CHAPTER 33 – OXYGENATION STUDY GUIDE

Key Concepts

Oxygenation

 The process of getting oxygen into the body and delivering it to tissues and organs.

 Oxygen is required for cell metabolism (energy production).

 Without oxygen, cells begin to die within minutes → this is why oxygenation is critical to life.

Respiration

 The exchange of gases (oxygen and carbon dioxide) in the body.

 Two types:

o External Respiration: Gas exchange between lungs and bloodstream (at the alveoli).

o Internal Respiration: Gas exchange between bloodstream and tissues.

Ventilation

 The physical movement of air in and out of the lungs.

o Inhalation = breathing in oxygen

o Exhalation = breathing out carbon dioxide

In simple terms:
→ Ventilation = movement of air
→ Respiration = gas exchange
→ Oxygenation = cells receiving oxygen

Pulmonary System (Respiratory System)

Airway

The pathway that air travels through to reach the lungs.

Functions:

 Moistens air to protect lung tissue.

 Warms air to body temperature.

 Filters air to trap bacteria and particles.

Upper Airway

Structur
Function
e

Pharynx Passageway for air and food.

Epiglott Flap of tissue that prevents food from entering airway

is during swallowing.

Trachea Windpipe; transports air into lungs.

Lower Airway

Structure Function

Trachea Continues to carry air downward.

Two main branches that lead to each

Bronchi
lung.

Bronchiol Smaller airways leading to the

es alveoli.

Lungs

Paired organs responsible for oxygen and carbon dioxide exchange.

Part Description

Apex Top of lung (narrow and pointed).

Base Bottom of lung (wide and rests on diaphragm).

Alveol Tiny air sacs where gas exchange occurs. Surrounded

i by capillaries.

Important Note:
Alveoli must stay open to allow gas exchange. If they collapse (atelectasis), oxygenation is impaired.

Functions of the Pulmonary System

1. Ventilation

Movement of air in and out of lungs.

Muscles Involved

Structure Role

Diaphragm Main muscle of breathing; contracts to pull air in.

Intercostal
Expand rib cage to allow lung expansion.
Muscles

Pleural Surrounds lungs and allows smooth movement in

Membrane chest cavity.
Factors Affecting Ventilation

Factor Explanation Nursing Considerations

Respiratory Rate & Too fast, too slow, too shallow affects oxygen
Count rate; observe chest rise.
Depth exchange.

Breathing too fast → CO₂ too low → dizziness, Calm breathing, rebreathing into hands
Hyperventilation
tingling. may help.

Breathing too slow/shallow → CO₂ retains →

Hypoventilation Can lead to confusion → monitor ABGs.
respiratory acidosis.

In diseases like emphysema, lungs lose elasticity →

Lung Elasticity May need pursed-lip breathing.
harder to exhale.

Stiff lungs (e.g., pneumonia, ARDS) make expansion Encourage deep breathing & incentive
Lung Compliance
difficult. spirometry.

Seen in asthma, COPD → narrow airway increases

Airway Resistance Bronchodilators to open airway.
effort to breathe.

2. Respiration (Gas Exchange)

External Respiration

 O₂ moves from alveoli → bloodstream.

 CO₂ moves from bloodstream → alveoli to be exhaled.

Internal Respiration

 O₂ moves from bloodstream → cells/tissues.

 CO₂ moves from cells → bloodstream to return to lungs.

Breathing Control

Breathing is mostly involuntary and controlled by the brainstem.

Chemoreceptors

 Located in brainstem and carotid arteries.

 Monitor CO₂ and O₂ levels.

 If CO₂ increases → breathing rate increases to blow it off.

Clinical Note:
In COPD patients, the body adapts to high CO₂ → they rely on low O₂ to trigger breathing.
→ Never give high-flow oxygen to a COPD patient suddenly.
It may stop their drive to breathe.

Lung Receptors
  Nerve receptors in airways and alveoli.

