Respiratory - Hinkle Prep U questions
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. Put in right order: . 4 "Inhale through your nose." 3 "Slowly count to 3." 1 "Exhale slowly through pursed lips." 2 "Slowly count to 7."
4 3 1 2 (Correct order: "Inhale through your nose." "Slowly count to 3." "Exhale slowly through pursed lips." "Slowly count to 7.") (Pursed-lip breathing is a technique used to prolong exhalation by propping the airways open and promoting the removal of trapped air and carbon dioxide. The nurse should instruct the client to first inhale through the nose to a slow count of 3. Next, the client should exhale slowly through pursed lips for a count of 7.)
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 (Apply suction while withdrawing and gently rotating the catheter 360 degrees (no longer than 10-15 seconds). Prolonged suctioning may result in hypoxia and dysrhythmias, leading to cardiac arrest.)
The nurse should monitor a client receiving mechanical ventilation for which of the following complications? A - Gastrointestinal B -hemorrhage C - Pulmonary emboli D - Increased cardiac output Immunosuppression
A (Gastrointestinal hemorrhage occurs in approximately 25% of clients receiving prolonged mechanical ventilation. Other possible complications include incorrect ventilation, oxygen toxicity, fluid imbalance, decreased cardiac output, pneumothorax, infection, and atelectasis. Immunosuppression and pulmonary emboli are not direct consequences of mechanical ventilation.)
A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? A - Partial pressure of arterial oxygen (PaO2) B - Bicarbonate (HCO3-) C - pH D - Partial pressure of arterial carbon dioxide (PaCO2)
A (The most significant and direct indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of oxygen delivery (cannula, Venturi mask, or mechanical ventilator), flow rate, and oxygen percentage. The other options reflect the client's ventilation status, not oxygenation. The pH, HCO3-, and PaCO2)
A client has a sucking stab wound to the chest. Which action should the nurse take first? A - Apply a dressing over the wound and tape it on three sides. B - Prepare to start an I.V. line. C - Draw blood for a hematocrit and hemoglobin level. D - Prepare a chest tube insertion tray.
A (The nurse should immediately apply a dressing over the stab wound and tape it on three sides to allow air to escape and to prevent tension pneumothorax (which is more life-threatening than an open chest wound). Only after covering and taping the wound should the nurse draw blood for laboratory tests, assist with chest tube insertion, and start an I.V. line.)
A client who is undergoing thoracic surgery has a nursing diagnosis of "Impaired gas exchange related to lung impairment and surgery" on the nursing care plan. Which of the following nursing interventions would be appropriately aligned with this nursing diagnosis? Select all that apply. A - Encourage deep breathing exercises. B - Request order for patient-controlled analgesia pump C - Regularly assess the client's vital signs every 2 to 4 hours. D - Monitor and record hourly intake and output. E - Monitor pulmonary status as directed and needed.
A C E (Interventions to improve the client's gas exchange include monitoring pulmonary status as directed and needed, assessing vital signs every 2 to 4 hours, and encouraging deep breathing exercises. The nurse would request an order for patient-controlled analgesia if appropriate for the client, but that would be an intervention related to post-surgical pain, not impaired gas exchange. Monitoring and recording hourly intake and output are essential interventions for ensuring appropriate fluid balance but not directly related to impaired gas exchange.)
A client who must begin oxygen therapy asks the nurse why this treatment is necessary? What would the nurse identify as the goals of oxygen therapy? Select all that apply. A - To provide adequate transport of oxygen in the blood B - To clear respiratory secretions C - To provide visual feedback to encourage the client to inhale slowly and deeply D - To reduce stress on the myocardium E - To decrease the work of breathing
A D E (Oxygen therapy is designed to provide adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium. Incentive spirometry is a respiratory modality that provides visual feedback to encourage the client to inhale slowly and deeply to maximize lung inflation and prevent or reduce atelectasis. A mini-nebulizer is used to help clear secretions.)
