Chapter 19: Introduction to the Respiratory System

Patient's arterial blood gas analysis reveals a pH of 7.32 and a PCO2 of 60. Which of the following imbalances do these values reveal? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

a A pH of 7.32 and a PCO2 of 60 correlate with respiratory acidosis. A normal pH is 7.35 to 7.45 and a normal PCO2 is 35 to 45 mm Hg. These values do not correlated with the other blood gas imbalances listed.

A client has been diagnosed with pulmonary hypertension, in which the capillaries in the alveoli are squeezed excessively. The nurse should recognize a disturbance in what aspect of normal respiratory function? a. Acid-base balance b. Perfusion c. Diffusion d. Ventilation

b Perfusion is influenced by alveolar pressure. The pulmonary capillaries are sandwiched between adjacent alveoli and, if the alveolar pressure is sufficiently high, the capillaries are squeezed. This does not constitute a disturbance in ventilation (air movement), diffusion (gas exchange), or acid-base balance.

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.

What are the primary functions of the lungs? Select all that apply. a. ventilation b. gas exchange c. oxygen production d. destroying CO

a, b The primary functions of the lungs include ventilation and gas exchange.

The clinical finding of pink, frothy sputum may be an indication of which condition? a. Lung abscess b. Pulmonary edema c. Infection d. Bronchiectasis

b Profuse frothy, pink material, often welling up into the throat, may indicate pulmonary edema. Foul-smelling sputum and bad breath may indicate a lung abscess, bronchiectasis, or an infection caused by fusospirochetal or other anaerobic organisms.

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. 1 "Inhale through your nose." 2 "Slowly count to 3." 3 "Exhale slowly through pursed lips." 4 "Slowly count to 7."

1, 2, 3, 4

The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard? a. Rales b. Crackles c. Wheezes d. Rhonchi

c Sibilant wheezes are continuous, musical, high-pitched, whistlelike sounds heard during inspiration and expiration caused by air passing through narrowed or partially obstructed airways; they may clear with coughing. Crackles, formerly called rales, are soft, high-pitched, discontinuous popping sounds that occur during inspiration (while usually heard on inspiration, they may also be heard on expiration); they may or may not be cleared by coughing. Rhonchi, or sonorous wheezes, are deep, low-pitched rumbling sounds heard primarily during expiration; they are caused by air moving through narrowed tracheobronchial passages.

A client with a severe exacerbation of COPD requires reliable and precise oxygen delivery. Which mask will the nurse expect the health care provider to prescribe? a. Non-rebreather air mask b. Tracheostomy collar c. Venturi mask d. Face tent

c The Venturi mask provides the most accurate method of oxygen delivery. Other methods of oxygen delivery include the aerosol mask, tracheostomy collar, and face tents, but these do not match the precision of a Venturi mask.

The nurse is caring for a client admitted with an acute exacerbation of chronic obstructive pulmonary disease. During assessment, the nurse finds that the client is experiencing increased dyspnea. What is the most accurate measurement of the concentration of oxygen in the client's blood? a. A capillary blood sample b. Pulse oximetry c. An arterial blood gas (ABG) study d. A complete blood count (CBC)

c The arterial oxygen tension (partial pressure or PaO2) indicates the degree of oxygenation of the blood, and the arterial carbon dioxide tension (partial pressure or PaCO2) indicates the adequacy of alveolar ventilation. ABG studies aid in assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide and the ability of the kidneys to reabsorb or excrete bicarbonate ions to maintain normal body pH. Capillary blood samples are venous blood, not arterial blood, so they are not as accurate as an ABG. Pulse oximetry is a useful clinical tool but does not replace ABG measurement, because it is not as accurate. A CBC does not indicate the concentration of oxygen.

