Chapter 19 Respiratory system

A nurse is teaching a client how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the client? "Hold the spirometer at your lips and breathe in and out like you normally would." "When you're ready, blow hard into the spirometer for as long as you can." "Take a deep breath and then blow short, forceful breaths into the spirometer." "Breathe in deeply through the spirometer, hold your breath briefly, and then exhale."

"Breathe in deeply through the spirometer, hold your breath briefly, and then exhale."

The nurse is preparing to discharge a client after thoracotomy. The client is going home on oxygen therapy and requires wound care. As a result, he will receive home care nursing. What should the nurse include in discharge teaching for this client? Safe technique for self-suctioning of secretions Technique for performing postural drainage Correct and safe use of oxygen therapy equipment How to provide safe and effective tracheostomy care

Correct and safe use of oxygen therapy equipment

A client has been diagnosed with heart failure that has not yet responded to treatment. What breath sound should the nurse expect to assess on auscultation? Expiratory wheezes Inspiratory wheezes Rhonchi Crackles

Crackles

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? Cyanosis Dyspnea Restlessness Confusion

Cyanosis

The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse's priority? Medication allergies Swallow reflex Presence of carotid pulse Ability to deep breathe

Swallow reflex

A medical client rings her call bell and expresses alarm to the nurse, stating, "I've just coughed up this blood. That can't be good, can it?" How can the nurse best determine whether the source of the blood was the client's lungs? Obtain a sample and test the pH of the blood, if possible. Try to see if the blood is frothy or mixed with mucus. Perform oral suctioning to see if blood is obtained. Swab the back of the client's throat to see if blood is present.

Try to see if the blood is frothy or mixed with mucus.

A client presents to the ED reporting severe coughing episodes. The client states that "the episodes are more intense at night." The nurse should suspect which of the following conditions based on the client's primary report? Left-sided heart failure Chronic obstructive pulmonary disorder (COPD) Emphysema Bronchitis

Left-sided heart failure

A client has been discharged home after thoracic surgery. The home care nurse performs the initial visit and finds the client discouraged and saddened. The client states, "I am recovering so slowly. I really thought I would be better by now." What nursing action should the nurse prioritize? Provide emotional support to the client and family. Schedule a visit to the client's primary physician within 24 hours. Notify the physician that the client needs a referral to a psychiatrist. Place a referral for a social worker to visit the client.

Provide emotional support to the client and family.

A client with a decreased level of consciousness is in a recumbent position. How should the nurse best assess the lung fields for a client in this position? Inform that physician that the client is in a recumbent position and anticipate an order for a portable chest x-ray. Turn the client to enable assessment of all the patient's lung fields. Avoid turning the client, and assess the accessible breath sounds from the anterior chest wall. Obtain a pulse oximetry reading, and, if the reading is low, reposition the client and auscultate breath sounds.

Turn the client to enable assessment of all the patient's lung fields.

The clinic nurse is caring for a client who has been diagnosed with emphysema and who has just had a pulmonary function test (PFT) ordered. The client asks, "What exactly is this test for?" What would be the nurse's best response? "A PFT measures how much air moves in and out of your lungs when you breathe." "A PFT measures how much energy you get from the oxygen you breathe." "A PFT measures how elastic your lungs are." "A PFT measures whether oxygen and carbon dioxide move between your lungs and your blood." TAKE ANOTHER QUIZ

"A PFT measures how much air moves in and out of your lungs when you breathe."

A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing. Place the steps in order in which the nurse will instruct the client. "Inhale through your nose." "Slowly count to 7." "Exhale slowly through pursed lips." "Slowly count to 3."

"Inhale through your nose." "Slowly count to 3." "Exhale slowly through pursed lips." "Slowly count to 7."

Following a chest X-ray, a patient has been diagnosed with a pleural effusion. The care team has concluded that the quantity of fluid in the patient's intrapleural space necessitates thoracentesis. What patient education should the nurse provide in anticipation of this procedure? "You can move around as normal after the procedure is finished, and I've applied a bandage over the site." "The doctor will ask you to cough a few times to facilitate the insertion of the needle." "If you're unable to lie on your side, you can sit upright and support yourself on your overbed table." "It's very important that you remain still while the doctor is performing the procedure."

"It's very important that you remain still while the doctor is performing the procedure."

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? 40% 75% 80% 95%

95%

The ED nurse is assessing a client complaining of dyspnea. The nurse auscultates the client's chest and hears wheezing throughout the lung fields. What might this indicate about the client? A narrowed airway. Pneumonia. The need for physiotherapy. Hemothorax.

A narrowed airway.

