Unit 5 Resp Questions
The sigh mechanism on an assist-control ventilator needs to be adjusted to provide ________ sigh(s) per hour at a rate that is ________ times the tidal volume.
1 to 3,1.5
FYI Low or decreased compliance occurs with certain pathology. Answer should include four of the following: morbid obesity, atelectasis, pneumothorax, hemothorax, pulmonary fibrosis or edema, pleural effusion, ARDS.
..
FYI Partial pressure is the pressure exerted by each type of gas (e.g., oxygen, carbon dioxide) in a mixture of gases.
..
FYI The epiglottis is a flap of cartilage that covers the opening of the larynx during swallowing.
..
FYI Ventilation refers to the movement of air in and out of the airways, whereas respiration refers to gas exchange between atmospheric air and blood and between the blood and the cells of the body.
..
and the tidal volume should be ________ mL/kg.
10 to 15, 6, 7 to 9
Cuff pressure for an endotracheal tube should be maintained at ________ mm Hg and should be checked every ________ hours.
15 and 20, 6 to 8
A patient has a dry suction water seal connected to a chest tube. When the water seal rises above ________ cm level, intrathoracic pressure increases.
2
The water seal used in a disposable chest drainage system is effective if the water seal chamber is filled to the level of ________ cm H2O.
2
The median survival age for individuals diagnosed with cystic fibrosis is now ________ years.
37
Hospital-acquired pneumonia develops ________ hours or more after admission and does not appear to be incubating at the time of admission.
48
The alveoli begin to lose elasticity at about age ________ years, resulting in decreased gas diffusion.
50
Oxygen toxicity may occur when oxygen concentration at greater than ________% is given for ________ (length of time).
50, >48 hours
Tidal volume, which may not significantly change with disease, has a normal value of approximately ________ mL.
500
The oxygen flow rate for a nasal cannula should not exceed ________L/min.
6
Name a genetic risk factor for COPD.
A genetic risk factor for COPD is a deficiency in alpha1-antitrypsin, an enzyme inhibitor that protects the lungs.
Explain what is meant when the patient is said to be "bucking the ventilator."
A patient "bucks the ventilator" when their breathing is out of phase with the machine. This occurs when the patient attempts to breathe out during the ventilator's mechanical inspiratory phase or when there is jerky and increased abdominal muscle effort.
Describe three ways that bronchodilators relieve bronchospasm.
Alter smooth muscle tone, reduce airway obstruction, and improve alveolar ventilation
Result of decreased effective hemoglobin concentration
Anemic hypoxia
List five of the nine major factors that determine the clinical course and survival of patients with COPD.
Answer should include five of the following: history of cigarette smoking, passive smoking exposure, age, rate of decline of FEV1, hypoxemia, weight loss, reversibility of airflow obstruction, pulmonary artery pressure, and resting heart rate.
What five assessment findings determine oxygen toxicity?
Answer should include five of the following: substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, alveolar infiltrates on xray.
If untreated, chronic rhinosinusitis can lead to severe complications. List four
Answer should include four of the following: severe orbital cellulitis, subperiosteal abscess, cavernous sinus thrombosis, meningitis, encephalitis, and ischemic infarction.
List six major signs and symptoms of respiratory disease.
Answer should include six of the following: dyspnea, cough, sputum production, chest pain, wheezing and hemoptysis, tachypnea, hypoxia.
________ remain the most common treatment for rhinitis and are administered for sneezing, pruritus, and rhinorrhea.
Antihistamines
What function does bilevel positive airway pressure (bi-PAP) ventilation serve for the patient?
Bi-PAP ventilation offers independent control of inspiratory and expiratory pressures while providing pressure support ventilation. It delivers two levels of positive airway pressure provided via a nasal or oral mask, nasal pillow, or mouthpiece with a tight seal and portable ventilator.
Explain the breathing pattern characterized as Cheyne-Stokes Respirations
Cheyne-Stokes respirations are characterized by alternating episodes of apnea (cessation of breathing) and periods of deep breathing. It is usually associated with heart failure and damage to the respiratory center.
List the three primary symptoms associated with the progressive stage of COPD.
Chronic cough, sputum production, and dyspnea on exertion.
Describe the results of chronic airway inflammation in COPD.
Chronic inflammation results in the following: increased goblet cells and enlarged submucosal glands (proximal airways), inflammation and airway narrowing (peripheral airways), and narrowing of the airway lumen.
What is the purpose of cilia?