 Detect irritants, stretch, and fluid.

 Trigger actions like coughing, bronchoconstriction, or rapid breathing.

Critical Nursing Considerations

Assessment Why it matters

Respiratory Rate, Depth,

Early indicator of deterioration.
Pattern

Shows oxygen saturation. Goal usually ≥ 95% (unless COPD

SpO₂ (Pulse Oximetry)
baseline is lower).

Crackles, wheezes, rhonchi indicate mucus, fluid, or airway

Lung Sounds
narrowing.

Skin Color Cyanosis indicates hypoxia.

Brain is very sensitive to oxygen deprivation. Confusion = early

Level of Consciousness
sign of hypoxia.

Priority Nursing Action for Low Oxygen

1. Raise Head of Bed (High Fowler’s Position)

2. Encourage Deep Breathing

3. Provide Oxygen if Ordered

4. Notify Provider if no improvement

Quick Summary

Term Simple Definition

Movement of air in and out of

Ventilation
lungs.

Respiration Gas exchange (O₂ ↔ CO₂).

Oxygenation Cells receiving oxygen.

Alveoli Site of gas exchange in lungs.

Chemorecepto Detect CO₂ and regulate

rs breathing.
External Factors Affecting Pulmonary (Respiratory) Function

These are outside influences that change how well a person can breathe or exchange gases.

1. Developmental Stage

Lung, heart, and circulatory function change across the lifespan — so oxygen needs and risks vary by age.

Stage Key Points Nursing Considerations

Lungs are immature, smaller airways → easily

Monitor breathing effort (flaring, grunting).
obstructed. They breathe faster. At risk for
Infants Keep infant upright to help breathe. Avoid
respiratory infections because immune system is
smoke exposure.
developing.

Increased risk of aspiration (putting objects/food Teach caregivers about choking hazards.
Toddlers
into airway). Still developing immunity. Encourage vaccinations.

Preschool & High exposure to viruses (daycare, school). Teach hand hygiene. Monitor for frequent
School-Age Tonsil/adenoid hypertrophy may obstruct airway. sore throats or snoring.

Often exposed to smoking, vaping, alcohol, Education about lung damage and addiction.
Adolescents
drugs. Rapid body growth increases oxygen needs. Assess for vaping history.

Young and Lifestyle factors (stress, smoking, sedentary lifestyle) Promote exercise, smoking cessation. Screen
Middle Adults influence breathing. for anxiety and sleep apnea.

Encourage incentive spirometry, deep

Lung elasticity decreases, chest wall stiffens,
Older Adults breathing, and hydration to thin secretions.
cough reflex weakens → higher pneumonia risk.
Watch for confusion (early hypoxia).

2. Environment

Factor What Happens Nursing Considerations

Increases respiratory rate → hyperventilation

Stress Teach slow breathing techniques.
→ dizziness, tingling.

Allergic Airway becomes inflamed and swollen → can Identify triggers; ensure patient has rescue
Reactions lead to asthma attack. inhaler. Monitor for wheezing.

Pollution and smoke irritate airways and

Air Quality Educate to stay indoors on poor air quality days.
worsen asthma/COPD.

Less oxygen in air → increases breathing and People may fatigue easily; allow rest and
Altitude
heart rate to compensate. gradual adjustment.

Temperature & Cold air constricts airway; warm humid air Asthma patients may benefit from warm
Humidity relaxes it. humidified air.

3. Lifestyle
Factor Effect on Breathing Nursing Considerations

Growing fetus pushes on diaphragm → Frequent rest, side-lying position to

Pregnancy
shortness of breath. improve oxygenation.

Occupational Hazards Causes chronic airway irritation → COPD,

Teach PPE use; screen for chronic cough.
(dust, asbestos, chemicals) lung cancer risk.

Poor nutrition weakens respiratory muscles.