The nurse is performing a respiratory assessment of a client who has been experiencing episodes of hypoxia. The nurse is aware that this is ultimately attributable to impaired gas exchange. On what factor does adequate gas exchange primarily depend? An appropriate perfusion-diffusion ratio An adequate ventilation-perfusion ratio Adequate diffusion of gas in shunted blood Appropriate blood nitrogen concentration

An adequate ventilation-perfusion ratio

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? Anemic hypoxia Histotoxic hypoxia Hypoxic hypoxia Stagnant hypoxia

Anemic hypoxia

The nurse is interviewing a patient who says he has a dry, irritating cough that is not "bringing anything up." What medication should the nurse question the patient about taking? Angiotensin converting enzyme (ACE) inhibitors Aspirin Bronchodilators Cardiac glycosides

Angiotensin converting enzyme (ACE) inhibitors

A client's plan of care specifies postural drainage. What action should the nurse perform when providing this noninvasive therapy? Administer the treatment with the client in a high Fowler's or semi-Fowler's position. Perform the procedure immediately following the client's meals. Apply percussion firmly to bare skin to facilitate drainage. Assist the client into a position that will allow gravity to move secretions.

Assist the client into a position that will allow gravity to move secretions.

The nurse has assessed a client's family history for three generations. The presence of which respiratory disease would justify this type of assessment? Asthma Obstructive sleep apnea Community-acquired pneumonia Pulmonary edema

Asthma

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? Auscultate the lung for adventitious sounds. Have the patient inform the nurse of the need to be suctioned. Assess the CO2 level to determine if the patient requires suctioning. Have the patient cough.

Auscultate the lung for adventitious sounds.

The nurse inspects the thorax of a patient with advanced emphysema. The nurse expects chest configuration changes consistent with a deformity known as: Barrel chest Funnel chest Kyphoscoliosis Pigeon chest

Barrel chest

The acute medical nurse is preparing to wean a client from the ventilator. Which assessment parameter is most important for the nurse to assess? Fluid intake for the last 24 hours Baseline arterial blood gas (ABG) levels Prior outcomes of weaning Electrocardiogram (ECG) results

Baseline arterial blood gas (ABG) levels

What finding by the nurse may indicate that the client has chronic hypoxia? Crackles Peripheral edema Clubbing of the fingers Cyanosis

Clubbing of the fingers

A client is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the most effective for this client? Surgery to remove the tonsils and adenoids Medications to assist the patient with sleep at night Continuous positive airway pressure (CPAP) Bi-level positive airway pressure (BiPAP)

Continuous positive airway pressure (CPAP)

The nurse working on a gerontology unit admits a 77-year-old with recent shortness of breath. The nurse knows that the amount of respiratory dead space increases with age. What do these changes result in? Increased diffusion of gases Decreased diffusion capacity for oxygen Decreased shunting of blood Increased ventilation

Decreased diffusion capacity for oxygen

Which is an age-related change associated with the respiratory system? Increased chest muscle mass Thinning of alveolar membranes Decreased size of the airway Increased elasticity of alveolar sacs

Decreased size of the airway

For air to enter the lungs (process of ventilation), the intrapulmonary pressure must be less than atmospheric pressure so air can be pulled inward. Select the movement of respiratory muscles that makes this happen during inspiration. Lungs are pulled up and pushed back against the thoracic cage. Diaphragm contracts and elongates the chest cavity. Intercostals muscles relax to allow for expansion. Anteroposterior rib diameter decreases.

Diaphragm contracts and elongates the chest cavity.

A nurse is preparing a client for bronchoscopy. Which instruction should the nurse give to the client? Do not walk after the procedure for 4 to 6 hours. Do not cough after the procedure until you are walking. Do not talk for 2 hours before the procedure. Do not eat or drink for 6 hours before the procedure.

Do not eat or drink for 6 hours before the procedure.

High or increased compliance occurs in which disease process? Emphysema Pneumothorax Pleural effusion ARDS

Emphysema

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? Have the patient lie in a supine position during the use of the spirometer. Encourage the patient to try to stop coughing during and after using the spirometer. Inform the patient that using the spirometer is not necessary if the patient is experiencing pain. Encourage the patient to take approximately 10 breaths per hour, while awake.

Encourage the patient to take approximately 10 breaths per hour, while awake

A sputum study has been ordered for a client who has developed coarse chest crackles and a fever. At what time should the nurse best collect the sample? Immediately after a meal First thing in the morning At bedtime After a period of exercise

First thing in the morning

A client with sinus congestion complains of discomfort when the nurse is palpating the supraorbital ridges. What sinus is the client referring? Frontal Ethmoidal Maxillary Sphenoidal

Frontal

A 4 year-old client has had recurrent episodes of bronchitis during the winter months. The client spends a significant amount of time outdoors enjoying the snow and breathes primarily through the mouth. What suggestion would the nurse most likely make to the client's mother? Help the client learn to breathe through her nose. Keep the client indoors. Increase the client's vitamin dosage. None of the options is correct.