While assessing an acutely ill client's respiratory rate, the nurse assesses four normal breaths followed by an episode of apnea lasting 20 seconds. How should the nurse document this finding? a Eupnea b. Apnea c. Biot's respiration d. Cheyne-Stokes

c The nurse will document that the client is demonstrating a Biot's respiration pattern. Biot's respiration is characterized by periods of normal breathing (three to four breaths) followed by varying periods of apnea (usually 10 seconds to 1 minute). Cheyne-Stokes is a similar respiratory pattern, but it involves a regular cycle where the rate and depth of breathing increase and then decrease until apnea occurs. Biot's respiration is not characterized by the increase and decrease in the rate and depth, as characterized by Cheyne-Stokes. Eupnea is a normal breathing pattern of 12 to 18 breaths per minute. Bradypnea is a slower-than-normal rate (<10 breaths per minute), with normal depth and regular rhythm, and no apnea.

The home care nurse is assessing a client who requires home oxygen therapy. What criterion indicates that an oxygen concentrator will best meet the needs of the client in the home environment? a. The client desires a low-maintenance oxygen delivery system that delivers oxygen flow rates up to 6 L/min. b. The client requires a high-flow system for use with a tracheostomy collar. c. The client desires a portable oxygen delivery system that can deliver 2 L/min. d. The client's respiratory status requires a system that provides an FiO2 of 65%.

c The use of oxygen concentrators is another means of providing varying amounts of oxygen, especially in the home setting. They can deliver oxygen flows from 1 to 10 L/min and provide an FiO2 of about 40%. They require regular maintenance and are not used for high-flow applications. The client desiring a portable oxygen delivery system of 2L/min will benefit from the use of an oxygen concentrator.

A client with chronic lung disease is undergoing lung function testing. What test result denotes the volume of air inspired and expired with a normal breath? a. Total lung capacity b. Forced vital capacity c. Tidal volume d. Residual volume

c Tidal volume refers to the volume of air inspired and expired with a normal breath. Total lung capacity is the maximal amount of air the lungs and respiratory passages can hold after a forced inspiration. Forced vital capacity is vital capacity performed with a maximally forced expiration. Residual volume is the maximal amount of air left in the lung after a maximal expiration.

The client has just had an MRI ordered because a routine chest x-ray showed suspicious areas in the right lung. The physician suspects bronchogenic carcinoma. An MRI would most likely be in order to assess for what in this client? a. Alveolar dysfunction b. Forced vital capacity c. Tidal volume d. Chest wall invasion

d MRI is used to characterize pulmonary nodules; to help stage bronchogenic carcinoma (assessment of chest wall invasion); and to evaluate inflammatory activity in interstitial lung disease, acute pulmonary embolism, and chronic thrombolytic pulmonary hypertension. Imaging would not focus on the alveoli since the problem in the bronchi. A static image such as MRI cannot inform PFT.

A client's plan of care specifies postural drainage. What action should the nurse perform when providing this noninvasive therapy? a. Administer the treatment with the client in a high Fowler's or semi-Fowler's position. b. Perform the procedure immediately following the client's meals. c. Apply percussion firmly to bare skin to facilitate drainage. d. Assist the client into a position that will allow gravity to move secretions.

d Postural drainage is usually performed two to four times per day. The client uses gravity to facilitate postural draining. The skin should be covered with a cloth or a towel during percussion to protect the skin. Postural drainage is not given in an upright position or directly following a meal.

A client is being treated for a pulmonary embolism and the medical nurse is aware that the client suffered an acute disturbance in pulmonary perfusion. This involved an alteration in what aspect of normal physiology? a. Maintenance of constant osmotic pressure in the alveoli b. Maintenance of muscle tone in the diaphragm c. pH balance in the pulmonary veins and arteries d. Adequate flow of blood through the pulmonary circulation.

d Pulmonary perfusion is the actual blood flow through the pulmonary circulation. Perfusion is not defined in terms of pH balance, muscle tone, or osmotic pressure.

In addition to heart rate, blood pressure, respiratory rate, and temperature, the nurse needs to assess a client's arterial oxygen saturation (SaO2). What procedure will best accomplish this? a. Incentive spirometry b. Arterial blood gas (ABG) measurement c. Peak flow measurement d. Pulse oximetry

d Pulse oximetry is a noninvasive procedure in which a small sensor is positioned over a pulsating vascular bed. It can be used during transport and causes the client no discomfort. An incentive spirometer is used to assist the client with deep breathing after surgery. ABG measurement can measure SaO2, but this is an invasive procedure that can be painful. Some clients with asthma use peak flow meters to measure levels of expired air.

