Oxygenation TEST BANK

1.

A patient has had a head injury affecting the brainstem. What is located in the brainstem that may affect respiratory function?

A)

chemoreceptors

B)

stretch receptors

C)

respiratory center

D)

oxygen center

• Correct Answer: C

• Rationale: The respiratory center is located in the medulla in the brainstem, immediately above the spinal cord, and it stimulates the rate and depth of ventilation.

• Why the others are wrong: Chemoreceptors are located in the aortic arch and carotid bodies, not the brainstem. Proprioceptors (which respond to stretching/movement) are located in the muscles and joints.

2.

Which of the following diseases may result in decreased lung compliance?

A)

emphysema

B)

appendicitis

C)

acne

D)

chronic diarrhea

• Correct Answer: A

• Rationale: Emphysema is a chronic lung condition that results in decreased elasticity of lung tissue, which in turn decreases lung compliance.

• Why the others are wrong: Appendicitis, acne, and chronic diarrhea are not respiratory conditions and do not affect the physical elasticity or compliance of lung tissue.

3.

A nurse is caring for a patient with pneumonia. The patient's oxygen saturation is below normal. What abnormal respiratory process does this demonstrate?

A)

changes in the alveolar-capillary membrane and diffusion

B)

alterations in the structures of the ribs and diaphragm

C)

rapid decreases in atmospheric and intrapulmonic pressures

D)

lower-than-normal concentrations of environmental oxygen

• Correct Answer: A

• Rationale: Conditions like pneumonia cause a thickening of the alveolar-capillary membrane, which hinders gas exchange and makes diffusion difficult.

• Why the others are wrong: Pneumonia is an infection affecting the alveoli, not a structural alteration of the ribs or diaphragm, nor does it change environmental oxygen levels or atmospheric pressure.

4.

While reading a physician's progress notes, a student notes that an assigned patient is having hypoxia. What abnormal assessments would the student expect to find?

A)

abdominal pain, hyperthermia, dry skin

B)

diarrhea, flatulence, decreased skin turgor

C)

hypotension, reddened skin, edema

D)

dyspnea, tachycardia, cyanosis

• Correct Answer: D

• Rationale: Hypoxia is a condition in which an inadequate amount of oxygen is available to the cells. The most common symptoms include dyspnea (difficulty breathing), increased pulse rates (tachycardia), increased respiratory rates, pallor, and cyanosis.

• Why the others are wrong: Hypoxia is characterized by an elevated blood pressure with a small pulse pressure, not hypotension. It is not primarily associated with gastrointestinal distress (diarrhea, flatulence) or hyperthermia.

5.

In what age group would a nurse expect to assess the most rapid respiratory rate?

A)

older adults

B)

middle adults

C)

adolescents

D)

infants

• Correct Answer: D

• Rationale: The respiratory rate is more rapid in infants than at any other age.

• Why the others are wrong: As a child develops and the alveoli increase in number and size, adequate oxygenation can be accomplished at progressively lower respiratory rates

6.

A father of a preschool-aged child tells the nurse that his child has had a constant cold since going to daycare. How would the nurse respond?

A)

Your child must have a health problem that needs medical care.

B)

Children in daycare have more exposure to colds.

C)

Are you washing your hands before you touch the child?

D)

Be sure and have your child wear a protective mask at school.

• Correct Answer: B

• Rationale: Preschool children usually experience fewer routine colds until they enter daycare or school, where they are exposed more frequently to pathogens from other children.

• Why the others are wrong: This is a normal developmental occurrence as the child builds antibodies, not necessarily an indication of a severe underlying health problem or a lack of parental hand hygiene.

7.

A 90-year-old woman has been in an automobile crash and sustained four fractured ribs on the left side of her thorax. Based on her age and the injury, what complication is she at risk for?