Help the client learn to breathe through her nose.

The nurse is performing client education for a client who is being discharged on mini-nebulizer treatments. What information should the nurse prioritize in the client's discharge teaching? How to count her respirations accurately How to collect serial sputum samples How to independently wean herself from treatment How to perform diaphragmatic breathing

How to perform diaphragmatic breathing

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? It prolongs exhalation. It increases the respiratory rate to improve oxygenation. It will assist with widening the airway. It will prevent the alveoli from overexpanding.

It prolongs exhalation.

A critical care nurse is caring for a client with an endotracheal tube who is on a ventilator. The nurse knows that meticulous airway management of this client is necessary. What is the main rationale for this? Maintaining a patent airway Preventing the need for suctioning Maintaining the sterility of the client's airway Increasing the client's lung compliance

Maintaining a patent airway

The critical care nurse is precepting a new nurse on the unit. Together they are caring for a client who has a tracheostomy tube and is receiving mechanical ventilation. What action should the critical care nurse recommend when caring for the cuff? Deflate the cuff overnight to prevent tracheal tissue trauma. Inflate the cuff to the highest possible pressure in order to prevent aspiration. Monitor the pressure in the cuff at least every 8 hours Keep the tracheostomy tube plugged at all times.

Monitor the pressure in the cuff at least every 8 hours

The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. What method of oxygen delivery is most appropriate for the client's needs? Non-rebreathing mask Nasal cannula Simple mask Partial-rebreathing mask

Nasal cannula

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? Dyspnea Orthopnea Tachypnea Bradypnea

Orthopnea

A client has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the client complains of tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What should the nurse suspect? Oxygen-induced hypoventilation Oxygen toxicity Oxygen-induced atelectasis Hypoxia

Oxygen toxicity

The nurse is assessing a client who frequently coughs after eating or drinking. How should the nurse best follow up this assessment finding? Obtain a sputum sample. Perform a swallowing assessment. Inspect the client's tongue and mouth. Assess the client's nutritional status.

Perform a swallowing assessment.

A patient comes to the emergency department complaining of a knifelike pain when taking a deep breath. What does this type of pain likely indicate to the nurse? Bacterial pneumonia Bronchogenic carcinoma Lung infarction Pleurisy

Pleurisy

The clinical finding of pink, frothy sputum may be an indication of which condition? Lung abscess Pulmonary edema Infection Bronchiectasis

Pulmonary edema

The nurse is caring for a client who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning, the nurse should anticipate that the weaning of the client will progress in what order? Removal from the ventilator, tube, and then oxygen Removal from oxygen, ventilator, and then tube Removal of the tube, oxygen, and then ventilator Removal from oxygen, tube, and then ventilator

Removal from the ventilator, tube, and then oxygen

A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. What breath sound should the nurse document? Rales Venous hum Rhonchi Bronchovesicular

Rhonchi

The nurse is caring for a client who has a pleural effusion and who underwent a thoracoscopic procedure earlier in the morning. The nurse should prioritize assessment for which of the following? Sputum production Shortness of breath Throat discomfort Epistaxis

Shortness of breath

Which ventilation-perfusion ratio is exhibited by acute respiratory distress syndrome (ARDS)? Silent unit Dead space Low ventilation-perfusion ratio Normal ratio of perfusion to ventilation

Silent unit

In which position should the client be placed for a thoracentesis? Prone Sitting on the edge of the bed Supine Lateral recumbent

Sitting on the edge of the bed

The nurse has explained to the client that after his thoracotomy, it will be important to adhere to a coughing schedule. The client is concerned about being in too much pain to be able to cough. What would be an appropriate nursing intervention for this client? Teach him postural drainage. Teach him how to perform huffing. Teach him to use a mini-nebulizer. Teach him how to use a metered dose inhaler.

Teach him how to perform huffing.

The home care nurse is assessing a client who requires home oxygen therapy. What criterion indicates that an oxygen concentrator will best meet the needs of the client in the home environment? The client desires a low-maintenance oxygen delivery system that delivers oxygen flow rates up to 6 L/min. The client requires a high-flow system for use with a tracheostomy collar. The client desires a portable oxygen delivery system that can deliver 2 L/min. The client's respiratory status requires a system that provides an FiO2 of 65%.

The client desires a portable oxygen delivery system that can deliver 2 L/min.

The nurse should convey which information to a client prior to a pulmonary function test? Select all that apply. The client should not eat 2 hours prior to the test. The client should wear loose-fitting clothing. The client will be reclining during the test. The client may be tired after the test. The client will receive contrast medium via catheter.

The client should not eat 2 hours prior to the test. The client should wear loose-fitting clothing. The client may be tired after the test.

