Test 3 #3

The client is to be extubated after having received mechanical ventilation for 4 days. The client is alert and oriented. Indicate in which order the following steps should be performed. (Separate letters by a comma and space as follows: A, B, C, D.) a. Deflate the endotracheal tube cuff. b. Ensure that emergency intubation equipment is at the bedside. c. Explain the entire procedure to the client. d. Give oxygen by face mask or nasal cannula. e. Hyperoxygenate the client. f. Instruct the client to cough. g. Rapidly remove the tube at peak inspiration. h. Suction the endotracheal tube and oral cavity. i. Tell the client to take a deep breath.

ANS: C, B, E, H, A, I, G, F, D Extubation is the removal of the endotracheal (ET) tube. Before removal, explain to the client exactly what is to be done and what will be expected of the client during the rocedure. Such explanations not only reduce anxiety, but also help ensure the client's cooperation. Set up the prescribed oxygen delivery system at the bedside and bring in the equipment for emergency reintubation. Keeping reintubation equipment on hand prevents a delay if reintubation becomes necessary. Hyperoxygenate the client and thoroughly suction both the ET tube and oral cavity. Suctioning removes any secretions that have collected in or around the tube and ensures that the secretions will not move further down the airway. Hyperoxygenating the client before extubation prevents hypoxia during the procedure. Rapidly deflate the cuff of the ET tube and remove the tube at peak inspiration. Immediately instruct the client to cough. Give oxygen by face mask or nasal cannula.

The client at risk for ARDS has become cyanotic and diaphoretic. Which is the nurse's priority assessment? a. Measuring pulse oximetry b. Auscultating breath sounds bilaterally c. Measuring the blood pressure in both arms d. Comparing the current electrocardiographic tracing with the baseline measurement

ANS: A In early ARDS, hypoxemia may be the only abnormal assessment finding and can be life-threatening. Changes in breath sounds, blood pressure, and electrocardiographic patterns would be much later signs of ARDS.

Which assessment alerts the nurse to the possibility that the intrathoracic pressure in a mechanically ventilated client is too high? a. Hypotension b. Pulse oximetry value of 96% c. Increased diaphragmatic excursion d. Low-pressure alarm sounds on the ventilator

ANS: A Increased intrathoracic pressure can inhibit blood return to the heart and cause decreased cardiac output. A pulse oximetry reading of 96% is normal. Increased diaphragmatic excursion is associated with taking keep breaths, not mechanical ventilation. The low-pressure alarm sounds when there is decreased resistance to airflow from the ventilator, as when the tubing becomes disconnected from the ventilator or endotracheal or tracheostomy tube.

A client admitted with respiratory difficulty and decreased oxygen saturation keeps pulling off the oxygen mask. What action will the nurse take? a. Stays with the client and replace the oxygen mask b. Asks the client's spouse to hold the oxygen mask in place c. Restrains the client d. Contacts the physician and requests sedation

ANS: A Restlessness and confusion are clinical manifestations of hypoxemia. It is important that the nurse stay with the client, ensure that the oxygen is maintained, and attempt to calm the client. Because of the client's restlessness, the nurse cannot delegate care to the spouse. Requesting a sedative might adversely affect the client's respiratory status further. Restraining the client could increase restlessness and increase oxygen demand.

The pilot balloon on the endotracheal tube of a client being mechanically ventilated is deflated. What is the consequence of this situation? a. The client's lungs may not be receiving the set tidal volume. b. The client has no airway and must be reintubated. c. The endotracheal tube is too small for the client. d. The client's residual volume is too low.

ANS: A The pilot balloon indicates whether the endotracheal tube cuff is inflated or deflated. A deflated balloon means that the cuff is also deflated and there is no longer a seal around the tube to prevent air from escaping. Thus, some of the air being moved into the client's airway by the ventilator is escaping through the client's trachea before it reaches the lower airways and alveoli.

Which client statement indicates a need for additional teaching about sodium warfarin (Coumadin) therapy? a. "I have been eating more salads and other green leafy vegetables to prevent constipation." b. "I have two pairs of antiembolic stockings so that one pair can be washed each day." c. "Instead of a safety razor, I have been using an electric shaver to shave." d. "On hot days, I make sure I drink at least 2 quarts of water."

