Oxygenation

PRACTICING FOR NCLEX

MULTIPLE CHOICE QUESTIONS

1. Which of the following is the primary

purpose of surfactant?

a. To propel sheets of mucus toward the

upper airway

b. To warm inspired air

c. To produce watery mucus

d. To reduce surface tension of the fluid lining

the alveoli

2. The small air sacs at the end of the terminal

bronchioles that are the sites of gas exchange

are known as which of the following?

a. Alveoli

b. Pleurae

c. Lobules

d. Bronchioles

3. A patient who has difficulty breathing,

increased respiratory and pulse rates, and

pale skin with regions of cyanosis may be

suffering from which of the following?

a. Hyperventilation

b. Hypoxia

c. Perfusion

d. Atelectasis

4. When inspecting a patient’s chest to assess

respiratory status, the nurse should be

aware of which of the following normal

findings?

a. The contour of the intercostal spaces

should be rounded.

b. The skin at the thorax should be cool and

moist.

c. The anteroposterior diameter should be

greater than the transverse diameter.

d. The chest should be slightly convex with

no sternal depression.

5. When percussing a normal lung, which of

the following sounds should be heard?

a. Tympany

b. Resonance

c. Dullness

d. Hyperresonance

6. Which of the following normal breath

sounds should be heard over the trachea?

a. Vesicular

b. Bronchovesicular

c. Bronchial

d. Tympanic

7. A patient who develops air in the pleural

space is experiencing which of the following

conditions?

a. Pleural effusion

b. Hemothorax

c. Pneumothorax

d. Pleura thorax
8. Which of the following cough suppressants

is generally preferred, despite its addictive

quality?

a. Cough syrup with codeine

b. Benylin

c. Balminil DM

d. Benadryl

9. A patient who complains of difficulty breathing

should be placed in which of the following

positions?

a. Prone position

b. Lateral position

c. Supine position

d. Fowler’s position

10. To drain the apical sections of the upper

lobes of the lungs, the nurse should place the

patient in which of the following positions?

a. Left side with a pillow under the chest wall

b. Side-lying position, half on the abdomen

and half on the side

c. High Fowler’s position

d. Trendelenburg position

11. Which of the following inhalers is used to

liquefy or loosen thick secretions?

a. Bronchodilators

b. Mucolytic agents

c. Corticosteroids

d. Metered-dose inhalers

12. The brain is sensitive to hypoxia and will

sustain irreversible brain damage after how

many minutes?

a. 2 to 4 minutes

b. 4 to 6 minutes

c. 6 to 8 minutes

d. 8 to 10 minutes

13. Mr. Parks has chronic obstructive pulmonary

disease. His nurse has taught him pursed-lip

breathing, which helps him in which of the

following ways?

a. Increases carbon dioxide, which stimulates

breathing

b. Teaches him to prolong inspiration and

shorten expiration

c. Helps liquefy his secretions

d. Decreases the amount of air trapping and

resistance

14. A nurse suctioning a patient through a

tracheostomy tube should be careful not to

occlude the Y-port when inserting the suction

catheter because it would cause which of the

following to occur?

a. Trauma to the tracheal mucosa

b. Prevention of suctioning

c. Loss of sterile field

d. Suctioning of carbon dioxide

15. When caring for a patient with a tracheotomy,

the nurse should be aware of which of the

following?
a. The wound around the tube and inner cannula,

if one is present, should be cleaned at

least every 24 hours.

b. The patient has no impairment of speaking

function.

c. A newly inserted tracheostomy tube requires

no immediate attention.

d. Suctioning of the tracheostomy tube must

be done using sterile technique.

16. When percussing the lungs of a patient with

emphysema, the nurse would probably hear

which of the following sounds?

a. Resonance

b. Hyperresonance

c. Tympany

d. Dullness

17. Which of the following is a function of the

upper airway?

a. Conduction of air

b. Mucociliary clearance

c. Production of pulmonary surfactant

d. Purification of inspired air

ALTERNATE-FORMAT QUESTIONS

Multiple Response Questions

Circle the letters that correspond to the best

answers for each question.

1. Which of the following are components of the

upper airway? (Select all that apply.)

a. Nose
b. Larynx

c. Trachea

d. Bronchi

e. Epiglottis

f. Bronchioles

2. Which of the following statements regarding

the physiology of the lungs are accurate?

(Select all that apply.)

a. The right lung has two lobes.

b. Each lobe in the lung is further divided into

lobules.

c. The right lung consists of 10 bronchopulmonary

segments.

d. The left lung consists of 12 bronchopulmonary

segments.

e. The lung is composed of alveoli.

f. Surfactant in the lungs increases the surface

tension of the fluid lining the alveoli.

