COPD & Asthma
Infection & Lung Expansion
Respiratory Emergencies & Chest Tubes
Coronary Artery Disease
Valves & Heart Muscle
100

Name two changes inside the airways that make breathing harder during an asthma attack.

  • For credit—any two: Bronchial smooth-muscle contraction, airway inflammation and swelling, or increased mucus.
  • What is happening: Asthma involves airway inflammation and variable airflow obstruction. Bronchospasm specifically means contraction of bronchial smooth muscle.
  • Findings: Wheezing, cough, chest tightness, prolonged exhalation, and shortness of breath. Very poor air movement or a “silent chest” during severe distress is concerning.
  • Nursing care and prevention: Assess breathing effort, oxygen saturation, and response to treatment. Support upright positioning, administer prescribed reliever medication and oxygen when indicated, and escalate severe distress. Teach inhaler technique, trigger management, and use of an asthma action plan.
100

Name three findings that can occur with pneumonia.


  • For credit—any three: Fever, chills, cough with or without sputum, shortness of breath, tachypnea, crackles, pleuritic chest pain, fatigue, hypoxemia, or tachycardia.
  • Definition: Pneumonia is an infection of lung tissue that causes inflammation and can impair gas exchange.
  • Additional cues: Older adults may have confusion or lack an obvious fever. Findings vary; no single finding establishes the diagnosis.
  • Nursing care: Assess breathing and oxygenation, administer prescribed antimicrobials and oxygen when indicated, encourage appropriate mobility and secretion clearance, and monitor for deterioration.
  • Prevention and teaching: Hand hygiene, recommended vaccinations, smoking cessation, and completing prescribed treatment. Support hydration when appropriate for the patient’s swallowing safety and fluid status
100

What collects in the pleural space in a pneumothorax versus a pleural effusion?


  • Pneumothorax: Air.
  • Pleural effusion: Excess fluid.
  • What happens: Either can limit lung expansion. The pleural space is between the membrane covering the lung and the membrane lining the chest wall.
  • Findings: Shortness of breath, reduced breath sounds, chest discomfort, and impaired oxygenation may occur.
  • Nursing care: Assess respiratory effort, oxygenation, pain, and hemodynamic status. Administer prescribed oxygen and prepare for drainage when indicated.
  • Treatment connection: Thoracentesis may remove pleural fluid for diagnosis or symptom relief; a chest tube may drain air or fluid. Treatment depends on the cause and severity. Sudden deterioration requires urgent escalation.
100

Name two actions a patient can take to reduce coronary artery disease risk.


  • Definition: Coronary artery disease commonly involves atherosclerotic plaque in the arteries supplying the heart, which can limit myocardial blood flow.
  • For credit—any two: Stop smoking; follow a diet lower in saturated fat and rich in fiber; participate in appropriate regular activity; manage blood pressure and diabetes; pursue healthy weight management; or take prescribed lipid-lowering medication.
  • Possible cues: Exertional chest pressure, shortness of breath, or reduced activity tolerance. Disease may also be present without obvious symptoms.
  • Teaching: Explain medication purposes and realistic lifestyle changes. Statins lower low-density lipoprotein (LDL) cholesterol and reduce cardiovascular risk.
  • Safety: New, worsening, or persistent chest discomfort requires urgent evaluation. 
100

Describe dilated cardiomyopathy (DCM) in your own words, and name one finding a patient might develop.


  • Definition: Dilated cardiomyopathy involves enlarged, weakened ventricles that contract less effectively. Reduced pumping can decrease forward blood flow and cause congestion.
  • Findings—accept any one: Shortness of breath, fatigue, reduced activity tolerance, peripheral edema, difficulty breathing when lying flat, or palpitations.
  • Complications: Heart failure, arrhythmias, and intracardiac clot formation may occur.
  • Nursing care: Monitor breathing, fluid balance, weight trends, blood pressure, and rhythm. Administer prescribed heart-failure therapies and monitor their effects.
  • Teaching: Reinforce medication adherence, appropriate activity, and the individualized sodium and fluid plan. Report worsening breathlessness, swelling, fainting, or rapid weight gain according to the care plan.