The home care nurse is visiting a client newly discharged home after a lobectomy. What would be most important for the home care nurse to assess? a. Resumption of the client's ADLs b. The family's willingness to care for the client c. Nutritional status and fluid balance d. Signs and symptoms of respiratory complications

d The nurse assesses the client's adherence to the postoperative treatment plan and identifies acute or late postoperative complications. All options presented need assessment, but respiratory complications are the highest priority because they most directly affect the client's airway and breathing.

The nurse is discussing activity management with a client who is postoperative following thoracotomy. What instructions should the nurse give to the client regarding activity immediately following discharge? a. Walk 1 mile (1.6 km) 3 to 4 times a week. b. Use weights daily to increase arm strength. c. Walk on a treadmill 30 minutes daily. d. Perform shoulder exercises five times daily.

d The nurse emphasizes the importance of progressively increased activity. The nurse also instructs the client on the importance of performing shoulder exercises five times daily. The client should ambulate with limits and realize that the return of strength will likely be gradual and likely will not include weight lifting or lengthy walks.

The decision has been made to discharge a ventilator-dependent client home. The nurse is developing a teaching plan for this client and his family. What would be most important to include in this teaching plan? a. Administration of inhaled corticosteroids b. Assessment of neurologic status c. Turning and coughing d. Managing a power failure

d The nurse teaches the client and family about topics including the management of a power failure. Neurologic assessment and turning and coughing are less important than knowing what to do if the ventilator loses power, because this could immediate threaten the client. Inhaled corticosteroids may or may not be prescribed.

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. Have the patient lie in a supine position during the use of the spirometer. b. Encourage the patient to try to stop coughing during and after using 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 nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient? a. 40% b. 75% c. 80% d. 95%

d With a normal value for the partial pressure of oxygen (PaO2) (80 to 100 mm Hg) and oxygen saturation (SaO2) (95% to 98%), there is a 15% margin of excess oxygen available to the tissues. With a normal hemoglobin level of 15 mg/dL and a PaO2 level of 40 mm Hg (SaO2 75%), there is adequate oxygen available for the tissues but no reserve for physiologic stresses that increase tissue oxygen demand.

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

a 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 client's arterial blood gas results reveal a pH of 7.35. The nurse would expect to find that the patient's PaCO2 is: a. 35. b. 25. c. 80. d. 50.

a A pH of 7.35 is within the normal range for blood gas, so the client's PaCO2 would also fall within the normal range, which is between 35-45 mm Hg.

While palpating the chest wall of a muscular athletic client, the nurse would expect to hear: a. decreased fremitus. b. increased fremitus. c. highly palpable fremitus. d. no fremitus.

a A thick or muscular chest wall, as in the case of an athlete, may decrease the fremitus heard on palpation. Lung diseases such as emphysema and pneumonia will increase fremitus. If the client is healthy and thin, the fremitus will be highly palpable. Tactile or vocal fremitus depend on the nurse's capacity to feel sound through the fingers and palm placed on the chest wall. Palpable vibrations, however, will occur when the client speaks.

Which is a true statement regarding air pressure variances? a. Air is drawn through the trachea and bronchi into the alveoli during inspiration. b. Air flows from a region of lower pressure to a region of higher pressure during inspiration. b. The diaphragm contracts during inspiration. d. The thoracic cavity becomes smaller during inspiration.

a Air flows from a region of higher pressure to a region of lower pressure. During inspiration, movement of the diaphragm and other muscles of respiration enlarge the thoracic cavity, thereby lowering the pressure inside the thorax to a level below that of atmospheric pressure.

The nurse has assessed a client's family history for three generations. The presence of which respiratory disease would justify this type of assessment? a. Asthma b. Obstructive sleep apnea c. Community-acquired pneumonia d. Pulmonary edema

a Asthma is a respiratory illness that has genetic factors. Sleep apnea, pneumonia, and pulmonary edema lack genetic risk factors.

