ANEMIA 9.

You are evaluating the laboratory data of the patient with suspected aplastic
anemia. Which findings support this diagnosis?
1. In a severely anemic pt, you expect to find A. Reduced RBCs, reduced white blood cells (WBCs). And reduced platelets
a. Dyspnea and tachypnea B. Reduced RBCs, normal WBCs, and normal platelets
b. cyanosis and pulmonary edema C. Normal RBCs, educed WBCs, and reduced platelets
c. cardiomegaly and pulmonary fibrosis D. Elevated RBCs, increased WBCs, and increased platelets
d. ventricular dysrhythmias and wheezing
10. The care plan for a patient with aplastic anemia should include activities to
2. When containing assessment data from a a patient with a microcytic, minimize the risk for which complications?
hypochronic anemia you question the patient about A. Dyspnea and pain
a. folic acid intake B. Diarrhea and fatigue
b. dietary; intake of iron C. Nausea and malnutrion
c. a history of gastric surgery D. Infection and hemorrhage
d. a history of sickle cell anemia
11. Which sign or symptoms would you recognize as a unique characteristic
3. you are caring for a patient with a diagnosis of iron-deficiency anemia. Which specific to hemolytic anemia?
clinical manifestation are you most likely to observe when assessing the patient? A. Tachycardia
a. Concave nails, bright red gums and alopecia B. Weakness
b. brittle nails, smooth, shiny tongue, and cheilosis C. Decreased RBCs
c. atanting of the skin, sunken eyes, and complaints of diarrhea D. Jaundice
d. pale pink tong dull, brittle hair, and blue mucous membranes
12. Multiple drugs are often used in combinations to treat leukemia and
4. when providing teaching for the patient with iron-deficiency anemia who has lymphoma because
been prescribed iron supplements, you should include taking the iron with which A. there are fewer toxic side effects.
beverage? B. the chance that one drug will be ffective is increased.
A. Milk C. the drugs are more effective without causing side effects.
B. Gingerable D. the drugs work by different mechanisms to maximize killing of malignant cells.
C. Orange juice
D. Water 13. A patient with acute myelogenous leukemia will soon start chemotherapy.
When you are teaching th paient about the induction stage of chemotherapy,
5. Which individual is at high risk for a cobalamin (vitamin b12) deficiency anemia? what is the best explanation?
A. A 47 year-old man who had a gastroectomy (removal of the stomach) A. The drugs are staretd slowly to minimize side effects.
B. A 54-year-old man with a history of irritable bowel disease and active colitis B. You will develop even greater bone marrow depression with risk for bleeding
C. A 26-year old woman who complains a havy menstrual periods and infection.
D. A 54-year old girl who is vegetarian C. It will be necessary to have high-dose treatment every day for several months.
D. During this time you will regain energy and become more resistant to infection.
6. You encourage the patient with cobalamin deficiency to seek treatment
because untreated pernicious anemia may result in 14. You receive a physicians order to transfuse fresh frozen plasma to a patient
A. death suffering from a acute blood loss. Which procedure is most appropriate for
B. liver failure infusing this blood product?
c. heart failure A. Infuse the fresh frozen plasma as rapidly as the patient will tolerate.
d. gastrectomy B. Hang the fresh frozen plasma as a piggyback to the primary IV solution.
C. Infuse the fresh frozen plasma as a piggyback to primary solution of normal
7. Which finding allows you to identify the patients anemia as folic acid deficiency saline.
rather than cobalamin deficiency? D. Hand the fresh frozen plasma as a piggyback to a new bag of primary IV
A. Loss of appetite solution without KCl.
B. Lack of neuromuscular symptoms
c. red tongue 15. The nurse is performing an assessment on a client with a diagnosis of
d. change in nail shape pernicious anemia. Which finding would the nurse expect to note in this client?
A. Dyspnea
8. Which foods should you encourage patients with folic acid deficiency to include B. Dusky mucous membranes
in their daily food intake (select all that apply)? C. Shortness of breath an exertion
A. ready-to-eat cereal D. Red tongue this smooth and sore
B. Wheet tortilias
C. Lentils 17. If a patient with blood type O rh+I given AB Rh- blood, the nurse would
D. strawberries expect
E. potatoes A. the patientss Rh factor to react with the RBCs of the donor blood.
B. no adverse reaction because the patient has no antibodies against the donor
blood.
C. the anti-A and anti-B antibodies in the patients blood to hemolyze the donor
blood.
D. the anti-A and anti-B antibodies in the donor blood to hemolyze the patients
blood.
18-21 Which the following characteristics with their related types of leukemia
(answers may be used more than once).
chronic lymphocytic leukemia (CLL) 18. Neoplasm of activated B lymphocytes
chronic lymphocytic leukemia (CLL) 19. Mature-appearing but functionally
inactive lymphocytes
acute myelogenous leukemia (AML) 20. 85% of acute leukemia in adults
acute lymphocytic leukemia (ALL) 21. Most common in children
A. acute myelogenous leukemia (AML)
B. acute lymphocytic leukemia (ALL)
C. Chronic myelogenous leukemia (CML)
