NURS 3000 Midterm Examination with
All Correct Answers 2025-2026
Updated.
Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of
ineffective airway clearance. Which assessment data best supports this diagnosis?
a. Weak, nonproductive cough effort
b. Large amounts of greenish sputum
c. Respiratory rate of 28 breaths/minute
d. Resting pulse oximetry (SpO2) of 85% - Answer ANS: A
The weak, nonproductive cough indicates that the patient is unable to clear the airway
effectively. The other
data would be used to support diagnoses such as impaired gas exchange and ineffective
breathing pattern
The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would
the nurse expect?
a. Increased tactile fremitus
b. Dry, nonproductive cough
c. Hyperresonance to percussion
d. A grating sound on auscultation - Answer ANS: A
Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial
pneumonias.
Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a
loose,
productive cough. Adventitious breath sounds such as crackles and wheezes are typical. A
grating sound is
more representative of a pleural friction rub rather than pneumonia
3. A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most
appropriate action to promote airway clearance?
a. Assist the patient to splint the chest when coughing.
b. Teach the patient about the need for fluid restrictions.
c. Encourage the patient to wear the nasal oxygen cannula.
d. Instruct the patient on the pursed lip breathing technique - Answer ANS: A
Coughing is less painful and more likely to be effective when the patient splints the chest during
coughing.
,Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas exchange,
but will not
improve airway clearance. Pursed lip breathing is used to improve gas exchange in patients with
COPD, but
will not improve airway clearance.
The nurse provides discharge instructions to a patient who was hospitalized for pneumonia.
Which statement, if made by the patient, indicates a good understanding of the instructions
a. I will call the doctor if I still feel tired after a week.
b. I will continue to do the deep breathing and coughing exercises at home.
c. I will schedule two appointments for the pneumonia and influenza vaccines.
d. Ill cancel my chest x-ray appointment if Im feeling better in a couple week - Answer ANS: B
Patients should continue to cough and deep breathe after discharge. Fatigue is expected for
several weeks. The
Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that
a follow-up
chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia
The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing
action will be most effective
a. Turn and reposition immobile patients at least every 2 hours.
b. Place patients with altered consciousness in side-lying positions.
c. Monitor for respiratory symptoms in patients who are immunosuppressed.
d. Insert nasogastric tube for feedings for patients with swallowing problem - Answer ANS: B
The risk for aspiration is decreased when patients with a decreased level of consciousness are
placed in a side-
lying or upright position. Frequent turning prevents pooling of secretions in immobilized
patients but will not
decrease the risk for aspiration in patients at risk. Monitoring of parameters such as breath
sounds and oxygen
saturation will help detect pneumonia in immunocompromised patients, but it will not decrease
the risk for
aspiration. Conditions that increase the risk of aspiration include decreased level of
consciousness (e.g.,
seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and nasogastric
intubation with
or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed,
and aspiration is
,more likely to occur. Other high-risk groups are those who are seriously ill, have poor dentition,
or are
receiving acid-reducing medications
A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days.
Which
assessment data obtained by the nurse indicates that the treatment has been effective?
a. Bronchial breath sounds are heard at the right base.
b. The patient coughs up small amounts of green mucus.
c. The patients white blood cell (WBC) count is 9000/L.
d. Increased tactile fremitus is palpable over the right chest - Answer ANS: C
The normal WBC count indicates that the antibiotics have been effective. All the other data
suggest that a
change in treatment is needed.
The health care provider writes an order for bacteriologic testing for a patient who has a
positive
tuberculosis skin test. Which action should the nurse take?
a. Teach about the reason for the blood tests.
b. Schedule an appointment for a chest x-ray.
c. Teach about the need to get sputum specimens for 2 to 3 consecutive days.
d. Instruct the patient to expectorate three specimens as soon as possible - Answer ANS: C
Sputum specimens are obtained on 2 to 3 consecutive days for bacteriologic testing for
M. tuberculosis. The patient should not provide all the specimens at once. Blood cultures are
not used for tuberculosis testing. A
chest x-ray is not bacteriologic testing. Although the findings on chest x-ray examination are
important, it is
not possible to make a diagnosis of TB solely based on chest x-ray findings because other
diseases can mimic
the appearance of TB.
A patient is admitted with active tuberculosis (TB). The nurse should question a health care
providers order
to discontinue airborne precautions unless which assessment finding is documented?
a. Chest x-ray shows no upper lobe infiltrates.
b. TB medications have been taken for 6 months.
c. Mantoux testing shows an induration of 10 mm.
, d. Three sputum smears for acid-fast bacilli are negative - Answer ANS: D
Negative sputum smears indicate that
Mycobacterium tuberculosis
is not present in the sputum, and the patient
cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine
whether treatment
has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant
forms of the
disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not
be done because
the result will not change even with effective treatment
The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy
for cancer of
the lung. Which information should the nurse include about the patients postoperative care?
a. Positioning on the right side
b. Bed rest for the first 24 hours
c. Frequent use of an incentive spirometer
d. Chest tube placement with continuous drainage - Answer NS: C
Frequent deep breathing and coughing are needed after chest surgery to prevent atelectasis. To
promote gas
exchange, patients after pneumonectomy are positioned on the surgical side. Early mobilization
decreases the
risk for postoperative complications such as pneumonia and deep vein thrombosis. In a
pneumonectomy, chest
tubes may or may not be placed in the space from which the lung was removed. If a chest tube
is used, it is
clamped and only released by the surgeon to adjust the volume of serosanguineous fluid that
will fill the space
vacated by the lung. If the cavity overfills, it could compress the remaining lung and
compromise the
cardiovascular and pulmonary function. Daily chest x-rays can be used to assess the volume and
space
A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine
(Procardia).
Which assessment would
best
indicate to the nurse that the patients condition is improving?
