Respiratory Disorders

Question 1

You are caring for a patient who has a diagnosis of syndrome of inappropriate anti-diuretic hormone secretion (SIADH). Your patient’s plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the patient’s health?

A. Nutritional status
B. Potassium balance
C. Calcium balance
D. Fluid volume status

Answer 1

D. Fluid volume status

Question 2

You are caring for a patient admitted with a diagnosis of AKI. When you review your patient’s most recent laboratory reports, you note that the patient’s magnesium levels are high. You should prioritize assessment for which of the following health problems?

A. Diminished DTRs
B. Tachycardia
C. Cool, clammy skin
D. Acute flank pain

Answer 2

A. Diminished DTRs

Question 3

You are working on a burns unit and one of your acutely ill patients is exhibiting signs & symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance?

A. Metabolic alkalosis
B. Hypermagnesemia
C. Hypercalcemia
D. Hypovolemia

Answer 3

D. Hypovolemia

Question 4

A patient with a longstanding diagnosis of generalized anxiety disorder presents to the ER. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid base imbalance?

A. Respiratory acidosis
B. Respiratory alkalosis
C. Increased PaCO2
D. CNS disturbances

Answer 4

B. Respiratory alkalosis

Question 5

You are an ER nurse caring for a trauma patient. Your patient has the following ABG results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results?

A. Respiratory acidosis with no compensation
B. Metabolic alkalosis with a compensatory alkalosis
C. Metabolic acidosis with no compensation
D. Metabolic acidosis with a compensatory respiratory alkalosis

Answer 5

D. Metabolic acidosis with a compensatory respiratory alkalosis

Question 6

You are making initial shift assessments on your patients. While assessing one patient’s peripheral IV site, you note edema around the insertion site. How should you document this complication related to IV therapy?

A. Air emboli
B. Phlebitis
C. Infiltration
D. Fluid overload

Answer 6

C. Infiltration

Question 7

You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patient’s skin turgor?

A. Overhydration is common among healthy older adults
B. Dehydration causes the skin to appear spongy
C. Inelastic skin turgor is a normal part of aging
D. Skin turgor cannot be assessed in patients over 70

Answer 7

C. Inelastic skin turgor is a normal part of aging

Question 8

The physician has ordered a peripheral IV to be inserted before the patient goes for CT. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter?

A. Choose a hairless site if available
B. Consider potential effects on the patient’s mobility when selecting a site
C. Have the patient briefly hold his arm over his head before insertion
D. Leave the tourniquet on for at least 3 minutes

Answer 8

B. Consider potential effects on the patient’s mobility when selecting a site

Question 9

A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased ICP. This solution will increase the number of dissolved particles in the patient’s blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following?

A. Hydrostatic pressure
B. Osmosis and osmolality
C. Diffusion
D. Active transport

Answer 9

B. Osmosis and osmolality

Question 10

You are the surgical nurse caring for a 65-year-old female patient who is postop day 1 following a thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should you first suspect?

A. Hypophosphatemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyperkalemia

Answer 10

B. Hypocalcemia

Question 11

A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, “A patient in renal failure partially loses the ability to regulate changes in pH.” What is the cause of this partial inability?

A. The kidneys regulate and reabsorb carbonic acid to change and maintain pH
B. The kidneys buffer acids through electrolyte changes
C. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH
D. The kidneys combine carbonic acid and bicarbonate to maintain a stable pH

Answer 11

C. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH

Question 12

You are caring for a 65-year old male patient admitted to your medical unit 72 hours ago with pyloric stenosis. A NG tube placed upon admission has been on low intermittent suction ever since. Upon review of the morning’s blood work, you notice that the patient’s potassium is below reference range. You should recognize that the patient may be at risk for what imbalance?

A. Hypercalcemia
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis

Answer 12

C. Metabolic alkalosis

Question 13

The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV antibiotics. How should the nurse always start the process of insertion?

A. Leave one hand in gloves to assess the site
B. Cleanse the skin with NS
C. Ask the patient about allergies to latex or iodine
D. Remove excessive hair from the selected site

Answer 13

C. Ask the patient about allergies to latex or iodine

Question 14

A patient who is being treated for PNA starts complaining of sudden SOB. An ABG is drawn. The ABG has the following values: pH 7.21, PaCO2 64, HCO3 24. What does the ABG reflect?

A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis

Answer 14

A. Respiratory acidosis

Question 15

One day after a patient is admitted to the medical unit, you note that the patient is oliguria. You notify the acute-care nurse practitioner who orders a fluid challenge of 200 mL of normal saline solution over 15 minutes. This intervention will achieve which of the following?