ANS: A Vitamin K, present in green leafy vegetables, enhances blood clotting by increasing the synthesis of specific clotting factors in the liver. Warfarin is a vitamin K antagonist. Ingestion of large amounts of vitamin K can counteract the therapeutic effects of warfarin and reduce the international normalized ratio (INR) until it is no longer within the therapeutic range. This information is critical when preparing a client for self-care.

Indicate which manifestations are associated with a pulmonary embolism. (Select all that apply.) a. Chest pain on inhalation b. Dyspnea c. Hemoptysis d. Muffled heart sounds e. Muscle weakness on one side f. Tachycardia

ANS: A, B, C, F Not every person with a PE has all manifestations. Most clients have chest pain on inhalation as a result of increased pressure in one area of the chest and possible vasospasms around the embolism. Because the oxygen in the alveoli beyond the area of the clot is not being exchanged into the blood, hypoxia develops. As a result, the client feels short of breath. The cardiac system attempts to compensate for this hypoxia by increasing the heart rate. Hemoptysis may be present if there is bleeding into the alveoli from increased pulmonary vascular pressure in front of the clot.

Which is the priority nursing diagnosis for a client who is in phase 4 of the course of ARDS and is being mechanically ventilated? a. Fatigue b. Risk for Infection c. Risk for Social Isolation d. Impaired Gas Exchange

ANS: B Although the client cannot breathe well on his or her own, mechanical ventilation is maintaining adequate oxygenation. However, mechanical ventilation is an invasive intervention and greatly increases the client's risk for infection and sepsis, a common cause of death in this population.

The nurse notes that each time the mechanical ventilator delivers a breath to a client with acute respiratory distress syndrome (ARDS), the peak inspiratory pressure alarm sounds. The nurse correlates this with a decrease in which parameter? a. Respiratory rate b. Lung compliance c. Tidal volume d. Expired air

ANS: B An increase in peak inspiratory pressure (PIP) in the ARDS client is indicative of decreased lung compliance, making it more difficult to ventilate the diseased lungs. Increased, not decreased, respiratory rate or tidal volume could trigger the PIP alarm. There is no relation to expired air and PIP because it reflects pressure as air is entering, not leaving, the lungs.

The nurse correlates which intervention to promoting a more normal V/Q match for a client receiving mechanical ventilation? a. Administering the prescribed muscle-paralyzing agents b. Positioning the client so that the healthier lung is dependent to the more diseased lung c. Ensuring that the pilot balloon on the endotracheal tube cuff is inflated to its maximal pressure d. Auscultating the lungs bilaterally every 4 hours for the presence of crackles, wheezes, and other abnormal breath sounds

ANS: B Clients who are being mechanically ventilated are experiencing a problem in which their normal ventilation is not adequate. (Mechanical ventilation does not improve pulmonary perfusion.) The recommended position for clients who have one lung affected by a problem more than the other lung is to place the "good lung down," keeping the healthier lung dependent to the less healthy lung. Such positioning allows gravity to keep more blood in the lower lung (healthier lung) and better ventilation in the upper lung.

Which client statement indicates that additional teaching is needed about anticoagulant therapy? a. "My gums may bleed some when I brush my teeth." b. "A little blood in my urine in the morning is normal." c. "I need to notify my provider if I see blood in my stool." d. "I should not take any medications with aspirin in them."

ANS: B Examine all stools, urine, drainage, and vomitus visually for gross blood and test for occult blood. Measure any blood loss as accurately as possible. Use a soft-bristled toothbrush and do not floss so as to decrease chance of bleeding. Because the gums are soft tissue, there may be some bleeding with vigorous brushing. Medications that contain aspirin increase the risk of bleeding by interfering with platelet function and should be avoided by clients taking anticoagulants.

Which assessment findings does the nurse correlate to a client with flail chest? a. Wheezes are present and are heard more loudly when the client inhales compared with what is heard on exhalation. b. An area on the client's left chest is sucked in during inhalation and puffs out during exhalation. c. The client is coughing copious amounts of frothy white sputum. d. The client cannot speak more than six words between breaths.

ANS: B Flail chest is the inward movement of the thorax during inspiration, with outward movement during expiration. It usually involves one side of the chest and results from multiple rib fractures caused by blunt chest trauma, leaving a segment of the chest wall loose. The movement of this loose segment becomes paradoxical to the expansion and contraction of the rest of the chest wall. It occurs more commonly in older adults who experience chest trauma. Wheezes are associated with narrowing of the airways. Copious amounts of frothy white sputum are suggestive of pulmonary edema. The client with flail may have shortness of breath that interferes with speaking. However, this is not as specific to flail chest as is the paradoxical movement with breathing.