D. chronic lymphocytic leukemia (CLL)
22. The nurse has obtained to unit of blood from the blood bank and has checked
the blood bag properly with another nurse, Just before the beginning transfusion,
the nurse assesses which of the following items?
A. vital signs
B. skin color
C. urine output
d. latest hematocrit level
23. The physician orders 2 units of packed RBCs to be administered to the client at
500 the night shift nurse initiates the first unit transfusion before going off shift. At
1000 the day shift nurse notes the IV line has clotted off and the transfusion has
not been completed. The nursing assessment revealed the transfusion was only
approximately 75% complete. Which of the actions by the nurse is most
appropriate?
A. Advise the blood bank about the delay for the next unit
B. Restart another peripheral line with 0.9% NS and restart the blood transfusion
with the remaining blood unit.
C. Discontinue the transfusion
D. Document the amount infused thus far and continues the transfusion.
24. About ten minutes after the nurse begins an infusion of packed RBCs, patient
complains of chills, chest and back pain and nausea his face is flushes and hes
anxious. Which is the priority nursing action?
A. Administering antihistamines STAT for an allergic reaction.
B. Notifying the physician of a possible transfusion reaction.
C. Obtaining a urine and serum specimen to send to the lab immediately.
D. Stopping the transfusion and monitoring a patient IV catheter.
25. The nurse is administering packed red blood cells (PRBCs) to a client. The
nurse should first.
A. Discontinue the IV catheter if a blood transfusion reaction occurs.
B. Admister the PRBCs through a previously inserted central catheter with 2 gauge
needle.
C. Finish PRBCs with 5% dextrose and 0.45% normal saline solution
D. Stay with the client during the first 15 minutes of infusion.
26. The nurse enters a clients room to assess the client, who began receiving a
blood transfusion. 45 minutes earlier and notes that the client is flushed in the
dyspneic. On assessment the nurse auscultates the presence of crackles in the
lung. The nurse determines that this client is most likely is experiencing which
complication of blood transfusion therapy?
A. Bacteremia
B. Hypovolemia
C. Fluid overload
D. Transfusion reaction
27. Before sending a transfusion of PRBC for anemic patient. The nurse would
arrange for a prior to monitor, his or her assigned patients for how minutes when
the nurse begins the transfusion?
A. 5 minutes
B. 15 minutes
C. 60 minutes
D. 30 minutes
28. A 52 year-old woman is admitted with a new diagnosis of gastrointestinal (GI)
bleed. The physician has obtained the client to receive 2 units of PRBCs for a
hemoglobin of 6.8 g/dl. The nurse begins he infuses of that unit at 100mL/h.
Fifteen minutes after the start of the infusion, the client complains that she is
feeling chilled, short of breath, and is experiencing lumbar pain rated 8 on a 1-10
scale. which of the following should be the nurses FIRST action
A. Obtain vital signs and notify the physician of potential reaction
B. Slow the infusion to 75 mL/hr and reassess after 15 minutes
C. Stops the infusion and run normal saline (NS) to keep the vein open (KV0)
D. Administer PRN pain medication as ordered, apply oxygen at 2 L/mn, and
provide an additional blanket.
29. The nurse working in a blood bank facility, units of blood from donors.
Which client would not be a candidate to donate blood?
A. The client who had wisdom tooth removd a wekk ago
B. The nursing student who receivd a masles immunization 2 months ago.
C. The mother with a six week old newborn
D. the client who developed an allergy to aspirin in childhood
30. Which statement is the scientific rationale for infusing a unit of blod in less han
four (4) hours?
A. The blood will coagulate if left out of the refrigerator for 4 hours.
B. The blood has the potential bacterial gowth if allowed infuse longer
C. the blood components begin o break down etr 4 hours.
D. The blood will not be affected,this is a laboratory procedure
31. A month after receiving a blood transfusion an immunocompromised male
patient develops fever, liver abnormalities,a rash and diarrhea. the nurse would
suspect this patient has
a. Nothing related to the blood transfusion
b. graft-venushost disease (GVHD)
c. myelosuppression
d. An allergic response to a recent edication.
32. A client receiving a transfusion of PRBCs begins to vomit the clients blood
pressure is 90/50 from a baseline of 125/78. Mp s 100 from baseline 99.2 orally.the
nurse determines patient is experiencing which complication with blood
transfusion?
a. septicemia
b. hyperkalemia
c. circulatory verload
d. delayed transfusion reaction
33. the nurse is aware that the following solutions routinely to flush with IV device
before and after administration of a patient is:
a. 0.9 Percent sodium chloride
b. 5 percent dextrose in water solution
c. sterile wter
d. heparin sodium
34. the nurse receives physicians order transfuse fresh fozen plasma in a patient
suffering from an acute blood loss. Which of the ff. procedures is most
appropriate for infusing this blood product?
a. infuse the fresh frozen plasma as rapidly as the patient will tolerate.
b. hang he fresh frozen plasma as a piggyback to the primary IV solution.