For credit: Enlarged and weakened pumping chambers plus one finding

200

Choose two: albuterol, ipratropium, or fluticasone/salmeterol. State each medication’s class or main purpose.


  • Albuterol: A short-acting beta₂ agonist (SABA) that rapidly relaxes airway smooth muscle.
  • Ipratropium: A short-acting muscarinic antagonist (SAMA), also called an anticholinergic bronchodilator.
  • Fluticasone/salmeterol: An inhaled corticosteroid combined with a long-acting beta₂ agonist (LABA), used for maintenance rather than immediate symptom relief.
  • Assessment: Evaluate breath sounds, breathing effort, symptoms, and response to treatment. Albuterol can cause tremor or tachycardia; ipratropium can cause dry mouth.
  • Teaching: Demonstrate correct device technique. Rinse the mouth and spit after the corticosteroid-containing inhaler. Explain which inhaler is prescribed for relief and which is for maintenance.


200

Match community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) with their acquisition settings.


  • Community-acquired: Acquired outside the hospital; often present at admission or recognized within the first 48 hours.
  • Hospital-acquired: Develops at least 48 hours after admission and was not incubating at admission.
  • Ventilator-associated: Develops more than 48 hours after endotracheal intubation.
  • Findings: These may include fever, abnormal secretions, worsening oxygenation, and respiratory distress. The label describes the setting, not a unique symptom pattern.
  • Nursing care and prevention: Monitor respiratory status, follow infection-prevention practices, provide oral care and appropriate mobility, and use aspiration precautions. For ventilated patients, follow the facility’s ventilator-associated pneumonia prevention practices.
200

In a wet-suction chest drainage system, which chamber normally has gentle bubbling? Which chamber’s continuous bubbling suggests an air leak?

  • Gentle bubbling: The wet suction-control chamber.
  • Continuous bubbling suggesting an air leak: The water-seal chamber.
  • How it works: The water seal helps prevent air from returning to the pleural space. The wet suction-control chamber regulates applied suction according to its water level.
  • Interpretation: Intermittent water-seal bubbling may occur as pleural air leaves the chest. Vigorous suction-control bubbling calls for adjustment according to device instructions; it does not mean more therapeutic suction.
  • Nursing care: Identify the system, assess the patient, inspect tubing and connections, and report unexpected changes. Dry-suction systems have different indicators. Do not routinely clamp the tube to investigate bubbling.
200

What do antiplatelet medications do, and name one important teaching point for a patient taking them.


  • Purpose: Antiplatelet medications reduce platelet sticking and aggregation, helping prevent clot formation. They do not dissolve existing clots.
  • Examples: Aspirin, clopidogrel, ticagrelor, and prasugrel.
  • Uses: They may be prescribed for coronary disease, after certain cardiovascular events, or after coronary stent placement.
  • Teaching—accept any one: Take as prescribed; do not stop without consulting the prescriber; report unusual bleeding; tell clinicians before procedures; or check before adding over-the-counter medicines that increase bleeding risk.
  • Assessment: Monitor for excessive bruising, prolonged bleeding, black stools, or blood in the urine. Significant or uncontrolled bleeding requires urgent evaluation.
200

Describe restrictive cardiomyopathy (RCM) in your own words, and name one finding a patient might develop.

  • Definition: Restrictive cardiomyopathy involves stiff ventricular walls that cannot relax and fill normally.
  • Effects: Impaired filling can limit forward blood flow and cause pressure and fluid to build up behind the heart. Ejection fraction may remain preserved, especially earlier.
  • Findings—accept any one: Shortness of breath, fatigue, reduced activity tolerance, peripheral edema, abdominal swelling, or distended neck veins.
  • Nursing care: Monitor respiratory status, fluid balance, weight, blood pressure, and activity tolerance. Administer prescribed therapy and assess for hypotension or excessive fluid loss.
  • Teaching: Follow the individualized treatment plan and report increasing congestion or reduced function. Treatment also addresses the underlying cause when possible.

    For credit: Stiffness with impaired filling plus one finding. www.heart.org
300

Name two changes from a patient’s usual chronic obstructive pulmonary disease (COPD) baseline that should prompt assessment for an exacerbation.


