QUESTIONS AND CORRECT
ANSWERS
Which assessment finding for a client receiving oxygen therapy with a nonrebreather
mask requires the nurse to intervene immediately?
A. The oxygen flow rate is set at 12 L/min.
B. The exhalation ports are open during exhalation.
C. The exhalation ports are closed during inhalation.
D. The reservoir bag is not inflated during inhalation. - Answer-D. The reservoir bag is
not inflated during inhalation.
Which statement made by a client prescribed oxygen therapy at home indicates to the
nurse that more instruction is needed?
A. "When I want to smoke, I will use the liquid oxygen reservoir instead of the
compressed oxygen tank."
B. "Using oxygen should help me have more breath and stamina when I eat, bathe, and
take care of myself."
C. "Even though they contain alcohol, I can still drink a glass of wine or can of beer
while using oxygen."
D. "If my shortness of breath becomes worse or if I have chest pain I will contact my
primary health care provider immediately." - Answer-A. "When I want to smoke, I will
use the liquid oxygen reservoir instead of the compressed oxygen tank."
Which action does the nurse take care to avoid while suctioning a client's tracheostomy
tube?
A. Twirling the catheter while applying suction
B. Applying suction only when withdrawing the catheter
C. Performing oral suctioning before suctioning the artificial airway
D. Lubricating the suction catheter with sterile saline before insertion - Answer-C.
Performing oral suctioning before suctioning the artificial airway
Which statements about oxygen and oxygen therapy are true? Select all that apply.
A. An oxygen concentrator reduces the amount of carbon dioxide in atmospheric air.
B. Clients must provide informed consent to receive oxygen therapy.
C. Excessive oxygen use is a contributing cause of chronic obstructive pulmonary
disease.
D. In nonemergency situations, a health care provider's prescription is needed for
oxygen therapy.
,E. Oxygen can explode when handled improperly.
F. Oxygen is a beneficial element but can harm lung tissue.
G. The liquid form of oxygen is a drug to manage hypoxia, whereas the gaseous form is
only an atmospheric element.
H. Unless humidity is added, therapy with oxygen dries the upper and lower mucous
membranes. - Answer-D. In nonemergency situations, a health care provider's
prescription is needed for oxygen therapy.
F. Oxygen is a beneficial element but can harm lung tissue.
H. Unless humidity is added, therapy with oxygen dries the upper and lower mucous
membranes.
The SpO2 of a client receiving oxygen therapy by nasal cannula at 6 L/min has dropped
from 94% an hour ago to 90%. Which action does the nurse perform first to improve gas
exchange before reporting the change to the primary health care provider?
A. Tighten the straps on the nasal cannula
B. Increase the oxygen flow rate to 8 L/min
C. Check the tubing for kinks, leaks, or obstructions
D. Check to determine whether the oxygen delivery system is adequately humidified -
Answer-C. Check the tubing for kinks, leaks, or obstructions
Which action does the nurse use to prevent harm by loss of tracheal tissue integrity in a
client with a tracheostomy?
A. Providing meticulous oral care every 8 hours
B. Deflating the cuff for 15 minutes every 2 hours
C. Feeding the client liquids rather than solid foods
D. Maintaining cuff inflation pressure less than 25 cm H2O - Answer-D. Maintaining cuff
inflation pressure less than 25 cm H2O
A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse
provides instructions regarding the adverse effects of this medication and should tell the
client that which undesirable effect is associated with this medication?
a. Insomnia
b. Constipation
c. Hypotension
d. Bronchospasm - Answer-d. Bronchospasm
Terbutaline is prescribed for a client with bronchitis. Which disorder in the client's
medical history requires caution by the nurse?
a. Osteoarthritis
b. Hypothyroidism
c. Diabetes mellitus
d. Polycystic disease - Answer-c. Diabetes mellitus
Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does
the nurse expect to be prescribed before the administration of this medication?
,a. Platelet count
b. Neutrophil count
c. Liver function tests
d. Complete blood count - Answer-c. Liver function tests
A client has been taking isoniazid for 2 months. The client complains to the nurse about
numbness, paresthesias, and tingling in the extremities. The nurse interprets that the
client is experiencing which problem?
a. Hypercalcemia
b. Peripheral neuritis
c. Small blood vessel spasm
d. Impaired peripheral circulation - Answer-b. Peripheral neuritis
A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to
teach the client to take which action?
a. Use alcohol in small amounts only.
b. Report yellow eyes or skin immediately.
c. Increase intake of Swiss or aged cheeses.
d. Avoid vitamin supplements during therapy. - Answer-b. Report yellow eyes or skin
immediately.
A client has been started on long-term therapy with rifampin. The nurse should provide
which information to the client about the medication?
a. Should always be taken with food or antacids
b. Should be double-dosed if 1 dose is forgotten
c. Causes orange discoloration of sweat, tears, urine, and feces
d. May be discontinued independently if symptoms are gone in 3 months - Answer-c.
Causes orange discoloration of sweat, tears, urine, and feces
The nurse has given a client taking ethambutol information about the medication. The
nurse determines that the client understands the instructions if the client states that they
will immediately report which finding?
a. Impaired sense of hearing
b. Gastrointestinal side effects
c. Orange-red discoloration of body secretions
d. Difficulty in discriminating the color red from green - Answer-d. Difficulty in
discriminating the color red from green
The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone
dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the
medication using which procedure?
a. Beclomethasone first and then the salmeterol
b. Salmeterol first and then the beclomethasone
c. Alternating a single puff of each, beginning with the salmeterol
d. Alternating a single puff of each, beginning with the beclomethasone - Answer-b.
Salmeterol first and then the beclomethasone
, A client with tuberculosis is starting antituberculosis therapy with isoniazid. Before giving
the client the first dose, the nurse should ensure that which baseline study has been
completed?
a. Electrolyte levels
b. Coagulation times
c. Liver enzyme levels
d. Serum creatinine level - Answer-c. Liver enzyme levels
Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC)
disease and tuberculosis. The nurse should monitor for which side and adverse effects
of rifabutin? Select all that apply.
a. Signs of hepatitis
b. Flu-like syndrome
c. Low neutrophil count
d. Vitamin B6 deficiency
e. Ocular pain or blurred vision
f. Tingling and numbness of the fingers - Answer-a. Signs of hepatitis
b. Flu-like syndrome
c. Low neutrophil count
e. Ocular pain or blurred vision
A client begins therapy with theophylline. The nurse plans to teach the client to limit the
intake of which items while taking this medication?
a. Coffee, cola, and chocolate
b. Oysters, lobster, and shrimp
c. Melons, oranges, and pineapple
d. Cottage cheese, cream cheese, and dairy creamers - Answer-a. Coffee, cola, and
chocolate
The nurse has just administered the first dose of omalizumab to a client. Which
statement by the client alerts the nurse of a life-threatening effect?
a. "I have a severe headache."
b. "My feet are quite swollen."
c. "I am nauseated and may vomit."
d. "My lips and tongue are swollen." - Answer-d. "My lips and tongue are swollen."
The nurse is teaching a client who is beginning antiviral therapy for influenza. Which
statement by the client indicates an understanding of the instructions?
a. "I must take the medication exactly as prescribed."
b. "Once I start the medication, I will no longer be contagious."
c. "I will not get any colds or infections while taking this medication."
d. "This medication has minimal side effects and I can return to normal activities." -
Answer-a. "I must take the medication exactly as prescribed."