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 - Collection chamber B - Water-seal chamber C - Suction control chamber D - Air-leak chamber
B (Fluctuations in the water-seal compartment are called tidal movements and indicate normal function of the system as the pressure in the tubing changes with the client's respirations. The air-leak meter — not chamber — detects air leaking from the pleural space. The collection chamber connects the chest tube from the client to the system. Drainage from the tube drains into and collects in a series of calibrated columns in this chamber. The suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest)
When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for how long? A - no longer than 5 seconds B - no longer than 10 seconds C - no longer than 20 seconds D - no longer than 30 seconds
B (In general, the nurse should apply suction no longer than 10. Applying suction for longer is hazardous and may result in the development of hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest. Applying suction for 0-5 seconds would provide too little time for effective suctioning of secretions.)
A nurse is caring for a client who has a tracheostomy tube and who is undergoing mechanical ventilation. The nurse can help prevent tracheal dilation, a complication of tracheostomy tube placement, by: A - using a cuffed tracheostomy tube. B - using the minimal-leak technique with cuff pressure less than 25 cm H2O. C - keeping the tracheostomy tube plugged. D - suctioning the tracheostomy tube frequently.
B (To prevent tracheal dilation, a minimal-leak technique should be used and the pressure should be kept at less than 25 cm H2O. Suctioning is vital but won't prevent tracheal dilation. Use of a cuffed tube alone won't prevent tracheal dilation. The tracheostomy shouldn't be plugged to prevent tracheal dilation. This technique is used when weaning the client from tracheal support..)
A client undergoes a tracheostomy after many failed attempts at weaning him from a mechanical ventilator. Two days after tracheostomy, while the client is being weaned, the nurse detects a mild air leak in the tracheostomy tube cuff. What should the nurse do first? A - Add more air to the cuff. B - Suction the client, withdraw residual air from the cuff, and reinflate it. C - Remove the malfunctioning cuff. D - Call the physician.
B (After discovering an air leak, the nurse first should check for insufficient air in the cuff — the most common cause of a cuff air leak. To do this, the nurse should suction the client, withdraw all residual air from the cuff, and then reinflate the cuff to prevent overinflation and possible cuff rupture. The nurse should notify the physician only after determining that the air leak can't be corrected by nursing interventions, or if the client develops acute respiratory distress. The tracheostomy tube cuff can't be removed and replaced with a new one without changing the tracheostomy tube; also, removing the cuff would create a total air leak, which isn't correctable. Adding more air to the cuff without first removing residual air may cause cuff rupture.)
A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings? A - 58 mm Hg B - 84 mm Hg C - 120 mm Hg D - 45 mm Hg
B (In general, clients with respiratory conditions are given oxygen therapy only to increase the arterial oxygen pressure (PaO2) back to the client's normal baseline, which may vary from 60 to 95 mm Hg.)
Which is a potential complication of a low pressure in the endotracheal tube cuff? A - Pressure necrosis B - Aspiration pneumonia C - Tracheal bleeding D -Tracheal ischemia
B (Low pressure in the cuff can increase the risk for aspiration pneumonia. High pressure in the cuff can cause tracheal bleeding, ischemia, and pressure necrosis.)
Which oxygen administration device has the advantage of providing a high oxygen concentration? A - Face tent B - Nonrebreathing mask C - Catheter D - Venturi mask
B (Nonrebreathing masks provide high oxygen concentrations but usually fit poorly. A Venturi mask provides low levels of supplemental oxygen. A catheter is an inexpensive device that provides a variable fraction of inspired oxygen and may cause gastric distention. A face tent provides a fairly accurate fraction of inspired oxygen but is bulky and uncomfortable; it would not be the device of choice to provide a high oxygen concentration.)
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? A - Oxygen-induced hypoventilation B - Oxygen toxicity C - Hypoxia D - Oxygen-induced atelectasis
B (Oxygen toxicity may occur when too high a concentration of oxygen (greater than 50%) is administered for an extended period (longer than 48 hours) (Urden, Stacy, & Lough, 2014). Signs and symptoms of oxygen toxicity include substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates evident on chest x-rays.)
A client is on a positive-pressure ventilator with a synchronized intermittent mandatory ventilation (SIMV) setting. The ventilator is set for 8 breaths per minute. The client is taking 6 breaths per minute independently. The nurse: A - Consults with the physician about removing the client from the ventilator B - Continues assessing the client's respiratory status frequently C - Contacts the respiratory therapy department to report the ventilator is malfunctioning D - Changes the setting on the ventilator to increase breaths to 14 per minute
B (The SIMV setting on a ventilator allows the client to breathe spontaneously with no assistance from the ventilator for those extra breaths. Data in the stem suggest that the ventilator is working correctly. The nurse would continue making frequent respiratory assessments of the client. There are not sufficient data to suggest the client could be removed from the ventilator. There is no reason to increase the ventilator's setting to 14 breaths per minute or to contact respiratory therapy to report the machine is not working properly.)
