Respiratory Ticket to Test
The nurse is teaching a postoperative client who had a coronary artery bypass graft about using the incentive spirometer. The nurse instructs the client to perform the exercise in the following order: 1 2 3 4 5 Sit in an upright position. Breathe air in through the mouth. Hold breath for about 3 seconds. Place the mouthpiece of the spirometer in the mouth. Exhale air slowly through the mouth.
1 4 2 3 5
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?
Respiratory alkalosis
Arterial blood gas analysis would reveal which of the following related to acute respiratory failure? a) pH 7.28 b) PaO 80 mm Hg c) pH 7.35 d) PaCO 32 mm Hg
a
You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? a) Progressive loss of lung function associated with chronic disease b) Sudden loss of lung function associated with chronic disease c) Progressive loss of lung function with history of normal lung function d) Sudden loss of lung function with history of normal lung function
a
Your client is scheduled for a bronchoscopy to visualize the larynx, trachea, and bronchi. What precautions would you recommend to the client before the procedure? a) Abstain from food for at least 6 hours before the procedure. b) Avoid atropines as they dry the secretions. c) Avoid sedatives or narcotics as they depress the vagus nerve. d) Practice holding the breath for short periods.
a
The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) a) Mucus secretions block airways. b) Overinflated alveoli impair gas exchange. c) Dry airways obstruct airflow. d) Inflamed airways obstruct airflow.
a b d
Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. a) Sudden chest pain b) Oxygen desaturation c) Unilateral retractions d) Bilaterally equal breath sounds e) Asymmetry of chest movement
a e c b
A client has a sucking stab wound to the chest. Which action should the nurse take first? a) Prepare to start an I.V. line. b) Apply a dressing over the wound and tape it on three sides. c) Prepare a chest tube insertion tray. d) Draw blood for a hematocrit and hemoglobin level.
b
A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? a) Elevating the head of the bed 30 degrees b) Encouraging increased fluid intake c) Turning the client every 2 hours d) Maintaining a cool room temperature
b
A client who sustained a pulmonary contusion in a motor vehicle crash develops a pulmonary embolism. Which nursing diagnosis takes priority with this client? a) Excess fluid volume related to excess sodium intake b) Ineffective breathing pattern related to tissue trauma c) Acute pain related to tissue trauma d) Activity intolerance related to insufficient energy to carry out activities of daily living
b
Constant bubbling in the water seal of a chest drainage system indicates which of the following problems? a) Increased drainage b) Air leak c) Tension pneumothorax d) Tidaling
b
For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? a) Encouraging the client to drink three glasses of fluid daily b) Using a Venturi mask to deliver oxygen as ordered c) Keeping the client in semi-Fowler's position d) Administering a sedative as ordered
b
The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first? a) A 62 year old with emphysema who has 300 mL of intravenous fluid remaining b) An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office c) A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26 d) An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen
b
The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis? a) Bronchoscopy b) Incentive spirometry c) Positive end-expiratory pressure (PEEP) d) Intermittent positive-pressure breathing (IPPB)
b
The nursing instructor is explaining how to provide postural drainage to a client. What would be an appropriate nursing action for providing postural drainage that the instructor would teach her students? a) Performing the procedure following the patient's meals b) Positioning the patient using pillows to promote postural drainage c) Administering physiotherapy in an upright position d) Applying percussion firmly to bare skin
b
When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? a) Hyperoxemia, hypocapnia, and hyperventilation b) Hypercapnia, hypoventilation, and hypoxemia c) Hyperventilation, hypertension, and hypocapnia d) Hypotension, hyperoxemia, and hypercapnia
b
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? a) Metabolic alkalosis b) Respiratory acidosis c) Respiratory alkalosis d) Metabolic acidosis
c
In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation? a) Decreased level of consciousness (LOC) b) Increased blood pressure c) Increased restlessness d) Decreased heart rate
c
In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances? a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis
c
In your presentation to the older adults at the Senior Center luncheon, you outline steps they can take to prevent falls in the home. Preventing falls in older adults directly correlates to preventing bone fractures. If an older adult falls and fractures one or more ribs, what is a possible complication that could develop after the fracture? a) Osteoporosis b) Bronchospasm c) Pneumonia d) Confusion
c
Pink frothy sputum may be an indication of a) a lung abscess. b) an infection. c) pulmonary edema. d) bronchiectasis.