Cilia move the mucus back to the larynx.
Results from inadequatecapillary circulation
Circulatory hypoxia
List five potential complications of an upper airway infection:
Complications may include sepsis, a peritonsillar abscess, otitis media, sinusitis, and meningitis.
________, one of the complications of emphysema, is right-sided heart failure brought on by long-term high blood pressure in the pulmonary arteries.
Cor pulmonale
Excision of the vocal cord for lesions in the middle third of the vocal cord
Cordectomy
For a patient with chronic obstructive pulmonary disease (COPD), what is the stimulus for respiration?
Decreased blood oxygen rather than elevated carbon dioxide levels.
List three goals of chest physiotherapy (CPT):
Dislodge mucus and remove bronchial secretions, improve ventilation, increase the efficiency of the respiratory muscles
Name seven possible clinical manifestations of atelectasis.
Dyspnea, cough, sputum production, tachycardia, tachypnea, pleural pain, and central cyanosis
Define the etiology of cor pulmonale.
Enlargement of the right ventricle of the heart because of diseases affecting the structure or functions of the lung
Identify eight nursing measures that can be used to prevent atelectasis.
Frequent turning, early mobilization, deep breathing maneuvers, assistance with the use of spirometry, suctioning, postural drainage, aerosol nebulizer treatments, and chest percussion
Toxic substance interferes with the ability of tissues to use oxygen.
Histotoxic hypoxia
A decrease in the arterial oxygen tension in the blood
Hypoxemia
Decrease in oxygen supply to the tissues
Hypoxemia
Describe the characteristic and diagnostic feature of ARDS.
Hypoxemia that does not respond to supplemental oxygen
Decreased oxygen level in the blood
Hypoxemic hypoxia
Describe the two main types of emphysema.
In the panlobular (panacinar) type of emphysema, there is destruction of the respiratory bronchiole, alveolar duct, and alveolus. All airspaces within the lobule are essentially enlarged, but there is little inflammatory disease. A hyperinflated (hyperexpanded) chest, marked dyspnea on exertion, and weight loss typically occur. In the centrilobular (centroacinar) form, pathologic changes take place mainly in the center of the secondary lobule, preserving the peripheral portions of the acinus (i.e., the terminal airway unit where gas exchange occurs). Frequently, there is a derangement of ventilation-perfusion ratios, producing chronic hypoxemia, hypercapnia, polycythemia (i.e., an increase in red blood cells), and episodes of right-sided heart failure. This leads to central cyanosis and respiratory failure. The patient also develops peripheral edema.
Microelectrodes are used for surgical resection of smaller laryngeal tumors
Laser surgery
What are five examples of low-flow oxygen delivery systems?
Nasal cannula, oropharyngeal catheter, simple mask, partial rebreather, nonrebreather.
It is important when a patient is on oxygen to post a ________ to prevent the danger of fire.
No Smoking sign
List the clinical manifestations that are used to diagnose obstructive sleep apnea.
Obstructive sleep apnea is defined as frequent loud snoring and breathing cessation for 10 seconds or longer with five or more episodes per hour. This is followed by awakening abruptly with a loud snort when the blood oxygen level drops.
The symbol used to identify the partial pressure of oxygen is ________.
PaO2
Portion of the larynx is removed, along with one vocal cord, and the tumor
Partial laryngectomy
________ is the most common major suppurative complication of sore throat
Peritonsillar abscess
Explain how positive pressure ventilators work.
Positive pressure ventilators inflate the lungs by exerting pressure on the airway, pushing air in, forcing the alveoli to expand during inspiration.
List four possible nursing diagnoses for a patient with an upper airway infection:
Refer to section "The Patient WithUpper Airway Infection" in the textbook.
Explain how rhinitis can lead to rhinosinusitis.Activity B
Rhinitis causes the nasal passages to become inflamed, congested, and edematous. The swollen conchae block the sinus openings and cause sinusitis.
________ depresses the activity of scavenger cells and affects the respiratory tract's ciliary cleansing mechanism, which keeps breathing passages free of inhaled irritants, bacteria, and other foreign matter.
Smoking
________ is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC).
Spirometry
To help prevent infections in patients with COPD, the nurse should recommend vaccination against two bacterial organisms: ________ and ________.
Streptococcus pneumoniae, Haemophilus influenzae
Name four bacterial organisms that account for more than 60% of all cases of acute rhinosinusitis
Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis
What are four common phenomena that can alter bronchial diameter?
Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis
Three common pathogens that cause aspiration pneumonia are ________, ________, and ________.
Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus Aureus
Explain the meaning of the term superinfection.
Superinfection is suspected when a subsequent infection occurs with another bacterium during antibiotic therapy.
A patient in the process of being weaned from the ventilator will have a ________ connected to the endotracheal tube.
T-piece
________, ________, and ________ are hallmarks of the severity of atelectasis.
Tachypnea, dyspnea, mild to moderate hypoxemia
Complete removal of the larynx
Total laryngectomy
________ are the alveolar cells that secrete surfactant.
Type II cells
A patient will require a ________ mask, which is the most reliable and accurate method of delivery, when a precise concentration of oxygen is required.
Venturi
Removal of the mucosa on the edge of the vocal cord
Vocal cord stripping
A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned? a. Auscultate the lung for adventitious sounds b. Have the patient inform the nurse of the need to be suctioned c. Assess the CO2 level to determine if the patient requires suctioning d. Have the patient cough
a
A patient comes to the clinic reporting a possible upper respiratory infection. What should the nurse assess that would indicate that an upper respiratory infection may be present? a. The nasal mucosa b. The buccal mucosa c. The frontal sinuses d. The tracheal mucosa
a
A patient comes to the clinic reporting a sore throat and is diagnosed with acute pharyngitis. Which causative bacteria does the nurse anticipate was the cause of the acute pharyngitis? a. Group A, beta-hemolytic streptococci b. Gram-negative Klebsiella c. Pseudomonas aeruginosa d. Staphylococcus aureus
a
A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication? a. 0 to 4 mm b. 5 to 6 mm c. 7 to 8 mm d. 9 mm
a
A patient has been diagnosed with acute rhinosinusitis caused by a bacterial organism. What antibiotic of choice for treatment of this disorder does the nurse anticipate educating the patient about? a. Amoxicillin-clavulanate b. Cephalexin c. Azithromycin d. Clarithromycin
a
A patient diagnosed 2 weeks ago with acute pharyngitis comes to the clinic stating that the sore throat got better for a couple of days and is now back along with an earache. What complications should the nurse be aware of related to acute pharyngitis? (Select all that apply.) a. Mastoiditis b. Otitis media c. Peritonsillar abscess d. Pericarditis e. Encephalitis
a, b, c
A patient who had a colon resection 3 days ago reports discomfort in the left calf. How should the nurse assess Homan sign to determine if the patient may have a thrombus formation in the leg? a. Dorsiflex the foot while the leg is elevated to check for calf pain b. Elevate the patient's legs for 20 minutes and then lower them slowly while checking for areas of inadequate blood return c. Extend the leg, plantar flex the foot, and check for the patency of the dorsalis pedis pulse d. Lower the patient's legs and massage the calf muscles to note any areas of tenderness
a
A patient with pulmonary hypertension has a positive vasoreactivity test. What medication does the nurse anticipate administering to this patient? a. Calcium channel blockers b. Angiotensin converting enzyme inhibitor c. Beta blockers d. Angiotensin receptor blockers
a
A patient with sinus congestion reports discomfort when the nurse is palpating the supraorbital ridges. The nurse is aware that the patient is referring to which sinus? a. Frontal b. Ethmoidal c. Maxillary d. SphenoidalActivity D
a
The nurse is developing a plan of care for a patient with acute tracheobronchitis. What nursing interventions should be included in the plan of care? (Select all that apply.) a. Increasing fluid intake to remove secretions b. Encouraging the patient to remain in bed c. Using cool-vapor therapy to relieve laryngeal and tracheal irritation d. Giving 3 L fluid per day e. Administering a narcotic analgesic for pain E
a, b, c
The nurse is educating a patient who is scheduled for a perfusion lung scan. What should be included in the information about the procedure? (Select all that apply.) a. A mask will be placed over the nose and mouth during the test b. The patient will be expected to lie under the camera c. The imaging time will amount to 20 to 40 minutes d. The patient will be expected to be NPO for 12 hours prior to the procedure e. An injection will be placed into the lung during the procedure
a, b, c
The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does in-line suction have for the patient? (Select all that apply.) a. Decreases hypoxemia b. Decreases patient anxiety c. Sustains positive end expiratory pressure (PEEP) d. Increases oxygen consumption e. Prevents aspiration
a, b, c
Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) a. Compromised gas exchange b. Decreased airflow c. Wheezes d. Jugular vein distention e. Ascites
a, b, c
List four conditions that are influenced by genetic factors that affect respiratory function:
asthma, COPD, cystic fibrosis, alpha-1 antitrypsin deficiency