Which is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means? A - Nasal cannula B - Venturi mask C - Partial-rebreathing mask D - T-piece
B (The Venturi mask is the most reliable and accurate method for delivering a precise concentration of oxygen through noninvasive means. The mask is constructed in a way that allows a constant flow of room air blended with a fixed flow of oxygen. Nasal cannula, T-piece, and partial-rebreathing masks are not the most reliable and accurate methods of oxygen administration.)
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 - Notify the physician. B - Assess pulse and blood pressure. C - Administer prescribed pain medication. D - Lay the client's head to a flat position.
B (The client has bled 120 mL of bloody drainage in the chest drainage system within 15 minutes. It is most important for the nurse to assess for signs and symptoms of hemorrhage, which may be indicated by a rapid pulse and decreasing blood pressure. The nurse may then lay the client in a flat position and notify the physician.)
A nurse is teaching a client about using an incentive spirometer. Which statement by the nurse is correct? A - "Breathe in and out quickly." B - "Before you do the exercise, I'll give you pain medication if you need it." C - "You need to start using the incentive spirometer 2 days after surgery." D - "Don't use the incentive spirometer more than 5 times every hour."
B (The nurse should assess the client's pain level before the client does incentive spirometry exercises and administer pain medication as needed. Doing so helps the client take deeper breaths and help prevents atelectasis. The client should breathe in slowly and steadily and hold the breath for 3 seconds after inhalation. The client should start doing incentive spirometry immediately after surgery and aim to do 10 incentive spirometry breaths every hour.)
The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique? A - Administer bronchodilators and mucolytic agents following the sequence. B - Perform this measure with the client once a day. C - Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes. D - Use aerosol sprays to deodorize the client's environment after postural drainage.
C (Postural drainage is usually performed two to four times daily, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. Prescribed bronchodilators, water, or saline may be nebulized and inhaled before postural drainage to dilate the bronchioles, reduce bronchospasm, decrease the thickness of mucus and sputum, and combat edema of the bronchial walls. The nurse instructs the client to remain in each position for 10 to 15 minutes and to breathe in slowly through the nose and out slowly through pursed lips to help keep the airways open so that secretions can drain while in each position. If the sputum is foul-smelling, it is important to perform postural drainage in a room away from other patients or family members. (Deodorizers may be used to counteract the odor. Because aerosol sprays can cause bronchospasm and irritation, they should be used sparingly and with caution.)
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? A - Surgery to remove the tonsils and adenoids B - Medications to assist the patient with sleep at night C - Continuous positive airway pressure (CPAP) D - Bi-level positive airway pressure (BiPAP)
C (CPAP provides positive pressure to the airways throughout the respiratory cycle. Although it can be used as an adjunct to mechanical ventilation with a cuffed endotracheal tube or tracheostomy tube to open the alveoli, it is also used with a leak-proof mask to keep alveoli open, thereby preventing respiratory failure. CPAP is the most effective treatment for obstructive sleep apnea because the positive pressure acts as a splint, keeping the upper airway and trachea open during sleep. CPAP is used for clients who can breathe independently. BiPAP is most often used for clients who require ventilatory assistance at night, such as those with severe COPD or sleep apnea.)
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 physician will take now that the patient has been intubated for this length of time? A - The patient will be extubated and a nasotracheal tube will be inserted. B - The patient will begin the weaning process. C - The patient will have an insertion of a tracheostomy tube. D - The patient will be extubated and another endotracheal tube will be inserted.
C (Endotracheal intubation may be used for no longer than 14 to 21 days, by which time a tracheostomy must be considered to decrease irritation of and trauma to the tracheal lining, to reduce the incidence of vocal cord paralysis (secondary to laryngeal nerve damage), and to decrease the work of breathing (Wiegand, 2011).)