c
Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? a) Administer an ordered decongestant. b) Administer ordered supplemental oxygen. c) Instruct the client to breathe into a paper bag. d) Offer the client fluids frequently.
c
A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? a) The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. b) The client exhibits restlessness and confusion. c) The client exhibits bronchial breath sounds over the affected area. d) The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher.
d
A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect? a) Myocardial infarction (MI) b) Pulmonary embolism c) Heart failure d) Pneumothorax
d
A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? a) Administer analgesics as ordered. b) Perform nasopharyngeal suctioning. c) Administer a heparin bolus and begin an infusion at 500 units/hour. d) Initiate oxygen therapy.
d
A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan? a) Keeping the head of the bed at 15 degrees or less b) Providing oral hygiene daily c) Turning the client every 4 hours to prevent fatigue d) Using strict hand hygiene
d
A nurse is caring for a client with chest trauma. Which nursing diagnosis takes the highest priority? a) Decreased cardiac output b) Ineffective tissue perfusion (cardiopulmonary) c) Anxiety d) Impaired gas exchange
d
A nurse provides care for a client receiving oxygen from a nonrebreather mask. Which nursing intervention has the highest priority? a) Changing the mask and tubing daily b) Applying an oil-based lubricant to the client's mouth and nose c) Posting a "No smoking" sign over the client's bed d) Assessing the client's respiratory status, orientation, and skin color
d
The nurse is caring for a client with COPD. It is time to do discharge teaching with this client. The nurse teaches the client about breathing exercises. What should the nurse include in the teaching? a) Exhale through an open mouth b) Use chest breathing c) Make inhalation longer than exhalation d) Use diaphragmatic breathing
d
The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? a) Pulmonary contusion b) Flail chest c) Cardiac tamponade d) Tension pneumothorax
d
Which of the following is a late sign of hypoxia? a) Restlessness b) Hypotension c) Somnolence d) Cyanosis
d
While caring for a patient who is receiving oxygen therapy for pneumonia, what should the nurse assess to determine if the patient is hypoxic? a) Noncompliance b) Cold hands c) Restlessness d) Confusion
d
You are a nurse in the radiology unit of your hospital. You are caring for a client who is scheduled for a lung scan. You know that lung scans need the use of radioisotopes and a scanning machine. Before the perfusion scan, what must the client be assessed for? a) Inflammation b) Dysrhythmias c) Bleeding d) Iodine allergy
d
The client is postoperative immediately following a total laryngectomy. The client's respirations are 32 breaths/minute, shallow, and noisy. The tracheostomy pad is moist. Pulse oximetry is 88%. The client's eyes are wide open, and the client appears apprehensive. The client is receiving humidified oxygen. A priority nursing diagnosis is:
ineffective airway clearance related to excess mucus production
On auscultation, which finding suggests a right pneumothorax? a) Bilateral inspiratory and expiratory crackles b) Absence of breath sounds in the right thorax c) Inspiratory wheezes in the right thorax d) Bilateral pleural friction rub
Absence of breath sounds in the right thorax
A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to a) Exhale slowly b) Increase the flow of oxygen c) Perform upper chest breaths d) Take deep breaths
a
Which of the following is the strongest predisposing factor for asthma? a) Allergy b) Air pollution c) Male gender d) Congenital malformations
a
A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: a) pulmonary edema. b) atelectasis. c) oxygen toxicity. d) pleural effusion.
b
A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? a) "Raise your arms over your head." b) "Delay self-care activities for 1 hour." c) "Sit in a chair whenever doing an activity." d) "Drink fluids upon arising from bed."
b
A nurse is assisting a client with mild chronic obstructive pulmonary disease (COPD) to set a goal related to the condition. Which of the following is an appropriate goal for this client? a) Relieve shortness of breath to a level as close as possible to tolerable. b) Increase walking distance around a city block without shortness of breath. c) Maintain activity level of walking to the mailbox. d) Continue with current level of mobility at home.