A nurse notes that the FEV1/FVC ratio is less than 70% for a patient with COPD. What stage should the nurse document the patient is in? a. 0 b. I c. II d. III
b
A patient arrives in the emergency department after being involved in a motor vehicle crash. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates? a. Pneumothorax b. Flail chest c. ARDS d. Tension pneumothorax
b
A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? a. Ascites b. Dyspnea c. Hypertension d. Syncope
b
The nurse is educating a patient diagnosed with acute bacterial rhinosinusitis about interventions that may assist with symptom control. What should the nurse include in this information? (Select all that apply.) a. Take an over-the-counter nasal decongestant b. Take an over-the-counter antihistamine c. Ensure an adequate fluid intake d. Increase the humidity in the home e. Apply local heat to promote drainage
c, d, e
The nurse is taking a respiratory history for a patient who has come into the clinic with a chronic cough. What information should the nurse obtain from this patient? (Select all that apply.) a. Financial ability to pay the bill b. Social support c. Previous history of lung disease in the patient or family d. Occupational and environmental influences e. Previous history of smoking
c, d, e
When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system should the nurse be aware of? (Select all that apply.) a. Decreased alveolar duct diameter b. Increased presence of mucus c. Decreased gag reflex d. Increased presence of collagen in alveolar walls e. Decreased presence of mucus
c, d, e
Oxygen transport to the tissues is dependent on four factors: ________, ________, ________, and ________.
cardiac output, arterial oxygen content, hemoglobin concentration, metabolic requirements
The single most cost-effective intervention to reduce the risk of developing COPD or slow its progression is ________.
cessation of smoking
Antioxidants such as ________, ________, and ________ may help defend against oxygen-free radicals.
chronic obstructive pulmonary disease (COPD)
A child is having an asthma attack and the parent cannot remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tells the parent to use which inhalant? a. Cromolyn sodium b. Theophylline c. Salmeterol d. Albuterol
d
A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient? a. 40 mm Hg b. 75 mm Hg c. 80 mm Hg d. 95 mm Hg
d
A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse recognize is the most common organism that causes community acquired pneumonia? a. Staphylococcus aureus b. Mycobacterium tuberculosis c. Pseudomonas aeruginosa d. Streptococcus pneumoniae
d
A patient with COPD requires oxygen administration. What method of delivery does the nurse know would produce optimal results for this patient? a. A nasal cannula b. An oropharyngeal catheter c. A nonrebreathing mask d. A Venturi mask
d
A patient with emphysema is placed on continuous oxygen at 2 L/min at home. Why is it important for the nurse to educate the patient and family that they must have No Smoking signs placed on the doors? a. Oxygen is combustible b. Oxygen is explosive c. Oxygen prevents the dispersion of smoke particles d. Oxygen supports combustion
d
A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse? a. "You are not a candidate because you have heart failure" b. "You would have a difficult time recovering from the procedure" c. "At this point, do you really want to go through something like that?" d. "You and your physician should discuss the options that are available for treatment"
d
The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? a. Cough b. Hemoptysis c. Syncope d. Tachypnea
d
The nurse is assessing a patient who has been admitted with possible acute respiratory distress syndrome (ARDS). What findings would distinguish ARDS from cardiogenic pulmonary edema? a. Elevated white blood count b. Elevated troponin levels c. Elevated myoglobin levels d. Elevated B-type natriuretic peptide (BNP) levels
d
The nurse is assessing a patient who smokes two packs of cigarettes per day and has a strong family history of cancer. What early sign of cancer of the larynx does the nurse look for in this patient? a. Burning of the throat when hot liquids are ingested b. Enlarged cervical nodes c. Dysphagia d. Affected voice sounds
d
The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient's diagnosis? a. Dullness or flatness on percussion over areas of collected fluid b. Dyspnea and coughing c. Fever and chills d. Stabbing pain during respiratory movement
d
The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
d
The exchange of oxygen and carbon dioxide from the alveoli into the blood occurs by ________.
diffusion
A(n) ________ is an accumulation of thick, purulent fluid within the pleural space, often with fibrin development and a loculated area where infection is located (Strange, 2016).
empyema
List three types of alaryngeal communication:
esophageal speech, an artificial larynx, tracheoesophageal puncture
The most serious complication of a tonsillectomy is ________
hemorrhage
Decreased gas exchange at the cellular level resulting from a toxic substance is classified as ________.