A client will be undergoing a bronchoscopy. Which statement shows that the client understands the procedure? a. "It sounds like the different drugs will make this much easier to stand." b. "At least I can eat normally again as soon as this is over." c. "If I cough up bloody mucus the next day, I need to call 911." d. "If the tube goes through my nose, why will my throat hurt?"

a Bronchoscopy is frightening to many clients due to lack of knowledge about what to expect during and after procedure. An expected outcome is that the client will exhibit coping behaviors and follow instructions. Food and liquids are withheld until the cough reflex returns, which usually takes several hours. The client may cough up blood-tinged mucus in the day following the procedure, and this is normal. A tube will be inserted through the nose and throat and into the lungs and that the medication will assist the client. The throat will be irritated and sore for a few days following the procedure.

A client is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube? a. To remove air from the pleural space b. To drain copious sputum secretions c. To monitor bleeding around the lungs d. To assist with mechanical ventilation

a Chest tubes and closed drainage systems are used to re-expand the lung involved and to remove excess air, fluid, and blood. The primary purpose of a chest tube is not to drain sputum secretions, monitor bleeding, or assist with mechanical ventilation.

The nurse is interviewing a patient who says he has a dry, irritating cough that is not "bringing anything up." What medication should the nurse question the patient about taking? a. Angiotensin converting enzyme (ACE) inhibitors b. Aspirin c. Bronchodilators d. Cardiac glycosides

a Common causes of cough include asthma, gastrointestinal reflux disease, infection, aspiration, and side effects of medications, such as angiotensin converting enzyme (ACE) inhibitors. The other medications listed are not associated with causing a cough.

After remaining in bed for 48 hours after surgery and dismissing nurses' encouragements to mobilize, a patient has begun to display the characteristic signs and symptoms of atelectasis. Because atelectasis is a health problem associated with decreased lung compliance, the nurse should understand that this patient is experiencing what pathophysiological phenomenon? a. Decreased expandability of the patient's lung tissue b. Decreased blood flow to the capillaries in the patient's alveoli c. Increased airway resistance d. A cessation of ventilation

a Compliance is a measure of the elasticity, expandability, and distensibility of the lungs and thoracic structures. Compliance does not directly involve alveolar blood flow or airway resistance, although each consideration affects the overall effectiveness of respiration. Ventilation is the mechanical movement of air, which would not cease in this patient's case.

A client presents to the ED reporting severe coughing episodes. The client states that "the episodes are more intense at night." The nurse should suspect which of the following conditions based on the client's primary report? a. Left-sided heart failure b. Chronic obstructive pulmonary disorder (COPD) c. Emphysema d. Bronchitis

a Coughing at night may indicate the onset of left-sided heart failure or bronchial asthma. A cough in the morning with sputum production may indicate bronchitis. A cough that worsens when the client is supine suggests postnasal drip (rhinosinusitis). Coughing after food intake may indicate aspiration of material into the tracheobronchial tree. A cough with recent onset is usually caused by an acute infection. A cough that occurs more frequently at night is not associated with COPD, emphysema, or bronchitis.

High or increased compliance occurs in which disease process? a. Emphysema b. Pneumothorax c. Pleural effusion d. ARDS

a High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended, as in emphysema. Conditions associated with decreased compliance include pneumothorax, pleural effusion, and acute respiratory distress syndrome (ARDS).

The nurse working on the respiratory intensive care unit is aware that several respiratory conditions can affect the compliance of the lung tissue. Which condition leads to an increase in lung compliance? a. Emphysema b. Pulmonary fibrosis c. Pleural effusion d. Acute respiratory distress syndrome

a High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended, in conditions such as emphysema. Conditions associated with decreased compliance include pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and acute respiratory distress syndrome.

The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? a. PaO2 b. pH c. PCO2 d. HCO3

a Hypoxemic hypoxia, or hypoxemia, is a decreased oxygen level in the blood (PaO2) resulting in decreased oxygen diffusion into the tissues.