  • For credit—any two: Increased shortness of breath, worsening cough, increased sputum amount or purulence, increased work of breathing, falling oxygen saturation, or reduced activity tolerance.
  • Meaning: An exacerbation is an acute worsening beyond the patient’s usual day-to-day symptoms.
  • Concerning cues: New confusion, drowsiness, exhaustion, or severe respiratory distress require urgent evaluation. Sputum color alone does not prove a bacterial infection.
  • Nursing care: Compare with baseline, assess oxygenation and mental status, administer prescribed treatment, and reassess.
  • Prevention: Reinforce maintenance medication adherence, inhaler technique, smoking cessation, recommended vaccinations, and early reporting of worsening symptoms.
300

What is atelectasis, and name one process that can cause it.


  • Definition: Atelectasis is incomplete expansion or collapse of alveoli, reducing the amount of lung available for gas exchange.
  • Causes—accept any one: A mucus plug or other airway obstruction, shallow breathing, or compression from air or fluid in the pleural space.
  • Findings: Small areas may cause no obvious symptoms. More extensive atelectasis can cause shortness of breath, tachypnea, decreased breath sounds, or reduced oxygen saturation.
  • Nursing care and prevention: Encourage early mobility when safe, upright positioning, position changes, deep breathing, and coughing. Provide prescribed analgesia so the patient can breathe deeply and move. Use incentive spirometry when indicated as part of a broader lung-expansion plan.
  • Key connection: Prevention focuses on maintaining expansion and clearing secretions; treatment also addresses the cause.
300

Name two early findings of developing respiratory failure and one finding that suggests serious deterioration.


  • Definition: Respiratory failure occurs when the respiratory system cannot adequately oxygenate blood, remove carbon dioxide, or both.
  • Early findings—accept any two: Air hunger, restlessness, anxiety, tachypnea, tachycardia, or diaphoresis. Headache can accompany carbon dioxide retention.
  • Deterioration—accept any one: Increasing drowsiness, reduced responsiveness, exhaustion, shallow or slowing respirations, cyanosis, bradycardia, or hypotension.
  • Nursing care: Assess airway, breathing, oxygenation, and mental status; activate help promptly; provide oxygen and prepare for ventilatory support as indicated.
  • Important point: Findings do not follow a fixed sequence. New confusion is concerning at any stage. A slowing respiratory rate in an exhausted patient may signal worsening, not recovery. 
300

Name one way nitroglycerin reduces cardiac workload and one safety assessment before giving it.


  • Mechanism: Nitroglycerin is a vasodilator. Venodilation reduces venous return and preload, lowering myocardial oxygen demand. It can also dilate coronary arteries.
  • Use: Relief or prevention of angina as prescribed; it does not dissolve a coronary clot.
  • Safety assessments—accept any one: Blood pressure, dizziness or hypotension, or recent phosphodiesterase type 5 (PDE-5) inhibitor use, such as sildenafil or tadalafil. Other contraindications also require review.
  • Nursing care: Follow the prescribed protocol, assist the patient to sit or lie safely, and reassess symptoms and blood pressure.
  • Teaching: Headache and dizziness can occur. Nitrates combined with PDE-5 inhibitors can cause dangerous hypotension. Persistent or new chest pain requires urgent evaluation.
300

What does valve regurgitation mean? Compare where blood leaks backward in mitral regurgitation and aortic regurgitation.

  • Definition: Regurgitation means a valve does not close effectively, allowing backward blood flow.
  • Mitral regurgitation: Blood returns from the left ventricle to the left atrium during systole—ventricular contraction.
  • Aortic regurgitation: Blood returns from the aorta to the left ventricle during diastole—ventricular relaxation.
  • Findings: A murmur, fatigue, reduced activity tolerance, shortness of breath, or signs of congestion may occur. Chronic disease may initially cause few symptoms.
  • Nursing care: Monitor breathing, perfusion, rhythm, and fluid status. Reinforce follow-up and prescribed treatment; significant disease may require valve intervention. Sudden severe breathlessness or hypotension warrants urgent escalation.

For credit: The meaning of regurgitation and the backflow destination for each valve. Timing is additional review.

400

Chronic bronchitis and emphysema both contribute to chronic obstructive pulmonary disease (COPD). Describe one major lung change associated with each.

