NGN NURS Advanced Pharmacology final
exam LATEST UPDATE 2025 GRADED A PLUS
12- A client is admitted to the emergency department following a motorcycle crash. The nurse
notes a crackling sensation upon palpation of the right side of the client’s chest. After
notifying the provider, the nurse document this finding as which of the following?
-Crepitus
Rational: crepitus also called subcutaneous emphysema, is a coarse crackling sensation that
the nurse can feel when palpating the skin surface over the client’s chest. Crepitus indicates an
air leak into the subcutaneous tissue, which is often a clinical manifestation of pneumothorax.
13- A nurse on a medical unit is caring for a client who aspirated gastric contents prior to
admission. The nurse administers 100% oxygen by nonrebreather mask after the client reports
severe dyspnea. Which of the following findings is a clinical manifestation of acute respiratory
distress syndrome (ARDS)?
-PaO2 50 mmHg
Rational: client who has manifestation of ARDS has a low PaO2 level, even after the
administration of oxygen. Hypoxemia after treatment with oxygen is a manifestation of ARDS.
14- A nurse is caring for an older adult client who has chronic obstructive pulmonary disease (COPD)
with pneumonia. The nurse should monitor the client for which of the following acid-base
imbalances?
-Respiratory acidosis.
, Rational: respiratory acidosis is a common complication of COPD. This complication occurs
because clients who have COPD are unable to exhale carbon dioxide due to a loss of elastic
recoil in the lungs.
15- A nurse in an urgent care clinic is collecting data from a client who report exposure to
anthrax. Which of the following findings is an indication of the prodromal stage of inhalation
anthrax?
-Dry cough
Rational: dry cough is a clinical manifestation of the prodromal stage of inhalation
anthrax. During this stage, it is difficult to distinguish the condition from influenza or
pneumonia because there is no sore throat or rhinitis.
16- A nurse is caring for a client who has a tracheostomy with an inflated cuff in place.
Which of the following findings indicates that the nurse should suction the client airway secretions?
-The nurse auscultates coarse crackles in the lung fields.
17- A nurse is planning care for a client following placement of a chest tube 1 hr ago. Which of the
following actions should the nurse include in the plan of care?
-Tape all connections between the chest tube and drainage system.
Rational: the nurse should tape all connections to ensure that the system is airtight and prevent
the chest tubing from accidentally disconnecting.
18- A nurse in the emergency department is assessing a client for closed pneumothorax and
significant bruising of the left chest following a motor-vehicle crash. The client reports severe
left chest pain on inspiration. The nurse should assess the client for which of the following
manifestations of pneumothorax?
-Absence of breath sounds
19- A nurse is providing discharge teaching about improving gas exchange for client who has
emphysema. Which of the following instructions should the nurse include in the teaching?
-Use pursed-lip breathing during periods of dyspnea.
, Rational: using pursed-lip breathing during periods of dyspnea will slow expiration, increase
airway pressure, and facilitate effective gas exchange.
20- A nurse is caring for a client who is scheduled to have his chest tube removed. Which of the
following actions the nurse takes?
-Instruct the client to perform the Valsalva maneuver during removal.
Rational: Valsalva maneuver will maintain the appropriate amount of negative pressure in the
chest in order to prevent air entry into the pleural space.
21- A nurse is caring for a client who is receiving mechanical ventilation and develops acute
respiration distress. Which of the following actions should the nurse take first?
-Initiate bag-valve-mask ventilation.
22- A client comes to the emergency department in severe respiratory distress following left- sided
blunt chest trauma. The nurse notes absent breath sounds on the client’s left side and a
tracheal shift to the right. For which of the following procedures should the nurse prepare the
client?
-Chest tube insertion.
Rational: client manifestations indicate pneumothorax due to blunt chest trauma. The nurse
should prepare for the provider to insert a chest tube and connect it to a water seal drainage
system.
23- A nurse a caring for a client who is experiencing acute opioid toxicity. Which of the
following actions should the nurse identify as the priority?
-Ensure an adequate airway.
24- A nurse on a medical-surgical unit is caring for 4 clients. Which of the following clients should
the nurse monitor for crepitus?