Which is the nurse's priority action for a client suspected of experiencing a pulmonary embolism? a. Increase the IV flow rate. b. Apply oxygen by mask or nasal cannula at 5 L/min. c. Assess the chest and axillary area for the presence of petechiae. d. Place the client supine with her head and neck flat and legs elevated.

ANS: B If this client is having a pulmonary embolism, she is hypoxic and at risk for other complications and tissue damage. Applying oxygen in this situation can be helpful and is unlikely to cause any problems. Increasing the IV flow rate and assessing for petechiae will not prevent problems. Both these actions can be performed after the physician is notified. Placing the client in shock position will not improve the hypoxia and may increase the extent of the pulmonary vascular block.

Which assessment finding alerts the nurse to a possible pulmonary contusion? a. Dyspnea b. Hemoptysis c. Hyperresonance on percussion d. Increased chest pain with movement

ANS: B Interstitial hemorrhage accompanies pulmonary contusion. Bleeding may not be evident at the initial injury, but the client develops hemoptysis and decreased breath sounds up to several hours after injury as bleeding into the alveoli or airways occurs. Dyspnea would be a later sign of pulmonary contusion related to decreased diffusion. Hyperresonance is associated with air in the chest, as with emphysema, but not pulmonary contusion. There is no relation to movement and increased pain with this disorder.

The nurse assesses the client with tracheobronchial trauma. Which finding supports the possibility of tracheal lacerations? a. Hypertympanic sound on affected side b. Subcutaneous emphysema over the trachea c. Hypotension and decreased capillary refill d. Deviation of the trachea to the affected side

ANS: B Lacerations of the trachea cause massive air leaks, which manifest as extensive subcutaneous emphysema and air in the mediastinum.

Which statement indicates the presence of orthopnea? a. "I have to stop to catch my breath halfway up a flight of stairs." b. "At night, I need to sleep on three pillows or in my recliner." c. "It seems I can't speak a complete sentence without stopping for breath." d. "When I am eating a meal, I notice my heart usually starts to beat hard and fast."

ANS: B Orthopnea is the sensation of dyspnea or breathlessness in the supine position. Clients feel that they cannot catch their breath in the supine position and must rest or sleep in a semisitting position by placing pillows behind their backs or by using a reclining chair. The degree of breathlessness can be roughly measured by the number of pillows needed to make the client less dyspneic (e.g., one-pillow orthopnea, two-pillow orthopnea).

The nurse includes which statement in discharge teaching to reduce the risk for recurrence of a pulmonary embolism? a. "Avoid bending over at the waist." b. "Avoid prolonged sitting or standing." c. "Apply ice immediately to any site of injury." d. "Use an incentive spirometer every 2 hours while awake."

ANS: B Prolonged sitting or standing contributes to increased venous stasis in the legs, increasing the risk for formation of a thrombus or embolus. Activity, such as stretching and bending at the waist, would increase blood flow and not increase the risk of thrombosis that could lead to pulmonary emboli. There is no relationship between ice to an injury and prevention of pulmonary emboli. The rationale for incentive spirometry is to promote deep breathing and gas exchange. It does not affect the risk of recurring pulmonary emboli.

Which client is at greatest risk for the development of a pulmonary embolism? a. A young adult athlete who lifts weights and was diagnosed with a pneumothorax yesterday b. A middle-aged woman who has used oral contraceptives for the past 15 years and who had abdominal surgery yesterday for cancer c. A middle-aged woman who has fragile capillaries and bruises very easily d. An older man who caught his right hand in a piece of machinery and has five broken fingers, with extensive soft tissue damage

ANS: B This client has several risk factors. She is at risk for deep vein thrombosis because of oral contraceptive use. The abdominal surgery also increases her risk, as does a diagnosis of cancer.

The client with respiratory difficulty has a V/Q ratio of 0.5. What is the significance of this value? a. The ratio is low. Ventilation is exceeding perfusion. b. The ratio is low. Perfusion is exceeding ventilation. c. The ratio is high. Ventilation is exceeding perfusion. d. The ratio is high. Perfusion is exceeding ventilation.