35. A 28 yo client with cancer is afraid of experiencing a febrile reactor,associated
the lood transfusions.he asks if this will happen to him. The nurse best response is
which of the following?
a. febrile reaction are caused when antibodies surface of blood cell
b. the transfusion are directed angainst antigens of the recipients.
c. febrile reaction are rarely immune0madated reactions a can be a sign of
hemolytic ransfusion.
CANCER
1. A patient has signed a consent form prior to beginning chemotherapy, and has
a questions regarding treatment. The nurse:
A. Addresses the patients concerns prior to initiating treatment.
B. Asks the health care provider to discuss the treatment with the patient.
C. Ensures that the consent is signed and begins the treatment.
D. Begins administration while discussing the treatment with the patient.
2. A patient with Colon Cancer is currently receiving Oxaliplatin. As the
chemotherapy nurse, you will advise the patient to:
A. Turn off the air conditioning unit during infusion.
B. Avoid drinking cold food and beverages during and 24 hours post infusion
C. A only
D. Both
3. The nurse is preparing the administration of Paclitaxel for Breast Cancer patient,
the nurse understands that (Select all that apply)
A. UV protect tubing is required to maintain the stability of the drug during
administration.
B. The nurse ensures that pre-medications are given on time.
C. The nurse instructs the oncopharmacy to use an IV tubing with 0.2 micron
filter in preparing the drug.
D. Cardiac monitoring is indicated for first time users due to high
hypersensitivity potential off the drug.
4. A new nurse in the onco-hema unit is about to perform a Consolidation
Chemotherapy for Mr. Smith, a known case of Acute Myelogenous Leukemia. This
means that:
A. The patient is receiving treatment with the aim of inducing remission.
B. The patient is receiving treatment to improve quality of life by mitigating the
long term effect of the disease.
C. The patient is receiving a maintenance drug
D. The patient is receiving treatment to prolong the remission phase.
5. Vesicants are drugs which causes tissue necrosis in the event that it is
inadvertently released outside the veins when the IV becomes unpatented. The
following is an example of a vesicant:
A, Doxorubicin
B. Vincristine
C. Paclitaxel
D. Docetaxel
6. A breast cancer patient who just recently finished 10 sessions of radiation 4
weeks ago is about to receive the TAC chemise protocol. You advise the patient
that:
A. Heart function test such as 2D Echo or MUGA is required prior to receiving
Adriamycin (Doxorubicin)
B. Doxorubicin does not have any compounding effect to radiotherapy.
C. Each patient has individualized response to treatment, thus, it is not clinically
possible to predict when counts begin to fall.
D. Urine will be bright red due to chemical hemorrhagic cyatitis.
7. Hot and cold application is indicated in the management of discomfort during
infusion due to the irritant nature of anti-neoplastics.
A. Vincristine
B. Innotecan
C. Cyclophosphamide
D. Etoposide
* 8. Biotherapy, or immunotherapy, is an emerging trend in the management of
cancer. These drugs are cytotoxic, in a sense that it boosts the immune system to
fight of cancer. Rituximab is a monoclonal antibody given to patients with Non
Hodgkins Lymphoma using the RCHOP protocol. What is the priority nursing
consideration in the administration of the drug?
A. Give the drug in bolus to ensure maximum effect.
B. Titrate the drug drop by drop as ordered since it expires in 24 hours
C. Monitor the vital signs of the patient during administration since this may
cause myocardial infarction and hypotension if given to fast.
D. Ensure that patient undergoes cardiac monitoring from the 1st up to the last
cycle due to its cardio toxicity effect.
* 9. Ms. Smith, a Colon Cancer patient, is going to undergo FolFirl, a 2nd line
chemo protocol. You understand that:
A. Folinic Acid is given to rescue normal cells from dying due to the high doses
of chemotherapy
B. Folinic Acid is given due to its synergistic effect to 5FU making it more potent
in killing cancer cells
C. Folinic Acid is given concurrently with irinotecan to prevent chemotherapy
induced diarrhea
D. Folinic Acid is given before 5FU to prevent Chemotherapy induced nausea
and vomiting
10. Ms. Doe, a stage 4 Breast Cancer patient, presented with bilateral edema of
the upper extremity along with symptoms of pulmonary edema. As an oncology
Nurse, you know that patient is highly likely suffering from Superior Vena Cava
Syndrome, which is considered an Oncologic emergency. You expect the
following actions to be a part of the palliative chemotherapeutic management,
A. No management shall be given aside from spiritual and emotional support
since the patient is at the end stage of cancer.
B. Chemotherapy shall not be indicated since the patient is showing sign of
severe cardiomyopathy.
 C. Prepare for hospice care and pain management for relaxation and palliation.
D. Chemotherapy (eg Eribulin) may be given to debulk the tumor, relieve
symptoms and improve the quality of life of the patient.
11. As a novice oncology nurse, you understand that 5FU, has district side effects
when given:
A. Nail blackening and ridging
