 2

B

Question 3

After teaching a client who is prescribed a long-acting beta2 agonist medication, a nurse assesses the client’s understanding. Which statement indicates the client comprehends the teaching?

a. “I will carry this medication with me at all times in case I need it.”
b. “I will take this medication when I start to experience an asthma attack.”
c. “I will take this medication every morning to help prevent an acute attack.”
d. “I will be weaned off this medication when I no longer need it.”

Answer 3

C

Question 4

After teaching a client how to perform diaphragmatic breathing, the nurse assesses the client’s understanding. Which action demonstrates that the client correctly understands the teaching?

a. The client lays on his or her side with his or her knees bent.
b. The client places his or her hands on his or her abdomen.
c. The client lays in a prone position with his or her legs straight.
d. The client places his or her hands above his or her head.

Answer 4

B

Question 5

After teaching a client who is prescribed salmeterol (Serevent), the nurse assesses the client’s understanding. Which statement by the client indicates a need for additional teaching?

a. “I will be certain to shake the inhaler well before I use it.”
b. “It may take a while before I notice a change in my asthma.”
c. “I will use the drug when I have an asthma attack.”
d. “I will be careful not to let the drug escape out of my nose and mouth.”

Answer 5

C

Question 6

A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that he no longer enjoys going out with his friends. How should the nurse respond?

a. “There are a variety of support groups for people who have COPD.”
b. “I will ask your provider to prescribe you with an antianxiety agent.”
c. “Share any thoughts and feelings that cause you to limit social activities.”
d. “Friends can be a good support system for clients with chronic disorders.”

Answer 6

C

Question 7

A nurse assesses a client who is prescribed fluticasone (Flovent) and notes oral lesions. Which action should the nurse take?

a. Encourage oral rinsing after fluticasone administration.
b. Obtain an oral specimen for culture and sensitivity.
c. Start the client on a broad-spectrum antibiotic.
d. Document the finding as a known side effect.

Answer 7

A

Question 8

A nurse cares for a client who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain. Which action should the nurse take?

a. Ambulate the client in the hallway to promote deep breathing.
b. Auscultate the client’s anterior and posterior lung fields.
c. Encourage the client to take shallow breaths to help with the pain.
d. Administer pain medication and encourage the client to take deep breaths.

Answer 8

D

Question 9

A nurse cares for a client who has a chest tube. When would this client be at highest risk for developing a pneumothorax?

a. When the insertion site becomes red and warm to the touch
b. When the tube drainage decreases and becomes sanguineous
c. When the client experiences pain at the insertion site
d. When the tube becomes disconnected from the drainage system

Answer 9

D

Question 10

A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which physiologic process should the nurse correlate with this client’s history and clinical manifestations?

a. Increased pulmonary pressure creating a higher workload on the right side of the heart
b. Exposure to irritants resulting in increased inflammation of the bronchi and bronchioles
c. Increased number and size of mucus glands producing large amounts of thick mucus
d. Left ventricular hypertrophy creating a decrease in cardiac output

Answer 10

A

Question 11

A nurse cares for a client with chronic obstructive pulmonary disease (COPD) who appears thin and disheveled. Which question should the nurse ask first?

a. “Do you have a strong support system?”
b. “What do you understand about your disease?”
c. “Do you experience shortness of breath with basic activities?”
d. “What medications are you prescribed to take each day?”

Answer 11

C

Question 12

The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, “The medication is too expensive to use every day. I only use my inhaler when I have an attack.” How should the nurse respond?

a. “You are using the inhaler incorrectly. This medication should be taken daily.”
b. “If you decrease environmental stimuli, it will be okay for you to use the inhaler only for asthma attacks.”
c. “Tell me more about your fears related to feelings of breathlessness.”
d. “It is important to use this type of inhaler every day. Let’s identify potential community services to help you.”