While assessing the client, the nurse observes constant bubbling in the water-seal chamber of the client's closed chest-drainage system. What should the nurse conclude? The system is functioning normally. The client has a pneumothorax. The system has an air leak. The chest tube is obstructed.

The system has an air leak

The amount of air inspired and expired with each breath is called: tidal volume. residual volume. vital capacity. dead-space volume.

Tidal volume

Which term refers to the volume of air inhaled or exhaled during each respiratory cycle? Vital capacity Functional residual capacity Tidal volume Maximal voluntary ventilation

Tidal volume

An 83-year-old female client is scheduled for a thoracentesis to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. Why should the nurse provide pertinent information and appropriate explanations of the diagnostic procedure to her? To manage her decreased energy levels To ensure adequate rest periods To manage respiratory distress To aid the caregivers of the client

To manage her decreased energy levels

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient? Perfusion exceeds ventilation. There is an absence of perfusion and ventilation. Ventilation exceeds perfusion. Ventilation matches perfusion.

Ventilation exceeds perfusion.

A client with a severe exacerbation of COPD requires reliable and precise oxygen delivery. Which mask will the nurse expect the health care provider to prescribe? Non-rebreather air mask Tracheostomy collar Venturi mask Face tent

Venturi mask

Which type of ventilator has a preset volume of air to be delivered with each inspiration? Negative pressure Volume cycled Time cycled Pressure cycled

Volume cycled

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? Rales Crackles Wheezes Rhonchi

Wheezes

While caring for a client with an endotracheal tube, the nurse should normally provide suctioning how often? Every 2 hours when the client is awake When adventitious breath sounds are auscultated When there is a need to prevent the client from coughing When the nurse needs to stimulate the cough reflex

When adventitious breath sounds are auscultated

During assessment of the respiratory system, the nurse inspects and palpates the trachea in order to assess: trachea? deviation from the midline. evidence of exudate. color of the mucous membranes. evidence of muscle weakness.

deviation from the midline

A client is being seen in the pediatric clinic for a middle ear infection. The client's mother reports that when the client develops an upper respiratory infection, an ear infection seems quick to follow. What contributes to this event? eustachian tubes genetics oropharynx epiglottis

eustachian tubes

A client has been newly diagnosed with emphysema. The nurse should explain to the client that by definition, ventilation: is breathing air in and out of the lungs. is when the body changes oxygen into CO2. provides a blood supply to the lungs. helps people who cannot breathe on their own.

is breathing air in and out of the lungs

A client has been diagnosed with pulmonary hypertension, in which the capillaries in the alveoli are squeezed excessively. The nurse should recognize a disturbance in what aspect of normal respiratory function? Acid-base balance Perfusion Diffusion Ventilation

Perfusion

A client is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what? Correct use of a ventilator Correct use of incentive spirometry Correct use of a mini-nebulizer Correct technique for rhythmic breathing

Corrective use of incentive spirometry

The nurse is assessing a client who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the client's respirations. How should the nurse best respond to this assessment finding? Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes. Inform the physician promptly that there is in imminent leak in the drainage system. Encourage the client to do deep breathing and coughing exercises. Document that the chest drainage system is operating as it is intended.

Document that the chest drainage system is operating as it is intended.

The nurse is discussing activity management with a client who is postoperative following thoracotomy. What instructions should the nurse give to the client regarding activity immediately following discharge? Walk 1 mile (1.6 km) 3 to 4 times a week. Use weights daily to increase arm strength. Walk on a treadmill 30 minutes daily. Perform shoulder exercises five times daily.

Perform shoulder exercises five times daily.

A nurse is transporting a client 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? Immediately reconnect the chest tube to the drainage apparatus. Clamp the chest tube close to the connection site. Place the chest tube in sterile water. Notify the health care provider.

Place the chest tube in sterile water.

The nurse auscultates the lung sounds of a client during a routine assessment. The sounds produced are harsh and cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as pleural friction rub. crackles. sonorous wheezes. sibilant wheezes.

Pleural friction rub

The nurse has admitted a client who is scheduled for a thoracic resection. The nurse is providing preoperative teaching and is discussing several diagnostic studies that will be required prior to surgery. Which study will be performed to determine whether the planned resection will leave sufficient functioning lung tissue? Pulmonary function studies Exercise tolerance tests Arterial blood gas values Chest x-ray

Pulmonary function studies

A nurse is discussing squamous epithelial cells lining each alveolus, which consist of different types of cells. Which type of alveolar cells produce surfactant? Type I cells Type II cells Type III cells Type IV cells

Type II cells

The nurse is caring for a client who has been scheduled for a bronchoscopy. How should the nurse prepare the client for this procedure? Administer a bolus of IV fluids. Arrange for the insertion of a peripherally inserted central catheter. Administer nebulized bronchodilators every 2 hours until the test. Withhold food and fluids for several hours before the test.

Withhold food and fluids for several hours before the test.