A critical care nurse is caring for a client with an endotracheal tube who is on a ventilator. The nurse knows that meticulous airway management of this client is necessary. What is the main rationale for this? a. Maintaining a patent airway b. Preventing the need for suctioning c. Maintaining the sterility of the client's airway d. Increasing the client's lung compliance

a Maintaining a patent (open) airway is achieved through meticulous airway management, whether in an emergency situation such as airway obstruction or in long-term management, as in caring for a client with an endotracheal or a tracheostomy tube. Airway management is not primarily conducted to reduce the need for suctioning, to maintain sterility or to increase compliance because none of these are important if the client's airway is not patent.

The nurse is performing a respiratory assessment of an adult client and is attempting to distinguish between vesicular, bronchovesicular, and bronchial (tubular) breath sounds. The nurse should distinguish between these normal breath sounds on what basis? a. Their location over a specific area of the lung b. The volume of the sounds c. Whether they are heard on inspiration or expiration d. Whether or not they are continuous breath sounds

a Normal breath sounds are distinguished by their location over a specific area of the lung; they are identified as vesicular, bronchovesicular, and bronchial (tubular) breath sounds. Normal breath sounds are heard on both inspiration and expiration, and are continuous. They are not distinguished solely on the basis of volume.

Which of the following clinical manifestations should a nurse monitor for during a pulmonary angiography, which indicates an allergic reaction to the contrast medium? a. Difficulty in breathing b. Hematoma c. Absent distal pulses d. Urge to cough

a Nurses must determine if the client has any allergies, particularly to iodine, shellfish, or contrast dye. During the procedure, the nurse should check for signs and symptoms of allergic reactions to the contrast medium, such as itching, hives, or difficulty in breathing. The nurses inspects for hematoma, absent distal pulses, after the procedure. When the contrast medium is infused, an urge to cough is often a sensation experienced by the client.

The clinic nurse is caring for a client who has been diagnosed with emphysema and who has just had a pulmonary function test (PFT) ordered. The client asks, "What exactly is this test for?" What would be the nurse's best response? a. "A PFT measures how much air moves in and out of your lungs when you breathe." b. "A PFT measures how much energy you get from the oxygen you breathe." c. "A PFT measures how elastic your lungs are." d. "A PFT measures whether oxygen and carbon dioxide move between your lungs and your blood."

a PFTs are routinely used in clients with chronic respiratory disorders. They are performed to assess respiratory function and to determine the extent of dysfunction. Such tests include measurements of lung volumes, ventilatory function, and the mechanics of breathing, diffusion, and gas exchange. Lung elasticity and diffusion can often be implied from PFTs, but they are not directly assessed. Energy obtained from respiration is not measured directly.

The nurse has admitted a client who is scheduled for a thoracic resection. The nurse is providing preoperative teaching and is discussing several diagnostic studies that will be required prior to surgery. Which study will be performed to determine whether the planned resection will leave sufficient functioning lung tissue? a. Pulmonary function studies b. Exercise tolerance tests c. Arterial blood gas values d. Chest x-ray

a Pulmonary function studies are performed to determine whether the planned resection will leave sufficient functioning lung tissue. ABG values are assessed to provide a more complete picture of the functional capacity of the lung. Exercise tolerance tests are useful to determine if the client who is a candidate for pneumonectomy can tolerate removal of one of the lungs. Preoperative studies, such as a chest x-ray, are performed to provide a baseline for comparison during the postoperative period and to detect any unsuspected abnormalities.

The OR nurse is setting up a water-seal chest drainage system for a client who has just had a thoracotomy. The nurse knows that the amount of suction in the system is determined by the water level. At what suction level should the nurse set the system? a. 20 cm H2O b. 15 cm H2O c. 10 cm H2O d. 5 cm H2O

a The amount of suction is determined by the water level. It is usually set at 20 cm H2O; adding more fluid results in more suction.