B. Chemical Conjuctivitis/Keratytis (Red eyes)
C. Chemical Hemorrhagic Cystitis
D. Blackening of veins
12-14. Give the antidote of the drugs:
Doxorubicin Dexrazoxane
Methotrexate Folinic Acid
Vincristine Hyaluronidase
15. The patient is a known case of Non-small Cell Lung Cancer. He will be
receiving Carboplatin, however, you noticed that one of his Hg 9.0. Being an
Oncology Nurse you know that the anti-neoplastic agent may result to
myelosuppression. What management is highly likely to be given by the doctor?
A. Give Pre-medications and proceed with chemotherapy.
B. Prepare and transfuse 1 unit of PRBC properly type as ordered with repeat
CBC 6 hours post transfusion.
C. Erythropoietin 4,000iu subcutaneously now and repeat CBC after 3 days.
D. Administer IV Hydration with electrolyte incorporate to prevent
Hyponatremia-induced seizure.
16. Mr. J.S, a known case of Primary CNS Lymphoma, is receiving High Dose
Methortraxate (HDMTX), your nursing intervention shall be:
A. Monitor VS and NVS during and immediately after infusion to detect eraly
signs of encephalopathy.
B. Administer NaHCO3 as ordered and perform urine pH monitoring q1 unit a
basic range is achieved (pH 8.0)
C. Perform strict I/O monitoring q1 and refer immediately for signs of urinary
retention.
D. Ask patient to stay on a Flat on bed upto 6 hours post-intrathecal (IT) chemo
to prevent Chemical Arachnoiditis
E. All, except D.
F. All of the above
17. A woman receiving Cituximab asks you for possible delayed side-effect of
treatment. Your answer is:
A. It increases risk for bleeding. Overt signs are coffee ground vomitus, dark
tarry stool.
B. Require dose titration to prevent heart attack during the course of admission.
C. It causes acne like growth of rashes on the neck, face, etc
D. Uromitexan (Mesna), is a known antidote of Cituximab. It increases risk of
developing cardiomyopathy.
18. A 25 year old patient is inquiring about the methods or ways to detect cancer
earlier. The nurse least likely identifies this method by stating:
A. Annual chest x-ray
B. Annual Pap smear for sexually active women only.
C. Annual digital rectal examination for persons over age 40
D. Yearly physical and blood examination
19. The removal of entire breast, pectoralis major and minor muscles and neck
lymph nodes which is followed by skin grafting is a procedure called:
A. Simple Mastectomy
B. Modified Radical Mastectomy
C. Radiation Therapy
D. Radical Mastectomy
20. Chemotherapy is one of the therapeutic modalities for cancer. This treatment
is contraindicated to which of the following conditions?
A. Recent surgery
B. Pregnancy
C. Bone marrow depression
D. All of the above
21. The nurse is preparing Cyclophosphamide (Cytoxan). Safe handling of the drug
should be implemented to protect the nurse from injury. Which of the following
action by the nurse should be corrected?
A. The nurse should wear mask and gloves
B. Air bubbles should be expelled on wet cotton
C. Label the hanging IV bottle with ANTINEOPLASTIC CHEMOTHERAPY sign.
D. Vent vials after mixing
22. Neoplasm can be classified as either benign or malignant. The following are
characteristics of malignant tumor apart from:
A. Metastasis
B. Infiltrates surrounding tissues
C. Encapsulated
D. Poorly differentiated cells
23. On a clinic visit a client who has a relative with cancer,, is asking about warning
signs that may relate to cancer. The nurse correctly identifies the warning signs of
cancer by responding:
A. If a sore healing took a month or more to heal, cancer should be expected
B. Presence of dry cough is one of the warning signs of cancer
C. A lump located only in the breast area may suggest the presence of cancer
D. Sudden weight loss of unexplained etiology can be a warning sign of
cancer
24. In staging and grading neoplasm TNM system is used, TNM stands for:
A. Time, neoplasm, mode of growth
B. Tumor, node, metastasis
C. Tumor, neoplasm, mode of growth
D. Time, node, metastasis
25. Breast self-examination (BSE) is one of the ways to detect breast cancer earlier.
The nurse is conducting a health teaching to female clients in a clinic. During
evaluation the clients are asked to state what they learned. Which of the
statement made by a client needs further teaching about BSE?
 A. BSE is done after menstruation 32. Contact of client on radiation therapy should be limited only to how many
B. BSE palpation is done by starting at the center going to the peripheral in a minutes to promote safety of the therapy personnel?
circular motion
C. BSE can be done in either supine or standing position A. 1 minute
D. BSE should start from age 20 B. 3 minutes
C. 5 minutes
26. A client had undergone radiation therapy (external). The expected side effects D. 10 minutes
include the following apart from:
33. A client is taking Cyclophosphamide (Cytoxan) for the treatment of lymphoma.
A. Hair loss The nurse is very cautions in administering the medication because this drug
B. Ulceration of oral mucous membranes poses the fatal side effect of:
C. Constipation
D. Headache A. Alopecia
B. Myeloma
27. Nurse Janet is assigned in the oncology section of the hospital. Which of the C. CNS toxicity
following orders should the nurse question if a client is on radiation therapy? D. Hemorrhagic cystitis

