OXYGEN & COPD
A nurse is caring for a client with COPD. Which oxygen saturation is considered acceptable?
A. 98%
B. 100%
C. 90-92%
D. 95%
C. 90-92%
COPD patients often maintain SpO₂ 90-92% to avoid suppressing the hypoxic respiratory drive.
A chest tube drainage system should always be kept:
A. Above the chest
B. Below the chest level
C. At the same level as the chest
D. Above the head
C. Below chest level
Keeping the system below chest level prevents backflow into the pleural space.
When teaching a client how to use a non-rebreather mask, which instruction is correct?
A. Mask should fit loosely
B. Reservoir bag should remain inflated
C. Oxygen flow should be below 5 L/min
D. Remove the mask frequently
B. Reservoir bag should remain inflated
The reservoir bag must remain partially inflated to ensure the client receives a high concentration of oxygen.
Which infection is transmitted through airborne precautions?
A. Influenza
B. Pneumonia
C. Tuberculosis
D. Bronchitis
Answer: C
C. Tuberculosis
Tuberculosis spreads via airborne droplet nuclei and requires an N95 mask and negative pressure room.
A client’s arterial blood gas results are:
pH 7.48
PaCO₂ 31 mm Hg
HCO₃ 24 mEq/L
Which acid–base imbalance is present?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
B. Respiratory alkalosis
A nurse is teaching a client with COPD pursed-lip breathing. Which instructions should the nurse include?
Select all that apply.
A. Inhale through the nose
B. Exhale slowly through pursed lips
C. Hold the breath for several seconds before exhaling
D. Perform breathing while sitting upright
E. Breathe rapidly through the mouth
A. Inhale through the nose
B. Exhale slowly through pursed lips
D. Perform breathing while sitting upright
Pursed-lip breathing improves ventilation and prevents airway collapse by prolonging exhalation. Rapid breathing is incorrect because the goal is slow controlled breathing.
Which findings indicate a properly functioning chest tube system?
Select all that apply.
A. Tidaling in water-seal chamber
B. Drainage system below chest level
C. Tubing secured with tape
D. Continuous bubbling in water seal
E. Tubing free of kinks
A. Tidaling in water-seal chamber
B. Drainage system below chest level
C. Tubing secured with tape
E. Tubing free of kinks
Continuous bubbling indicates air leak.
Which action helps improve breathing in a client with respiratory distress?
A. Supine positioning
B. Trendelenburg position
C. Orthopneic (tripod) position
D. Lying flat
C. Orthopneic (tripod) position
The tripod position helps expand lung capacity and improves ventilation.
Which intervention helps control an influenza outbreak in a long-term care facility?
A. Encourage fluids
B. Limit visitors
C. Administer antibiotics
D. Increase room temperature
B. Limit visitors
Limiting visitors reduces transmission during an outbreak.
A post-operative client suddenly develops shortness of breath and chest pain. What condition should the nurse suspect?
A. Pneumonia
B. Pulmonary embolism
C. COPD
D. Asthma
B. Pulmonary embolism
Pulmonary embolism often presents with sudden dyspnea and chest pain after surgery.
Which findings are commonly seen in COPD?
Select all that apply.
A. Barrel chest
B. Clubbing of fingers
C. Dyspnea
D. Bradycardia
E. Productive cough
A. Barrel chest
B. Clubbing of fingers
C. Dyspnea
E. Productive cough
Bradycardia is not typical.
If a chest tube becomes disconnected from the drainage system, what should the nurse do?
A. Clamp the tube
B. Place the tube end in sterile water
C. Remove the tube
D. Elevate the drainage system
B. Place the tube end in sterile water
Placing the tube in sterile water re-creates a water seal, preventing air from entering the pleural space.
A ventilator alarm sounds while the nurse is in the hallway. What should the nurse do first?
A. Increase oxygen settings
B. Turn off the alarm
C. Check the client
D. Call respiratory therapy
C. Check the client
The priority is always the patient, not the machine.
Which symptom is commonly associated with pneumonia?