  • Chronic bronchitis: Persistent airway inflammation and excess mucus contribute to airway narrowing and chronic productive cough.
  • Emphysema: Alveolar destruction and loss of elastic recoil promote air trapping and reduce the surface area available for gas exchange.
  • Findings: Both can cause shortness of breath, cough, wheezing, and activity intolerance. Many patients have features of both.
  • Nursing care and prevention: Support smoking cessation and avoidance of inhaled irritants. Reinforce prescribed inhalers, recommended vaccinations, pulmonary rehabilitation, activity pacing, and nutrition. Assess changes from baseline rather than assuming all breathlessness is “normal COPD.”
400

Name two factors that increase aspiration risk.


  • For credit—any two: Impaired swallowing, reduced consciousness, sedation, weak airway-protective reflexes, vomiting or reflux, gastric tube feeding, or lying flat during feeding.
  • Definition: Aspiration occurs when material such as food, fluid, oral secretions, or gastric contents enters the airway.
  • Cues: Coughing or choking during intake, a wet-sounding voice, respiratory changes, or falling oxygen saturation. Aspiration can also be silent.
  • Nursing care and prevention: Assess alertness and swallowing safety, use appropriate positioning and feeding precautions, and obtain a swallowing evaluation when indicated.
  • Important point: A feeding tube does not eliminate aspiration risk, and aspiration does not require visible vomiting.
400

When helping a patient with a chest tube reposition or get out of bed, name two precautions that protect the drainage system.


  • Purpose: A chest tube removes air or fluid from the pleural space to help restore lung expansion.
  • For credit—any two: Keep the unit upright; keep it below the insertion site; prevent tubing kinks or compression; allow enough slack to prevent pulling; secure tubing and connections according to policy.
  • Assess before and after movement: Breathing, oxygen saturation, pain, insertion site, drainage, and connections.
  • Concerning changes: New breathlessness, falling oxygen saturation, new or expanding crepitus, disconnection, or unexpected drainage changes require prompt assessment.
  • Safety: Follow the prescribed suction and mobility plan. Do not routinely clamp or strip the tube. Provide prescribed pain relief to support breathing and movement.
400

A patient reports new chest pressure. Name two questions you would ask while initiating urgent assessment for possible acute coronary syndrome (ACS).


  • For credit—any two: When did it start? What were you doing? What does it feel like? Where is it, and does it radiate? How severe is it? How long has it lasted? What changes it? Are there associated symptoms?
  • Definition: Acute coronary syndrome includes conditions caused by an abrupt reduction in coronary blood flow, including unstable angina and myocardial infarction.
  • Cues: Chest pressure, shortness of breath, sweating, nausea, or unusual weakness; presentations vary.
  • Nursing care: Assess vital signs, obtain a prompt 12-lead electrocardiogram (ECG), initiate the appropriate response, and administer prescribed treatment. Do not delay care for a lengthy interview.
  • Lab connection: Troponin indicates myocardial injury; symptoms, electrocardiogram findings, and serial values help establish the cause.
400

What happens in aortic stenosis, and name one effect it can have on the heart or the patient.

  • Definition: Aortic stenosis is narrowing of the aortic valve opening, obstructing blood flow from the left ventricle into the aorta.
  • Effects—accept any one: Increased ventricular pressure and workload, ventricular thickening, increased myocardial oxygen demand, reduced forward output, or heart-failure symptoms.
  • Findings: Exertional chest discomfort, shortness of breath, fainting, fatigue, or a systolic murmur.
  • Nursing care: Assess symptoms, blood pressure, perfusion, and activity tolerance. Escalate new syncope, chest pain, or worsening breathlessness.
  • Teaching: Follow prescribed activity recommendations and cardiology follow-up. Severe symptomatic disease generally requires evaluation for valve replacement; symptom management does not remove the obstruction.

For credit: Narrowing that obstructs forward flow plus one effect or manifestation.

500

Name two nursing measures that can help a breathless patient with chronic obstructive pulmonary disease (COPD) while you assess breathing and arrange treatment.