3. Which of the following statements accurately

describe how respirations are controlled in the

body? (Select all that apply.)

a. The medulla in the brain stem is the respiratory

center.

b. The medulla is stimulated by a decrease in

the concentration of carbon dioxide and

hydrogen ions and by the decreased

amount of oxygen in the arterial blood.

c. Chemoreceptors in the aortic arch and

carotid bodies can shut down the medulla.

d. Stimulation of the medulla increases the

rate and depth of ventilation to blow off

carbon dioxide and hydrogen and increase

oxygen levels.

e. The medulla sends an impulse down the

spinal cord to the respiratory muscles

to stimulate a contraction leading to

inhalation.

f. The lungs contract in response to pressure

changes in the intrapleural space and lungs.

4. Which of the following statements describe

the developmental variations that occur in the

respiratory process? (Select all that apply.)

a. The normal infant’s chest is small,

although the airways are comparatively

long, and aspiration is a potential problem.

b. The respiratory rate is slower in infants

than at any other age.

c. Respiratory rate stabilizes in young

adulthood.

d. Surfactant is formed in utero at about 34 to

36 weeks.

e. Respiratory activity is primarily abdominal

in infants.

f. Infants have a rounded chest wall in which

the anteroposterior diameter is greater than

the transverse diameter.

5. Which of the following normal conditions

would a nurse expect to find when performing

a physical assessment of a patient’s respiratory

system? (Select all that apply.)

a. The chest contour is slightly convex with

no sternal depression.

b. The anteroposterior diameter of the chest

should be less than the transverse diameter.

c. The contour of the intercostal spaces

should be rounded, and the movement of

the chest should be symmetric.

d. When palpating the trachea, the nurse

should note a slightly higher skin temperature.

e. When assessing tactile fremitus by placing

a palm to the patient’s chest wall, the vibrations

from the patient’s repeated word

should be equal bilaterally in different areas

on the chest wall.

f. Hyperresonance, a loud, hollow, lowpitched

sound, should be heard over

normal lungs when they are percussed.

6. Which of the following actions should a nurse

perform when inserting an oropharyngeal airway?

(Select all that apply.)

a. Use an airway that is the correct size (size

60 mm is appropriate for the average

adult).

b. Wash hands and don gloves. Wear a mask

and goggles if the patient is coughing.

c. Position patient on his/her back with the

head turned to one side, resting on the

cheekbone.

d. Insert the airway with the curved tip pointing

down toward the base of the mouth.

e. Slide the airway across the tongue to the

back of the mouth and rotate it 180 degrees

as it passes the uvula.

f. Remove airway for a brief period every

4 hours.

7. Which of the following actions would a nurse

perform when correctly providing postural

drainage? (Select all that apply.)

a. Place the patient in a high Fowler’s position

to drain the apical sections of the upper

lobes of the lungs.

b. Place the patient in the Trendelenburg position

to drain the right lobe of the lung.

c. Carry out postural drainage two to four

times a day for 20 to 30 minutes.

d. Perform postural drainage 15 minutes after

meals to aid digestion.

e. Place the patient in a lying position, half

on the abdomen and half on the side, right

and left, to drain the posterior sections of

the upper lobes of the lungs.

f. Place the patient lying on the right side

with a pillow under the chest wall to drain

the right lobe of the lung.

8. Which of the following statements describes

the proper use of inhaled medications? (Select

all that apply.)

a. Bronchodilators are used to liquefy or

loosen thick secretions or reduce inflammation

in airways.

b. Nebulizers are used to deliver a controlled

dose of medication with each compression

of the canister.

c. When using an MDI, the patient must activate

the device before and after inhaling.

d. DPIs are actuated by the patient’s inspiration,

so there is no need to coordinate the delivery

of puffs with inhalation.

e. Metered-dose inhalers deliver a controlled

dose of medications with each compression

of the canister.

f. Inhalers can be used safely without serious

side effects whenever they are needed by

the patient.

9. Which of the following nutritional guidelines

are recommended for a patient with COPD?

(Select all that apply.)

a. The patient should follow a high-protein

and low-calorie diet.

b. The diet should consist of 40% to 55% carbohydrates.

c. The diet should be rich in antioxidants and

vitamin A, C, and B.

d. The diet should contain 45% to 50% fat to

counter malnutrition.

e. The diet should contain 12% to 20%

protein.

f. Obese patients should not be encouraged to

try to lose weight to prevent malnutrition

from occurring as the disease progresses.

1. A nurse caring for a patient with chronic obstructive pulmonary disease (COPD) knows that hypoxia
may occur in patients with respiratory problems. What are signs of this serious condition? Select all
answers that apply.

a. Dyspnea

b. Hypotension

c. Small pulse pressure

d. Decreased respiratory rate

e. Pallor

f. Increased pulse rate

2. A nurse is suctioning the nasopharyngeal airway of a patient to maintain a patent airway. For which
condition would the nurse anticipate the need for a nasal trumpet?

a. The patient vomits during suctioning.

b. The secretions appear to be stomach contents.

c. The catheter touches an unsterile surface.

d. Epistaxis is noted with continued suctioning.