Answer 12

D

Question 13

A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first?

a. A 46-year-old with a 30–pack-year history of smoking
b. A 52-year-old in a tripod position using accessory muscles to breathe
c. A 68-year-old who has dependent edema and clubbed fingers
d. A 74-year-old with a chronic cough and thick, tenacious secretions

Answer 13

B

Question 14

A nurse administers medications to a client who has asthma. Which medication classification is paired correctly with its physiologic response to the medication?

a. Bronchodilator – Stabilizes the membranes of mast cells and prevents the release of inflammatory mediators
b. Cholinergic antagonist – Causes bronchodilation by inhibiting the parasympathetic nervous system
c. Corticosteroid – Relaxes bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors
d. Cromone – Disrupts the production of pathways of inflammatory mediators

Answer 14

B

Question 15

A nurse evaluates the following arterial blood gas and vital sign results for a client with chronic obstructive pulmonary disease (COPD):
Arterial Blood Gas Results Vital Signs
pH = 7.32
PaCO2 = 62 mm Hg
PaO2 = 46 mm Hg
HCO3– = 28 mEq/L Heart rate = 110 beats/min
Respiratory rate = 12 breaths/min
Blood pressure = 145/65 mm Hg
Oxygen saturation = 76%
Which action should the nurse take first?
a. Administer a short-acting beta2 agonist inhaler.
b. Document the findings as normal for a client with COPD.
c. Teach the client diaphragmatic breathing techniques.
d. Initiate oxygenation therapy to increase saturation to 92%.

Answer 15

D- the other interventions do not address the patient’s hypoxia, which is the priority.

Question 16

A nurse assesses a client with asthma and notes bilateral wheezing, decreased pulse oxygen saturation, and suprasternal retraction on inhalation. Which actions should the nurse take? (Select all that apply.)

a. Administer prescribed salmeterol (Serevent) inhaler.
b. Assess the client for a tracheal deviation.
c. Administer oxygen to keep saturations greater than 94%.
d. Perform peak expiratory flow readings.
e. Administer prescribed albuterol (Proventil) inhaler.

Answer 16

C, E

Question 17

A nurse teaches a client who has chronic obstructive pulmonary disease. Which statements related to nutrition should the nurse include in this client’s teaching? (Select all that apply.)

a. “Avoid drinking fluids just before and during meals.”
b. “Rest before meals if you have dyspnea.”
c. “Have about six small meals a day.”
d. “Eat high-fiber foods to promote gastric emptying.”
e. “Increase carbohydrate intake for energy.”

Answer 17

A, B, C

Question 18

A nurse assesses a client with chronic obstructive pulmonary disease. Which questions should the nurse ask to determine the client’s activity tolerance? (Select all that apply.)

a. “What color is your sputum?”
b. “Do you have any difficulty sleeping?”
c. “How long does it take to perform your morning routine?”
d. “Do you walk upstairs every day?”
e. “Have you lost any weight lately?”

Answer 18

B, C, E

Question 19

A nurse plans care for a client who has chronic obstructive pulmonary disease and thick, tenacious secretions. Which interventions should the nurse include in this client’s plan of care? (Select all that apply.)

a. Ask the client to drink 2 liters of fluids daily.
b. Add humidity to the prescribed oxygen.
c. Suction the client every 2 to 3 hours.
d. Use a vibrating positive expiratory pressure device.
e. Encourage diaphragmatic breathing.

Answer 19

A, B, D

Question 20

An intubated client’s oxygen saturation has dropped to 88%. What action by the nurse takes priority?

a. Determine if the tube is kinked.
b. Ensure all connections are patent.
c. Listen to the client’s lung sounds.
d. Suction the endotracheal tube.

Answer 20

C - CHECK FOR DOPE (displaced tube, obstruction, pneumothorax, and equipment problems)

• Listen for equal bilateral sounds to determine if tube is correctly placed

Question 21

A nurse is caring for a client on mechanical ventilation and finds the client agitated and thrashing about. What action by the nurse is most appropriate?

a. Assess the cause of the agitation.
b. Reassure the client that he or she is safe.
c. Restrain the client’s hands.
d. Sedate the client immediately.

Answer 21

A

Question 22

A nurse is preparing to admit a client on mechanical ventilation from the emergency department. What action by the nurse takes priority?

a. Assessing that the ventilator settings are correct
b. Ensuring there is a bag-valve-mask in the room
c. Obtaining personal protective equipment
d. Planning to suction the client upon arrival to the room

Answer 22

B

Question 23

A client is on mechanical ventilation and the client’s spouse wonders why ranitidine (Zantac) is needed since the client “only has lung problems.” What response by the nurse is best?

a. “It will increase the motility of the gastrointestinal tract.”
b. “It will keep the gastrointestinal tract functioning normally.”
c. “It will prepare the gastrointestinal tract for enteral feedings.”
d. “It will prevent ulcers from the stress of mechanical ventilation.”

