Respiratory System & Disorders
For which individual(s) does U.S. Public Health Service recommend the influenza immunization? (Select all that apply.) a. Physicians b. Compromised infants c. Older adults d. Chronically ill e. Nurses
a c d e
The nurse clarifies that when interstitial edema occurs in the lung tissue, it inhibits ventilation by causing which problem(s)? (Select all that apply.) a. Thickening alveolar membranes b. Pus formation c. Alveoli filling with fluid d. Evaporating surfactant e. Gas failing to diffuse across membrane
a c e
Which organism(s) are common causative agents for sinusitis? (Select all that apply.) a. Pneumococci b. Pseudomonas c. Staphylococci d. Haemophilus influenzae e. Streptococci
a d e
The nurse is assisting the physician with the insertion of a new tracheostomy tube. The physician asks for the obturator. The nurse correctly hands the physician which device? a. The guide for the tracheostomy tube to be inserted b. The scalpel used to make the tracheostomy stoma c. A single-cannula tracheostomy tube d. A cuffed tracheostomy tube
a
The nurse is aware that the patient is in respiratory failure when the blood gas findings contain which values? a. PaO2 46 mm Hg; PaCO2 52 mm Hg b. PaO2 50 mm Hg; PaCO2 45 mm Hg c. PaO2 52 mm Hg; PaCO2 42 mm Hg d. PaO2 55 mm Hg; PaCO2 58 mm Hg
a
The nurse is caring for a patient with a closed-chest drainage system with chest tubes. Which observation confirms that the system is intact and working? a. The water level in the water-seal chamber fluctuates. b. The level of fluid in the collection chamber rises. c. There are constant bubbles in the water-seal chamber. d. The suction has been attached.
a
Most of the inspired oxygen is carried to the tissues via which component of the body? a. Plasma b. Lymphatic system c. Red blood cells d. White blood cells
c
The nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which assessment finding indicates a potential complication and requires the nurse's immediate attention? a. Distended neck veins b. Left lower quadrant tenderness c. Urinary output of 40 mL/hr d. Excessive coughing
a
The nurse is educating a patient who requires daily postural drainage treatments. Which statement indicates that the patient understands when and why treatments will be scheduled? a. "I will have treatments first thing in the morning to get rid of fluids that have built up over night." b. "I will have my treatments after an hour after breakfast to make sure that I am fully alert." c. "I will have treatments after lunch to prevent an unsafe drop in my blood sugar." d. "I will have treatments right before bed to ensure that I breathe more easily at night."
a
The patient with sleep apnea is fitted with a continuous positive airway pressure (CPAP) mask and asks the nurse how this device will help. How should the nurse respond? a. "The device delivers constant positive pressure to keep your airway open." b. "The device will require you to be intubated to open your airway." c. "The device delivers oxygen only when you are apneic." d. "The device delivers negative pressure to stimulate your respirations."
a
When creating a visual aid to show the mechanics of inhaling, the nurse correctly illustrates which scenario? a. The diaphragm moves downward. b. The negative pressure of the lung converts to positive pressure. c. The muscles contract and pull the rib cage downward. d. The bronchi enlarge.
a
When the nurse places the diaphragm of the stethoscope over one of the main bronchi, which expected normal breath sound should the nurse hear? a. Bronchovesicular sounds b. Bronchial sounds c. Sonorous sounds d. Vesicular sounds
a
While performing an assessment, the nurse auscultates a coarse low-pitched sonorous rattling in the left lower lobe. Based on the presence of this adventitious lung sound, which action should the nurse take next? a. Instruct the patient to turn, cough, and deep-breathe. b. Administer the diuretic as ordered. c. Administer the bronchodilator as ordered. d. Instruct the patient to blow into the incentive spirometer.
a
The nurse is caring for a patient on a mechanical ventilator that it is set on assist-control mode. Which statement(s) accurately describe this function? (Select all that apply.) a. The ventilator delivers a set tidal volume. b. The ventilator delivers a set number of breaths if the patient's rate falls. c. The ventilator automatically cuts off if the patient is breathing independently. d. The ventilator delivers more oxygen at the end of an inspiration. e. The ventilator helps correct respiratory acidosis.
a b
The nurse is performing an occupational history as part of the respiratory assessment. Which occupation(s) place the patient at increased risk for an occupational lung disorder? (Select all that apply.) a. A firefighter b. A cotton gin worker c. A construction contractor d. A bartender e. A landscaper ANS: A, B, C
a b c
The nurse is teaching a patient with a newly resolved episode of epistaxis. Which information is important for the nurse to include? (Select all that apply.) a. Avoid sneezing. b. Rest for several hours until all threat of epistaxis is gone. c. Avoid rubbing the nose. d. Gently remove clotted blood from the occluded nostril. e. Blow the nose gently in small breaths.