A) pneumonia

B) altered thought processes

C) urinary incontinence

D) viral influenza

• Correct Answer: A

• Rationale: Older adults experience physical changes such as less elastic tissues and a less efficient diaphragm, which inherently increases their risk for chest infections like pneumonia. Pain from fractured ribs further limits chest expansion, compounding this risk.

• Why the others are wrong: Rib fractures and altered chest expansion do not directly cause urinary incontinence or viral influenza, and while altered thought processes can result from chronic hypoxia, pneumonia is the direct acute respiratory complication.

8.

Which of the following individuals is at greater risk for respiratory illnesses from environmental causes?

A)

a farmer on a large farm

B)

a factory worker in a large city

C)

a woman living in a small town

D)

a child living in a rural area

• Correct Answer: B

• Rationale: Occupational exposure to pollutants (such as coal dust or asbestos in a factory) combined with high levels of environmental pollution (found in a large city) highly increases the risk of chronic pulmonary disease.

• Why the others are wrong: Rural areas, farms, and small towns typically have lower concentrations of these specific heavy industrial and environmental pollutants compared to a factory setting in a large city.

9.

A nurse is beginning to conduct a health history for a patient with respiratory problems. He notes that the patient is having respiratory distress. What would the nurse do next?

A)

Continue with the health history, but more slowly.

B)

Ask questions of the family instead of the patient.

C)

Conduct the interview later and let the patient rest.

D)

Initiate interventions to help relieve the symptoms.

• Correct Answer: D

• Rationale: If a patient is experiencing cardiopulmonary distress during an assessment, the nurse must immediately initiate appropriate actions to help relieve the symptoms before doing anything else.

• Why the others are wrong: Continuing the interview (even slowly) or just letting the patient rest ignores the immediate physical distress; while family can answer questions later, relieving the patient's respiratory symptoms is the first priority.

10.

A nurse is percussing the thorax of a patient with chronic emphysema. What percussion sound would most likely be assessed?

A)

resonance

B)

hyperresonance

C)

flat

D)

tympany

• Correct Answer: B

• Rationale: Emphysema is a chronic lung condition that decreases lung elasticity, leading to air trapping and an enlarged barrel chest. Hyperresonance is the expected percussion sound over hyperinflated lungs filled with excess air.

• Why the others are wrong: Resonance is heard over normal lung tissue, flat sounds are heard over solid areas (like bone or muscle), and tympany is heard over the stomach.

11.

An emergency room nurse is auscultating the chest of a child who is having an asthmatic attack. Auscultation reveals the presence of wheezes. During what part of respirations do wheezes occur?

A)

inspiration and expiration

B)

only on inspiration

C)

only on expiration

D)

when coughing

• Correct Answer: A

• Rationale: Wheezes are continuous sounds that are heard on expiration, and sometimes also on inspiration, as air passes through airways that are constricted by swelling or tumors.

• Why the others are wrong: Wheezes are not limited strictly to inspiration or strictly to expiration, nor are they only present during coughing.

12.

A patient is experiencing hypoxia. Which of the following nursing diagnoses would be appropriate?

A)

Anxiety

B)

Nausea

C)

Pain

D)

Hypothermia

• Correct Answer: A

• Rationale: Anxiety, restlessness, and confusion are common signs of hypoxia because an inadequate amount of oxygen is available to the brain and cells.

• Why the others are wrong: Nausea, pain, and hypothermia are not primary manifestations of hypoxia

13.

A nurse is caring for a toddler who is having an acute asthmatic attack with copious mucus and difficulty breathing. The child's skin is cyanotic, respirations are labored and rapid, and pulse is rapid. What nursing diagnosis would have priority for care of this child?

A)

Anxiety

B)

Ineffective Airway Clearance

C)

Excess Fluid Volume

D)

Disturbed Sensory Perception

• Correct Answer: B

• Rationale: The child is experiencing copious mucus and labored breathing, which points directly to an inability to clear the airway of secretions (Ineffective Airway Clearance).