All Correct Answers 2025-2026
Updated.
Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of
ineffective airway clearance. Which assessment data best supports this diagnosis?
a. Weak, nonproductive cough effort
b. Large amounts of greenish sputum
c. Respiratory rate of 28 breaths/minute
d. Resting pulse oximetry (SpO2) of 85% - Answer ANS: A
The weak, nonproductive cough indicates that the patient is unable to clear the airway
effectively. The other
data would be used to support diagnoses such as impaired gas exchange and ineffective
breathing pattern
The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would
the nurse expect?
a. Increased tactile fremitus
b. Dry, nonproductive cough
c. Hyperresonance to percussion
d. A grating sound on auscultation - Answer ANS: A
Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial
pneumonias.
Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a
loose,
productive cough. Adventitious breath sounds such as crackles and wheezes are typical. A
grating sound is
more representative of a pleural friction rub rather than pneumonia
3. A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most
appropriate action to promote airway clearance?
a. Assist the patient to splint the chest when coughing.
b. Teach the patient about the need for fluid restrictions.
c. Encourage the patient to wear the nasal oxygen cannula.
d. Instruct the patient on the pursed lip breathing technique - Answer ANS: A
Coughing is less painful and more likely to be effective when the patient splints the chest during
coughing.
,Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas exchange,
but will not
improve airway clearance. Pursed lip breathing is used to improve gas exchange in patients with
COPD, but
will not improve airway clearance.
The nurse provides discharge instructions to a patient who was hospitalized for pneumonia.
Which statement, if made by the patient, indicates a good understanding of the instructions
a. I will call the doctor if I still feel tired after a week.
b. I will continue to do the deep breathing and coughing exercises at home.
c. I will schedule two appointments for the pneumonia and influenza vaccines.
d. Ill cancel my chest x-ray appointment if Im feeling better in a couple week - Answer ANS: B
Patients should continue to cough and deep breathe after discharge. Fatigue is expected for
several weeks. The
Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that
a follow-up
chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia
The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing
action will be most effective
a. Turn and reposition immobile patients at least every 2 hours.
b. Place patients with altered consciousness in side-lying positions.
c. Monitor for respiratory symptoms in patients who are immunosuppressed.
d. Insert nasogastric tube for feedings for patients with swallowing problem - Answer ANS: B
The risk for aspiration is decreased when patients with a decreased level of consciousness are
placed in a side-
lying or upright position. Frequent turning prevents pooling of secretions in immobilized
patients but will not
decrease the risk for aspiration in patients at risk. Monitoring of parameters such as breath
sounds and oxygen
saturation will help detect pneumonia in immunocompromised patients, but it will not decrease
the risk for
aspiration. Conditions that increase the risk of aspiration include decreased level of
consciousness (e.g.,
seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and nasogastric
intubation with
or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed,
and aspiration is
,more likely to occur. Other high-risk groups are those who are seriously ill, have poor dentition,
or are
receiving acid-reducing medications
A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days.
Which
assessment data obtained by the nurse indicates that the treatment has been effective?
a. Bronchial breath sounds are heard at the right base.
b. The patient coughs up small amounts of green mucus.
c. The patients white blood cell (WBC) count is 9000/L.
d. Increased tactile fremitus is palpable over the right chest - Answer ANS: C
The normal WBC count indicates that the antibiotics have been effective. All the other data
suggest that a
change in treatment is needed.
The health care provider writes an order for bacteriologic testing for a patient who has a
positive
tuberculosis skin test. Which action should the nurse take?
a. Teach about the reason for the blood tests.
b. Schedule an appointment for a chest x-ray.
c. Teach about the need to get sputum specimens for 2 to 3 consecutive days.
d. Instruct the patient to expectorate three specimens as soon as possible - Answer ANS: C
Sputum specimens are obtained on 2 to 3 consecutive days for bacteriologic testing for
M. tuberculosis. The patient should not provide all the specimens at once. Blood cultures are
not used for tuberculosis testing. A
chest x-ray is not bacteriologic testing. Although the findings on chest x-ray examination are
important, it is
not possible to make a diagnosis of TB solely based on chest x-ray findings because other
diseases can mimic
the appearance of TB.
A patient is admitted with active tuberculosis (TB). The nurse should question a health care
providers order
to discontinue airborne precautions unless which assessment finding is documented?
a. Chest x-ray shows no upper lobe infiltrates.
b. TB medications have been taken for 6 months.
c. Mantoux testing shows an induration of 10 mm.
, d. Three sputum smears for acid-fast bacilli are negative - Answer ANS: D
Negative sputum smears indicate that
Mycobacterium tuberculosis
is not present in the sputum, and the patient
cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine
whether treatment
has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant
forms of the
disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not
be done because
the result will not change even with effective treatment
The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy
for cancer of
the lung. Which information should the nurse include about the patients postoperative care?
a. Positioning on the right side
b. Bed rest for the first 24 hours
c. Frequent use of an incentive spirometer
d. Chest tube placement with continuous drainage - Answer NS: C
Frequent deep breathing and coughing are needed after chest surgery to prevent atelectasis. To
promote gas
exchange, patients after pneumonectomy are positioned on the surgical side. Early mobilization
decreases the
risk for postoperative complications such as pneumonia and deep vein thrombosis. In a
pneumonectomy, chest
tubes may or may not be placed in the space from which the lung was removed. If a chest tube
is used, it is
clamped and only released by the surgeon to adjust the volume of serosanguineous fluid that
will fill the space
vacated by the lung. If the cavity overfills, it could compress the remaining lung and
compromise the
cardiovascular and pulmonary function. Daily chest x-rays can be used to assess the volume and
space
A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine
(Procardia).
Which assessment would
best
indicate to the nurse that the patients condition is improving?