a b c
The radical neck resection removes a large amount of tissue on the same side as the lesion. Which statement(s) about the tissue removed is/are correct? (Select all that apply.) a. The tissue includes all muscle, lymph nodes, and soft tissue from the lower edge of the mandible to the top of the clavicle. b. The tissue includes all muscle, lymph nodes, and soft tissue from the top of the trapezius to the midline. c. The tissue includes all muscle, lymph nodes, and soft tissue from the lower edge of the eye socket to the bottom of the maxilla, including the zygomatic arch. d. The tissue includes part of the tongue and parotid salivary glands. e. The tissue includes all lower lip to midline.
a b c
The nurse is assessing an older adult with a family tendency of developing laryngeal cancer. The nurse should ask the patient about which risk factors? (Select all that apply.) a. History of smoking b. Alcohol abuse c. Exposure to asbestos d. Occupational exposure to wood dust e. Infection with Streptococcus bacteria
a b c d
Which physical signs indicate labored breathing? (Select all that apply.) a. Grunting on expiration b. Elevating shoulders and ribs on inspiration c. Tensing neck and shoulder muscles d. Substernal retraction e. Productive cough
a b c d
The home health nurse is educating a 60-year-old patient with emphysema with a nutritional deficit. Which instructions should the nurse include in the teaching plan to address this problem? (Select all that apply.) a. Rest before eating. b. Avoiding gas-producing foods. c. Eat four to six small meals instead of three large meals. d. Lie down after eating. e. Take small bites and chew slowly.
a b c e
The nurse is caring for a patient with advanced emphysema. Which signs are manifestations of this disorder? (Select all that apply.) a. Productive cough b. Dyspnea c. Barrel chest d. Wheezing e. Cyanotic skin tone
a b c e
Which action(s) may help to reduce the risk of transmitting a common cold? (Select all that apply.) a. Cover the mouth and nose when sneezing. b. Wash the hands frequently. c. Use saline nose sprays. d. Turn the head to the crook of the arm when coughing. e. Drink juices with vitamin C.
a b d
The home health nurse is making an initial call on a newly diagnosed tuberculosis (TB) patient. The patient lives with his wife and child. Which infection control instructions should the nurse include in the teaching plan? (Select all that apply.) a. Place contaminated tissues in sealable plastic bag. b. Take medications exactly as directed. c. Implement airborne precautions. d. Wash hands frequently. e. Wear a mask when in crowds.
a b d e
The nurse is setting up the environment for tracheal suction on a newly postoperative tracheostomy patient. Which action(s) should the nurse perform? (Select all that apply.) a. Auscultate lungs for retained secretions. b. Wash hands and open sterile suction kit. c. Don clean gloves and lift out catheter and connect to suction. d. Inform the patient about the procedure. e. Perform suction with sterile supplies.
a b d e
Which manifestation(s) are age-related changes that alter the respiratory system? (Select all that apply.) a. Weakened cough b. Kyphosis c. Increased ciliary movement d. Decrease in body fluid e. Muscle weakness
a b d e
Through which method(s) can influenza spread? (Select all that apply.) a. Direct contact b. Indirect contact c. Vector d. Blood-borne method e. Droplets
a b e
A patient is admitted to the medical unit with an acute illness accompanied by a fever for the last 3 days. What will likely be the patient's respiratory response? a. Hypercarbia b. Respiratory alkalosis c. Kussmaul respirations d. Respiratory acidosis
b
A patient with emphysema presents to the emergency room with severe dyspnea; O2 saturation is 74%, pulse is 120, and respirations are 26. The nurse positions the patient in high Fowler. What action should the nurse take next? a. Collect a sputum specimen. b. Coach the patient in pursed-lip breathing. c. Give oxygen at 5 L/min by nasal cannula. d. Ensure patent intravenous (IV) access.
b
The 75-year-old patient presents to the emergency department with shortness of breath, fatigue, and a dry cough. When information leads the nurse to suspect that this patient should undergo workup for histoplasmosis? a. The patient reports drinking pond water. b. The patient lives on a farm and raises chickens. c. The patient recently went hunting in a wooded area. d. The patient owns a landscaping company.