histotoxic
A ________ is used when a patient requires a low to medium concentration of oxygen for which precise accuracy is not essential.
nasal cannula
Three severe complications of pneumonia are ________, ________, and ________.
hypotension, shock, respiratory failure
Hypoxemia usually leads to ________, a decrease in oxygen supply to the tissues.
hypoxia
Four respiratory system mechanisms that can lead to acute respiratory failure (ARF) are ________, ________, ________, and ________.
impaired central nervous system (CNS) function, neuromuscular, musculoskeletal, pulmonary dysfunction
The maximum volume of air that can be inhaled after a normal inhalation is known as ________.
inspiratory reserve volume
Medication therapy for allergic and nonallergic rhinitis focuses on ________.
symptom relief
The divisions of the lung proceed in the following order, beginning at the mainstem bronchi: ________, ________, ________, and ________.
lobar bronchi, segmented bronchi, subsegmented bronchi, bronchioles
The pulmonary circulation is considered a ________, ________.
low-pressure system
The left lung, in contrast to the right lung, has ________.
one less lobe
The lungs are enclosed in a serous membrane called the ________.
pleura
The term used to describe thoracic surgery in which an entire lung is removed is known as ________.
pneumonectomy
Gas exchange between the lungs and blood and between the blood and tissues is called ________.
respiration
Patients with COPD are at risk for ________ and ________, which in turn increase the risk of acute and chronic respiratory failure.
respiratory insufficiency, chronic respiratory failure
In current tuberculosis (TB) treatment, four first-line medications are used: ________, ________, ________, and ________.
rifampin, pyrazinamide, ethambutol, isoniazid
When a nonfunctioning nasogastric tube allows the gastric contents to accumulate in the stomach, a condition known as ________ may result.
silent aspiration
Complications of asthma may include ________, ________,________, and ________.
status asthmaticus, respiratory failure, pneumonia, atelectasis
The two centers in the brain that are responsible for the neurologic control of ventilation are ________ and ________.
the apneustic center in the lower pons, the pneumotaxic center in the upper Pons
Primary causes for an acute exacerbation of COPD are ________ and ________.
tracheobronchial infection, air pollution
The most common cause of laryngitis is ________, with symptoms including ________, ________, and ________.
viral
Antioxidants such as ________, ________, and ________ may help defend against oxygen-free radicals.
vitamin E, vitamin C, beta carotene
The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation? a. PaO2 b. PaCO2 c. pH d. SaO2
b
A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection? a. An antiviral agent such as acyclovir b. An antibiotic such as amoxicillin c. An antihistamine such as diphenhydramine d. An ointment such as bacitracin
a
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis
a
A patient is brought into the emergency department with carbon monoxide poisoning after escaping a house fire. What should the nurse monitor this patient for? a. Anemic hypoxia b. Histotoxic hypoxia c. Hypoxic hypoxia d. Stagnant hypoxia
a
The nurse inspects the thorax of a patient with advanced emphysema. What does the nurse expect the chest configuration to be for this patient? a. Barrel chest b. Funnel chest c. Kyphoscoliosis d. Pigeon chest
a
The nurse is admitting a patient with chronic obstructive pulmonary disorder (COPD). The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? a. PaO2 b. pH c. PCO2 d. HCO3ivity E
a
The nurse is assessing a patient with chest tubes connected to a drainage system. What should the first action be when the nurse observes excessive bubbling in the water seal chamber? a. Notify the healthcare provider b. Place the head of the patient's bed flat c. Milk the chest tube d. Disconnect the system and get another
a
The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? a. Providing sufficient oxygen to improve oxygenation b. Avoiding the use of oxygen to decrease the hypoxic drive c. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise d. Increasing pH
a
The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema? a. Crackles in the lung bases b. Low-pitched rhonchi during expiration c. Pleural friction rub d. Sibilant wheezes
a
The nurse is caring for a patient who had a total laryngectomy and has drains in place. When does the nurse understand that the drains will most likely be removed? a. When the patient has less than 30 mL for 2 consecutive days b. When the patient states that there is discomfort and requests removal c. When the drainage tube comes out d. In 1 week when the patient no longer has serous drainage