A. Analgesics before meals 34. Cytarabhine (Ara-C) is an antimetabolite that can cause a common cytarabine
B. Saline rinses every 2 hours syndrome which includes the following apart from:
C. Aspirin every 4 hours
D. Bland diet A. Fever
B. Myalgia
28. Skin reactions are common radiation therapy. Nursing responsibilities on C. Chest pain
promoting skin integrity should be promoted apart from: D. Diarrhea

A. Avoiding the use of ointments, powders and lotion to the area. 35. To provide relief from the cytarabine syndrome, which drug is given?
B. Using soft cotton fabrics for clothing
C. Washing the area with a mild soap and water and patting it dry not rubbing A. Analgesic
it B. Aspirin
D. Avoiding direct sunshine and cold. C. Steroids
D. Allopurinol

29. Nausea and vomiting is an expected side effect of chemotherapeutic drug use. 36. Chemotherapeutic agents have different specific classifications. The following
Which of the following drug should be administered to a client on chemotherapy medications are antineoplastic antibiotics except:
to prevent nausea and vomiting?
A. Doxorubicin (Adriamycin)
A. Metochiopramide (Metozol) B. Fluorouracil (Adrucil)
B. Succimer (Chemet) C. Mitoxantrone (Novantrone)
C. Anastrazole (Arimidex) D. Bleomycin (Blenoxane)
D. Busulfan (Myleran)
37. Specific classification of the chemotherapeutic agent. Vincristine (Oncovin) is:
30. Radiation protection is very important to implement when performing nursing
procedures. When the nurse is not performing any nursing procedures what A. Hormone modulator
distance should be maintained from the client? B. Mitotic inhibitor
C. Antineoplastic antibiotic
A. 1 feet D. Antimetabolite
B. 2 feet
C. 2.5 feet 38. A client is diagnosed with progressive prostate cancer. The nurse expects
D. 3 feet which drug is given?