Answer 23

D - Zantac is a histamine blocking agent (prevents ulcers)

Question 24

The nurse caring for mechanically ventilated clients uses best practices to prevent ventilator-associated pneumonia. What actions are included in this practice? (Select all that apply.)

a. Adherence to proper hand hygiene
b. Administering anti-ulcer medication
c. Elevating the head of the bed
d. Providing oral care per protocol
e. Suctioning the client on a regular schedule

Answer 24

A, B, C, D

Question 25

A nurse is caring for a client who is on mechanical ventilation. What actions will promote comfort in this client? (Select all that apply.) a. Allow visitors at the client’s bedside. b. Ensure the client can communicate if awake. c. Keep the television tuned to a favorite channel. d. Provide back and hand massages when turning. e. Turn the client every 2 hours or more.

Answer 25

A, B, D, E

Question 26

The nurse caring for mechanically ventilated clients knows that older adults are at higher risk for weaning failure. What age-related changes contribute to this? (Select all that apply.) a. Chest wall stiffness b. Decreased muscle strength c. Inability to cooperate d. Less lung elasticity e. Poor vision and hearing

Answer 26

A, B, D

Question 27

A client has a bone density score of –2.8. What action by the nurse is best? a. Asking the client to complete a food diary b. Planning to teach about bisphosphonates c. Scheduling another scan in 2 years d. Scheduling another scan in 6 months

Answer 27

B

Question 28

A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best? a. Ask the client about fear of falling. b. Instruct the client to increase calcium. c. Suggest other exercises the client can do. d. Tell the client to try weight lifting.

Answer 28

A

Question 29

The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option? a. Client with diabetes who has a serum creatinine of 0.8 mg/dL b. Client who recently fell and has vertebral compression fractures c. Hypertensive client who takes calcium channel blockers d. Client with a spinal cord injury who cannot tolerate sitting up

Answer 29

D

Question 30

A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first? a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago b. Client taking ibandronate (Boniva) who cannot remember when the last dose was c. Client taking raloxifene (Evista) who reports unilateral calf swelling d. Client taking risedronate (Actonel) who reports occasional dyspepsia

Answer 30

C - DVTs are an adverse effect of Raloxifine (SERM)

Question 31

A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best? a. Arrange a home safety evaluation. b. Ensure the client has a walker at home. c. Help the client look into assisted living. d. Refer the client to Meals on Wheels.

Answer 31

A

Question 32

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.) a. Alcohol b. Caffeine c. Fat d. Carbonated beverages e. Vitamin D

Answer 32

A, B, D, E

Question 33

A nurse is providing education to a community women’s group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.) a. Cut down on tobacco product use. b. Limit alcohol to two drinks a day. c. Strengthening exercises are important. d. Take recommended calcium and vitamin D. e. Walk 30 minutes at least 3 times a week.

Answer 33

C, D, E | - Women should not have more than one drink per day

Question 34

A nurse cares for a dying client. Which manifestation of dying should the nurse treat first? a. Anorexia b. Pain c. Nausea d. Hair loss

Answer 34

B

Question 35

A nurse plans care for a client who is nearing end of life. Which question should the nurse ask when developing this client’s plan of care? a. “Is your advance directive up to date and notarized?” b. “Do you want to be at home at the end of your life?” c. “Would you like a physical therapist to assist you with range-of-motion activities?” d. “Have your children discussed resuscitation with your health care provider?”

Answer 35

B

Question 36

A nurse is caring for a client who has lung cancer and is dying. Which prescription should the nurse question? a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5 b. Albuterol (Proventil) metered dose inhaler every 4 hours PRN for wheezes c. Atropine solution 1% sublingual every 4 hours PRN for excessive oral secretions d. Sodium biphosphate (Fleet) enema once a day PRN for impacted stool

Answer 36

A - pain meds should be scheduled around the clock to maintain comfort and prevent recurrence of pain

Question 37

After teaching a client about advance directives, a nurse assesses the client’s understanding. Which statement indicates the client correctly understands the teaching? a. “An advance directive will keep my children from selling my home when I’m old.” b. “An advance directive will be completed as soon as I’m incapacitated and can’t think for myself.” c. “An advance directive will specify what I want done when I can no longer make decisions about health care.” d. “An advance directive will allow me to keep my money out of the reach of my family.”