b
The 79-year-old patient with bacterial pneumonia becomes increasingly restless, confused, and agitated. The patient's temperature is 100° F, and his pulse, blood pressure, and respirations are elevated since the last assessment 6 hours ago. What action should the nurse take first? a. Auscultate the patient's lungs. b. Assess the patient's oxygen saturation. c. Administer the mild sedative as ordered. d. Administer an ordered analgesic for discomfort.
b
The nurse is assessing the patient with influenza. The patient reports having general malaise and aching muscles over the past 2 weeks. The nurse suspects that the patient may have developed which complication of influenza? a. Bronchitis b. Bacterial pneumonia c. Urinary infection d. Encephalitis
b
The nurse is aware that the patient seeking antibiotic treatment for pharyngitis will only receive the desired medication if the condition is caused by what type of pathogen? a. Protozoa b. Bacteria c. A virus d. Fungi
b
The nurse is caring for a 20-year-old patient who recently underwent a tonsillectomy. The patient is fully awake and clearing his throat frequently but denies pain. Which action is most important for the nurse to take first? a. Place the patient in a side-lying position. b. Look in the patient's mouth. c. Offer the patient a grape popsicle. d. Remove the straw from the patient's tray.
b
The nurse is caring for a first-day postoperative thoracotomy patient. The nurse assesses that the level of drainage has not increased over the last 3 hours. After assessing the patient's respiratory status, what should the nurse do next? a. Raise the system above the patient's heart. b. Check the tubing for kinks. c. Reposition the patient. d. Notify the physician.
b
The nurse is caring for a patient with sleep apnea. The patient complains that he is constantly fatigued. Which response is most appropriate for the nurse to make? a. "Patients with sleep apnea experience oxygen overloads, which lead to drowsiness." b. "Patients with sleep apnea often wake frequently during the night." c. "Patients with mild sleep apnea benefit from a small amount of red wine right before bed." d. "All patients have difficulty sleeping properly in the hospital."
b
The nurse is caring for a patient with suspected sinusitis. Which assessment finding supports this diagnosis? a. Maxillary sinuses nontender on percussion. b. Generalized pain in the upper teeth. c. Clear drainage from the ear. d. Ear pain when lying down
b
The nurse is caring for a postoperative patient. After instructing the patient to cough and deep-breathe, what action should the nurse take next? a. Offer a warm drink. b. Perform mouth care. c. Deliver oxygen by mask. d. Take the patient's temperature.
b
The nurse is educating an asthma patient about proper use of the peak flowmeter. The nurse determines that the patient needs further teaching when observing which action? a. The patient repeats the procedure and obtains three readings. b. The patient breathes deeply through the mouthpiece. c. The patient stands while performing the test. d. The patient reports the highest reading on the peak flow sheet.
b
The nurse is teaching a patient who underwent a laryngectomy. Which statement describes the correct technique for warming inspired air during cold weather? a. Cover the stoma with a clean hand. b. Cover the stoma with a scarf. c. Apply a moist dressing over the stoma. d. Carry a portable humidifier.
b
The patient with asthma is prescribed a leukotriene modifier drug, montelukast (Singulair). Which statement describes an advantage of this medication? a. Limited gastrointestinal (GI) side effects b. Bronchodilation and anti-inflammatory effects c. Stringent control of acute episodes of asthma d. Ability to replace all other asthma remedies
b
What is the contagion period of a cold? a. 2 days b. 3 days c. 4 days d. 7 days
b
What is the purpose of mucus? a. To warm the air entering the lungs. b. To trap particles and bacteria. c. To protect the cilia. d. To clean the sinus cavity.
b
Which substance decreases the surface tension of the alveolar walls? a. Plasma b. Surfactant c. Cilia d. Mucus
b
The nurse is caring for a patient with a respiratory disorder who complains of anorexia. Which factor(s) may contribute to the patient's anorexia? (Select all that apply.) a. Increased sense of taste b. Bad taste in mouth c. Fear of exacerbate coughing by eating d. Fatigue e. Altered sense of smell
b c d e
The nurse is preparing a presentation that highlights the benefits of annual influenza vaccination. The nurse correctly targets which groups? (Select all that apply.) a. Parents of children 3 to 6 months of age. b. Diabetics who are over 50 years old. c. Pregnant women. d. Home health aides. e. CNAs who work in long-term care facilities.