The nurse assesses a patient with a heart rate of 42 and a blood pressure of 70/46. What type of hypoxia does the nurse determine this patient is displaying? A - Histotoxic hypoxia B - Hypoxemic hypoxia C - Circulatory hypoxia D - Anemic hypoxia
C (Given the vital signs, this client appears to be in shock. Circulatory hypoxia results from inadequate capillary circulation and may be caused by decreased cardiac output, local vascular obstruction, low-flow states such as shock, or cardiac arrest. Although tissue partial pressure of oxygen (PO2) is reduced, arterial oxygen (PaO2) remains normal. Circulatory hypoxia is corrected by identifying and treating the underlying cause. The low blood pressure is consistent with circulatory hypoxia but not consistent with the other options. Anemic hypoxia is a result of decreased effective hemoglobin concentration. Histotoxic hypoxia occurs when a toxic substance interferes with the ability of tissues to use available oxygen. Hypoxemic hypoxia results from a low level of oxygen in the blood.)
What assessment method would the nurse use to determine the areas of the lungs that need draining? A - Chest X-ray B - Arterial blood gas (ABG) levels C - Auscultation D - Inspection
C (The nurse should assess breath sounds before doing postural drainage to determine the areas that need draining. Inspection, chest X-rays, and ABG levels are all assessment parameters that give good information about respiratory function but aren't necessary to determine lung areas requiring postural drainage.)
The nurse is caring for a client who is scheduled for a lobectomy. Following the procedure, the nurse will plan care based on the client: A - requiring mechanical ventilation following surgery. B - requiring sedation until the chest tube(s) are removed. C - returning to the nursing unit with two chest tubes. D - returning from surgery with no drainage tubes.
C (The nurse should plan for the client to return to the nursing unit with two chest tubes intact. During a lobectomy, the lobe is removed, and the remaining lobes of the lung are re-expanded. Usually, two chest catheters are inserted for drainage. The upper tube is for air removal; the lower one is for fluid drainage. Sometimes only one catheter is needed. The chest tube is connected to a chest drainage apparatus for several days.)
A nurse is weaning a client from mechanical ventilation. Which nursing assessment finding indicates the weaning process should be stopped? A - Oxygen saturation of 93% B - Respiratory rate of 16 breaths/minute C - Runs of ventricular tachycardia D - Blood pressure remains stable
C (Ventricular tachycardia indicates that the client isn't tolerating the weaning process. The weaning process should be stopped before lethal ventricular arrhythmias occur. A respiratory rate of 16 breaths/minute and an oxygen saturation of 93% are normal findings. The client's blood pressure remains stable, so the weaning can continue.)
The nurse is caring for a client with an endotracheal tube (ET). Which nursing intervention is contraindicated? A - Ensuring that humidified oxygen is always introduced through the tube B - Checking the cuff pressure every 6 to 8 hours C - Deflating the cuff before removing the tube D - Routinely deflating the cuff
D (Routine cuff deflation is not recommended because of the increased risk for aspiration and hypoxia. The cuff is deflated before the ET is removed. Cuff pressures should be checked every 6 to 8 hours. Humidified oxygen should always be introduced through the tube.)
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 - Stripping the chest tube every hour B - Maintaining continuous bubbling in the water-seal chamber C - Keeping the collection chamber at chest level D - Measuring and documenting the drainage in the collection chamber
D (The nurse should regularly measure and document the amount of chest tube drainage to detect abnormal drainage patterns, such as may occur with a hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling in the water-seal chamber indicates a leak in the closed chest drainage system, which must be corrected. The nurse should keep the collection chamber below chest level to allow fluids to drain into it. The nurse shouldn't strip chest tubes because doing so may traumatize the tissue or dislodge the tube)
A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A - change in the oxygen concentration without resetting the oxygen level alarm B - An ET cuff leak C - A disconnected ventilator circuit D - Kinking of the ventilator tubing
D (Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm, pulmonary embolus, mucus plugging, water in the tube, and coughing or biting on the ET tube. The alarm may also be triggered when the client's breathing is out of rhythm with the ventilator. A disconnected ventilator circuit or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm, not the high-pressure alarm.)