Answer 37

C

Question 38

A nurse teaches a client who is considering being admitted to hospice. Which statement should the nurse include in this client’s teaching? a. “Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge.” b. “Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms.” c. “Hospice care will not help with your symptoms of depression. I will refer you to the facility’s counseling services instead.” d. “You seem to be experiencing some difficulty with this stage of the grieving process. Let’s talk about your feelings.”

Answer 38

B

Question 39

A nurse is caring for a dying client. The client’s spouse states, “I think he is choking to death.” How should the nurse respond? a. “Do not worry. The choking sound is normal during the dying process.” b. “I will administer more morphine to keep your husband comfortable.” c. “I can ask the respiratory therapist to suction secretions out through his nose.” d. “I will have another nurse assist me to turn your husband on his side"

Answer 39

D

Question 40

The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client’s anxiety and restlessness. Which statement made by the family member indicates understanding of the nurse’s teaching? a. “Maybe we should just hire an around-the-clock sitter to stay with Grandmother.” b. “I have some of her favorite hymns on a CD that I could bring for music therapy.” c. “I don’t think that she’ll need pain medication along with her herbal treatments.” d. “I will burn therapeutic incense in the room so we can stop the anxiety pills.”

Answer 40

B

Question 41

A nurse assesses a client who is dying. Which manifestation of a dying client should the nurse assess to determine whether the client is near death? a. Level of consciousness b. Respiratory rate c. Bowel sounds d. Pain level on a 0-to-10 scale

Answer 41

B - periods of apnea and Cheyne- Strokes respirations indicate death is near

Question 42

A nurse is caring for a client who is terminally ill. The client’s spouse states, “I am concerned because he does not want to eat.” How should the nurse respond? a. “Let him know that food is available if he wants it, but do not insist that he eat.” b. “A feeding tube can be placed in the nose to provide important nutrients.” c. “Force him to eat even if he does not feel hungry, or he will die sooner.” d. “He is getting all the nutrients he needs through his intravenous catheter.”

Answer 42

A

Question 43

A nurse discusses inpatient hospice with a client and the client’s family. A family member expresses concern that her loved one will receive only custodial care. How should the nurse respond? a. “The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left.” b. “Palliative care will release you from the burden of having to care for someone in the home. It does not mean that curative treatment will stop.” c. “A palliative care facility is like a nursing home and costs less than a hospital because only pain medications are given.” d. “Your relative is unaware of her surroundings and will not notice the difference between her home and a palliative care facility.”

Answer 43

A

Question 44

An intensive care nurse discusses withdrawal of care with a client’s family. The family expresses concerns related to discontinuation of therapy. How should the nurse respond? a. “I understand your concerns, but in this state, discontinuation of care is not a form of active euthanasia.” b. “You will need to talk to the provider because I am not legally allowed to participate in the withdrawal of life support.” c. “I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death.” d. “There is no need to worry. Most religious organizations support the client’s decision to stop medical treatment.”

Answer 44

C

Question 45

A hospice nurse is caring for a dying client and her family members. Which interventions should the nurse implement? (Select all that apply.) a. Teach family members about physical signs of impending death. b. Encourage the management of adverse symptoms. c. Assist family members by offering an explanation for their loss. d. Encourage reminiscence by both client and family members. e. Avoid spirituality because the client’s and the nurse’s beliefs may not be congruent.

Answer 45

A, B, D

Question 46

A nurse admits an older adult client to the hospital. Which criterion should the nurse use to determine if the client can make his own medical decisions? (Select all that apply.) a. Can communicate his treatment preferences b. Is able to read and write at an eighth-grade level c. Is oriented enough to understand information provided d. Can evaluate and deliberate information e. Has completed an advance directive

Answer 46

A, C, D

Question 47

A hospice nurse plans care for a client who is experiencing pain. Which complementary therapies should the nurse incorporate in this client’s pain management plan? (Select all that apply.) a. Play music that the client enjoys. b. Massage tissue that is tender from radiation therapy. c. Rub lavender lotion on the client’s feet. d. Ambulate the client in the hall twice a day. e. Administer intravenous morphine.

Answer 47

A, C

Question 48

A nurse teaches a client’s family members about signs and symptoms of approaching death. Which manifestations should the nurse include in this teaching? (Select all that apply.) a. Warm and flushed extremities b. Long periods of insomnia c. Increased respiratory rate d. Decreased appetite e. Congestion and gurgling

Answer 48

D, E