ANS: B When ventilation and perfusion match, the ratio is or close to 1. When this ratio is less than 1, ventilation is decreased and is not matched with perfusion. Ventilation and perfusion are not the same throughout, even in healthy lungs. Perfusion is greater at the bases of the lungs and ventilation is greater at the apices of the lungs. Therefore, the normal V/Q ratio for the entire lung is about 0.8. When the V/Q ratio is 0.5, essentially blood flow through some area is occurring, but the blood is not becoming oxygenated because ventilation is less than adequate.

The nurse assesses a client with a suspected hemothorax. Which finding is expected? a. Hemoptysis b. Paradoxical chest movements c. Percussion dullness on affected side d. Hypertympanic sound on affected side

ANS: C A hemothorax involves bleeding into the thoracic cavity (not into the pulmonary tree, so hemoptysis does not occur), decreasing lung inflation on the affected side. As a result of decreased lung inflation, percussion sounds become duller and less resonant.

The pressure reading during inspiration on the ventilator of a client receiving mechanical ventilation is fluctuating widely. Which is the correct action to take for this problem? a. Determine whether there is an air leak in the client's endotracheal tube cuff. b. Increase the tidal volume by at least 100 mL or by the client's weight in kilograms. c. Assess the client's oxygen saturation to determine the adequacy of oxygenation. d. Disconnect the ventilator from the client and use a manual resuscitation bag until the machine has been checked.

ANS: C A widely fluctuating pressure reading is one indication of inadequate flow and oxygenation. The client may be air hungry from hypoxia. Check the client's oxygen saturation to determine the adequacy of oxygenation and, if the saturation is less than adequate, increase the flow rate setting on the ventilator.

Which is the most important intervention for the client with ARDS? a. Antibiotic therapy b. Bronchodilators c. Oxygen therapy d. Diuretic therapy

ANS: C Although the client with ARDS may not respond to oxygen therapy to the same degree as clients who have other types of respiratory problems, oxygen is still the most important intervention. Without oxygen therapy, the client with ARDS will always die of respiratory failure.

The nurse assesses a client with dyspnea, tracheal deviation, and pulse oximetry reading of 86%. What is the nurse's interpretation of these findings? a. Flail chest b. Pulmonary contusion c. Tension pneumothorax d. Acute respiratory distress syndrome

ANS: C Blunt chest trauma can cause an air leak into the thoracic cavity, collapsing the lung on the side with the air leak. More air enters the pleural space with each breath, increasing intrathoracic pressure on the affected side, moving the trachea to the unaffected side, and leading to decreased cardiac output. This condition is life-threatening without intervention.

A client is scheduled to have a surgical procedure that will require endotracheal intubation and mechanical ventilation for several days postoperatively. What will the nurse tell the client about postoperative communication? a. "You will be sedated and won't need to communicate." b. "I will call the anesthesiologist to discuss your concerns." c. "We will use a variety of strategies to make sure that your needs are meet." d. "You will have to use gestures to communicate."

ANS: C Communication is integral to decreasing the client's anxiety. Describing various strategies for communication (e.g., blinking, using hands, communication boards) is important to allay fear and anxiety.

Which set of arterial blood gases will the nurse expect to find in a client who developed a pulmonary embolism 15 minutes ago? a. pH, 7.30; HCO3-, 22 mEq/L; PCO2, 60 mm Hg; PO2, 66 mm Hg b. pH, 7.38; HCO3-, 22 mEq/L; PCO2, 45 mm Hg; PO2, 96 mm Hg c. pH, 7.47; HCO3-, 23 mEq/L; PCO2, 25 mm Hg; PO2, 82 mm Hg d. pH, 7.30; HCO3-, 28 mEq/L; PCO2, 65 mm Hg; PO2, 75 mm Hg

ANS: C Early changes in blood gases reflect the respiratory alkalosis caused by the hyperventilation caused by pain, hypoxia, and anxiety. This problem results in excessive loss of carbon dioxide, even though the client is somewhat hypoxic at this time. The reduced partial pressure of carbon dioxide results in a diminished hydrogen concentration and a higher than normal pH.