-A client who has a chest tube following a pneumothorax
25- A nurse is caring for a client with pneumonia who is experiencing thick oral secretions.
Which of the following actions should the nurse take first?
-Encourage deep-breathing and coughing
26- A nurse is caring for a client who has a chronic obstructive pulmonary disease (COPD) and is
experiencing shortness of breath. Which of the following actions should the nurse perform first?
, -Place the client in an upright position
27- A nurse is auscultating the lungs of a client who is having an acute asthma attack. Which of the
following sounds should the nurse expect to hear?
-Noisy wheezing
Rational: asthma causes the bronchioles of the lung to constrict, creating a wheezing sound.
50-A nurse is assessing a client who has pharyngitis. Which of the following Is the nurse’s priority
to report to the provider?
-Inspiratory stridor
51-A nurse is providing postoperative care for a client who has 2 chest tubes in place following a
lobectomy. The client asks the nurse the reason for having 2 chest tubes. The nurse should inform the
client that lower chest tube is placed for which of the following reasons?
-Draining blood and fluid from the pleural space.
52- A nurse is caring for a client who has a 20-year history of COPD and is receiving oxygen at 2 L/min
via nasal canula. The client is dyspneic and has an oxygen saturation via pulse oximetry of 85%. Which of
the following actions should the nurse take?
-Increase the oxygen flow and request an arterial blood gas determination.
Rational: the client requires oxygen at a rate that will keep the oxygen saturation between 88%
and 92%. The nurse should increase the client’s oxygen and evaluate its effectiveness with ABG
results and oxygen saturation via pulse oximetry measurements.
53- A nurse is teaching breathing techniques to a client who has emphysema. Which of the
following statements indicates that the client understands the mechanics of pursed-lip breathing?
- “When I breath out through pursed lips, my airway don’t collapse between breath.”
54- A nurse is planning care for a client who is postoperative following a hip arthroplasty. In the client’s
medical records, the nurse notes a history of chronic obstructive pulmonary disease (COPD). Which of
the following oxygen-delivery methods should the nurse plan to use for this client?
-Nasal cannula
exam LATEST UPDATE 2025 GRADED A PLUS
12- A client is admitted to the emergency department following a motorcycle crash. The nurse
notes a crackling sensation upon palpation of the right side of the client’s chest. After
notifying the provider, the nurse document this finding as which of the following?
-Crepitus
Rational: crepitus also called subcutaneous emphysema, is a coarse crackling sensation that
the nurse can feel when palpating the skin surface over the client’s chest. Crepitus indicates an
air leak into the subcutaneous tissue, which is often a clinical manifestation of pneumothorax.
13- A nurse on a medical unit is caring for a client who aspirated gastric contents prior to
admission. The nurse administers 100% oxygen by nonrebreather mask after the client reports
severe dyspnea. Which of the following findings is a clinical manifestation of acute respiratory
distress syndrome (ARDS)?
-PaO2 50 mmHg
Rational: client who has manifestation of ARDS has a low PaO2 level, even after the
administration of oxygen. Hypoxemia after treatment with oxygen is a manifestation of ARDS.
14- A nurse is caring for an older adult client who has chronic obstructive pulmonary disease (COPD)
with pneumonia. The nurse should monitor the client for which of the following acid-base
imbalances?
-Respiratory acidosis.
, Rational: respiratory acidosis is a common complication of COPD. This complication occurs
because clients who have COPD are unable to exhale carbon dioxide due to a loss of elastic
recoil in the lungs.
15- A nurse in an urgent care clinic is collecting data from a client who report exposure to
anthrax. Which of the following findings is an indication of the prodromal stage of inhalation
anthrax?
-Dry cough
Rational: dry cough is a clinical manifestation of the prodromal stage of inhalation
anthrax. During this stage, it is difficult to distinguish the condition from influenza or
pneumonia because there is no sore throat or rhinitis.
16- A nurse is caring for a client who has a tracheostomy with an inflated cuff in place.
Which of the following findings indicates that the nurse should suction the client airway secretions?
-The nurse auscultates coarse crackles in the lung fields.