A. Help distinguish hyponatremia from hypernatremia
B. Help evaluate pituitary gland function
C. Help distinguish reduced renal blood flow from decreased renal function
D. Help provide effective treatment for hypertension-induced oliguria

Answer 15

C. Help distinguish reduced renal blood flow from decreased renal function

Question 16

The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, “i’ll stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom.” What would be the nurse’s best response?

A. I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete work up
B. Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids
C. It is normal to be a little confused following surgery, and it is safe not to urinate at night
D. If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress

Answer 16

B. Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids

Question 17

A 73-year old man comes into the ED by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His HR is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurse’s most likely explanation for the low urine output?

A. The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place
B. The man likely has a traumatic brain injury, lacks ADH, and needs vasopressin
C. The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output
D. The man is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output

Answer 17

D. The man is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output

Question 18

A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How should these nurses be encouraged to deal with excess hair at the intended site?

A. Leave the hair intact
B. Shave the area
C. Clip the hair in the area
D. Remove the hair with a depilatory

Answer 18

C. Clip the hair in the area

Question 19

You are the nurse evaluating a newly admitted patient’s laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of ADH?

A. Increased serum sodium
B. Decreased serum potassium
C. Decreased hemoglobin
D. Increased platelets

Answer 19

A. Increased serum sodium

Question 20

A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurse’s preceptor is going over the patient’s past lab reports with the new nurse. The nurse takes note that the patient’s PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurse’s best response?

A. The patient’s calcium will rise dramatically due to pituitary stimulation
B. Oxygen will increase the patient’s intracranial pressure and create confusion
C. Oxygen may cause the patient to hyperventilate and become acidotic
D. Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia

Answer 20

D. Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia

Question 21

The nurse is providing care for a patient with COPD. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process?

A. Diffusion
B. Osmosis
C. Active transport
D. Filtration

Answer 21

A. Diffusion

Question 22

When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur?

A. Active transport of hydrogen ions across the capillary walls
B. Pressure of the blood in the renal capillaries
C. Action of the dissolved particles contained in a unit of blood
D. Hydrostatic pressure resulting from the pumping action of the heart

Answer 22

D. Hydrostatic pressure resulting from the pumping action of the heart

Question 23

The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect?

A. Decrease in the release of aldosterone
B. Increase of filtration in the Loop of Henle
C. Decrease in the reabsorption of sodium
D. Decrease in glomerular filtration

Answer 23

D. Decrease in glomerular filtration

Question 24

You are the nurse caring for a 77-year-old male patient who has been involved in a MVA. You and your colleague note that the patient’s labs indicate minimally elevated serum creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older adults?

A. Substantially reduced renal function
B. AKI
C. Decreased cardiac output
D. Alterations in ratio of body fluids to muscle mass

Answer 24

A. Substantially reduced renal function

Question 25

A medical nurse educator is reviewing a patient’s recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?

A. The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance
B. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance
C. The kidneys react rapidly to compensate for imbalances in the body
D. The kidneys regulate the bicarbonate level in the intracellular fluid

Answer 25

B. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance

Question 26

The nurse in the MICU is caring for a patient who is in respiratory acidosis due to inadequate ventilation. What diagnosis could the patient have that could cause inadequate ventilation?

A. Endocarditis
B. Multiple myeloma
C. Guillain-Barré syndrome
D. Overdose of amphetamines

Answer 26

C. Guillain-Barré syndrome

Question 27

The ICU nurse is caring for a patient who experienced trauma in a workplace accident. The patient is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3 23 mEq/L. The nurse should recognize the likelihood of what acid-base disorder?

A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Mixed acid-base disorder

Answer 27

D. Mixed acid-base disorder

Question 28

You are called to your patient’s room by a family member who voices concern about the patient’s status. On assessment, you find the patient tachypnea, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patient’s signs and symptoms?

A. Hypocalcemia
B. Hyponatremia
C. Hyperchloremia
D. Hypophosphatemia

Answer 28

C. Hyperchloremia

Question 29

Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis?

A. Metastases
B. Excessive potassium intake
C. Water intoxication
D. Excessive administration of chloride

Answer 29

D. Excessive administration of chloride

Question 30

The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the medication orders?

A. Cimetidine
B. Maalox
C. Potassium chloride elixir
D. Furosemide

Answer 30

A. Cimetidine

Question 31

The ED nurse is assessing a patient complaining of dyspnea. The nurse auscultates the patient’s chest and hears wheezing throughout the lung fields. What might this indicate?

