NUR 330: Exam 3 Review Questions With Complete
Solutions
A 34 year old woman with a history of asthma is admitted to the
emergency department. The nurse notes that the client is
dyspneic, with a respiratory rate of 35 breaths/ minutes, nasal
flaring, and use of accessory muscles. Auscultation of the lung
fields reveals greatly diminished breath sounds. Based on these
findings, what action should the nurse take to initiate care of the
client?
a. Initiate oxygen therapy at 2L via NC and reevaluate in 10
minutes
b. draw blood for an AGB and send the client to get a chest x-
ray
c. encourage the client to relax and breath slowly through the
mouth
d. administer bronchodilators Correct Answers d. administer
bronchodilators
A 71 year old patient is admitted with acute respiratory distress
related to cor pulmonale. Which of the following nursing
interventions is most appropriate during admission of this
patient?
a. delay any physical assessment of the patient and review with
the family the patient's history of respiratory problems
b. perform a comprehensive health history with the patient to
review prior respiratory complications
,c. Perform a physical assessment of the respiratory system and
ask specific questions related to this episode of respiratory
distress
d. complete a full physical examination to determine the effect
of the respiratory distress on the other body functions Correct
Answers c. Perform a physical assessment of the respiratory
system and ask specific questions related to this episode of
respiratory distress
A client with acute asthma is prescribed short-term
corticosteroid therapy. What is the rational for the use of
steroids in clients with asthma?
a. corticosteroids promote bronchodilation
b. corticosteroids act as an expectorant
c. corticosteroids have an anti- inflammatory effect
d. corticosteroids prevent development of respiratory infections
Correct Answers c. corticosteroids have an anti- inflammatory
effect
A nurse is explaining the difference between respiration and
ventilation to a nursing student. Which statement made by the
student shows that the teaching was effective?
a. "Ventilation is the movement of the air in and out of the
lungs, and respiration is the process of gas exchange"
b. "ventilation involves the lower airways and respiration
involves the upper airways"
c. "ventilation and respiration means the same thing and can be
used interchangeably"
,d. "ventilation refers to healthy lungs, and respiration refers to
diseased lungs" Correct Answers a. "Ventilation is the
movement of the air in and out of the lungs, and respiration is
the process of gas exchange"
A patient with acute exacerbation of COPD needs to receive
precise amounts of oxygen. Which of the following types of
equipment should the nurse prepare to use?
a. venturi mask
b. partial non-rebreather mask
c. oxygen tent
d. nasal cannula Correct Answers a. venturi mask
A physical assessment finding that the nurse would expect to be
present in the patient with acute left- sided heart failure is:
a. bubbling crackles and tachycardia
b. hepatomegaly and tachycardia
c. peripheral edema and cool, diaphoretic skin
d. frothy blood- tinged sputum and distended jugular vein
Correct Answers a. bubbling crackles and tachycardia
ABG Normal Values Correct Answers pH: 7.35 - 7.45
pCO2: 35-45 mmHg
HCO3-: 22- 26 mEq/L
PaO2: 80-100 mmHg
SaO2: >95%
, Actions to take when Peak Flow Numbers change Correct
Answers PEF goes between ____L/min and ____ L/min (50%
less than 80% of personal best, yellow zone)
ACTION: take inhaled short acting beta 2 agonist as prescribed
by your doctor
PEF increases 20% or more when measured before & after
taking an inhaled short-acting beta 2 agonist
ACTION: Talk to your doctor about adding more medicine to
control your asthma better
Acute Bilateral pleural effusion Correct Answers Fluid in the
thoracic cavity between the visceral and parietal pleural caused
by increasing pressure in the pleural capillaries and a
transudation of fluid occurs from these capillaries into the
pleural space (Left sided heart failure)
Asthma: Subjective Data Correct Answers Past- Allergic
reactions, sinus issues, previous sinus attacks & hospitalizations,
Gastroesophageal reflux, Occupational exposures to chemical
irritants
Medications- Adherence, inhaler technique, meds that may
precipitate attack in susceptible asthmatics
Activity- exercise; fatigue; decreased or absent exercise
tolerance
Sleep- rest: awaken from sleep due to cough or breathing
problems; insomnia
Solutions
A 34 year old woman with a history of asthma is admitted to the
emergency department. The nurse notes that the client is
dyspneic, with a respiratory rate of 35 breaths/ minutes, nasal
flaring, and use of accessory muscles. Auscultation of the lung
fields reveals greatly diminished breath sounds. Based on these
findings, what action should the nurse take to initiate care of the
client?