Promote balanced diet; monitor for
Nutrition Obesity compresses lungs → decreases
shortness of breath in obese patients.
ventilation.

Strengthens respiratory muscles and Encourage gradual conditioning if

Exercise
improves oxygen use. sedentary.

Monitor respirations closely; high

Substance Abuse Depresses respiratory drive in brain →
overdose risk → prepare naloxone if
(opioids, sedatives, alcohol) slower breathing → CO₂ buildup.
opioids involved.

4. Smoking

 Damages alveoli, increases airway inflammation, destroys lung elasticity.

 Major cause of COPD, lung cancer, and emphysema.

Nursing Considerations:

 Assess pack-year history (packs/day × years smoked).

 Provide smoking cessation support (nicotine patch, counseling).

 Do not shame; support behavior change.

5. Medications

 Opioids, sedatives, benzodiazepines → slow breathing → risk of hypoventilation.

 Bronchodilators (e.g., albuterol) → open airway.

 Steroids → reduce inflammation in lungs.

Nursing Tip: Always assess respiratory rate before giving sedative medications.

Pathophysiological Conditions That Alter Gas Exchange

1. Respiratory Infections

Examples: Pneumonia, Bronchitis, Influenza

Cause inflammation and mucus that block airflow and gas exchange.

Signs: Fever, cough, crackles, shortness of breath.

Nursing: Encourage coughing, deep breathing, hydration, and antibiotics if bacterial.
2. Pulmonary System Abnormalities

Type Explanation Examples Nursing Considerations

Changes to shape or chest Scoliosis, rib Positioning to maximize lung

Structural
movement. fractures. expansion.

Bronchodilators, breathing
Airway Disorders Narrowed or blocked airway. Asthma, COPD.
techniques (pursed-lip).

Encourage incentive
Collapse of alveoli → no gas Postoperative
Atelectasis spirometry and frequent
exchange. patients at high risk.
ambulation.

Alveolar-Capillary Damage to alveoli or capillaries ARDS, Pulmonary May require oxygen or ventilation
Membrane Disorders → impaired gas exchange. Edema. support.

3. Pulmonary Circulation Abnormalities

Affect blood flow to and from the lungs.

Examples:

 Pulmonary Embolism → blood clot blocks flow to lungs.

 Pulmonary Hypertension → high pressure in lung blood vessels.

Nursing: Monitor chest pain, dyspnea, anxiety, decreased SpO₂. Requires rapid response.

4. CNS / Neuromuscular Conditions

Breathing relies on brain and muscles.

 If brain cannot signal → breathing decreases.

o Example: Head injury, stroke

 If muscles are weak → lungs cannot expand.

o Example: ALS, Guillain-Barré, spinal cord injury

Nursing: Monitor respiratory effort. May require mechanical ventilation.

Quick Summary

 Breathing is influenced by age, environment, lifestyle, smoking, and medications.

 Gas exchange can fail due to infection, airway obstruction, alveoli collapse, circulation issues, or
neurological damage.

ASSESSMENT OF OXYGENATION
Nurses assess how well the lungs, heart, and circulatory system are delivering oxygen to tissues.

1. Lung, Heart, and Circulatory Function

 The lungs bring oxygen in and remove CO₂ (ventilation + respiration).

 The heart pumps oxygenated blood to tissues.

 The circulatory system delivers oxygen to cells.

If any part is impaired → oxygenation decreases.

2. Identify Risk Factors

Common risk factors:

 Smoking / vaping

 Age (infants and older adults)

 Chronic lung disease (Asthma, COPD)

 Occupational exposure (chemicals/dust)

 Obesity (restricts chest expansion)

 Immobility (risk of atelectasis and pneumonia)

Nursing Tip:
Always ask smoking history in pack-years. (packs/day × years)

3. Physical Examination

Assessment
What You Look For What It Means
Area

Chest pain with breathing may indicate

Pain Respiratory pain often worsens on inspiration.
pleurisy, pneumonia, PE.