31. The following are teaching guidelines regarding radiation therapy except? A. Anstrazole (Arimidex)
B. Estramustine (Emcyt)
A. The therapy is painless C. Politaxel (Taxol)
B. To promote safety, the client is assisted by therapy personnel while the D. Irinotecan (Camptosar)
machine is in operation
C. The client may communicate all his concerns or needs or discomforts while the 39. A client taking a chemotherapeutic agent understands the effects of therapy
machine is operating. by stating:
D. Safety precautions are necessary only during the time of actual irradiation
A. I will avoid eating hot and spicy foods.
B. I should stay in my room all the time.
C. I should limit my fluid intake to about 500ml per day 29. HCO3 = 30 METABOLIC
D. I should notify the physician immediately if a urine color change is observed. pCO2 = 38 ALKALOSIS

METHODS OF OXYGEN ADMINISTRATION AND ABGS

1. Shapes and supports the chest wall THORACIC CAGE

2. Covers the larynx during swallowing EPIGLOTTIS
3. Separates the larynx and the bronchi TRACHEA
4. Point of bifurcation of the trachea into bronchi
5. 150ml of air in this area is not available for gas exchange SURFACTANT
6. Keeps the alveoli from collapsing
7. Terminal structures of the respiratory tract ALVEOLI SACS
8. Elasticity of the lungs and thorax COMPLIANCE
9. Location of the vocal cords LARYNX
10. Warm and moisturized inhaled air - TURBINATES
11. Manubriosternal junction at level of carina
12. Membrane lining the chest cavity PARENTAL PLEURA
13. Innervates the diaphragm
14. Small hairs that move mucus up to the respiratory tract EMPYEMA
15. The pleura lines the lungs
16. Collection of pus in thoracic cavity
17. Volume of air inhaled and exhaled with each breath- VT
18. Maximum amount of air lungs can contain RV
19. Maximum amount of air that can be exhaled after maximum inhalation
TLC/VC
21. Amount of air that can be quickly and forcefully exhaled after maximum
inspiration FVC
22. Maximum rate of airflow during forced expiration PEFR
23. Amount of air exhaled in first second of forced vital capacity FEV1
24. Volume of air in lungs after normal exhalation FRC
25. Priority Decision: A pulse oximetry monitor indicates that the patient hbas a
drop in SpO2 from 95% to 85% over several hours. The first action the nurse
should take is to:
A. Ordered stat ABGs to confirm the SpO2 with a SaO2
B. Notify the health care provider of the change in baseline PaO2
C. Check the position of the probe on the finger or earlobe
D. Start oxygen administration by nasal cannula at 2L/min
26. HCO3 = 22 30 50 RESPIRATORY
pCO2 = 48 ACIDOSIS
24 40
30. HCO3 = 26 RESPIRATORY
pCO2 = 30 ALKALOSIS
COPD
1. While assisting a patient with asthma to identify specific triggers of the asthma,
the nurse explains that
a. food and drug allergies do not manifest in respiratory symptoms.
b. exercise-induced asthma is seen only in individuals with sensitivity to cold air.
c. asthma attacks are psychogenic in origin and can be controlled with relaxation
techniques.
D. viral upper respiratory infections are a common precipitating factor in acute
asthma attacks.
2. A patient admitted to the emergency department with an acute asthma attack.
Which of the following assessments of the patient is of greatest concern to the
nurse?
A. the presence of a pulsus paradoxus
b. markedly diminished breath sounds with no wheezing
c. use of accessory muscles of respiration and a feeling of suffocation
d. a respirator rate of 34 breaths/min and increased pulse and blood pressure
3. A patient with asthma has the following arterial blood gas (ABG)results early in
an acute asthma attack: ph 7.48, PaCO2 30mm Hg PaO2 78 mmHg. The most
appropriate action by the nurse is to
a. prepare the patient for mechanical centilation.
b. have the patient breathe in a paper bag to raise the PaCO2.
C. Document the findings and monitor the ABGs for atrend toward acidosis.
d. reduce the patients oxygen flow rate to keep the PaO2 at the current levl.
4. Marked bronchoconstriction with air trapping and hyperinflation of the lungs in
the patient with asthma is indicated by
a. SaO2 of 85%
B. PEFR of <150 L/min
c. FEV1 of 5% of predicted.
d. chest x-ray showing a flattened diahargm.