A client is placed on a mechanical ventilator with the following settings: Mode: Assist Control Rate = 8 Tidal volume = 700 mL FiO2 = 35 If the client's respiratory rate is 12 breaths/min, how many ventilator breaths is the client receiving? a. 4 b. 8 c. 12 d. 20

ANS: C In the Assist Control mode, the number of mechanical breaths is based on the client's number of spontaneous breaths, unless that rate falls below the set ventilator rate.

Which statement indicates that the client's spouse does not understand discharge teaching about risk prevention with major abdominal surgery? a. "While he is awake, I will make sure he gets up and walks for at least 5 minutes every 2 hours." b. "He is prone to constipation, so I will increase the amount of fiber in his meals every day." c. "I will massage his feet and legs twice a day to help blood return." d. "I will check his breathing rate and level twice a day."

ANS: C It is possible that massaging the feet and legs could promote venous return. However, there is a greater danger of loosening a clot that may have formed in the deep veins of the legs, which would allow it to move. Thus, after surgery, the feet and legs of a client should never be massaged. Ambulation is important to decrease the risk of clot formation in the client after abdominal surgery. Constipation is also a complication of decreased mobility and increasing fiber will help prevent this postoperative complication. Changes in breathing, particularly pain, dyspnea, and shortness of breath, are signs of pulmonary emboli and may develop in the client with deep vein thrombosis.

Which assessment finding requires the nurse's immediate action? a. The client has been intubated for 4 days. b. The endotracheal tube is midline in the mouth. c. The endotracheal tube is taped to the lower jaw. d. The client has hydrocolloid membrane on the skin of the cheeks.

ANS: C The endotracheal tube can be taped to the upper lip but should never be taped to the lower jaw because the lower jaw moves too much.

The nurse recognizes that which communication strategy should be discouraged in the client who is orally intubated and on a mechanical ventilator? a. Asking the client to point to words b. Asking the client to blink to questions c. Having the client mouth words d. Having the client use paper and pen

ANS: C The endotracheal tube is positioned and placement maintained with tape or some other type of appliance. Asking the client to move his or her mouth and lips could result in possible extubation.

In providing care to a client on a mechanical ventilator, the nurse correlates the administration of warm humidified oxygen with which rationale? a. To increase oxygen saturation b. To increase airway diameter c. To decrease viscosity of secretions d. To decrease risk of hypoxia

ANS: C The oxygen delivered to the client is warmed to body temperature (98.6° F [37° C]) and humidified to 100%. This is needed because upper air passages of the respiratory tree, which normally warm, humidify, and filter air, are bypassed. Humidifying and warming prevent mucosal damage and ease the clearance of secretions.

The client with a massive pulmonary embolism is receiving alteplase (Activase). What is the priority nursing diagnosis or collaborative problem for this client? a. Risk for Fluid Volume Excess b. Ineffective Breathing Pattern c. Potential for Anaphylaxis d. Risk for Injury (Bleeding)

ANS: D Alteplase is a fibrinolytic agent that dissolves formed clots. The dose of fibrinolytic agents for PE is much higher than the dose used to treat clots in a coronary artery. The drug has an impact on clots outside the pulmonary embolism and the client is at great risk for hemorrhage and shock. The client with a PE already has an impaired breathing pattern and alteplase will not worsen this problem. Alteplase, unlike urokinase, is a totally synthetic drug and does not stimulate allergic or anaphylactic reactions. The client may be concerned about his or her family and professional roles but, at this time, the risk for bleeding has a higher priority than this psychosocial issue.

A client with severe respiratory insufficiency becomes severely short of breath during activities of daily living. Which nursing intervention is best? a. Complete all activities for the client. b. Have the client's spouse complete all activities. c. Cluster morning activities to provide long rest periods. d. Space out interventions to provide for periods of rest.

ANS: D Clients with shortness of breath and decreased oxygen saturation must be monitored closely and provided with adequate rest periods to prevent exacerbation of hypoxemia. Spreading out activities over a period of time allows for frequent rest periods and decreases shortness of breath.

The client being mechanically ventilated has become more restless over the course of the shift. Which is the nurse's best action? a. Darkens the room and ask visitors to leave b. Documents the observation as the only action c. Administers a dose of pain medication or sedative d. Checks the client's oxygen saturation by pulse oximetry

ANS: D Increasing restlessness in a client being mechanically ventilated may mean that the client is not receiving sufficient oxygen and may be air hungry. It can also be a manifestation of pain. When in doubt, determining the adequacy of ventilation has the highest priority.