Breathing Rate, rhythm, depth. Normal: 12–20 Tachypnea = anxiety, fever, hypoxia. Bradypnea =
Pattern breaths/min. narcotics or neuro injury.

Respiratory Use of accessory muscles, nasal flaring, tripod

Increased effort = difficulty breathing.
Effort position.

Productive cough → mucus. Dry cough → airway

Cough Productive or dry? Frequency?
irritation.

Lung Sounds
Sound Indicates

Wheezes Narrowed airways (asthma, COPD).

Crackles Fluid in alveoli (pneumonia, heart failure).

Rhonchi Mucus in the airway.

Absent Medical emergency → possible pneumothorax or

sounds atelectasis.

4. Diagnostic Testing

Test Purpose Nursing Notes

Sputum Culture Identifies organisms (bacteria/virus). Collect before antibiotics.

Skin Tests (TB) Detect exposure to tuberculosis. Read results in 48–72 hours.

Pulse Oximetry Measures O₂ saturation. Goal ≥95% unless Poor circulation & nail polish may affect
(SpO₂) COPD baseline lower. accuracy.

Capnography Measures exhaled CO₂ — shows ventilation

Useful for monitoring sedation/opioid use.
(ETCO₂) effectiveness.

Measures lung volumes & airflow; used for

Spirometry Patient must use consistent effort.
asthma/COPD.

Measures airflow during exhalation; used for Green, Yellow, Red zones guide
Peak Flow Meter
asthma control. treatment.

Arterial Blood Gases Most accurate measure of oxygenation

Measures pH, PaO₂, PaCO₂, HCO₃.
(ABGs) & ventilation.

ANALYSIS / NURSING DIAGNOSIS

Based on assessment, determine what the problem is and what is causing it.
Common Nursing Diagnoses

 Impaired Gas Exchange

Alveoli cannot exchange O₂ / CO₂ effectively.
Examples: Pneumonia, ARDS, Pulmonary Edema.

 Ineffective Airway Clearance

Mucus or obstruction prevents airflow.
Examples: Bronchitis, COPD.

 Ineffective Breathing Pattern

Rate or rhythm is abnormal.
Examples: Anxiety, pain, neurological injury.

 Risk for Aspiration

Swallowing impairment → food or fluid enters airway.
Examples: Stroke, decreased LOC.

Always link the diagnosis to a cause (etiology)

Example: Ineffective airway clearance r/t thick mucus AEB crackles & productive cough.

PLANNING OUTCOMES / INTERVENTIONS

Goal: Improve oxygenation and maintain open airways.

1. Respiratory Medications

Type Action Example Nursing Considerations

Bronchodilat Assess HR (can ↑). Use before steroid

Open airways Albuterol
ors inhalers.

Corticosteroi Reduce Rinse mouth after inhaled steroids. Monitor

Prednisone
ds inflammation glucose.

Guaifenesi
Mucolytics Thin secretions Encourage fluids.
n

2. Promote Optimal Respiratory Function

 High-Fowler’s position to increase lung expansion.

 Incentive spirometer 10× every hour while awake.

 Encourage deep breathing and coughing.

3. Prevent HCAP (Hospital-Acquired Pneumonia)

 Elevate HOB ≥ 30–45°.

 Oral hygiene every 2–4 hours.

 Encourage early ambulation.

4. Promote Immunization
  Influenza vaccine annually.

 Pneumococcal vaccine for older adults, immunocompromised, and chronic lung disease patients.

5. Support Smoking Cessation

 Offer nicotine replacement therapy.

 Encourage support groups.

 Use nonjudgmental language.

6. Positioning

 High Fowler’s improves breathing.

 Tripod position helps COPD patients exhale easier.

