A patient with darker skin pigmentation has a pulse oximeter reading in the normal range, but the nurse counts a rapid respiratory rate and sees intercostal muscle use. How should the nurse interpret the oximeter reading?
It may overestimate the true oxygen saturation
✓
It confirms that oxygenation is adequate
It reflects the carbon dioxide level instead
It is accurate only while oxygen is running
Correct Answer
It may overestimate the true oxygen saturation
Pulse oximeters can read falsely high in people with darker skin pigmentation, so a normal number can mask hypoxemia; the nurse trusts the signs of distress, reports them, and anticipates an arterial blood gas. It confirms that oxygenation is adequate is wrong because the rapid rate and muscle use say otherwise. It reflects the carbon dioxide level instead is wrong because oximetry estimates hemoglobin saturation, not carbon dioxide. It is accurate only while oxygen is running is wrong because supplemental oxygen does not decide whether the device is accurate.
Category: Respiratory Assessment
Question 2
A patient receiving IV opioids after surgery needs monitoring that measures exhaled carbon dioxide and can reveal respiratory depression before oxygen saturation falls. Which monitoring does the nurse use?
Pulse oximetry
Capnography
✓
Peak flow monitoring
Incentive spirometry
Correct Answer
Capnography
Capnography measures end-tidal carbon dioxide breath by breath, so it shows hypoventilation from sedation or opioids earlier than a drop in saturation. Pulse oximetry lags behind, especially when the patient is receiving oxygen. Peak flow monitoring measures how fast air can be forced out and is used to track asthma. Incentive spirometry is a breathing exercise to expand the lungs, not a monitor.
Category: Respiratory Assessment
Question 3
While auscultating a patient with bronchitis, the nurse hears coarse, low-pitched sounds over the large airways that partly clear after the patient coughs. How should the nurse document these sounds?
Fine crackles
Stridor
Rhonchi
✓
Pleural friction rub
Correct Answer
Rhonchi
Rhonchi are coarse, loud, low-pitched sounds caused by mucus or fluid in the larger airways, which is why coughing can change or clear them. Fine crackles are soft, high-pitched popping sounds from fluid in the alveoli or small airways opening. Stridor is a harsh, high-pitched inspiratory sound from upper airway obstruction. Pleural friction rub is a grating sound from inflamed pleural layers rubbing together.
Category: Respiratory Assessment
Question 4
A patient with asthma reports a peak flow reading in the yellow zone of the asthma action plan. What does this reading mean?
Asthma is well controlled and no change is needed
A medical alert that calls for an ambulance now
The peak flow meter needs to be replaced
Asthma is worsening and the action plan steps are needed
✓
Correct Answer
Asthma is worsening and the action plan steps are needed
The yellow zone signals caution: lung function is dropping, and the patient follows the plan's steps for a flare and contacts the provider as the plan directs. Asthma is well controlled and no change is needed describes the green zone. A medical alert that calls for an ambulance now describes the red zone. The peak flow meter needs to be replaced is wrong because a lower reading reflects narrowed airways, not a faulty device.
Category: Asthma and Bronchiectasis
Question 5
During an asthma attack, a patient can speak only in single words between breaths. How should the nurse interpret this finding?
Severe respiratory distress needing immediate treatment
✓
Mild anxiety that will pass with reassurance
A mild flare that can be managed at home
An expected finding whenever wheezing occurs
Correct Answer
Severe respiratory distress needing immediate treatment
Being unable to speak in full sentences shows the patient lacks the air to talk, a sign of a severe exacerbation that needs oxygen, bronchodilators and close monitoring right away. Mild anxiety that will pass with reassurance is wrong because the problem is airflow, not emotion. A mild flare that can be managed at home underestimates the danger. An expected finding whenever wheezing occurs is wrong because many patients who wheeze can still speak normally.
Category: Asthma and Bronchiectasis
Question 6
Which finding suggests that a patient's asthma is not well controlled?
Clear breath sounds between flares
Waking at night with cough or wheezing
✓
Peak flow readings in the green zone
Using a spacer with the inhaler
Correct Answer
Waking at night with cough or wheezing
Asthma severity and control are judged largely by how often symptoms occur, including nighttime awakenings and how often rescue medication is needed, so symptoms that wake the patient point to poor control. Clear breath sounds between flares is expected when asthma is controlled. Peak flow readings in the green zone mean the patient is doing well. Using a spacer with the inhaler is good technique, not a sign of poor control.
Category: Asthma and Bronchiectasis
Question 7
Which test confirms a diagnosis of bronchiectasis?
Spirometry
Sputum culture
Chest CT scan
✓
Peak flow measurement
Correct Answer
Chest CT scan
A CT scan shows the dilated, thickened airways and which lung regions are affected, so it is required to confirm bronchiectasis. Spirometry measures lung function and tracks the disease but does not diagnose it. Sputum culture identifies the organism during an infection. Peak flow measurement tracks airflow in asthma.