A. The patient has a narrowed airway
B. The patient has PNA
C. The patient needs physiotherapy
D. The patient has a hemothorax

Answer 31

A. The patient has a narrowed airway

Question 32

The nurse is caring for a patient who has just returned to the unit after a colon resection. The patient is showing signs of hypoxia. The nurse knows that this is probably caused by what?

A. Nitrogen narcosis
B. Infection
C. Impaired diffusion
D. Shunting

Answer 32

D. Shunting

Question 33

A patient with chronic lung disease is undergoing lung function testing. What test results denotes the volume of air inspired and expired with a normal breath?

A. Total lung capacity
B. Forced vital capacity
C. Tidal volume
D. Residual volume

Answer 33

C. Tidal volume

Question 34

A patient has a diagnosis of MS. The nurse is aware that neuromuscular disorders such as MS may lead to a decreased vital capacity. What does vital capacity measure?

A. The volume of air inhaled and exhaled with each breath
B. The volume of air in the lungs after maximal inspiration
C. The maximal volume of air inhaled after normal expiration
D. The maximal volume of air exhaled from the point of maximal inspiration

Answer 34

D. The maximal volume of air exhaled from the point of maximal inspiration

Question 35

The nurse is performing a respiratory assessment of a patient who has been experiencing episodes of hypoxia. The nurse is aware that this is ultimately attributable to impaired gas exchange. On what factor does adequate gas exchange primarily depend?

A. An appropriate perfusion-diffusion ratio
B. An adequate ventilation-perfusion ratio
C. Adequate diffusion of gas in shunted blood
D. Appropriate blood nitrogen

Answer 35

B. An adequate ventilation-perfusion ratio

Question 36

The patient just had an MRI ordered because a routine CXR showed suspicious areas in the right lung. The physician suspects bronchogenic carcinoma. An MRI would most likely be order to assess what in this patient?

A. Alveolar dysfunction
B. Forced vital capacity
C. Tidal volume
D. Chest wall invasion

Answer 36

D. Chest wall invasion

Question 37

The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurse’s assessment findings would best corroborate this diagnosis?

A. The patient is experiencing painless hemoptysis
B. The patient’s ABGs are normal, but he demonstrates increased work of breathing
C. The patient’s oxygen saturation level is below 88%, but he denies shortness of breath
D. The patient’s pain intensifies when he coughs or takes a deep breath

Answer 37

D. The patient’s pain intensifies when he coughs or takes a deep breath

Question 38

The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client’s oxygen saturation rapidly dropping. The patient complains of shortness of breath and become tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what?

A. Diminished or absent breath sounds on the affected side
B. Paradoxical chest wall movement with respiration
C. Sudden loss of consciousness
D. Muffled heart sounds

Answer 38

A. Diminished or absent breath sounds on the affected side

Question 39

An X-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patient’s plan of care?

A. Suction the patient’s airway secretions
B. Immobilize the ribs with an abdominal binder
C. Prepare the patient for surgery
D. Immediately sedate and intubate the patient

Answer 39

A. Suction the patient’s airway secretions

Question 40

The nurse is assessing an adult patient following a motor vehicle accident. The nurse observes that the patient has an increased use of accessory muscles and is complaining of chest pain and shortness of breath. The nurse should recognize the possibility of what condition?

A. Pneumothorax
B. Anxiety
C. Acute bronchitis
D. Aspiration

Answer 40

A. Pneumothorax

Question 41

The nurse is assessing a patient who has a 35 pack-year history of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the patient for further assessment?

A. Lately, I have this cough that just never seems to go away
B. I find that I don’t have nearly the stamina that I used to
C. I seem to get nearly every cold and flu that goes around my workplace
D. I never used to have any allergies, but now I think I’m developing allergies to dust and pet hair

Answer 41

A. Lately, I have this cough that just never seems to go away

Question 42

The nurse is caring for a 46-year-old patient recently diagnosed with the early stages of lung cancer. The nurse is aware that the preferred method of treating patients with non-small tumors is what?

A. Chemotherapy
B. Radiation
C. Surgical resection
D. Bronchoscopes opening of the airway

Answer 42

C. Surgical resection

Question 43

A 54-year old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurse’s response?

A. The cells in small cell cancer of the lung are not large enough to visualize in surgery
B. Small cell lung cancer is self-limiting in many patients and surgery should be delayed
C. Patients with small cell lung cancer aren’t normally stable enough to survive surgery
D. Small cell cancer of the lung grows rapidly and metastasizes early and extensively

Answer 43

D. Small cell cancer of the lung grows rapidly and metastasizes early and extensively