18 30 5. To decrease the patients sense of panic during an acute asthma attack, t best
action of the nurse is to
27. HCO3 = 22 RESPIRATORY a. leave the patient alone to rest in a quiet, calm environment.
pCO2 = 30 ALKALOSIS b. stay with the patient and encourage slow, pursed-lip breathing.
c. reassure the patient that the attack can be controlled with treatment.
d. feel the tient know his or her status is being closely monitored with frequent
measuremen of vtal signs and SpO2.

28. HCO3 = 18 METABOLIC 6. When a patient with asthma is admitted to the emergency department in
pCO2 = 42 ACIDOSIS severe respiratory distress. The nurse anticipates that initial drug treatment will
most likely include administration of
a. IV aminosphyllase.
b. IV hydrocortisone
c. inhaled ipratropium
d. aerosolized albuterol
7. When teaching the patient with asthma about the use of the peak flow met,the
nurse instructs the patient to
a. carry the flow meter with with the patientat all times in case an asthma attak
occurs.
b. follow written asthma action plan (e.g., increasing quick relief drugs if the peak
expiratory flow rate is in the yellow zone.
c. use the flow meter to check he status of the patients asthma every time the
patient takes quick-relief medication.
d. Use the flow meter by emptying the lungs, closing the mouth arounf the
mouthpiece,d inhalingthrough the mete as quickly as possible.
8. The nurse recognizes the additional teaching is needed to patient with asthma
says.
a. I should exercise evy day if my symptoms are controlled.
b. I may use over-the-counter bronchodilator drugs occasionally if I develop
chest tightness.
c. I should inform spouse about my dications how to get help f I have a severe
asthma attack.
d. A dietary to record my medication use, symptoms, peak expiratory flow ra
(PEFR) levls, and acitivity lev will helo in adjusting therapy.
9. The pulmonary vasoconstriction reading to the development of cor pulmonale
the patient with COPD results from
a. Increased viscosity of the blood
b. alveolar hypoxia and percapnia
c. long-erm low-flow oxygen therapy
d. administration of high concentrations of oxygen
10. In addition smoking cessation,treatment for COPD that is indicated to slow the
progression the disease includes
a. use of bronchodilator drugs
b. use of inhaled corticosteroids
c. lung-volume-reduction surgery
d. prevention of respiratory tract infections
11. A patient is being discharged with plans for home oxygen therapy provided a
liquid oxygen reservoir with a reffilable portable In preparing the patient to use
the equipment,the nurse teaches patient that
a. the portable tank filled from the reservoir will last about 6 to 8 hours at 2 L/min.
b. the unit concentrates oxygen from the air, providing continuous oxygen supply.
c. the unit should be kept out of the bedroom and extension tubing used at night
because of the noise.
d. weekly delivery of one large cylinder of oxygen will be necessary for a 7-to-10
day supply of oxygen.
12. A breathing technique the nurse should teach the patient with COPD to
promote exhalation is
a. huff coughing
b. thoracic breathing
c. pursed-lip breathing
d. diaphragmatic breathing.
13. In planning for postural drainage for the patient with COPD, the nurse
a. schedules te procedure 1 hour before and after meals.
b. has the patient cough before positioning to clear the lungs.
c. assesses the patients tolerance for dependent (head-down) positions.
d. ensures that percussion and vibration e performed efore positioning the
patient.
14. Which of the following oxygen delivery systems elivers a precise oxygen
concentration of o2 used for COPD patients?
a. Nasal cannula
b. Simple face mask
c. venturi face mask
d. nonrebreather face mask
15. During an acute exacerbation of COPD, the patient is severely short of breath
and the nurse identifies a nursing diagnosis of ineffective breathing pattern r/t
obstruction of airflow and anxiety. The best action by the nurse is to
a. prepare and admister bronchodilator medications
b. perform chest physiotherapy to promote removal of secretions
c. admister oxygen at 5 L/min until the shortnes of breath is relieved.
d. position the patient upright with the elbows resting on the over-the=bed table
16. The husband of a patient with COPD tells the nurse that they have not had any
sexual ctivity since the patient was dx with COPD because she becomes short of
breath. The best response by the nurse is,
a. you need o discuss your feling and needs ith your wife o she knows what you
expect of her.
b.there are other ways o maintain intimacy besides exual ntercourse that will not
make her short of breath.
c. You should explore other ways to meet your sexual needs since your wife is no
longer capable of sexual activity.
d. would you like for me talk you and your wife about some medications that
can be made to maintain sexual activity?
17. In teaching the patient with COPD about the need for physical exercise, the
nurse informs the patient that
a. all patients with COPD should be able to increase walking gradually up o 20
min/day.
b. a bronchodilator inhaler should be used to relieve exercise-induced dyspnea
immediately after exercise
c. shortness of breath is expected during exercise but whould return to baseline
within 5 minutes after the exercise.
d. monirting the heart rate before and after exercise is the best ay to determine
how uch exercise can e tolerated.
Identify wether the following statements are true (T) or false (F).
F 18. Partial pressure of oxygen (PaO2) is the amount of oxygen bound to hgb in
comparison ith the amount of oxygen the hbg can carry, expressed in mm hg.
F 19. Arterial oxygen saturation (SaO2) is the amount of oxygen dissolved In
plasma and is expressed as a percentage.
T 20. If hgb is desaturated of oxygen, more oxygen is released from the hgb to
provide oxygen to the tissues.
21. Pulse oximetry may be a reliable indicator of oxygen saturation In the patient
a. with a fever
b. who is anesthetized.
c. in hypovolemic shock
d. receiving oxygen therapy
22. A primary nursing responsibility after obtaining a blood specimen for ABGs is
a. adding heparin to the blood specimen
b. applying pressure to the puncture site for 2 full minutes
c. taking the specimen immediately to the laboratory in iced container
d. avoiding any changes in oxygen intervention for 20 min. following the c. to strengthen the intercostal muscles
procedure d. to promote carbon dioxide elimination