The nurse is preparing to perform tracheostomy care for a client with a newly inserted tracheostomy tube. Which action, if performed by the nurse, indicates the need for further review of the procedure? A - Puts on clean gloves; removes and discards the soiled dressing in a biohazard container B - Cleans an infected wound and the plate with a sterile cotton tip moistened with hydrogen peroxide C - Dries and reinserts the inner cannula or replaces it with a new disposable inner cannula D - Places clean tracheostomy ties then removes soiled ties after the new ties are in place without a second nurse assisting
D (For a new tracheostomy, two people should assist with tie changes to help make sure the new tracheostomy is not dislodged. A dislodged tracheostomy is a medical emergency. The other actions, if performed by the nurse during tracheostomy care, are correct. The wound and plate should be cleaned with sterile cotton-tipped applicators moistened with saline or sterile water or with hydrogen peroxide if infection is present. The inner cannula should be dried before reinsertion or if a disposable is being used, a new disposable cannula should be reinserted. The nurse should put on clean gloves and discard the soiled dressing in a biohazard container.)
For a client with an endotracheal (ET) tube, which nursing action is the most important? A - Monitoring serial blood gas values every 4 hours B - Turning the client from side to side every 2 hours C - Providing frequent oral hygiene D - Auscultating the lungs for bilateral breath sounds
D (For the client with an ET tube, the most important nursing action is auscultating the lungs regularly for bilateral breath sounds to ensure proper tube placement and effective oxygen delivery. Although turning the client from side to side every 2 hours, monitoring serial blood gas values every 4 hours, and providing frequent oral hygiene are appropriate actions for this client, they're secondary to ensuring adequate oxygenation.)
A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? A - Water-seal chest drainage set-up B - Oxygen analyzer C - Tracheostomy cleaning kit D - Manual resuscitation bag
D (The client with COPD depends on mechanical ventilation for adequate tissue oxygenation. The nurse must keep a manual resuscitation bag at the bedside to ventilate and oxygenate the client in case the mechanical ventilator malfunctions. Because the client doesn't have chest tubes or a tracheostomy, keeping a water-seal chest drainage set-up or a tracheostomy cleaning kit at the bedside isn't necessary. Although the nurse may keep an oxygen analyzer (pulse oximeter) on hand to evaluate the effectiveness of ventilation, this equipment is less important than the manual resuscitation bag.)
A client with supraglottic cancer undergoes a partial laryngectomy. Postoperatively, a cuffed tracheostomy tube is in place. When removing secretions that pool above the cuff, the nurse should instruct the client to: A - take a deep breath as the nurse deflates the cuff. B - hold the breath as the cuff is being reinflated. C - exhale deeply as the nurse reinflates the cuff. D - cough as the cuff is being deflated.
D (The nurse should instruct the client to cough during cuff deflation. If the client can't cough, the nurse should perform suctioning to prevent aspiration of secretions. Because the cuff should be deflated during expiration, the client shouldn't take a deep breath as the nurse deflates the cuff. Likewise, because the cuff is reinflated during inspiration, the client shouldn't hold the breath or exhale deeply during reinflation.)
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 - the patient to try to stop coughing during and after using the spirometer. B - Have the patient lie in a supine position during the use of 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 (The patient should be instructed to perform the procedure approximately 10 times in succession, repeating the 10 breaths with the spirometer each hour during waking hours. The patient should assume a semi-Fowler's position or an upright position before initiating therapy, not be supine. Coughing during and after each session is encouraged, not discouraged. The patient should Splint the incision when coughing postoperatively. The patient should still use the spirometer when in pain.)
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 - Assess the CO2 level to determine if the patient requires suctioning. B - Have the patient inform the nurse of the need to be suctioned. C - Have the patient cough. D - Auscultate the lung for adventitious sounds.
D (When a tracheostomy or endotracheal tube is in place, it is usually necessary to suction the patient's secretions because of the decreased effectiveness of the cough mechanism. Tracheal suctioning is performed when adventitious breath sounds are detected or whenever secretions are obviously present. Unnecessary suctioning can initiate bronchospasm and cause mechanical trauma to the tracheal mucosa)
Which type of ventilator has a preset volume of air to be delivered with each inspiration? A - Time-cycled B - Negative-pressure C - Pressure-cycled D - Volume-controlled
D (With volume-controlled ventilation, the volume of air to be delivered with each inspiration is preset. Negative-pressure ventilators exert a negative pressure on the external chest. Time-cycled ventilators terminate or control inspiration after a preset time. When the pressure-cycled ventilator cycles on, it delivers a flow of air (inspiration) until it reaches a preset pressure, and then cycles off, and expiration occurs passively)