a
The nurse is caring for a patient with a pulmonary disorder. What observation by the nurse is indicative of a very late symptom of hypoxia? a. Cyanosis b. Dyspnea c. Restlessness d. Confusion
a
The nurse is caring for a patient with suspected acute respiratory distress syndrome (ARDS) with a PO2 of 53. The patient is placed on oxygen via face mask and the PO2 remains the same. What does the nurse recognize as a key characteristic of ARDS? a. Unresponsive arterial hypoxemia b. Diminished alveolar dilation c. Tachypnea d. Increased PaO2
a
The nurse is collecting a sputum culture to identify the causative organism for a patient with acute tracheobronchitis. What causative fungal organism does the nurse suspect? a. Aspergillus b. Haemophilus c. Mycoplasma pneumoniae d. Streptococcus pneumoniae
a
The nurse is educating a patient with COPD about the technique for performing pursed lip breathing. What does the nurse inform the patient is the importance of using this technique? a. It prolongs exhalation b. It increases the respiratory rate to improve oxygenation c. It will assist with widening the airway d. It will prevent the alveoli from overexpanding
a
The nurse is interviewing a patient who reports a dry, irritating cough that is not "bringing anything up." What medication should the nurse question the patient about taking? a. Angiotensin converting enzyme (ACE) inhibitors b. Aspirin c. Bronchodilators d. Cardiac glycosides
a
The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for? a. Atelectasis b. Emphysema c. Pleurisy d. Pneumonia
a
The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient? a. The patient is hypoxic from suctioning b. The patient is having a stress reaction c. The patient is having a myocardial infarction d. The patient is in a hypermetabolic state
a
The nurse is educating the patient diagnosed with acute pharyngitis on methods to alleviate discomfort. What interventions should the nurse include in the information? (Select all that apply.) a. Apply an ice collar b. Stay on bed rest during the febrile stage of the illness c. Gargle with an alcohol-based mouthwash d. Try a liquid or soft diet during the acute stage of the disease e. Drink warm or hot liquids during the acute stage of the disease
a, b, d
The nurse is educating the patient in the use of a mini-nebulizer. What should the nurse encourage the patient to do? (Select all that apply.) a. Hold the breath at the end of inspiration for a few seconds b. Cough frequently c. Take rapid, deep breaths d. Frequently evaluate progress e. Prolong the expiratory phase after using the nebulizer
a, b, d
The physician prescribes a beta2-adrenergic agonist agent that is shortacting and administered only by inhaler. What medication does the nurse anticipate will be administered? a. Metaproterenol b. Terbutaline c. Formoterol d. Isoproterenol
b
The nurse is planning the care for a patient at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan? (Select all that apply.) a. Encouraging a liberal fluid intake b. Assisting the patient to do leg elevations above the level of the heart c. Instructing the patient to dangle the legs over the side of the bed for 30 minutes, four times a day d. Using elastic stockings, especially when decreased mobility would promote venous stasis e. Applying a sequential compression device
a, b, d, e
The nurse is assigned to care for a patient in the intensive care unit (ICU) who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care? (Select all that apply.) a. To combat dehydration b. To assist with the effectiveness of the corticosteroids c. To loosen secretions d. To facilitate expectoration e. To relieve bronchospasm
a, c, d
The nurse is instructing the patient on the collection of a sputum specimen. What should be included in the instructions? (Select all that apply.) a. Initially, clear the nose and throat b. Spit surface mucus and saliva into a sterile specimen container c. Take a few deep breaths before coughing d. Use diaphragmatic contractions to aid in the expulsion of sputum e. Rinse with mouthwash prior to providing the specimen
a, c, d
Rhinosinusitis is classified by duration of symptoms as ________, ________, and ________.
acute, subacute, chronic
Pneumonia tends to occur in patients with one or more of these five underlying disorders: ________, ________, ________, ________, and ________.
alcoholism, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), diabetes, heart failure
the three most common symptoms are ________, ________, and ________.
