Respiratory 201 Adaptive Quizzing
Which would the nurse consider to be a potential respiratory system-related complication of surgery? 1) Atelectasis 2) Hyperthermia 3) Wound dehiscence 4) Hypovolemic shock
Answer: 1 Atelectasis Atelectasis is a potential complication of the respiratory system that can occur after surgery. Hyperthermia is a potential neuromuscular complication. Wound dehiscence is a potential skin complication. Hypovolemic shock is a cardiovascular complication that can occur after surgery.
While preparing the client for a diagnostic procedure, the nurse positions the client upright with elbows on an overbed table and the feet supported. The nurse also instructs the client not to talk or cough during the procedure. Which diagnostic test is the client undergoing? 1) Lung biopsy 2) Thoracentesis 3) Mediastinoscopy 4) Ventilation-perfusion scan
Answer: 2 Thoracentesis A thoracentesis is performed to obtain a specimen of pleural fluid for diagnosis. The client should be positioned upright with elbows on an overbed table with the feet supported. The client should not talk or cough during the procedure because the inserted needle may cause trauma. A lung biopsy or mediastinoscopy may not require the client to be seated upright. No special precautions are needed after performing ventilation-perfusion scan because the gas and isotope transmits radioactivity for only a brief interval.
A client who is homeless is hospitalized for alcohol withdrawal. When considering the type of personal protective equipment that is needed for the client's care, what condition does the nurse recall that homeless persons are at risk for? 1) Prostatitis 2) Tuberculosis 3) Osteoarthritis 4) Diverticulosis
Answer: 2 Tuberculosis Medically underserved clients such as the homeless, clients who are alcohol or drug dependent, and those who have human immunodeficiency virus (HIV) infections are at risk for developing tuberculosis. Being homeless does not increase a person's risk for developing prostatitis, osteoarthritis, or diverticulosis.
A nurse is a preceptor for an orientee (newly hired nurse). The orientee is providing postoperative care to a client who recently returned from a laryngoscopy. The orientee reminds the client not to eat or drink anything until instructed to do so. How does the preceptor evaluate the suitability of the instructions given to the client by the orientee? 1) Appropriate; oral intake after the procedure may result in aspiration 2) Appropriate; it is important to limit painful swallowing 3) Inappropriate; the client is too groggy after general anesthesia to comprehend information 4) Inappropriate; fluid replacement should begin immediately after the procedure
Answer: 1 Appropriate; oral intake after the procedure may result in aspiration Oral intake should not be attempted after the procedure until the return of the gag reflex. Even an alert person may choke and aspirate if eating or drinking is attempted while the pharyngeal wall is anesthetized. Although some slight irritation may occur after the procedure, there usually is no painful sequela. Clients do not receive general anesthesia for a laryngoscopy. The procedure does not produce a fluid deficit. The client needs to remain nothing by mouth.
The nurse provides discharge instructions to a client who had a rhinoplasty. Which instructions should the nurse share with the client? 1) Avoid items that may trigger sneezing 2) Consume fluids at a tepid temperature 3) Brush the teeth thoroughly after each food intake 4) Sleep on the back using one pillow under the head
Answer: 1 Avoid items that may trigger sneezing Sneezing involves high pressures in the respiratory passageways during the expulsive phase of a sneeze; this can disrupt sutures or alignment of bone, promoting bleeding, and therefore should be avoided. Fluids that are soothing for the client are given at any temperature; cool or warm temperatures usually are preferred. Brushing teeth after any intake is not a necessity; the client's regular routine may be followed. Sleeping on the back with one pillow promotes the accumulation of facial edema and possible aspiration of drainage; the semi-Fowler position is preferred.
Which surgical procedure is appropriate for the removal of a vocal cord due to laryngeal cancer? 1) Cordectomy 2) Tracheotomy 3) Total laryngectomy 4) Oropharyngeal resections
Answer: 1 Cordectomy A cordectomy is a surgical procedure performed in clients with laryngeal cancer; this surgery involves the removal of a vocal cord. A tracheotomy is a surgical incision in the trachea for the purpose of establishing an airway. A total laryngectomy is a surgical procedure in which the entire larynx, hyoid bone, strap muscles, and one or two tracheal rings are removed. A nodal neck dissection is also done in a total laryngectomy if the nodes are involved. An oropharyngeal resection is a surgical procedure performed to treat cancer of the oropharynx.