b
A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: a) Impaired tissue integrity. b) Ineffective airway clearance. c) Ineffective breathing pattern. d) Risk for falls.
b
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first? a) Auscultate breath sounds bilaterally every 4 hours. b) Instruct the client to breathe into a paper bag. c) Administer oxygen by nasal cannula as ordered. d) Encourage the client to deep-breathe and cough every 2 hours.
c
A client has undergone a left hemicolectomy for bowel cancer. Which activities prevent the occurrence of postoperative pneumonia in this client? a) Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer b) Administering pain medications, frequent repositioning, and limiting fluid intake c) Administering oxygen, coughing, breathing deeply, and maintaining bed rest d) Coughing, breathing deeply, maintaining bed rest, and using an incentive spirometer
a
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Respiratory alkalosis
a
A client with chronic obstructive pulmonary disease tells a nurse that he feels short of breath. The client's respiratory rate is 36 breaths/minute and the nurse auscultates diffuse wheezes. His arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer an ordered nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm finished, I'll come and assess the client." The nurse's most appropriate action is to: a) give the nebulizer treatment herself. b) stay with the client until the therapist arrives. c) notify the primary physician immediately. d) administer the treatment by metered-dose inhaler.
a
A critical-care nurse is caring for a postoperative patient following lung surgery. The patient has a shallow, monotonous respiratory pattern and is reluctant to cough. What may the patient may be at an increased risk for? a) Atelectasis b) Malnutrition c) Increased oxygen saturation d) Aspiration
a
A nurse enters a client's room and observes a container with sputum. Upon questioning about the specimen, which of the following items of information from the client would necessitate the nurse to obtain a new specimen? a) "I coughed that up about 8 hours ago." b) "The lid is secured with tape." c) "The specimen is from a deep cough." d) "The container used is sterile."
a
A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client a) Has wheezes in the right lung lobes b) Has a respiratory rate of 28 breaths/minute c) Cannot perform activities of daily living d) Reports shortness of breath
a
A nurse is caring for a client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do? a) Place the end of the chest tube in a container of sterile saline. b) Apply an occlusive dressing and notify the physician. c) Clamp the chest tube immediately. d) Secure the chest tube with tape.
a
A nurse is preparing a client with a pleural effusion for a thoracentesis. The nurse should: a) assist the client to a sitting position on the edge of the bed, leaning over the bedside table. b) raise the head of the bed to a high Fowler's position. c) raise the arm on the side of the client's body on which the physician will perform the thoracentesis. d) place the client supine in the bed, which is flat.
a
A nurse is teaching a client about using an incentive spirometer. Which statement by the nurse is correct? a) "Before you do the exercise, I'll give you pain medication if you need it." b) "You need to start using the incentive spirometer 2 days after surgery." c) "Breathe in and out quickly." d) "Don't use the incentive spirometer more than 5 times every hour."
a
A patient returns to the unit after thoracic surgery with a water-sealed chest drainage system. What should the nurse instruct the patient and the family that this drainage system is used for? a) Re-expanding the lung and removing excess air and fluid b) Providing positive intrathoracic pressure c) Monitoring pleural fluid d) Maintaining positive chest-wall pressure
a
A physician stated to the nurse that the patient has fluid noted in the pleural space and will need a thoracentesis. The nurse would expect that the physician will document this fluid as which of the following? a) Pleural effusion b) Consolidation c) Hemothorax d) Pneumothorax
a
An 81-year-old client is recovering in your hospital unit from a bout with empyema. Because of her condition, you implement an intervention to promote healing and oxygenation. What intervention do you implement? a) Encourage breathing exercises. b) Do not allow visitors with a respiratory infection. c) Place suspected clients together. d) Institute droplet precautions.