A client is undergoing a thoracentesis. Which nursing action will the nurse perform following the procedure? a. Maintain the client on bed rest for several hours. b. Ambulate the client following the procedure. c. Instruct the client to cough forcefully every ten minutes. d. Place the client in a supine position.

a The client remains on bed rest and usually lies on the unaffected side for at least 1 hour to promote expansion of the lung on the affected side. The client should not ambulate following the procedure, but remain on bed rest for at least an hour. The client usually lies on the unaffected side to promote expansion of the lung on the affected side. Clients should cough forcefully when expectorating sputum for a specimen, but not following a thoracentesis.

A nurse is teaching a client how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the client? a. "Hold the spirometer at your lips and breathe in and out like you normally would." b. "When you're ready, blow hard into the spirometer for as long as you can." c. "Take a deep breath and then blow short, forceful breaths into the spirometer." d. "Breathe in deeply through the spirometer, hold your breath briefly, and then exhale."

a The client should be taught to lace the mouthpiece of the spirometer firmly in the mouth, breathe air in through the mouth, and hold the breath at the end of inspiration for about 3 seconds. The client should then exhale slowly through the mouthpiece.

The nurse is educating a patient with COPD about the technique for performing pursed-lip breathing. What does the nurse inform the patient is the importance of using this technique? a. It prolongs exhalation. b. It increases the respiratory rate to improve oxygenation. c. It will assist with widening the airway. d. It will prevent the alveoli from overexpanding.

a The goal of pursed-lip breathing is to prolong exhalation and increase airway pressure during expiration, thus reducing the amount of trapped air and the amount of airway resistance.

The nurse is caring for a client with a lower respiratory tract infection. When planning a focused respiratory assessment, the nurse should know that this type of infection most often causes what? a. Impaired gas exchange b. Collapsed bronchial structures c. Necrosis of the alveoli d. Closed bronchial tree

a The lower respiratory tract consists of the lungs, which contain the bronchial and alveolar structures needed for gas exchange. A lower respiratory tract infection does not collapse bronchial structures or close the bronchial tree. An infection does not cause necrosis of lung tissues.

The nurse is assessing a newly admitted medical client and notes there is a depression in the lower portion of the client's sternum. This client's health record should note the presence of what chest deformity? a. A barrel chest b. A funnel chest c. A pigeon chest d. Kyphoscoliosis

b A funnel chest occurs when there is a depression in the lower portion of the sternum, and this may lead to compression of the heart and great vessels, resulting in murmurs. A barrel chest is characterized by an increase in the anteroposterior diameter of the thorax and is a result of overinflation of the lungs. A pigeon chest occurs as a result of displacement of the sternum and includes an increase in the anteroposterior diameter. Kyphoscoliosis, which is characterized by elevation of the scapula and a corresponding S-shaped spine, limits lung expansion within the thorax.

What would the critical care nurse recognize as a condition that may indicate a client's need to have a tracheostomy? a. A client has a respiratory rate of 10 breaths per minute. b. A client requires permanent ventilation. c. A client exhibits symptoms of dyspnea. d. A client has respiratory acidosis.

b A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of oral and gastric secretions in the unconscious or paralyzed client. Indications for a tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of dyspnea, or respiratory acidosis.

The nurse is performing a respiratory assessment of a client who has been experiencing episodes of hypoxia. The nurse is aware that this is ultimately attributable to impaired gas exchange. On what factor does adequate gas exchange primarily depend? a. An appropriate perfusion-diffusion ratio b. An adequate ventilation-perfusion ratio c. Adequate diffusion of gas in shunted blood d. Appropriate blood nitrogen concentration

b Adequate gas exchange depends on an adequate ventilation-perfusion ratio. There is no perfusion-diffusion ratio. Adequate gas exchange does not depend on the diffusion of gas in shunted blood or a particular concentration of nitrogen.