In a recently extubated client exhibiting stridor, which is the nurse's best next action after applying humidified oxygen? a. Documenting the observation as the only action b. Asking the client to cough and breathe deeply c. Suctioning the client's mouth and pharynx d. Notifying the emergency team

ANS: D Stridor on inspiration is caused by laryngospasm or edema and heralds impending airway occlusion. The client's airway is in jeopardy and the physician must take immediate action by prescribing an aerosol vasoconstrictor or reintubating the client.

Which is the priority nursing diagnosis for the client with an uncomplicated rib fracture? a. Ineffective Breathing Pattern b. Impaired Gas Exchange c. Activity Intolerance d. Acute Pain

ANS: D Treatment for uncomplicated rib fractures is nonspecific because the fractured ribs unite spontaneously. Movement of the ribs during inhalation (and on exhalation, to some extent) increases the pain. Clients may breathe so shallowly to reduce the pain that their breathing pattern becomes ineffective secondary to compensation for the pain. The primary consideration is to decrease pain so that adequate ventilatory status is maintained.

What precaution will the nurse teach a client who is being discharged on sodium warfarin (Coumadin)? a. "Decrease your intake of sodium." b. "Your blood-clotting time will decrease." c. "Increase your intake of multiple vitamins." d. "Avoid aspirin and aspirin-containing drugs."

ANS: D Warfarin inhibits the synthesis of vitamin K-dependent clotting factors. Aspirin inhibits platelet aggregation. These two mechanisms greatly increase the client's risk for uncontrollable bleeding. There is no relationship between sodium intake and clotting or bleeding. Blood clotting times increase when a client is taking anticoagulants. The client should not increase intake of multivitamins because they may contain vitamin K, which would interfere with the Coumadin.

A nurse is making initial rounds on assigned clients at the beginning of the shift. One client is receiving a heparin infusion at 12 mL/hr. The nurse notes that 25,000 units of heparin are mixed in 500 mL of solution, and verifies that the client is receiving how many units/hr of heparin? __________ units/hr

ANS: 600 25,000 units/500 mL = X units/hr/(12 mL/hr) 500X = 300,000 X = 600 units/hr

Which set of arterial blood gases will the nurse expect to find in a client who developed a pulmonary embolism (PE) 6 hours ago? a. pH, 7.30; HCO3-, 22 mEq/L; PCO2, 60 mm Hg; PO2, 66 mm Hg b. pH, 7.38; HCO3-, 22 mEq/L; PCO2, 45 mm Hg; PO2, 96 mm Hg c. pH, 7.47; HCO3-, 23 mEq/L; PCO2, 25 mm Hg; PO2, 82 mm Hg d. pH, 7.30; HCO3-, 28 mEq/L; PCO2, 65 mm Hg; PO2, 75 mm Hg

ANS: A As this condition of poor gas exchange continues in the client with a PE, blood flowing through the lungs does not receive adequate oxygenation and carbon dioxide is retained. This causes an increase in hydrogen ions and a decreased pH, indicative of respiratory acidosis. If this condition continues further, the hypoxia results in greater production of carbon dioxide production, resulting in a metabolic acidosis as well as a respiratory acidosis. The bicarbonate level remains normal because not enough time has passed to trigger renal compensation for the acidosis.

Which values are expected with hypoxemia and hyperventilation? a. pH, 7.32; PaCO2, 55 mm Hg; PaO2, 70 mm Hg b. pH, 7.45; PaCO2, 42 mm Hg; PaO2, 70 mm Hg c. pH, 7.48; PaCO2, 38 mm Hg; PaO2, 60 mm Hg d. pH, 7.55; PaCO2, 32 mm Hg; PaO2, 60 mm Hg

ANS: D The hyperventilation triggered by hypoxia and pain first leads to respiratory alkalosis, indicated by low partial pressure of arterial carbon dioxide (PaCO2) values on arterial blood gas (ABG) analysis.

Which finding indicates that suctioning is required for the client who is being mechanically ventilated? a. The client is talking around the endotracheal tube. b. Condensation is present in the ventilator tubing. c. Breath sounds are heard only in one lung. d. Wheezes are auscultated.

ANS: D The presence of wheezes (rhonchi) indicates partial obstruction by secretions. Although the fact that breath sounds are heard only in one lung represents a problem, it cannot be helped by suctioning the endotracheal tube.