Category: Asthma and Bronchiectasis
Question 8
A patient with bronchiectasis suddenly coughs up a large amount of bright red blood. What is the nurse's priority?
Collect a sputum sample for culture
Encourage oral fluids to thin secretions
Begin chest physiotherapy
Protect the airway and suction as needed
✓
Correct Answer
Protect the airway and suction as needed
Large-volume hemoptysis is an emergency because blood can flood the airways, so the nurse protects the airway, suctions, gives oxygen and calls for help while procedures to stop the bleeding are arranged. Collect a sputum sample for culture can wait until the airway is safe. Encourage oral fluids to thin secretions does nothing for active bleeding and adds aspiration risk. Begin chest physiotherapy could worsen the bleeding.
Category: Asthma and Bronchiectasis
Question 9
A nurse starts supplemental oxygen for a patient with a COPD exacerbation. Which new finding suggests the patient is retaining carbon dioxide?
Increasing drowsiness and confusion
✓
Improved skin color
A productive cough
Dry nasal passages
Correct Answer
Increasing drowsiness and confusion
Some patients with COPD retain carbon dioxide when given oxygen, so the nurse watches for rising carbon dioxide after oxygen starts; drowsiness, confusion and headache are warning signs, and an arterial blood gas confirms the level. Improved skin color suggests better oxygenation. A productive cough is common in COPD and does not reflect carbon dioxide. Dry nasal passages are a local effect of oxygen flow.
Category: COPD
Question 10
A young adult who has never smoked is diagnosed with emphysema that mainly affects the lower lobes. Which cause does the nurse expect the provider to test for?
Cystic fibrosis
Alpha-1 antitrypsin deficiency
✓
Asbestos exposure
Latent tuberculosis
Correct Answer
Alpha-1 antitrypsin deficiency
Alpha-1 antitrypsin deficiency is an inherited cause of COPD in which the body cannot neutralize an enzyme that destroys lung tissue; unlike smoking-related disease, it typically damages the lower lobes and appears at a younger age. Cystic fibrosis causes thick mucus and bronchiectasis rather than this pattern of emphysema. Asbestos exposure causes asbestosis and mesothelioma. Latent tuberculosis causes no lung damage while it stays walled off.
Category: COPD
Question 11
After a car crash, a patient has severe dyspnea, falling blood pressure, absent breath sounds on one side and a trachea that is not midline. Which intervention does the nurse anticipate first?
A chest x-ray to confirm the diagnosis
A CT scan of the chest
Immediate needle decompression
✓
An arterial blood gas
Correct Answer
Immediate needle decompression
These findings point to a tension pneumothorax, which can quickly cause cardiovascular collapse, so treatment with needle decompression starts at once without waiting for imaging. A chest x-ray to confirm the diagnosis delays lifesaving treatment. A CT scan of the chest takes even longer and moves an unstable patient. An arterial blood gas would show low oxygen but would not change the immediate action.
Category: Pneumothorax and Chest Tubes
Question 12
A patient with COPD develops a pneumothorax without any injury or procedure. How is this pneumothorax classified?
Primary spontaneous
Traumatic
Iatrogenic
Secondary spontaneous
✓
Correct Answer
Secondary spontaneous
A secondary spontaneous pneumothorax occurs as a complication of underlying lung disease such as COPD, cystic fibrosis or pneumonia. Primary spontaneous occurs in a person with no underlying lung disease. Traumatic follows an injury to the chest. Iatrogenic is caused by a medical procedure, such as placing a central venous catheter.
Category: Pneumothorax and Chest Tubes
Question 13
A chest tube was placed to drain a pleural effusion, with no air in the pleural space. The nurse now sees continuous bubbling in the water seal chamber. What does this finding suggest?
An air leak in the drainage system
✓
The lung has fully reexpanded
Fluid is draining as expected
The suction setting is correct
Correct Answer
An air leak in the drainage system
When a tube drains only fluid, bubbling in the water seal means air is entering somewhere it should not, so the nurse checks the connections and the insertion site. With a pneumothorax, intermittent bubbling in the water seal during exhalation or coughing is expected as air leaves the chest; continuous bubbling points to a leak. The lung has fully reexpanded would reduce bubbling, not start it. Fluid is draining as expected shows up in the collection chamber, not as bubbles. The suction setting is correct is judged at the suction control, not the water seal.
Category: Pneumothorax and Chest Tubes
Question 14
A patient has been receiving antibiotics for bacterial pneumonia. Which finding shows that treatment is working?