allergy
A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient? a. Chest pain during respiration b. Sputum and a productive cough c. Fever, chills, and diaphoresis d. Tachypnea and tachycardia
b
A patient has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the patient reports tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What condition should the nurse suspect? a. Oxygen-induced hypoventilation b. Oxygen toxicity c. Oxygen-induced atelectasis d. Hypoxia
b
A patient playing softball was hit in the nose by the ball and has been determined to have an uncomplicated fractured nose with epistaxis. The nurse should prepare to assist the health care provider with what tasks? a. Preparing the patient for a septoplasty b. Applying nasal packing c. Administering nasal lavage d. Applying steroidal nasal spray
b
A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What information should the nurse provide to the patient? a. "Only wear your contact lenses during the day and take them out in the evening before bed" b. "You should switch to wearing your glasses while taking this medication" c. "The health care provider can give you eye drops to prevent any problems" d. "There are no significant problems with wearing contact lenses"
b
A patient with an advanced laryngeal tumor is to have radiation therapy. The patient tells the nurse, "If I am going to have radiation, I won't need surgery." What is the best response by the nurse? a. "That is correct. The radiation will eradicate the tumor and you won't have to have further treatment" b. "Radiation is used to shrink the tumor size and is an adjunct to surgery" c. "All patients have to have radiation before they have surgery. It is protocol" d. "You really don't have to have radiation but you won't have to have such invasive surgery if you have the radiation first"
b
A patient with emphysema informs the nurse, "The surgeon will be removing about 30% of my lung so that I will not be so short of breath and will have an improved quality of life." What surgery does the nurse understand the surgeon will perform? a. A sleeve resection b. A lung volume reduction c. A wedge resection d. Lobectomy
b
During a preadmission assessment, for what diagnosis would the nurse expect to find decreased tactile fremitus and hyperresonant percussion sounds? a. Bronchitis b. Emphysema c. Atelectasis d. Pulmonary edema
b
The nurse assesses a patient with a heart rate of 42 bpm and a blood pressure of 70/46 mm HG. What type of hypoxia does the nurse determine this patient is displaying? a. Anemic hypoxia b. Circulatory hypoxia c. Histotoxic hypoxia d. Hypoxic hypoxia
b
The nurse hears the patient's ventilator alarm sound and attempts to find the cause. What is the priority action of the nurse when the cause of the alarm is not able to be determined? a. Call respiratory therapy and wait until they arrive to determine what is happening b. Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved c. Stop the ventilator by pressing the off button, wait 15 seconds, and then turn it on again to see if the alarm stops d. Suction the patient since the patient may be obstructed by secretions
b
The nurse is having an information session with a women's group at the YMCA about lung cancer. What frequent and commonly experienced symptom should the nurse be sure to include in the session? a. Copious sputum production b. Coughing c. Dyspnea d. Severe pain
b
The nurse is performing an assessment for a patient with congestive heart failure. The nurse asks if the patient has difficulty breathing in any position other than upright. What is the nurse referring to? a. Dyspnea b. Orthopnea c. Tachypnea d. Bradypnea
b
When observing the chest wall of a patient, the nurse detects a depression in the lower portion of the sternum. What assessment finding will the nurse anticipate detecting due to this condition? a. Clubbing of fingers b. Cyanosis c. Crackles d. Murmurs
b
A patient comes to the clinic reporting symptoms of the common cold and wants something to help relieve the symptoms. What should the nurse include in educating the patient about the uncomplicated common cold? (Select all that apply.) a. Tell the patient to take prescribed antibiotics to decrease the severity of symptoms b. Inform the patient about the symptoms of secondary infection c. Suggest that the patient take adequate fluids and get plenty of rest d. Inform the patient that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase e. Inform the patient that taking an antihistamine will help to decrease the duration of the cold
b, c, d
A ________ is a surgical option for select patients with bullous emphysema.