b c d e
The nurse is performing discharge teaching for a patient who underwent a microlaryngoscopy with laser removal of polyps. Which instruction(s) should the nurse include? (Select all that apply.) a. Be alert for massive swelling. b. You can return to work in 3 days. c. Cough gently to expectorate blood. d. Observe 2 days of voice rest. e. Take opioids as needed for pain control.
b d
The nurse is teaching an adult post-tonsillectomy patient. Which dietary instructions are most important for the nurse to include? (Select all that apply.) a. Increase intake of citrus fruits. b. Avoid hot fluids. c. Avoid milk products. d. Avoid foods with red dye. e. Use a straw to drink liquids.
b d
The clinic nurse is giving discharge instructions to the mother of a 10-year-old boy who has been diagnosed with a mild cold. Which statements indicate that the mother accurately understands the nurse's instructions? (Select all that apply.) a. "I will be sure he takes the entire prescription of antibiotic." b. "I will be sure he drinks plenty of apple and orange juice." c. "If he runs a fever, I will give him two aspirin every 4 hours until his fever comes down." d. "I will be sure he washes his hands well so he doesn't pass this cold on to his younger sister." e. "Since his cold symptoms just started, zinc lozenges may be helpful for him to take."
b d e
The nurse is caring for a 30-year-old American Indian female who is taking Rifater, a drug containing rifampin, isoniazid, and pyrazinamide. The patient asks how long she will have to take the medication. Which response explains when the patient may discontinue the medication? a. When the sputum culture comes back negative b. When the medication has been taken for 9 months c. When three consecutive sputum cultures are negative d. When the tuberculin skin test (TST) is no longer positive
c
The nurse is caring for a patient during the immediate postoperative period following a rhinoplasty. Which finding is most concerning to the nurse? a. The patient complains of being cold and chilled. b. The patient complains of nausea. c. The nurse notices the patient is swallowing frequently. d. The nurse notices drainage on the nasal drip pad.
c
The nurse is caring for a patient who has had a cold for 1 week. The patient questions why the health care provider issued a prescription for an antibiotic. Which explanation is best? a. "The antibiotic will cure your cold." b. "The antibiotic will help to reduce your symptoms." c. "The antibiotic will treat the secondary bacterial infection that has developed." d. "The antibiotic will decrease the amount of time for which you are contagious."
c
The nurse is caring for a patient who underwent a laryngectomy. Which need should the nurse address first? a. Pain control b. Family support c. Communication method d. Plan for long-term care
c
The nurse is caring for a patient with chronic obstructive pulmonary disorder (COPD) who has been in the hospital for several days. The patient complains of shortness of breath and asks the nurse to turn up his oxygen to compensate for his labored breathing. What is the best nursing response? a. Turn up the patient's oxygen flow by 1 liter. b. Call the physician for an order to turn up the oxygen. c. Assess the patient in an attempt to identify the cause of the shortness of breath. d. Ask the patient what he usually keeps his oxygen set on at home.
c
The nurse is caring for a patient with suspected bacterial pneumonia. Which finding supports the potential diagnosis? a. Elevated white blood cell (WBC) count b. Consolidation of lung tissue c. Interstitial inflammation d. Copious exudate
c
The nurse is performing deep tracheal suctioning of a patient with a respiratory disorder. Which action demonstrates appropriate technique? a. The nurse maintains clean technique. b. The nurse places the patient in a side-lying position. c. The nurse suctions the patient for 10 to 15 seconds. d. The nurse reassures the patient that he will feel no discomfort.
c
The patient with acute bronchitis asks if antibiotics will be ordered for the condition. Which response is best for the nurse to make? a. "Antibiotics are the best treatment option." b. "Antibiotics will not help a viral condition." c. "Antibiotics will be given if the sputum culture indicates your bronchitis is caused by bacteria." d. "Antibiotics will inhibit the inflammatory response of your body to the invasion of this infection."
c
What is the purpose of treatment with amantadine (Symmetrel)? a. To prevent viral pneumonia if taken regularly. b. To prevent avian flu if taken at the first signs and symptoms of disease. c. To lessen the severity of type A flu symptoms if taken within 48 hours of exposure. d. To reduce irritation of bronchitis if taken weekly.
c
When teaching a patient about esophageal speech, which technique should the nurse instruct the patient to use first? a. Coordinate lip and tongue movements with produced sound. b. Relax the diaphragm to allow air into the esophagus. c. Cough to express air. d. Swallow air and force it back up through the esophagus.
d
Which statement is most important for the nurse to make when caring for an anxious patient with a new tracheostomy? a. "I have cared for patients who were able to have the tracheostomy reversed." b. "I will be efficient and give care quickly." c. "I will wait until your tracheostomy heals before teaching." d. "I understand that you might be apprehensive."