A. Chest pain and productive cough
B. Slow respirations
C. Bradycardia
D. Decreased temperature
A. Chest pain and productive cough
Common pneumonia symptoms include:
Fever
Productive cough
Chest pain
Crackles
What is the priority intervention for suspected pulmonary embolism?
A. Insert IV line
B. Perform chest X-ray
C. Start antibiotics
D. Apply oxygen
D. Apply oxygen
Using the ABC priority, oxygen is the first intervention.
A client with COPD is experiencing difficulty breathing while at home on oxygen. What is the first nursing action?
A. Increase oxygen flow rate
B. Assess respiratory sounds
C. Call the provider
D. Administer bronchodilator
B. Assess respiratory sounds
The first action is assessment. Evaluating lung sounds helps determine the cause of dyspnea.
A nurse finds the chest tube has become disconnected. What actions should the nurse take?
Select all that apply.
A. Place the tube in sterile water
B. Apply sterile occlusive dressing
C. Assess respiratory status
D. Clamp the chest tube
E. Notify provider
A. Place the tube in sterile water
C. Assess respiratory status
E. Notify provider
• Place tube in sterile water (temporary seal)
• Assess breathing
• Notify provider
Clamping may cause tension pneumothorax.
A client arrives to the emergency department with an acute asthma attack, reporting severe dyspnea, wheezing, and use of accessory muscles.
Which intervention should the nurse implement first?
A. Administer montelukast
B. Encourage pursed-lip breathing
C. Administer inhaled albuterol
D. Administer oral prednisone
C. Administer inhaled albuterol
Albuterol is a rapid-acting bronchodilator (rescue medication) that quickly relaxes bronchial smooth muscle and opens the airways.
A. Montelukast – Used for long-term asthma prevention, not acute attacks
B. Pursed-lip breathing – Helpful for COPD, but does not immediately relieve bronchospasm.
D. Prednisone – Corticosteroid that reduces inflammation slowly, not first-line in emergencies.
Which factor increases a person’s risk for tuberculosis infection?
A. Obesity
B. Cannabis use
C. Living in crowded conditions such as prison
D. Male gender
C. Living in crowded conditions such as prison
TB spreads easily in crowded environments, such as prisons or shelters.
Which assessment finding suggests tension pneumothorax?
A. Crackles
B. Tracheal deviation
C. Fever
D. Productive cough
B. Tracheal deviation
Air buildup in the pleural space pushes the trachea to the opposite side.
Which interventions should the nurse include in the care plan for a client with COPD?
Select all that apply.
A. Encourage fluids 2-3 L/day
B. Provide high-calorie small meals
C. Encourage pursed-lip breathing
D. Encourage cough suppressants daily
E. Position client in Fowler’s position
A. Encourage fluids 2-3 L/day
B. Provide high-calorie small meals
C. Encourage pursed-lip breathing
E. Position client in Fowler’s position
Routine cough suppressants are avoided because they prevent secretion clearance.
Which finding suggests tension pneumothorax?
A. Crackles
B. Hemoptysis
C. Tracheal deviation
D. Fever
C. Tracheal deviation
Which intervention should the nurse implement for a client on a ventilator with increased secretions?
A. Suction routinely every hour
B. Suction only when needed
C. Increase ventilator pressure
D. Disconnect ventilator tubing
B. Suction only when needed
Routine suctioning increases mucus production. Clients should be suctioned only as needed.
A client with suspected TB should undergo which diagnostic test to confirm active disease?
A. Sputum culture for acid-fast bacilli
B. Chest CT
C. Blood culture
D. Pulse oximetry
A. Sputum culture for acid-fast bacilli
Active TB is confirmed with sputum culture for acid-fast bacilli (AFB).
A client weighs 154 lb and is prescribed 16 units/kg/hr of heparin.
The IV bag contains 25,000 units in 500 mL.
What rate should the nurse set the infusion pump?
A. 18.4 mL/hr
B. 22.4 mL/hr
C. 28.0 mL/hr
D. 32.0 mL/hr
B. 22.4 mL/hr