bullectomy
A health care provider requests a study of diaphragmatic motion because of suspected pathology. What diagnostic test will the nurse prepare the patient for? a. Barium swallow b. Bronchogram c. Fluoroscopy d. Tomogram
c
A nurse caring for a patient with a pulmonary embolism understands that high ventilation-perfusion ratio may exist. What does this mean for the patient? a. Perfusion exceeds ventilation b. There is an absence of perfusion and ventilation c. Ventilation exceeds perfusion d. Ventilation matches perfusion
c
A patient arrives in the emergency department with an edematous face, tongue, and difficulty breathing after starting a new medication for hypertension. When reviewing medication, which antihypertensive would the nurse suspect as the causative factor? a. Metoprolol succinate b. Amlodipine c. Enalapril d. Valsartan
c
A patient comes to the clinic and is diagnosed with tonsillitis and adenoiditis. What bacterial pathogen does the nurse know is commonly associated with tonsillitis and adenoiditis? a. Gram-negative Klebsiella b. Pseudomonas aeruginosa c. Group A, beta-hemolytic streptococcus d. Staphylococcus aureus
c
A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a severe stroke. What action does the nurse anticipate the healthcare provider will take now that the patient has been intubated for this length of time? a. The patient will be extubated and another endotracheal tube will be inserted b. The patient will be extubated and a nasotracheal tube will be inserted c. The patient will have an insertion of a tracheostomy tube d. The patient will begin the weaning process
c
A patient is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the most effective for this patient? a. Surgery to remove the tonsils and adenoids b. Medications to assist the patient with sleep at night c. Continuous positive airway pressure d. Bi-level positive airway pressure
c
A patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly used medication will the nurse educate the patient about? a. Albuterol b. Budesonide c. Cromolyn sodium d. Theophylline
c
A patient is to receive an oxygen concentration of 70%. What is the best way for the nurse to deliver this concentration? a. A nasal cannula b. An oropharyngeal catheter c. A partial rebreathing mask d. A Venturi mask
c
A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? a. "I am going to have a tuna fish sandwich for lunch" b. "It is all right if I drink a glass of red wine with my dinner" c. "It is all right if I have a grilled cheese sandwich with American cheese" d. "It is fine if I eat sushi with a little bit of soy sauce"
c
A patient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the patient has been prescribed? a. After meals and at bedtime b. Before meals c. With meals d. Three times a day regardless of meal time
c
The nurse auscultates crackles in a patient with a respiratory disorder. What condition does the nurse recognize that these symptoms are indicative of? a. Asthma b. Bronchospasm c. Collapsed alveoli d. Pulmonary fibrosis
c
The nurse is administering anticoagulant therapy with heparin. What international normalized ratio (INR) would the nurse know is within therapeutic range? a. 0.5 to 1.0 b. 1.5 to 2.5 c. 2.0 to 2.5 d. 3.0 to 3.5
c
The nurse is conducting a community program about prevention of respiratory illness. What illness does the nurse recognize is the most common cause of death in the United States? a. Atelectasis b. Pulmonary embolus c. Pneumonia d. Tracheobronchitis
c
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? a. 3 months b. 3 to 5 months c. 6 to 12 months d. 13 to 18 months
c
The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack? a. Using a long-acting steroid inhaler when an attack is coming b. Avoiding exercise and any strenuous activity c. Preparing a written action plan d. Staying in the house if it is too cold or too hot
c
The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education? a. The patient should take the medication with meals since it may cause nausea b. The patient should take the medication separately without other medications c. The patient should take the medication an hour before meals or 2 hours after a meal d. The patient should take the medication with a small amount of liquid
c
The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard? a. Rales b. Crackles c. Wheezes d. Rhonchi
c
The nurse is transporting a patient with chest tubes to a treatment room. The chest tube becomes disconnected and falls between the bed rail. What is the priority action by the nurse? a. Immediately reconnect the chest tube to the drainage apparatus b. Clamp the chest tube close to the connection site c. Cut the contaminated tip of the tube and insert a sterile connector and reattach d. Call the healthcare provider
c
What finding by the nurse may indicate that the patient has chronic hypoxia? a. Crackles b. Peripheral edema c. Clubbing of the fingers d. Cyanosis
c
A patient is being mechanically ventilated with an oral endotracheal tube in place. The nurse observes that the cuff pressure is 25 mm Hg. The nurse is aware of what complications that can be caused by this pressure? (Select all that apply.) a. Tracheal aspiration b. Hypoxia c. Tracheal ischemia d. Tracheal bleeding e. Pressure necrosis
c, d, e
A patient comes to the emergency department reporting a knifelike pain when taking a deep breath. What does this type of pain likely indicate to the nurse? a. Bacterial pneumonia b. Bronchogenic carcinoma c. Lung infarction d. Pleurisy
d
A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education? a. Have the patient lie in a supine position during the use of the spirometer b. Encourage the patient to try to stop coughing during and after using the spirometer c. Inform the patient that using the spirometer is not necessary if the patient is experiencing pain d. Encourage the patient to take approximately 10 breaths per hour, while awake
d
A patient is diagnosed as being in the early stage of laryngeal cancer of the glottis with only one vocal cord involved. For what type of surgical intervention will the nurse plan to provide education? a. Total laryngectomy b. Cordectomy c. Vocal cord stripping d. Partial laryngectomy
d
The nurse is performing an assessment of a patient who arrived in the emergency department with a barbiturate overdose. The respirations are normal for 3 to 4 breaths followed by a 60-second period of apnea. How does the nurse document the respirations? a. Cheyne-Stokes b. Tachypnea c. Bradypnea d. Biot respirations
d