3. A nurse is inserting an oropharyngeal airway for a patient who vomits when it is inserted. Which
action would be the first that should be taken by the nurse related to this occurrence?

a. Quickly position the patient on his or her side.

b. Put on disposable gloves and remove the oral airway.

c. Check that the airway is the appropriate size for the patient.

d. Put on sterile gloves and suction the airway.

4. A nurse is choosing a catheter to use to suction a patient’s endotracheal tube via an open system.
On which variable would the nurse base the size of the catheter to use?

a. The age of the patient

b. The size of the endotracheal tube

c. The type of secretions to be suctioned

 d. The height and weight of the patient

5. A nurse is caring for a 16-year-old male patient who has been hospitalized for an acute asthma
exacerbation. Which testing methods might the nurse use to measure the patient’s oxygen saturation?
Select all that apply.

a. Thoracentesis

b. Spirometry

c. Pulse oximetry

d. Peak expiratory flow rate

e. Diffusion capacity

f. Maximal respiratory pressure

6. A patient with COPD is unable to perform activities of daily living (ADLs) without becoming
exhausted. Which nursing diagnosis best describes this alteration in oxygenation as the etiology?

a. Decreased Cardiac Output related to difficulty breathing

b. Impaired Gas Exchange related to use of bronchodilators

c. Fatigue related to impaired oxygen transport system

d. Ineffective Airway Clearance related to fatigue

7. A nurse working in a long-term care facility is providing teaching to patients with altered
oxygenation due to conditions such as asthma and COPD. Which measures would the nurse
recommend? Select all that apply.

a. Refrain from exercise.

b. Reduce anxiety.

c. Eat meals 1 to 2 hours prior to breathing treatments.

d. Eat a high-protein/high-calorie diet.

e. Maintain a high-Fowler’s position when possible.

f. Drink 2 to 3 pints of clear fluids daily.

8. A nurse is providing postural drainage for a patient with cystic fibrosis. In which position should the
nurse place the patient to drain the right lobe of the lung?

a. High Fowler’s position

b. Left side with pillow under chest wall

c. Lying position/half on abdomen and half on side

d. Trendelenberg position
9. A nurse is teaching a patient how to use a meter-dosed inhaler for her asthma. Which comments
from the patient assure the nurse that the teaching has been effective? Select all that apply.

a. “I will be careful not to shake up the canister before using it.”

b. “I will hold the canister upside-down when using it.”

c. “I will inhale the medication through my nose.”

d. “I will continue to inhale when the cold propellant is in my throat.”

e. “I will only inhale one spray with one breath.”

f. “I will activate the device while continuing to inhale.”

10. When planning care for a patient with chronic lung disease who is receiving oxygen through a nasal
cannula, what does the nurse expect?

a. The oxygen must be humidified.

b. The rate will be no more than 2 to 3 L/min or less.

c. Arterial blood gases will be drawn every 4 hours to assess flow rate.

d. The rate will be 6 L/min or more.

11. A nurse is securing a patient’s endotracheal tube with tape and observes that the tube depth
changed during the retaping. Which action would be appropriate related to this incident?

a. Instruct assistant to notify the primary care provider.

b. Assess the patient’s vital signs.

c. Remove the tape, adjust the depth to ordered depth and reapply the tape.

d. No action is required as depth will adjust automatically.

12. What action does the nurse perform to follow safe technique when using a portable oxygen
cylinder?

a. Checking the amount of oxygen in the cylinder before using it

b. Using a cylinder for a patient transfer that indicates available oxygen is 500 psi

c. Placing the oxygen cylinder on the stretcher next to the patient

d. Discontinuing oxygen flow by turning cylinder key counterclockwise until tight

13. A nurse providing care of a patient’s chest drainage system observes that the chest tube has
become separated from the drainage device. What would be the first action that should be taken by
the nurse in this situation?

a. Notify the physician.

b. Apply an occlusive dressing on the site.

 c. Assess the patient for signs of respiratory distress.

d. Put on gloves and insert the chest tube in a bottle of sterile saline.

14. An emergency department nurse is using a manual resuscitation bag (Ambu bag) to assist
ventilation in a patient with lung cancer who has stopped breathing on his own. What is an
appropriate step in this procedure?

a. Tilt the patient’s head forward.

b. Hold the mask tightly over the patient’s nose and mouth.

c. Pull the patient’s jaw backward.

d. Compress the bag twice the normal respiratory rate for the patient.

15. Which assessments and interventions should the nurse consider when performing tracheal
suctioning? Select all that apply.

a. Closely assess the patient before, during, and after the procedure.

b. Hyperoxygenate the patient before and after suctioning.

c. Limit the application of suction to 20 to 30 seconds.

d. Monitor the patient’s pulse frequently to detect potential effects of hypoxia and stimulation of
the vagus nerve.

e. Use an appropriate suction pressure (80–150 mm Hg).

f. Insert the suction catheter no further than 1 cm past the length of the tracheal or endotracheal
tube.