a. Initiate oxygen therapy at 2L via NC and reevaluate in 10
minutes
b. draw blood for an AGB and send the client to get a chest x-
ray
c. encourage the client to relax and breath slowly through the
mouth
d. administer bronchodilators Correct Answers d. administer
bronchodilators
A 71 year old patient is admitted with acute respiratory distress
related to cor pulmonale. Which of the following nursing
interventions is most appropriate during admission of this
patient?
a. delay any physical assessment of the patient and review with
the family the patient's history of respiratory problems
b. perform a comprehensive health history with the patient to
review prior respiratory complications
,c. Perform a physical assessment of the respiratory system and
ask specific questions related to this episode of respiratory
distress
d. complete a full physical examination to determine the effect
of the respiratory distress on the other body functions Correct
Answers c. Perform a physical assessment of the respiratory
system and ask specific questions related to this episode of
respiratory distress
A client with acute asthma is prescribed short-term
corticosteroid therapy. What is the rational for the use of
steroids in clients with asthma?
a. corticosteroids promote bronchodilation
b. corticosteroids act as an expectorant
c. corticosteroids have an anti- inflammatory effect
d. corticosteroids prevent development of respiratory infections
Correct Answers c. corticosteroids have an anti- inflammatory
effect
A nurse is explaining the difference between respiration and
ventilation to a nursing student. Which statement made by the
student shows that the teaching was effective?
a. "Ventilation is the movement of the air in and out of the
lungs, and respiration is the process of gas exchange"
b. "ventilation involves the lower airways and respiration
involves the upper airways"
c. "ventilation and respiration means the same thing and can be
used interchangeably"
,d. "ventilation refers to healthy lungs, and respiration refers to
diseased lungs" Correct Answers a. "Ventilation is the
movement of the air in and out of the lungs, and respiration is
the process of gas exchange"
A patient with acute exacerbation of COPD needs to receive
precise amounts of oxygen. Which of the following types of
equipment should the nurse prepare to use?
a. venturi mask
b. partial non-rebreather mask
c. oxygen tent
d. nasal cannula Correct Answers a. venturi mask
A physical assessment finding that the nurse would expect to be
present in the patient with acute left- sided heart failure is:
a. bubbling crackles and tachycardia
b. hepatomegaly and tachycardia
c. peripheral edema and cool, diaphoretic skin
d. frothy blood- tinged sputum and distended jugular vein
Correct Answers a. bubbling crackles and tachycardia
ABG Normal Values Correct Answers pH: 7.35 - 7.45
pCO2: 35-45 mmHg
HCO3-: 22- 26 mEq/L
PaO2: 80-100 mmHg
SaO2: >95%
, Actions to take when Peak Flow Numbers change Correct
Answers PEF goes between ____L/min and ____ L/min (50%
less than 80% of personal best, yellow zone)
ACTION: take inhaled short acting beta 2 agonist as prescribed
by your doctor
PEF increases 20% or more when measured before & after
taking an inhaled short-acting beta 2 agonist
ACTION: Talk to your doctor about adding more medicine to
control your asthma better
Acute Bilateral pleural effusion Correct Answers Fluid in the
thoracic cavity between the visceral and parietal pleural caused
by increasing pressure in the pleural capillaries and a
transudation of fluid occurs from these capillaries into the
pleural space (Left sided heart failure)
Asthma: Subjective Data Correct Answers Past- Allergic
reactions, sinus issues, previous sinus attacks & hospitalizations,
Gastroesophageal reflux, Occupational exposures to chemical
irritants
Medications- Adherence, inhaler technique, meds that may
precipitate attack in susceptible asthmatics
Activity- exercise; fatigue; decreased or absent exercise
tolerance
Sleep- rest: awaken from sleep due to cough or breathing
problems; insomnia