7. Mobilizing Secretions

Intervention Purpose

Hydration Thins mucus

Chest
Loosens mucus
Physiotherapy

Humidified Prevents dryness that thickens

Oxygen secretions

8. Oxygen Therapy

Oxygen Therapy Systems

Oxygen therapy is used to increase the amount of oxygen available to the lungs when a person cannot
maintain adequate oxygen levels on their own.

Important Nursing Rule:

Always administer oxygen based on provider order, unless the patient is in respiratory distress → then
apply oxygen and notify provider.

1. Wall Oxygen Outlets (Hospital)

What it is:

 Oxygen delivered from the hospital’s central oxygen supply system.

 Connected to the patient via flowmeter and tubing.

When Used:

 For hospitalized patients who require continuous oxygen.

Nursing Considerations:

 Ensure oxygen is connected to the green oxygen outlet (not the yellow air outlet).
  Adjust flow using the flowmeter.

 Always check that the oxygen is flowing (float ball rises).

 Humidification may be needed if flow is > 4 L/min to prevent airway dryness.

2. Portable Oxygen Tanks

What it is:

 Metal cylinder filled with compressed oxygen.

 Used for transport, home care, or mobility.

When Used:

 During patient transport (wheelchair, stretcher).

 For patients who need oxygen outside the hospital or at home.

Nursing Considerations:

 Secure tank upright — they are pressurized and can become projectiles if dropped.

 Always check tank pressure gauge → change tank before it runs low.

 No open flames or smoking near oxygen tanks.

 Teach patient how to carry and store safely (avoid heat and rolling).

3. Liquid Oxygen

What it is:

 Oxygen stored in liquid form in a small insulated container.

 Converts to gas when released.

When Used:

 Home oxygen users who require higher amounts of oxygen continuously.

 More portable and lighter than compressed tanks.

Advantages:

 Lasts longer than compressed tanks.

 Better for active patients.

Nursing Considerations:

 Must be kept upright and protected from heat.

 Do not store in warm or enclosed spaces.

 Avoid skin contact — liquid oxygen can cause frostbite.

4. Oxygen Concentrator

What it is:

 A home device that pulls room air in and filters out nitrogen, leaving concentrated oxygen.
  Uses a power source (electricity).

When Used:

 Long-term oxygen therapy in home-care settings.

Advantages:

 No refills needed (unlike tanks).

 Cost-effective for chronic conditions (COPD, pulmonary fibrosis).

Limitations:

 Cannot be used when the power goes out.

 Portable versions exist but have limited battery life.

Nursing Considerations:

 Teach patient to clean filters regularly.

 Ensure backup oxygen supply available (like a portable tank) in case of power outage.

 Avoid placing concentrator near curtains or heat sources (requires airflow).

Quick Comparison Table

System Best For Notes

Wall Outlet Inpatient, continuous oxygen Requires flowmeter; humidify >4 L/min.

Must be stored securely; check pressure

Portable Tank Transport, short-term mobility
gauge.

Active home users needing

Liquid Oxygen Keep upright; frostbite risk if spilled.
higher flow

Oxygen Requires electricity; clean filters; backup

Long-term home therapy
Concentrator tank needed.

Critical Safety Reminders (Always Tested!)

 No smoking or flames near oxygen.

 Avoid petroleum-based products (Vaseline) → use water-based lubricants.

 Post “Oxygen in Use” sign.

 Keep oxygen at least 10 feet away from heat sources.

Use the lowest O₂ flow that maintains SpO₂ within the provider’s ordered range.

Airways & Ventilation Support

Airway Type Use Notes

Pharyngeal Keeps tongue from blocking

Used in unconscious clients.
Airway airway
Airway Type Use Notes

Endotracheal Short-term mechanical

Maintain cuff pressure; prevent VAP.
Tube ventilation

Keep obturator at bedside; suction as

Tracheostomy Long-term airway support
needed.

Suctioning

 Use sterile technique.

 Preoxygenate before suctioning.

 Limit suction time to 10–15 seconds.