A rising white blood cell count
Falling temperature and less sputum
✓
New crackles at the lung bases
Rising oxygen needs to keep saturation stable
Correct Answer
Falling temperature and less sputum
Response to pneumonia treatment is judged by trends in temperature, sputum, lung sounds, white cell count and oxygen needs, so a falling temperature with less sputum shows the infection is resolving. A rising white blood cell count suggests the infection is persisting or worsening. New crackles at the lung bases point to more fluid in the alveoli. Rising oxygen needs to keep saturation stable signal worsening gas exchange.
Category: Pneumonia and Tuberculosis
Question 15
Which nursing measure helps prevent ventilator-associated pneumonia?
Keeping the head of the bed flat
Changing the ventilator tubing every shift
Providing regular oral care
✓
Limiting turning to reduce coughing
Correct Answer
Providing regular oral care
Bacteria that collect in the mouth and on teeth can be aspirated around the endotracheal tube, so regular oral care, along with raising the head of the bed, lowers the risk of ventilator-associated pneumonia. Keeping the head of the bed flat increases aspiration. Changing the ventilator tubing every shift is not recommended, because opening the circuit adds contamination risk. Limiting turning to reduce coughing lets secretions pool in the lungs.
Category: Pneumonia and Tuberculosis
Question 16
A patient is admitted with suspected active tuberculosis. Which room placement does the nurse arrange?
A private room with positive airflow
A shared room with the door kept closed
Any room once the patient wears gloves
A private room with negative airflow
✓
Correct Answer
A private room with negative airflow
TB spreads through droplet nuclei that stay suspended in the air for long periods, so the patient goes in a private room with negative airflow that pulls air in rather than letting it escape to the hallway. A private room with positive airflow pushes contaminated air out into the unit. A shared room with the door kept closed still exposes the roommate. Any room once the patient wears gloves is wrong because gloves do nothing to stop airborne spread.
Category: Pneumonia and Tuberculosis
Question 17
A patient has a positive TB skin test. Which test confirms active tuberculosis?
Sputum culture for tubercle bacilli
✓
A repeat skin test
A TB blood test
A complete blood count
Correct Answer
Sputum culture for tubercle bacilli
Growing Mycobacterium tuberculosis from a sputum culture confirms active TB; a smear showing acid-fast bacilli supports the diagnosis while the culture is pending. A repeat skin test cannot separate latent infection from active disease. A TB blood test has the same limit, so it also cannot confirm active disease. A complete blood count may show anemia or a high white cell count but is not specific for TB.
Category: Pneumonia and Tuberculosis
Question 18
A young adult with cystic fibrosis has bulky, fatty stools and has trouble keeping weight on. Which problem explains these findings?
Excess bile production by the liver
Blocked pancreatic ducts causing malabsorption
✓
Lactose intolerance from a milk allergy
An overactive thyroid gland
Correct Answer
Blocked pancreatic ducts causing malabsorption
Thick secretions in cystic fibrosis block the pancreatic ducts, so digestive enzymes cannot reach the intestine and fat and nutrients are poorly absorbed; pancreatic enzymes are given to replace them. Excess bile production by the liver is wrong because CF tends to block bile ducts rather than raise bile output. Lactose intolerance from a milk allergy mixes up two different conditions and does not explain fatty stools in CF. An overactive thyroid gland can cause weight loss but not pancreatic malabsorption.
Category: Cystic Fibrosis and Exposures
Question 19
A patient who will use home oxygen says he still smokes. Which explanation of the danger is accurate?
Oxygen tubing gives off toxic fumes when warm
Smoke blocks the flow of oxygen in the tubing
Oxygen makes any flame burn hotter and spread faster
✓
Nicotine reacts chemically with the oxygen
Correct Answer
Oxygen makes any flame burn hotter and spread faster
Oxygen itself does not burn, but it feeds combustion, so a cigarette or other open flame near oxygen can start a fire that spreads rapidly; smoking in the same room as oxygen is potentially life-threatening. Oxygen tubing gives off toxic fumes when warm is not the hazard. Smoke blocks the flow of oxygen in the tubing is not how smoke behaves. Nicotine reacts chemically with the oxygen is not true; the danger is fire.
Category: Airway and Oxygen Care
Question 20
When performing tracheal suctioning, when should the nurse apply suction?
Only while inserting the catheter
Throughout insertion and withdrawal
Before the catheter enters the airway
Only while withdrawing the catheter
✓
Correct Answer
Only while withdrawing the catheter
Suction is applied only as the catheter is withdrawn, which removes secretions while limiting how much oxygen is pulled from the airway and how much the mucosa is injured. Only while inserting the catheter would strip oxygen and traumatize tissue on the way in. Throughout insertion and withdrawal doubles the oxygen loss and trauma. Before the catheter enters the airway removes nothing from the airway.
Category: Airway and Oxygen Care