Respiratory PrepU

When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for which of the following time periods? a) 10 to 15 seconds b) 20 to 25 seconds c) 0 to 5 seconds d) 30 to 35 seconds

a) 10 to 15 seconds

A client experiences a head injury in a motor vehicle accident. The client's level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client's respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth? a) Central sulcus b) The pons c) Wernicke's area d) The frontal lobe

b) The pons in the brainstem controls rate and depth of respirations. When injury occurs or increased intracranial pressure results, respirations are slowed. The frontal lobe completes executive functions and cognition. The central sulcus is a fold in the cerebral cortex called the central fissure. The Wernicke's area is the area linked to speech

Which of the following are indicators that a client is ready to be weaned from a ventilator? Select all that apply. a) FiO2 45% b) Tidal volume of 8.5 mL/kg c) PaO2 of 64 mm Hg d) Vital capacity of 13 mL/kg e) Rapid/shallow breathing index of 112 breaths/min

b) Tidal volume of 8.5 mL/kg c) PaO2 of 64 mm Hg d) Vital capacity of 13 mL/kg Weaning criteria for clients are as follows: Vital capacity 10 to 15 mL/kg; Maximum inspiratory pressure at least -20 cm H2; Tidal volume: 7 to 9 mL/kg; Minute ventilation: 6 L/min; Rapid/shallow breathing index below 100 breaths/min; PaO2 > 60 mm Hg; FiO2 < 40%

A patient describes his chest pain as knife-like on inspiration. Which of the following is the most likely diagnosis? a) A lung infection b) Bronchogenic carcinoma c) Pleurisy d) Bacterial pneumonia

c) Pleurisy Pleuritic pain from irritation of the parietal pleura is sharp and seems to "catch" on inspiration. Some patients describe the pain as being "stabbed by a knife." Chest pain associated with the other conditions may be dull, aching, and persistent.

The body of a critically ill client may use which of the following homeostatic mechanisms to maintain normal pH? a) The lungs increase respiratory volume. b) The lungs retain more CO2 to lower the pH. c) The lungs eliminate carbonic acid by blowing off more CO2. d) The kidneys retain more HCO3 to raise the pH.

c) The lungs eliminate carbonic acid by blowing off more CO2.

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) 45 mm Hg b) 58 mm Hg c) 120 mm Hg d) 84 mm Hg

d) 84 mm Hg 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.

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) Anemic hypoxia c) Hypoxic hypoxia d) Circulatory hypoxia

d) Circulatory hypoxia.

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) Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes. c) Perform this measure with the client once a day. d) Use aerosol sprays to deodorize the client's environment after postural drainage.

b) Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.

The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about? a) Excessive capillary refill b) Flushed feeling in the client c) Absent distal pulses d) Raised temperature in the affected limb

c) Absent distal pulses

A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? a) The client has a pneumothorax. b) The chest tube is obstructed. c) The system is functioning normally. d) The system has an air leak.

d) The system has an air leak. Constant bubbling in the water-seal chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the fluid would stop fluctuating in the water-seal chamber.

Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? a) IMV b) Pressure support c) Assist-control d) SIMV

C. Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. Intermittent mandatory ventilation (IMV) provides a combination of mechanically assisted breaths and spontaneous breaths. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the patient can breathe spontaneously with no assistance from the ventilator for those extra breaths.

A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation? a) Endotracheal suctioning b) Incentive spirometry c) Encouragement of coughing d) Use of a cooling blanke

a) Endotracheal suctioning

A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? a) Inspection b) Arterial blood gas (ABG) levels c) Auscultation d) Chest X-ray

c) Auscultation

Which of the following interventions does a nurse implement for patients with empyema? a) Institute droplet precautions b) Place suspected patients together c) Encourage breathing exercises d) Do not allow visitors with respiratory infection

c) Encourage breathing exercises

What is the difference between respiration and ventilation? a) Ventilation is the exchange of gases in the lung. b) Ventilation is the process of gas exchange. c) Ventilation is the process of getting oxygen to the cells. d) Ventilation is the movement of air in and out of the respiratory tract.

d) Ventilation is the movement of air in and out of the respiratory tract.

The nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first? a) Pulse oximetry b) Pulmonary function test c) Arterial blood gases d) Chest x-ray

A. Pulse oximetry

A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3−of 28 mEq/L. The nurse reports to the physician which finding? a) Respiratory alkalosis b) Respiratory acidosis c) Metabolic alkalosis d) Metabolic acidosis

B. Respiratory acidosis

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. Oxygen analyzer B. Manual resuscitation bag C. Water-seal chest drainage set up D. Tracheostomy cleaning kit

B. 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

The term for the volume of air inhaled and exhaled with each breath is: A. Expiratory reserve volume B. Tidal volume C. Residual volume D. Vital capacity

B. Tidal volume is the volume of air inhaled and exhaled with each breath. Residual volume is the volume of air remaining in the lungs after a maximum expiration. Vital capacity is the maximum volume of air exhaled from the point of maximum inspiration. Expiratory reserve volume is the maximum volume of air that can be exhaled after a normal inhalation.