9. Mechanical Ventilation & VAP Prevention

 HOB 30–45° at all times.

 Oral care with chlorhexidine.

 Sedation vacations & weaning trials.

10. Chest Tube Care

Used to remove air, blood, or fluid from pleural space.

Drainage System Components

Chamber Function

Prevents air from re-entering pleural space. Tidaling

Water Seal Chamber
is normal.

Suction Control
Regulates suction (water or dry system).
Chamber

Collection Chamber Collects drainage. Measure output.

Report: sudden ↑ in drainage, bright red blood, or no tidaling (may indicate obstruction).

Quick Review

 Assessment focuses on lung sounds, breathing effort, cough, SpO₂, and ABGs.

 Nursing diagnoses connect problem → cause → evidence.

 Interventions focus on airway first, then breathing, then circulation.

NCLEX Style Questions: Oxygenation (Chapter 33)

1.
A nurse is assessing a patient with pneumonia. Which assessment finding is the earliest indicator of hypoxia?

A. Cyanosis
B. Restlessness and confusion
C. Slow capillary refill
D. Blue discoloration around the lips

Answer: B. Restlessness and confusion

Rationale: The brain is highly sensitive to low oxygen. Confusion, anxiety, and restlessness are early signs.
Cyanosis is a late sign.

2.

A patient with COPD is receiving oxygen via nasal cannula at 2 L/min. The provider orders an increase to 6 L/min.
What is the priority nursing action?

A. Increase oxygen to 6 L/min

B. Apply a non-rebreather mask
C. Clarify the order before increasing O₂
D. Notify respiratory therapy

Answer: C. Clarify the order

Rationale: COPD patients rely on low O₂ levels to stimulate breathing. Sudden high flow may decrease
respiratory drive and cause respiratory arrest.

3.

Which breathing pattern is associated with hyperventilation?

A. Slow, shallow breathing

B. Rapid, deep breathing
C. Irregular breathing
D. Long pauses between breaths

Answer: B. Rapid, deep breathing

Rationale: Hyperventilation causes excessive CO₂ loss → dizziness and tingling.

4.

The nurse hears wheezing upon auscultation. This finding indicates:

A. Fluid in the alveoli

B. Air moving through narrowed airways
C. Thick mucus in large airways
D. Collapsed lung tissue

Answer: B. Narrowed airways

Rationale: Wheezing occurs in asthma and COPD due to airway constriction.

5.

Which patient is most at risk for atelectasis?

A. A toddler with a viral infection

B. A patient who is postoperative and immobile
C. An adolescent who vapes
D. A pregnant patient in the third trimester

Answer: B. Postoperative immobile patient

Rationale: Immobility leads to alveolar collapse. Encourage incentive spirometry.

6.

A patient has a respiratory rate of 8 breaths/min after receiving IV morphine. Which acid-base imbalance is likely?

A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis

Answer: B. Respiratory acidosis

Rationale: Opioids suppress breathing → CO₂ retention → acidosis.

7.

Which intervention best helps mobilize thick respiratory secretions?

A. Restrict fluids
B. High-Fowler’s position
C. Cool mist humidification
D. Increase oral fluid intake

Answer: D. Increase oral fluids

Rationale: Hydration thins secretions, making them easier to cough up.

8.

Which oxygen delivery system is most appropriate for short-term transport?

A. Wall oxygen
B. Liquid oxygen system
C. Portable oxygen tank
D. Home oxygen concentrator

Answer: C. Portable oxygen tank

Rationale: Tanks are used for transport and mobility.

9.

The nurse teaches a COPD patient pursed-lip breathing. What is the goal?

A. Increase lung expansion

B. Prevent airway collapse during exhalation
C. Increase oxygen intake
D. Reduce pain with breathing

Answer: B. Prevent airway collapse

Rationale: Pursed-lip breathing prolongs exhalation, improving CO₂ removal.
10.

Which finding indicates effective airway clearance interventions?