17- A nurse is planning care for a client following placement of a chest tube 1 hr ago. Which of the
following actions should the nurse include in the plan of care?
-Tape all connections between the chest tube and drainage system.
Rational: the nurse should tape all connections to ensure that the system is airtight and prevent
the chest tubing from accidentally disconnecting.
18- A nurse in the emergency department is assessing a client for closed pneumothorax and
significant bruising of the left chest following a motor-vehicle crash. The client reports severe
left chest pain on inspiration. The nurse should assess the client for which of the following
manifestations of pneumothorax?
-Absence of breath sounds
19- A nurse is providing discharge teaching about improving gas exchange for client who has
emphysema. Which of the following instructions should the nurse include in the teaching?
-Use pursed-lip breathing during periods of dyspnea.
, Rational: using pursed-lip breathing during periods of dyspnea will slow expiration, increase
airway pressure, and facilitate effective gas exchange.
20- A nurse is caring for a client who is scheduled to have his chest tube removed. Which of the
following actions the nurse takes?
-Instruct the client to perform the Valsalva maneuver during removal.
Rational: Valsalva maneuver will maintain the appropriate amount of negative pressure in the
chest in order to prevent air entry into the pleural space.
21- A nurse is caring for a client who is receiving mechanical ventilation and develops acute
respiration distress. Which of the following actions should the nurse take first?
-Initiate bag-valve-mask ventilation.
22- A client comes to the emergency department in severe respiratory distress following left- sided
blunt chest trauma. The nurse notes absent breath sounds on the client’s left side and a
tracheal shift to the right. For which of the following procedures should the nurse prepare the
client?
-Chest tube insertion.
Rational: client manifestations indicate pneumothorax due to blunt chest trauma. The nurse
should prepare for the provider to insert a chest tube and connect it to a water seal drainage
system.
23- A nurse a caring for a client who is experiencing acute opioid toxicity. Which of the
following actions should the nurse identify as the priority?
-Ensure an adequate airway.
24- A nurse on a medical-surgical unit is caring for 4 clients. Which of the following clients should
the nurse monitor for crepitus?
-A client who has a chest tube following a pneumothorax
25- A nurse is caring for a client with pneumonia who is experiencing thick oral secretions.
Which of the following actions should the nurse take first?
-Encourage deep-breathing and coughing
26- A nurse is caring for a client who has a chronic obstructive pulmonary disease (COPD) and is
experiencing shortness of breath. Which of the following actions should the nurse perform first?
, -Place the client in an upright position
27- A nurse is auscultating the lungs of a client who is having an acute asthma attack. Which of the
following sounds should the nurse expect to hear?
-Noisy wheezing
Rational: asthma causes the bronchioles of the lung to constrict, creating a wheezing sound.
50-A nurse is assessing a client who has pharyngitis. Which of the following Is the nurse’s priority
to report to the provider?
-Inspiratory stridor
51-A nurse is providing postoperative care for a client who has 2 chest tubes in place following a
lobectomy. The client asks the nurse the reason for having 2 chest tubes. The nurse should inform the
client that lower chest tube is placed for which of the following reasons?
-Draining blood and fluid from the pleural space.
52- A nurse is caring for a client who has a 20-year history of COPD and is receiving oxygen at 2 L/min
via nasal canula. The client is dyspneic and has an oxygen saturation via pulse oximetry of 85%. Which of
the following actions should the nurse take?
-Increase the oxygen flow and request an arterial blood gas determination.
Rational: the client requires oxygen at a rate that will keep the oxygen saturation between 88%
and 92%. The nurse should increase the client’s oxygen and evaluate its effectiveness with ABG
results and oxygen saturation via pulse oximetry measurements.
53- A nurse is teaching breathing techniques to a client who has emphysema. Which of the
following statements indicates that the client understands the mechanics of pursed-lip breathing?
- “When I breath out through pursed lips, my airway don’t collapse between breath.”
54- A nurse is planning care for a client who is postoperative following a hip arthroplasty. In the client’s
medical records, the nurse notes a history of chronic obstructive pulmonary disease (COPD). Which of
the following oxygen-delivery methods should the nurse plan to use for this client?
-Nasal cannula