A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does serous fluid indicate? A. Trauma B. Infection C. Cancer D.

C. Cancer. A thoracentesis may be performed to obtain a sample of pleural fluid or to biopsy a specimen from the pleural wall for diagnostic purposes. Serous fluid may be associated with cancer, inflammatory conditions, or heart failure. Blood fluid typically suggests trauma. Purulent fluid is diagnostic for infection. Complications that may follow a thoracentesis include pneumothorax and subcutaneous emphysema.

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. Hemothorax B. Consolidation C. Pneumothorax D. Pleural effusion

D. Fluid accumulating within the pleural space is called a pleural effusion. A pneumothorax is air in the pleural space. A hemothorax is blood within the pleural space. Consolidation is lung tissue that has become more solid in nature due to collapse of alveoli or infectious process.

The nurse is caring for a patient with recurrent hemoptysis who has undergone a bronchoscopy. Immediately following the procedure, the nurse should complete which of the following? a) Assess the patient for a cough reflex. b) Ensure the patient remains moderately sedated to decrease anxiety. c) Offer the patient ice chips. d) Instruct the patient that bed rest must be maintained for 2 hours.

a) Assess the patient for a cough refle After the procedure, the patient must take nothing by mouth until the cough reflex returns, because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing.

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) Have the patient cough. d) Assess the CO2 level to determine if the patient requires suctioning.

a) Auscultate the lung for adventitious sounds. 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.

A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? a) Blood-tinged sputum b) Productive cough c) Bradypnea d) Respiratory alkalosis

a) Blood-tinged sputum The clinical manifestations of pulmonary contusions are based on the severity of bruising and parenchymal involvement. The most common signs and symptoms are crackles, decreased or absent bronchial breath sounds, dyspnea, tachypnea, tachycardia, chest pain, blood-tinged secretions, hypoxemia, and respiratory acidosis. Patients with moderate pulmonary contusions often have a constant, but ineffective cough and cannot clear their secretions

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) Continues assessing the client's respiratory status frequently b) Contacts the respiratory therapy department to report the ventilator is malfunctioning c) Consults with the physician about removing the client from the ventilator d) Changes the setting on the ventilator to increase breaths to 14 per minute

a) Continues assessing the client's respiratory status frequently 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

The nurse identifies which finding to be most consistent prior to the onset of acute respiratory distress? a) Normal lung function b) Chronic lung disease c) Loss of lung function d) Slow onset of symptoms

a) Normal lung function Acute respiratory failure occurs suddenly in clients who previously had normal lung function.

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options. a) Reduce airway obstruction b) Alter smooth muscle tone c) Decrease alveolar ventilation d) Increase oxygen distribution

a) Reduce airway obstruction b) Alter smooth muscle tone d) Increase oxygen distribution Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation

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? a) Ventilation exceeds perfusion. b) Perfusion exceeds ventilation. c) Ventilation matches perfusion. d) There is an absence of perfusion and ventilation.

a) Ventilation exceeds perfusion. A high ventilation-perfusion rate means that ventilation exceeds perfusion, causing dead space. The alveoli do not have an adequate blood supply for gas exchange to occur. This is characteristic of a variety of disorders, including pulmonary emboli, pulmonary infarction, and cardiogenic shock

For a client with an endotracheal (ET) tube, which nursing action is the most important? a) Turning the client from side to side every 2 hours b) Auscultating the lungs for bilateral breath sounds c) Providing frequent oral hygiene d) Monitoring serial blood gas values every 4 hours

b) Auscultating the lungs for bilateral breath sounds 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.

Nursing instruction during postural drainage should include telling the patient to: a) Remain in each position for 30 to 45 minutes for best results. b) Change positions frequently and cough up secretions. c) Lie supine to rest the lungs. d) Sit upright to promote ventilation

b) Change positions frequently and cough up secretions.

The nurse is caring for a patient with an endotracheal tube (ET). Which of the following nursing interventions is contraindicated? a) Checking the cuff pressure every 6 to 8 hours b) Deflating the cuff routinely c) Deflating the cuff prior to tube removal d) Ensuring that humidified oxygen is always introduced through the tube

b) Deflating the cuff routinely 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

The nurse is caring for a client with a new tracheostomy. Which of the following nursing diagnoses are priorities? Select all that apply. a) Risk for Infection related to operative incision and tracheostomy tube placement b) Ineffective Airway Clearance related to increased secretions c) Knowledge Deficit related to care of the tracheostomy tube and surrounding site d) Impaired Gas Exchange related to shallow breathing and anxiousness

b) Ineffective Airway Clearance related to increased secretion d) Impaired Gas Exchange related to shallow breathing and anxiousness

A nurse is weaning a client from mechanical ventilation. Which assessment finding indicates the weaning process should be stopped? a) Oxygen saturation of 93% b) Runs of ventricular tachycardia c) Respiratory rate of 16 breaths/minute d) Blood pressure increase from 120/74 mm Hg to 134/80 mm Hg

b) Runs of ventricular tachycardia

The nurse is caring for a patient who is to undergo a thoracentesis. In preparation for the procedure, the nurse will position the patient in which of the following positions? a) Lateral recumbent b) Sitting on the edge of the bed c) Prone d) Supine

b) Sitting on the edge of the bed

The most diagnostic clinical symptom of pleurisy is: a) Dyspnea and coughing. b) Stabbing pain during respiratory movements. c) Dullness or flatness on percussion over areas of collected fluid. d) Fever and chills.

b) Stabbing pain during respiratory movements.