A. Respiratory rate 8/min

B. SpO₂ 84%
C. Decreased wheezing and improved breath sounds
D. Increased work of breathing

Answer: C
Rationale: Improved breath sounds and easier breathing show airway clearance is improving.

11.

A nurse prepares to suction a tracheostomy. Which action is correct?

A. Suction for 30 seconds

B. Do not provide oxygen before suctioning
C. Maintain clean technique
D. Limit suctioning to 10–15 seconds

Answer: D
Rationale: Longer suctioning may cause hypoxia. Always preoxygenate.

12.

Which is a late sign of hypoxia?

A. Confusion
B. Pale skin
C. Cyanosis
D. Anxiety

Answer: C. Cyanosis

13.

Which teaching is correct for home oxygen use?

A. Use petroleum jelly to prevent dryness

B. Store tanks lying flat
C. Keep oxygen 10 feet away from heat sources
D. Smoking is safe in another room

Answer: C
Rationale: Fire risk. Also avoid petroleum-based products (use water-based instead).

14.

Which patient should receive the pneumococcal vaccine?

A. 8-year-old child
B. 68-year-old adult with COPD
C. 20-year-old nonsmoker
D. 40-year-old athlete
Answer: B

15.

A nurse notices no tidaling in the chest tube’s water seal chamber. What is the correct action?

A. Document the finding

B. Check for kinks or obstruction
C. Increase suction
D. Notify provider immediately

Answer: B
Rationale: No tidaling = obstruction or lung re-expansion. First check tubing.

16.

A patient is suspected of having a pulmonary embolism. Which assessment finding requires immediate
intervention?

A. Productive cough
B. Sudden shortness of breath
C. Low-grade fever
D. Crackles in lung bases

Answer: B. Sudden shortness of breath

Rationale: A sudden onset of dyspnea is a hallmark sign of pulmonary embolism and is life-threatening.

17.

Which oxygen delivery device provides the most precise oxygen concentration?

A. Nasal cannula
B. Simple face mask
C. Venturi mask
D. Non-rebreather mask

Answer: C. Venturi mask

Rationale: The Venturi mask delivers exact FiO₂ and is preferred for COPD patients.

18.

Which is an expected finding in a patient with chronic COPD?

A. Barrel chest
B. High oxygen saturation
C. Bradypnea
D. Respiratory alkalosis

Answer: A. Barrel chest

Rationale: Overinflation of the lungs causes a barrel-shaped chest.

19.

A nurse is caring for a patient with pneumonia. Which intervention is most important for airway clearance?
A. Encourage deep breathing and coughing
B. Restrict fluids
C. Maintain supine position
D. Provide antipyretics

Answer: A
Rationale: Coughing and deep breathing help clear secretions and improve ventilation.

20.

A patient experiencing orthopnea should be positioned:

A. Prone
B. High-Fowler’s position
C. Semi-Fowler’s position
D. Side-lying

Answer: B
Rationale: Upright positioning maximizes lung expansion.

21.

Which finding indicates respiratory distress?

A. SpO₂ 98%
B. Use of accessory muscles
C. Regular breathing pattern
D. Clear breath sounds

Answer: B
Rationale: Using neck and chest muscles shows increased work of breathing.

22.

A patient with COPD has thick, tenacious secretions. Which intervention is most helpful?

A. Oral suctioning
B. Chest physiotherapy
C. Humidified oxygen
D. Bronchodilators only

Answer: C
Rationale: Humidity helps moisten airway secretions, making them easier to clear.

23.

Which breath sound indicates fluid in the alveoli?

A. Wheeze
B. Rhonchi
C. Crackles
D. Stridor

Answer: C
Rationale: Crackles are caused by collapsed alveoli popping open.
24.

Which breathing technique is appropriate for dyspnea and anxiety?

A. Diaphragmatic breathing
B. Huff coughing
C. Incentive spirometry
D. Pursed-lip breathing

Answer: D

25.