  • For credit—any two: Support upright or comfortable tripod positioning; coach pursed-lip breathing if able; reduce exertion; administer prescribed oxygen or bronchodilators; summon help for worsening distress.
  • Why these help: Airflow obstruction and air trapping increase breathing effort. Positioning and controlled exhalation can help reduce that effort.
  • Assess: Respiratory rate and effort, oxygen saturation, breath sounds, mental status, and ability to speak.
  • Safety: Give oxygen to the prescribed target; do not withhold it solely because the patient has COPD. New drowsiness, exhaustion, or reduced air movement warrants urgent escalation.
  • Follow-up: Reassess after interventions. Pulse oximetry does not measure carbon dioxide; blood gases may be needed when ventilation is a concern
500

Name two nursing measures that help prevent aspiration in patients at risk.

  • For credit—any two: Position upright for oral intake; assess swallowing safety; follow prescribed food textures and liquid consistencies; provide appropriate feeding assistance; avoid oral intake when too drowsy to swallow safely; elevate the head of the bed during tube feeding; verify feeding-tube placement appropriately.
  • Tube-feeding precautions: Maintain approximately 30–45° head elevation unless contraindicated. Check for displacement and assess feeding tolerance according to policy.
  • Watch for: Coughing, choking, regurgitation, a wet voice, or respiratory changes.
  • If aspiration is suspected: Stop the feeding or oral intake, assess airway and breathing, and escalate according to the patient’s condition.
  • Teaching point: Precautions must match the individual’s risk; modified textures and feeding tubes do not eliminate aspiration
500

Name two actions a patient can take to reduce coronary artery disease risk.

  • Definition: Coronary artery disease commonly involves atherosclerotic plaque in the arteries supplying the heart, which can limit myocardial blood flow.
  • For credit—any two: Stop smoking; follow a diet lower in saturated fat and rich in fiber; participate in appropriate regular activity; manage blood pressure and diabetes; pursue healthy weight management; or take prescribed lipid-lowering medication.
  • Possible cues: Exertional chest pressure, shortness of breath, or reduced activity tolerance. Disease may also be present without obvious symptoms.
  • Teaching: Explain medication purposes and realistic lifestyle changes. Statins lower low-density lipoprotein (LDL) cholesterol and reduce cardiovascular risk.
  • Safety: New, worsening, or persistent chest discomfort requires urgent evaluation.
500

An adult is unresponsive, only gasping, and has no definite pulse within 10 seconds. Help and an automated external defibrillator (AED) are on the way. What should you begin, and at what compression rate?


  • For credit: Begin cardiopulmonary resuscitation (CPR), starting with chest compressions at 100–120 per minute.
  • Meaning: Cardiac arrest is loss of effective circulation. Gasping is not normal breathing.
  • Assessment: Healthcare professionals assess breathing and pulse simultaneously for no more than 10 seconds.
  • High-quality compressions: Compress at least 2 inches (5 centimeters), avoiding depths greater than 2.4 inches (6 centimeters); allow full recoil and minimize interruptions.
  • Additional actions: Use 30 compressions to 2 breaths before an advanced airway is placed. Apply the defibrillator as soon as available and follow its prompts. Resume compressions promptly after analysis or a shock.
  • Key distinction: A myocardial infarction can cause arrest, but they are not synonymous.
500

Name two findings associated with pericarditis and one position that often reduces its chest pain.


  • Definition: Pericarditis is inflammation of the sac surrounding the heart.
  • Findings—accept any two: Sharp pleuritic chest pain, a pericardial friction rub, fever, or shortness of breath. Pain may radiate toward the shoulder or neck.
  • Position: Sitting upright and leaning forward often helps. Lying flat, coughing, or deep inspiration may worsen pain.
  • Nursing care: Assess new chest pain promptly, monitor vital signs and symptoms, support comfortable positioning, and administer prescribed anti-inflammatory treatment, often aspirin or a nonsteroidal anti-inflammatory drug plus colchicine.
  • Complication awareness: Pericardial fluid can accumulate. Worsening breathlessness, hypotension, tachycardia, or distended neck veins requires urgent assessment for possible tamponade.
  • Teaching: Follow treatment and activity restrictions. A helpful pain position does not independently establish the diagnosis.

For credit: Two findings plus sitting upright/leaning forward.

M
e
n
u