23. An advantage of a tracheostomy over an endotracheal tube for long-term

mgt of an upper airway obstruction is that a tracheostomy
a. is safer to perform in an emergency
b. allows for more comfort and mobility
c. has a lower risk of tracheal pressure necrosis
d. is less likely to lead to lower respiratory tract infection

24. Nursing care of the the patient with a cuffed tracheostomy tube in place
includes
a. changing the tube every 3 days
b. recording cuff pressure every 8 hours
c. performing mouth care every 12 hours
d. assessing the arterial blood gases every 8 hours.

25. Priority Decision: A patients tracheostomy tube becomes dislodged with

vigorous coughing. The first action by the nurse is to
a. attempt to replace the tube
b. notify the health care provider
c. place the patient in high fowlers position.
d. ventilate the patient with a manual resuscitation bag until the health care
provider arrives.

26. Aminophylline (theophylline) is prescribed for a client with acute bronchitis.A

nurse administers the medication, knowing that the primary action of this
medication is to:
a. promote expectoration
b. suppress the cough
c. relax smooth muscles of the bronchial airway
d. prevent infection

27. A nurse is assessing a client with chronic airflow limitation nd notes that
theclient has a barrel chest the nurse interprets that this client has which of the
following forms of chronic airflow limitation?
a. Chronic obstructive bronchitis
b. emphysema
c. bronchial asthma
d. bronchial asthma and bronchitis

28. which of the following outcomes would be appropriate for a client with COPD
who has been discharged to home? The client:
a. promises to do pursed lip breathing at home
b. stated actions to reduce pain
c. states that he will use oxygen via a nasal cannula at 5 L/min.
d. Agrees to call the physician if dyspnea on exertion increases.

29. which of the following physical assessment findings would the nurse expect to
find in a client with advanced COPD?
a. Increased anteroposterior chest diameter
d. Underdeveloped neck muscles
c. Collapsed neck veins
d. Increased chest excursions with respiration

30. which of the following is the primary reason to teach pursed-lip breathing to
clients with emphysema?
a. to promote oxygen intake
b. to strengthen the diaphragm