A patient is receiving 100% O₂ via non-rebreather mask. The reservoir bag is fully collapsed during inspiration. What
should the nurse do?

A. Notify the provider

B. Increase oxygen flow rate
C. Switch to a nasal cannula
D. Remove the mask temporarily

Answer: B
Rationale: The flow must be high enough to keep the reservoir bag two-thirds full.

26.

Which condition requires droplet precautions?

A. Asthma
B. Influenza
C. Emphysema
D. Pulmonary fibrosis

Answer: B

27.

Which lab value indicates chronic CO₂ retention?

A. Low hemoglobin
B. Low potassium
C. Elevated bicarbonate (HCO₃⁻)
D. Decreased hematocrit

Answer: C
Rationale: The kidneys compensate for chronic respiratory acidosis by retaining bicarbonate.

28.

A patient has a chest tube for pneumothorax. Bubbling is continuously present in the water seal chamber. What
does this indicate?

A. Lung re-expansion
B. Normal function
C. Air leak
D. Need for suction

Answer: C

29.

The nurse should discontinue suctioning if the patient:

A. Has thick secretions

B. Develops bradycardia
C. Coughs
D. Becomes restless

Answer: B
Rationale: Vagal stimulation during suctioning may cause dangerous bradycardia.

30.

Which patient is at highest risk for developing aspiration pneumonia?

A. Patient with COPD

B. Patient with asthma
C. Patient post-stroke with impaired swallowing
D. Patient on nasal cannula

Answer: C

31.

Low oxygen saturation due to poor ventilation corresponds to which ABG finding?

A. pH 7.48
B. PaCO₂ 55 mmHg
C. HCO₃⁻ 22 mEq/L
D. PaO₂ 98 mmHg

Answer: B
Rationale: Elevated CO₂ = respiratory acidosis from hypoventilation.

32.

Which intervention prevents postoperative atelectasis?

A. Bedrest
B. Decreasing fluids
C. Incentive spirometry
D. Supine positioning

Answer: C

33.

A key sign of tuberculosis is:

A. Productive yellow sputum
B. Night sweats and weight loss
C. Cough relieved by fluids
D. High-pitched stridor

Answer: B

34.

A nurse hears stridor. What should be done first?

A. Encourage coughing
B. Administer cough suppressant
C. Call rapid response / prepare for airway support
D. Provide incentive spirometry

Answer: C
Rationale: Stridor = upper airway obstruction, medical emergency.

35.

Which finding indicates effective incentive spirometry?

A. Increased work of breathing

B. Improved lung expansion and oxygenation
C. Decreased tidal volume
D. Fatigue

Answer: B

36.

A patient on 2 L/min nasal cannula has dry nasal passages. The best action is:

A. Increase flow
B. Add humidification
C. Switch to mask
D. Provide oral suctioning

Answer: B

37.

A nurse notes thick mucus plugging in a tracheostomy. First action?

A. Call provider
B. Suction the airway
C. Increase O₂
D. Perform chest x-ray

Answer: B

38.
COPD patients should be encouraged to consume:

A. High carbohydrate diet

B. Low calorie diet
C. Small, frequent meals high in protein and calories
D. High volume fluids during meals

Answer: C
Rationale: They require more energy to breathe.

39.

A patient is lethargic with shallow breathing and a rising CO₂ level. Priority intervention:

A. Increase fluids
B. Initiate noninvasive ventilation (BiPAP)
C. Place flat in bed
D. Provide bronchodilator only

Answer: B

40.

Which statement shows correct understanding of home oxygen safety?

A. “I can use Vaseline for dry lips.”

B. “I can store extra tanks in my closet.”
C. “I will keep oxygen away from open flames.”
D. “Smoking is safe in another room.”

Answer: C
Rationale: Oxygen accelerates combustion. Avoid petroleum products and all smoking.