d
a. Mast cell-mediated inflammatory response in bronchi b. Mucus production c. Plugging of small airways d. Contact with precipitator e. Mucosal edema 27. Step 1 28. Step 2 29. Step 3 30. Step 4 31. Step 5
d a e b c
The nurse describes the ability of the lungs to respond to change in the volume and pressure of inhaled air by expanding as lung __________.
compliance
After using a nasal cannula delivery system at 3 L/min, a patient with chronic airflow limitation (CAL) changes to a simple face mask. The nasal equipment oxygen was set at 3 L/min. How should the nurse adjust the oxygen flow for the new delivery system? a. Decrease it to 2 L. b. Keep it the same. c. Increase it to 4 L. d. Increase it to 6 L.
d
The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him. Which reply is most accurate? a. "Pneumovax protects you for your lifetime." b. "Immunity afforded you by Pneumovax lasts only 2 years." c. "Pneumovax protection varies according to your risk factors and living situation." d. "After 6 years, you need a repeat dose of Pneumovax for full immunity."
d
The nurse carefully applies suction prior to deflating the cuff on a cuffed tracheostomy in order to prevent which complication? a. Bleeding b. Excessive negative pressure c. Accidental dislodgement of the tube d. Aspiration
d
The nurse explains that the mechanism that triggers rate and depth of respiration is based on which factor? a. Ease of respiration. b. Alveolar pressure. c. Patency of bronchi. d. Blood pH.
d
The nurse is caring for a patient experiencing epistaxis. What action should the nurse take first? a. Obtain the patient's vital signs. b. Firmly pack the nostrils with gauze. c. Apply a cold compress. d. Instruct the patient to sit forward and pinch the nose below the bone.
d
The nurse is caring for a patient immediately postoperative after a left pneumonectomy. How should the nurse position the patient? a. In high Fowler position b. In semi-Fowler position c. In a right side-lying position d. In a left side-lying position
d
The nurse is caring for a patient who has a tracheostomy with a one-way valve box. The nurse explains to the CNA that this valve allows the patient to carry out which function? a. Drinking b. Eating c. Coughing d. Talking
d
The nurse is caring for a patient who was recently admitted with a traumatic head injury. The nurse anticipates that the patient may display which type of respirations? a. Apneustic respirations b. Cheyne-Stokes c. Kussmaul d. Biot
d
The nurse is caring for a patient with an obstructive respiratory disorder. Which of these conditions is an example of an obstructive lung disorder? a. Atelectasis b. Lung cancer c. Guillain-Barré syndrome d. Chronic bronchitis
d
The nurse is caring for multiple patients. After reviewing the patients' histories, the nurse determines that which patient possesses the highest risk of throat cancer? a. A male patient who drinks four cups of coffee per day b. A female patient who smokes a pack of cigarettes weekly c. A female patient who drinks three carbonated drinks per day d. A male patient who drinks four vodka tonics per day
d
The nurse is preparing to administer the influenza immunization to four patients. Allergy to which substance should cause the nurse to question giving the immunization? a. Strawberries b. Ragweed c. Penicillin d. Eggs
d
The nurse reading a tuberculin skin test (TST) on a new employee who lives in the Midwest, is 20-years-old, and has no known history of contact with any people with tuberculosis (TB). The nurse should interpret the reading as positive if the area around the injection site has an induration of how many millimeters? a. 0 mm b. 5 mm c. 10 mm d. 15 mm
d
When caring for a patient with acquired immune deficiency syndrome (AIDS), the nurse is aware that this patient is most at risk for developing which type of pneumonia? a. Hypostatic b. Streptococcus pneumoniae c. Atypical d. Pneumocystis jiroveci
d
When doing routine cleaning of a double-lumen tracheostomy tube, the nurse should include which action? a. Place the patient supine. b. Reinsert the inner cannula without touching the faceplate of the tracheostomy tube. c. Rinse the inner cannula in a basin of hydrogen peroxide. d. Clean the inner cannula with a pipe cleaner.
d
The nurse uses a visual aid to show the "hinged door" that helps prevent aspiration. This "hinged door" is the __________.
epiglottis
Rapid opening and closing of the glottis combined with movement of the mouth, lips, and tongue is what makes _____________.
speech
The nurse encourages a patient with larynx cancer that the "near-total laryngectomy" is a new procedure that preserves the ability to __________ and to __________.
swallow; speak