a
Following a tracheostomy, the patient is exhibiting signs of a pneumothorax. The surgeon inserts a chest tube into the anterior of the chest wall. What would the nurse tell the family that the primary purpose of the chest tube is? a) To remove air b) To assist with mechanical ventilation c) To monitor bleeding d) To drain sputum secretions
a
For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan? a) Measuring and documenting the drainage in the collection chamber b) Stripping the chest tube every hour c) Maintaining continuous bubbling in the water-seal chamber d) Keeping the collection chamber at chest level
a
On auscultation, which finding suggests a right pneumothorax? a) Absence of breath sounds in the right thorax b) Bilateral pleural friction rub c) Bilateral inspiratory and expiratory crackles d) Inspiratory wheezes in the right thorax
a
The nurse received a client from the post-anesthesia care unit (PACU) who has a chest tube to a closed drainage system. Report from the PACU nurse included drainage in the chest tube at 80 mL of bloody fluid. Fifteen minutes after transfer from the PACU, the chest tube indicates drainage as pictured. The client is reporting pain at "8" on a scale of 0 to 10. The first action of the nurse is to: a) Assess pulse and blood pressure. b) Notify the physician. c) Administer prescribed pain medication. d) Lay the client's head to a flat position.
a
The pathophysiology of emphysema is directly related to airway obstruction. The end result of deterioration is respiratory acidosis from airway obstruction. Knowing this, the nursing student would choose which of the following as the MOST important nursing intervention. a) Assess vital signs every 2 hours including O2 saturations and ABG results. b) Refer to respiratory therapy if breathing becomes labored. c) Apply oxygen as ordered via nasal cannula. d) Educate the importance of pursed lip breathing.
a
Which assessment finding would be most consistent with advanced emphysema? a) Barrel-shaped chest b) Aortic bruit c) Dependent edema d) Epigastric pain
a
You are caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from? a) A puncture at the radial artery b) A catheter in the arm vein c) The pleural surfaces d) The trachea and bronchi
a
A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? a) A client who ambulates in the hallway every 4 hours b) A client with a nasogastric tube c) A client who is receiving acetaminophen (Tylenol) for pain d) A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago
b
A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? a) It decreases use of accessory breathing muscles. b) It helps prevent early airway collapse. c) It prolongs the inspiratory phase of respiration. d) It increases inspiratory muscle strength.
b
After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? a) Air-leak chamber b) Water-seal chamber c) Collection chamber d) Suction control chamber
b
During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: a) follow up with the physician in 2 weeks. b) continue to take antibiotics for the entire 10 days. c) turn and reposition himself every 2 hours. d) maintain fluid intake of 40 oz (1,200 ml) per day.
b
You've been invited to speak to the Hospital Guild of the hospital where you practice nursing. You've been asked to address "Communicable Diseases of Winter" and are speaking to a large group of volunteer women, most of whom are older than 60 years. What practices should you encourage in these women, who are at the risk of pneumococcal and influenza infections? Choose all correct options. a) Technique for incentive spirometry b) Receiving vaccination c) Using prescribed opioids d) Hand antisepsis
b d
A critical-care nurse is caring for a 68-year-old patient diagnosed with mycoplasmal pneumonia after a surgical procedure. The nurse documents that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do? a) Lie in a low Fowler's position b) Increase activity c) Increase oral fluids unless contraindicated d) Call the nurse for deep suctioning
c
A home health nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use? a) "I lubricate my lips and nose with K-Y jelly." b) "I have a 'no smoking' sign posted at my front door to remind guests not to smoke." c) "I make sure my oxygen mask is on tightly so it won't fall off while I nap." d) "I clean my mask with water after every meal."
c
A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? a) Sore throat and abdominal pain b) Hemoptysis and dysuria c) Dyspnea and wheezing d) Nonproductive cough and normal temperature
c
You are caring for a 65-year-old male patient admitted to your unit 72 hours ago with pyloric stenosis. A nasogastric tube was placed upon admission has been on low intermittent suction ever since. You notice that the patient's potassium is very low. What would you be concerned that the patient may be at risk for? a) Hypercalcemia b) Metabolic acidosis c) Metabolic alkalosis d) Respiratory acidosis
c
You are caring for a patient who has returned to the unit following a bronchoscopy. The patient is asking for something to drink. Which criterion will determine when you will allow the patient to drink fluids? a) Absence of nausea b) Ability to demonstrate deep inspiration c) Presence of a cough and gag reflex d) Ability to speak
c