• Why the others are wrong: While the child may be anxious, the physical airway obstruction from mucus is the immediate priority. Excess fluid volume and disturbed sensory perception do not fit the primary respiratory symptoms.

14.

What information would a home care nurse provide to a patient who is measuring peak expiratory flow rate at home?

A)

Although the test is uncomfortable, it is not painful.

B)

You will be asked to forcefully exhale into a mouthpiece.

C)

The test is used to determine how much air you inhale.

D)

You will do this each morning while still lying in bed.

• Correct Answer: B

• Rationale: To measure the peak expiratory flow rate, the patient must stand or sit straight, take a deep breath, and forcefully exhale into the peak flow meter.

• Why the others are wrong: The test measures the highest flow during forced expiration, not inhalation. It is performed standing or sitting upright, not lying flat in bed.

15.

What does pulse oximetry measure?

A)

cardiac output

B)

peripheral blood flow

C)

arterial oxygen saturation

D)

venous oxygen saturation

• Correct Answer: C

• Rationale: Pulse oximetry is a noninvasive technique that measures the peripheral arterial oxyhemoglobin saturation (SpO2) of arterial blood.

• Why the others are wrong: It specifically measures arterial saturation, not venous saturation, cardiac output, or peripheral blood flow.

16.

Of all factors, what is the most important risk factor in pulmonary disease?

A)

air pollution from vehicles

B)

dangerous chemicals in the workplace

C)

active and passive cigarette smoke

D)

loss of the ozone layer of the atmosphere

• Correct Answer: C

• Rationale: Cigarette smoking, both active and passive, is a major contributor to lung disease and is identified as the most important risk factor for chronic obstructive pulmonary disease (COPD).

• Why the others are wrong: While air pollution and workplace chemicals can lead to pulmonary disease, cigarette smoke is the single most significant risk factor

17.

A nurse is caring for a patient who suddenly begins to have respiratory difficulty. In what position would the nurse place the patient to facilitate respirations?

A)

supine

B)

prone

C)

high Fowler's

D)

dorsal recumbent

• Correct Answer: C

• Rationale: Patients with respiratory difficulty (dyspnea) are most comfortable in a high-Fowler (upright sitting) position because it allows free movement of the diaphragm, promotes chest expansion, and allows accessory muscles to be used easily.

• Why the others are wrong: Lying flat (supine or dorsal recumbent) allows abdominal contents to push upward on the diaphragm, decreasing lung expansion.

18.

A nurse is teaching a preoperative patient how to effectively deep breathe. Which of the following would be included?

A)

Make each breath deep enough to move the bottom ribs.

B)

Breathe through the mouth when you inhale and exhale.

C)

Breathe in through the mouth and out through the nose.

D)

Practice deep breathing at least once each week.

• Correct Answer: A

• Rationale: When teaching deep breathing, the nurse instructs the patient to make each breath deep enough to physically move the bottom ribs.

• Why the others are wrong: Patients should be taught to breathe in through the nose to filter and humidify the air, and exhale slowly through the mouth. Deep breathing must be practiced frequently (e.g., every 2 hours postoperatively), not just once a week.

19.

A nurse is teaching a home care patient how to do pursed-lip breathing. What is the therapeutic effect of this procedure?

A)

using upper chest muscles more effectively

B)

replacing the use of incentive spirometry

C)

reducing the need for p.r.n. pain medications

D)

prolonging expiration to reduce airway resistance

• Correct Answer: D

• Rationale: Pursed-lip breathing creates a smaller opening for air, which effectively slows and prolongs expiration, preventing the collapse of small airways and reducing airway resistance.

• Why the others are wrong: It is used to control dyspnea and panic, not to replace spirometry, reduce pain medication, or target upper chest muscles

20.

A nurse is explaining a chest tube to family members who do not understand where it is placed. What would the nurse tell them?

A)

It is inserted into the space between the lining of the lungs and the ribs.

B)

I don't exactly know, but I will make sure the doctor comes to explain.

C)

It is inserted directly into the lung itself, connecting to a lung airway.

