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Cough five times per hour to prevent alveolar collapse. While coughing helps clear secretions and promote airway patency, it does not directly stimulate surfactant production. Deep breathing, not coughing, is the physiologic action that enhances surfactant release by expanding the alveoli.

Decrease fluid intake to reduce fluid accumulation in the alveoli. Limiting fluid intake does not influence surfactant production and could even lead to dehydration, thickened secretions, and impaired airway clearance. Surfactant release depends on alveolar expansion, not fluid restriction.

Sit with head of bed elevated to promote air movement through the pores of Kohn. Elevating the head of the bed aids ventilation but does not directly stimulate surfactant release. The pores of Kohn allow for collateral air movement between alveoli, but this process is not affected by patient positioning alone.

Recent weight loss or weight gain. Although changes in weight can provide important information about overall health and nutrition, they are not specific to activity–exercise patterns. Weight changes may indicate metabolic or cardiac issues rather than directly assessing respiratory function.

Ability to sleep through the entire night. This relates more to the sleep–rest pattern than to the activity–exercise pattern. While nighttime breathing difficulties (e.g., orthopnea) are important, they are assessed under a different functional health category.

Willingness to wear oxygen equipment in public. This question addresses the patient’s coping and self-concept rather than their activity–exercise pattern. Although it may influence treatment adherence, it does not evaluate respiratory tolerance to physical activity.

Begin listening at the apices. Although the apices should be assessed, starting here may cause the nurse to miss early signs of congestion or collapse at the bases. The apices are less commonly affected in early respiratory distress.

Begin listening on the anterior chest. While anterior assessment is necessary, lung sounds—especially in conditions like heart failure or pneumonia—are often more prominent and diagnostically significant on the posterior side, particularly at the bases.

Ask the patient to breathe through the nose with the mouth closed. During auscultation, the patient should breathe slowly and deeply through the mouth, not the nose, to ensure maximal air movement and clearer breath sounds. Breathing through the nose may muffle or obscure important respiratory findings.

Inspiratory chest expansion of 1 in. Normal chest expansion during inspiration is about 1 inch (2.5 cm) and should be symmetric. This finding is expected and indicates adequate lung inflation.

Percussion resonance over the lung bases. Resonance is the normal percussion tone over healthy lung tissue, reflecting air-filled alveoli. It indicates normal lung aeration and is not abnormal.

Symmetric chest expansion and contraction. Equal movement of both sides of the chest during breathing reflects normal respiratory mechanics and adequate bilateral lung expansion.

Bronchoscopy. A bronchoscopy involves inserting a flexible tube through the nose or mouth into the bronchi to directly visualize the airways, obtain tissue biopsies, or remove secretions. It does not involve removal of pleural fluid from the pleural space.

Pulmonary angiography. This test involves injecting contrast dye into the pulmonary arteries to evaluate blood flow and detect pulmonary embolism or vascular abnormalities. It is not used for fluid removal or pleural fluid analysis.

Sputum culture and sensitivity. A sputum test analyzes mucus expectorated from the lungs to identify microorganisms causing infection, such as pneumonia or tuberculosis. It evaluates airway secretions, not pleural fluid from the pleural cavity.

Impaired cardiac output. Low cardiac output would reduce tissue perfusion, leading to decreased PvO₂ and increased PvCO₂ due to poor oxygen delivery and CO₂ accumulation. However, the normal venous values here indicate that cardiac output is sufficient.

Unstable hemodynamics. Unstable hemodynamics, such as hypotension or shock, would alter tissue oxygen extraction and cause abnormal mixed venous gas values. These results show stable gas exchange and therefore do not suggest hemodynamic instability.

Inadequate delivery of oxygen to the tissues. Inadequate oxygen delivery would result in low PvO₂ (<30 mm Hg) and high PvCO₂, reflecting tissue hypoxia. The normal values here (PvO₂ 40 mm Hg, PvCO₂ 46 mm Hg) indicate that oxygen delivery is appropriate and tissue oxygenation is adequate.

Patient with a fever. Fever increases oxygen demand but does not affect pulse oximeter accuracy as long as perfusion is adequate.

Patient who is anesthetized. Pulse oximetry remains accurate during anesthesia with proper probe placement and perfusion.

Patient receiving oxygen therapy. Oxygen therapy raises SpO₂ but does not make readings unreliable; values still reflect actual oxygen saturation.

CO₂ displaces oxygen on hemoglobin, leading to decreased PaO₂. While CO₂ can bind to hemoglobin, it does not directly displace oxygen to the extent that it causes increased respiratory drive; the primary mechanism involves pH changes in CSF.

CO₂ causes an increase in the amount of hydrogen ions available in the body. Although this is true, it is incomplete — the lowered CSF pH, not simply the presence of hydrogen ions, is what stimulates the respiratory center.

CO₂ directly stimulates chemoreceptors in the medulla to increase respiratory rate and volume. CO₂ itself is not the direct stimulant; rather, the acidic pH resulting from CO₂ conversion to carbonic acid activates the chemoreceptors.

Cough reflex. Although chronic smoking may eventually dull the cough reflex, its initial and most significant effect is on the cilia and mucus transport system, not the cough reflex itself.

Filtration of air. Filtration primarily occurs in the nasal passages through hairs and turbinates, which are less affected by smoking compared to the ciliary mechanism in the lower airways.

Reflex bronchoconstriction. This reflex protects the airways from irritants by narrowing the bronchi; while smoke can trigger bronchoconstriction, it does not impair this reflex as consistently as it damages cilia.

There is no redness or induration at the injection site.A lack of induration means the test is negative, indicating no infection or no immune response.

There is an induration of only 5 mm at the injection site.An induration of 5 mm is considered positive only in high-risk groups (e.g., HIV-positive individuals, recent TB contacts, or immunosuppressed patients). For healthy nurses, 10 mm is the diagnostic threshold.

A negative skin test is followed by a negative chest x-ray.A negative result on both tests suggests no infection, but does not meet the criteria for being “infected.”

Adding heparin to the blood specimen.Heparin is already present in the syringe before sampling to prevent clotting; adding more after collection is unnecessary and could dilute the specimen.

Applying pressure to the puncture site for 2 full minutes.Pressure should be applied for at least 5 minutes (or longer if the patient is on anticoagulants) to prevent bleeding or hematoma formation.

Avoiding any changes in oxygen intervention for 20 minutes following the procedure.Oxygen interventions should not be altered before the ABG draw, but this restriction does not apply after the sample has been collected.