Which statement appropriately describes tidal volume? 1) It is the volume of air inhaled and exhaled with each breath. 2) It is the amount of air remaining in the lungs after forced expiration. 3) It is the additional air that can be forcefully inhaled after normal inhalation. 4) It is the additional air that can be forcefully exhaled after normal exhalation.
Answer: 1 It is the volume of air inhaled and exhaled with each breath. Tidal volume is the volume of air inhaled and exhaled with each breath. Residual volume is the amount of air remaining in the lungs after forced expiration. Inspiratory reserve volume is the additional air that can be forcefully inhaled after normal inhalation. Expiratory reserve volume is the additional air that can be forcefully exhaled after normal exhalation.
Thick mucous gland secretions, elevated sweat electrolytes, meconium ileus, and difficulty maintaining and gaining weight are associated with which autosomal recessive disorder? 1) Cerebral palsy 2) Cystic fibrosis 3) Muscular dystrophy 4) Multiple sclerosis
Answer: 2 Cystic fibrosis The early symptom of cystic fibrosis is meconium ileus, which is impacted stool in the newborn. Thick mucous secretions, salty sweat, and difficulty gaining weight because of high caloric demands are characteristics of the condition. Cerebral palsy is a motor disorder caused by damage to the brain. Muscular dystrophy is a muscular disorder. Multiple sclerosis is a condition with progressive disintegration of the myelin sheath.
Which client would have relatively smaller tidal volumes due to limited chest wall movement? 1) A client with asthma 2) A client with pneumonia 3) A client with pulmonary fibrosis 4) A client with phrenic nerve paralysis
Answer: 4 A client with phrenic nerve paralysis Some respiratory conditions such as phrenic nerve paralysis may limit the diaphragm or chest wall movement and may result in smaller tidal volumes. In this condition, the lungs do not fully inflate, and the gas exchange may be impaired. Exacerbations of asthma may cause expiration to become an active labored process. Pneumonia may result in decreased lung compliance due to an accumulation of fluid in the lungs. As the lung tissue becomes less elastic or distensible, the client with pulmonary fibrosis may have decreased lung compliance.
A client with a history of rheumatic fever and a heart murmur reports gaining weight in spite of nausea and anorexia. The client also reports shortness of breath several times each day and when performing minor tasks. Which additional information should the nurse obtain? 1) Retrospective 24-hour calorie count 2) Elimination pattern during the last 30 days 3) Complete gynecological and sexual history 4) Presence of a cough and pulmonary secretions
Answer: 4 Presence of a cough and pulmonary secretions The presence of a cough and pulmonary secretions, in addition to a history of rheumatic fever, requires an assessment for other cardiopulmonary problems and fluid overload. Anorexia and weight gain do not indicate a nutritional problem but a fluid balance problem. Loss of appetite in conjunction with shortness of breath and the history of rheumatic fever makes gastrointestinal (elimination) symptoms secondary in importance. There is no reason to investigate the gynecological and sexual history in relation to the current problem.
A client is transferred from the postanesthesia care unit to the intensive care unit after a radical neck dissection. In what position should the nurse place the client to facilitate respirations and promote comfort? 1) Sims 2) Lateral 3) Orthopneic 4) Semi-Fowler
Answer: 4 Semi-Fowlers The semi-Fowler position helps maintain the head and neck in functional alignment and facilitates respirations because the abdominal organs are not pressing against the diaphragm, which allows the thoracic cavity to expand without resistance. The Sims position will place tension on the operative site because the head must be turned to the side. The lateral position inhibits respiratory excursion because the abdominal organs press against the diaphragm, and full expansion of the lung on the side on which the client is lying is inhibited. The orthopneic position may cause flexion of the neck, which may place tension on the suture line.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and PCO2 of 60 mm Hg. These blood gases require nursing attention because they indicate which condition? 1) Metabolic acidosis 2) Metabolic alkalosis 3) Respiratory acidosis 4) Respiratory alkalosis
Answer: Respiratory acidosis The normal blood pH range is 7.35 to 7.45; therefore, a blood pH of 7.25 indicates acidosis. The parameter for respiratory function is CO2 and the acceptable range of arterial PCO2 is 35 to 45 mm Hg; therefore, 60 mm Hg is elevated, resulting in respiratory acidosis. HCO3 is the parameter for metabolic functions. A pH of 7.25 is acidic, indicating acidosis and not alkalosis.