D)

It is inserted into the peritoneal space and drains into the lungs.

• Correct Answer: A

• Rationale: A chest tube is inserted into the pleural space to drain fluid or air. The pleural space lies precisely between the visceral pleura (covering the lungs) and the parietal pleura (lining the thoracic cavity and ribs).

• Why the others are wrong: It is not inserted directly into the lung tissue or airway, nor is it inserted into the abdominal (peritoneal) space.

21. What prevents air from re-entering the pleural space when chest tubes are inserted?

A)

the location of the tube insertion

B)

the sutures that hold in the tube

C)

a closed water-seal drainage system

D)

respiratory inspiration and expiration

• Correct Answer: C

• Rationale: A chest tube is attached to a closed water-seal drainage system that specifically prevents air from reentering the chest once it has escaped.

• Why the others are wrong: While sutures hold the tube in place and respiration affects pressure, the water-seal system is the mechanical component that prevents the backflow of air

22.

What is the action of codeine when used to treat a cough?

A)

antisuppressant

B)

suppressant

C)

antihistamine

D)

expectorant

• Correct Answer: B

• Rationale: Codeine is generally considered the preferred cough suppressant ingredient because it acts to depress the cough reflex.

• Why the others are wrong: It is a suppressant, not an expectorant (which thins secretions) or an antihistamine.

23.

A nurse is teaching a patient who has congested lungs how to keep secretions thin and more easily coughed up and expectorated. What would be one self-care measure to teach?

A)

Limit oral intake of fluids to less than 500 mL per day.

B)

Increase oral intake of fluids to 2 to 3 quarts per day.

C)

Maintain bedrest for at least 3 days.

D)

Take warm baths every night for a week.

• Correct Answer: B

• Rationale: Patients can keep their respiratory secretions thin and easier to expectorate by increasing their fluid intake to at least 1.5 to 2 liters (approximately 2 to 3 quarts) daily.

• Why the others are wrong: Limiting fluids makes secretions thicker and harder to clear. Bedrest and warm baths do not directly thin pulmonary secretions

24.

What category of medications may be administered by nebulizer or metered-dose inhaler to open narrowed airways?

A)

bronchoconstrictors

B)

antihistamines

C)

narcotics

D)

bronchodilators

• Correct Answer: D

• Rationale: Bronchodilators are medications administered via nebulizers or metered-dose inhalers specifically to open narrowed airways.

• Why the others are wrong: Bronchoconstrictors would narrow the airways further, while narcotics and antihistamines do not serve the primary function of dilating respiratory airways.

25.

A nurse is teaching a home care patient and his family about using prescribed oxygen. What is a critical factor that must be included in teaching?

A)

the importance of communicating with the patient

B)

the safety measures necessary to prevent a fire

C)

the cost and source of supply for the oxygen

D)

the need to provide good skin care

• Correct Answer: B

• Rationale: Oxygen supports combustion, meaning a small spark can cause a fire. Educating patients on safety measures—like keeping oxygen 6 feet away from heat sources and not smoking—is absolutely critical.

• Why the others are wrong: While communication, cost, and skin care are important nursing considerations, fire safety is a critical, life-threatening factor that must be included in oxygen teaching.

26.

What can a nurse ask a patient to do before suctioning to prevent hypoxemia?

A)

Sit in an upright position and cough.

B)

Breathe normally for at least 5 minutes.

C)

Lie flat in bed and practice relaxation.

D)

Take several deep breaths.

• Correct Answer: D

• Rationale: Suctioning removes oxygen from the respiratory tract and can cause hypoxemia. The nurse should preoxygenate the patient by having them take several deep breaths and increasing supplemental oxygen before inserting the catheter.

• Why the others are wrong: Breathing normally or practicing relaxation does not build up the necessary oxygen reserves prior to suctioning, and lying flat makes breathing more difficult.

27.