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 in a hypermetabolic state. b) The patient is hypoxic from suctioning. c) The patient is having a myocardial infarction. d) The patient is having a stress reaction.

b) The patient is hypoxic from suctioning. 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.

What client would be most in need of an endotracheal tube? a) Ambulatory clients b) Older adult clients c) Comatose clients d) A client status post tonsillectomy

c) Comatose clients Examples include those with respiratory difficulty, comatose clients, those undergoing general anesthesia, and clients with extensive edema of upper airway passages

The nurse is assessing a patient who has been admitted with possible ARDS. What findings would distinguish ARDS from cardiogenic pulmonary edema? a) Elevated troponin levels b) Elevated white blood count c) Elevated B-type natriuretic peptide (BNP) levels d) Elevated myoglobin levels

c) Elevated B-type natriuretic peptide (BNP) levels

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) An ET cuff leak b) A change in the oxygen concentration without resetting the oxygen level alarm c) Kinking of the ventilator tubing d) A disconnected ventilator tube

c) Kinking of the ventilator tubing 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 tube 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 assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for: a) Cool air humidified through the tube b) Tracheal cuff pressure set at 30 mm Hg c) Symmetry of the client's chest expansion d) A scheduled time for deflation of the tracheal cuff

c) Symmetry of the client's chest expansion Immediately after intubation, the nurse should check for symmetry of chest expansion. This is one finding that indicates successful endotracheal placement. The tracheal cuff pressure is set between 15 and 20 mm Hg.

Which type of ventilator has a pre-sent volume of air to be delivered with each inspiration? a) Pressure cycled b) Negative pressure c) Volume cycled d) Time cycled

c) Volume cycled With volume-cycled ventilation, the volume of air to be delivered with each inspiration is present. 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 present pressure, and then cycles off, and expiration occurs passively

Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain? a) Electrocardiogram (ECG) results b) Prior outcomes of weaning c) Fluid intake for the past 24 hours d) Baseline arterial blood gas (ABG) levels

d) Baseline arterial blood gas (ABG) levels

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a) Bicarbonate (HCO3-) b) pH c) Partial pressure of arterial carbon dioxide (PaCO2) d) Partial pressure of arterial oxygen (PaO2)

d) Partial pressure of arterial oxygen (PaO2) 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 with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? a) Check for an apical pulse. b) Increase the oxygen percentage. c) Ventilate the client with a handheld mechanical ventilator. d) Suction the client's artificial airway

d) Suction the client's artificial airway A high-pressure alarm on a continuous mechanical ventilator indicates an obstruction in the flow of oxygen from the machine to the client. The nurse should suction the client's artificial airway to remove respiratory secretions that could be causing the obstruction. The sounding of a ventilator alarm has no relationship to the apical pulse. Increasing the oxygen percentage and ventilating with a handheld mechanical ventilator wouldn't correct the airflow blockage

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) Collection chamber c) Suction control chamber d) Water-seal chamber

d) Water-seal chamber 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.

In general, chest drainage tubes are not used for the patient undergoing a) wedge resection. b) lobectomy. c) segmentectomy. d) pneumonectomy.

d) pneumonectomy. Usually, no drains are used for the pneumonectomy patient because the accumulation of fluid in the empty hemothorax prevents mediastinal shift. With lobectomy, two chest tubes are usually inserted for drainage, the upper tube for air and the lower tube for fluid. With wedge resection, the pleural cavity usually is drained because of the possibility of an air or blood leak. With segmentectomy, drains are usually used because of the possibility of an air or blood leak.

A nurse is caring for a client who was intubated because of respiratory failure. The client is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The client has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as: a) assist-control (AC) ventilation. b) pressure support ventilation (PSV). c) continuous positive airway pressure (CPAP). d) synchronized intermittent mandatory ventilation (SIMV).

d) synchronized intermittent mandatory ventilation (SIMV). In SIMV mode, the ventilator delivers a preset number of breaths at a preset tidal volume. The client can breathe on his own in between the breaths delivered by the ventilator. In PSV, a pressure plateau is added to the ventilator to prevent the airway pressure from falling beneath a preset level. In AC ventilation, the ventilator delivers a preset number of breaths at a preset tidal volume and any breaths that the client takes on his own are assisted by the ventilator so they reach the preset tidal volume. In CPAP, the ventilator provides only positive airway pressure; it doesn't provide any breaths to the client.