A patient has had a tracheostomy and the nurse is prepared to conduct tracheostomy care. What part of the tracheostomy tube is removed for cleaning?

A)

obturator

B)

outer cannula

C)

inner cannula

D)

cuff

• Correct Answer: C

• Rationale: The outer cannula remains in place in the trachea, while the inner cannula is removed for cleaning or replaced to prevent accumulated secretions from occluding the airway.

• Why the others are wrong: The obturator is only used to guide the tube during initial insertion, the outer cannula stays in the airway, and the cuff is a balloon that creates a seal.

28.

What is the rationale for placing a writing board in the room of a patient who has had surgery to insert a tracheostomy tube?

A)

The patient is not able to speak.

B)

Verbal communication will be too tiring.

C)

It will occupy the patient's time.

D)

Voice rest will decrease pain levels.

• Correct Answer: A

• Rationale: Placement of a tracheostomy tube (or endotracheal tube) bypasses the vocal cords, resulting in an inability to speak. Alternative communication tools, like writing boards, must be provided.

• Why the others are wrong: The primary reason is the physical inability to form words due to the tube's placement, not merely because speaking is tiring or painful

29.

A student observes a nurse instilling a small amount of saline into a tracheostomy tube before suctioning. What should the student discuss with the nurse?

A)

a description of how the nurse is carrying out the skill

B)

saline is no longer recommended for routine suctioning

C)

nothing; the nurse has been doing this for years

D)

compliments for carrying out the procedure skillfully

• Correct Answer: B

• Rationale: The practice of instilling saline directly into the airway during tracheal suctioning is not supported by evidence and is not recommended.

• Why the others are wrong: The student should intervene or discuss this because it is an outdated and non-evidence-based practice, regardless of how long the nurse has been doing it.

30.

A home care nurse finds a patient lying on the floor. The patient is not breathing. Her response is based on the ABCs of basic life support. What does the B stand for in these initials?

A)

blood

B)

beware

C)

breathing

D)

be sure

• Correct Answer: C

• Rationale: In the basic life support sequence (historically known as ABC, and now commonly taught as the CAB sequence), the B stands for Breathing. The elements are Airway, Breathing, and Chest compressions.

31.

A nurse is caring for older adults in a nursing home. Which of the following age-related changes may affect the respiratory functioning of the patients living there? Select all that apply.

A)

increased elastic recoil of the lungs

B)

less fibrous tissue in alveoli

C)

increase in vital capacity and residual volume

D)

less air exchange, more secretions in lungs

E)

greater risk for aspiration due to slower gastric motility

F)

impaired mobility and inactivity, effects of medication

• Correct Answers: D, E, F

• Rationale: Age-related respiratory changes include less air exchange with more secretions remaining in the lungs, greater risk for aspiration due to slower gastric motility, and the effects of impaired mobility and medications.

• Why the others are wrong: Older adults experience decreased elastic recoil of the lungs, more fibrous tissue in the alveoli, and a reduction in vital capacity (though residual volume does increase).

32.

Which of the following statements accurately describe a step for inserting an oropharyngeal airway? Select all that apply.

A)

Use an airway that is the correct size (size 90 mm is appropriate for the average adult).

B)

Airway should reach from opening of mouth to the back angle of the jaw.

C)

Position patient on his or her stomach with neck hyperextended (unless this is inappropriate).

D)

Open patient's mouth by using your thumb and index finger to gently pry teeth apart.

E)

Insert the airway with the curved tip pointing up toward the roof of the mouth.

F)

Rotate the airway 360 degrees as it passes the uvula.

• Correct Answers: B, D, E

• Rationale: Correct insertion steps include measuring the airway so it reaches from the mouth opening to the back angle of the jaw. The mouth is opened by prying the teeth apart with the thumb and index finger. The airway is inserted with the curved tip pointing up toward the roof of the mouth.

• Why the others are wrong: The patient should be positioned in semi-Fowler's, not on their stomach. The airway is rotated 180 degrees, not 360 degrees.