A client with a decreased level of consciousness is in a recumbent position. How should the nurse best assess the lung fields for a client in this position? a. Inform that physician that the client is in a recumbent position and anticipate an order for a portable chest x-ray. b. Turn the client to enable assessment of all the patient's lung fields. c. Avoid turning the client, and assess the accessible breath sounds from the anterior chest wall. d. Obtain a pulse oximetry reading, and, if the reading is low, reposition the client and auscultate breath sounds.

b Assessment of the anterior and posterior lung fields is part of the nurse's routine evaluation. If the client is recumbent, it is essential to turn the client to assess all lung fields so that dependent areas can be assessed for breath sounds, including the presence of normal breath sounds and adventitious sounds. Failure to examine the dependent areas of the lungs can result in missing significant findings. This makes the other given options unacceptable.

The acute medical nurse is preparing to wean a client from the ventilator. Which assessment parameter is most important for the nurse to assess? a. Fluid intake for the last 24 hours b. Baseline arterial blood gas (ABG) levels c. Prior outcomes of weaning d. Electrocardiogram (ECG) results

b Before weaning a client from mechanical ventilation, it is most important to have baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are relevant, but less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client's record, and the nurse can refer to them before the weaning process begins.

The nurse is assessing a client who frequently coughs after eating or drinking. How should the nurse best follow up this assessment finding? a. Obtain a sputum sample. b. Perform a swallowing assessment. c. Inspect the client's tongue and mouth. d. Assess the client's nutritional status.

b Coughing after food intake may indicate aspiration of material into the tracheobronchial tree; a swallowing assessment is thus indicated. Obtaining a sputum sample is relevant in cases of suspected infection. The status of the client's tongue, mouth, and nutrition is not directly relevant to the problem of aspiration.

Which is a late sign of hypoxia? a. Restlessness b. Cyanosis c. Hypotension d. Somnolence

b Cyanosis is a late sign of hypoxia. Hypoxia may cause restlessness and an initial rise in blood pressure that is followed by hypotension and somnolence.

The nurse is assessing a patient in respiratory failure. What finding is a late indicator of hypoxia? a. Clubbing of fingers b. Cyanosis c. Crackles d. Restlessness

b Cyanosis, a bluish coloring of the skin, is a very late indicator of hypoxia. The presence or absence of cyanosis is determined by the amount of unoxygenated hemoglobin in the blood. Cyanosis appears when there is at least 5 g/dL of unoxygenated hemoglobin.

A 68-year-old male patient has been admitted to the surgical unit from the PACU after surgical repair of an inguinal hernia. When performing the patient's admission assessment, the nurse notes that the patient has a barrel chest. This assessment finding should suggest to the nurse that the patient may have a history of what health problem? a. Asthma b. Emphysema c. Tuberculosis d. Chronic bronchitis

b Emphysema

The nurse is caring for a client who has a pleural effusion and who underwent a thoracoscopic procedure earlier in the morning. The nurse should prioritize assessment for which of the following? a. Sputum production b. Shortness of breath c. Throat discomfort d. Epistaxis

b Follow-up care in the health care facility and at home involves monitoring the client for shortness of breath (which might indicate a pneumothorax). All of the listed options are relevant assessment findings, but shortness of breath is the most serious complication.

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. Anemic hypoxia b. Circulatory hypoxia c. Histotoxic hypoxia d. Hypoxic hypoxia

b Given this patient's vital signs, he appears to be in shock. Circulatory hypoxia is hypoxia resulting from inadequate capillary circulation. It 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.

In which position should the client be placed for a thoracentesis? a. Prone b. Sitting on the edge of the bed c. Supine d. Lateral recumbent

b If possible, place the client upright or sitting on the edge of the bed with the feet supported and arms and head on a padded over-the-bed table. Other positions in which the client could be placed include straddling a chair with the arms and head resting on the back of the chair, or lying on the unaffected side with the head of the bed elevated 30 to 45 degrees (if the client is unable to assume a sitting position).

The nurse hears the patient's ventilator alarm sound and attempts to find the cause. What is the priority action of the nurse when the cause of the alarm is not able to be determined? a. Call respiratory therapy and wait until they arrive to determine what is happening. b. Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved. c. Stop the ventilator by pressing the off button, wait 15 seconds, and then turn it on again to see if the alarm stops. d. Suction the patient since the patient may be obstructed by secretions.

b If the cause of an alarm cannot be determined, the nurse should disconnect the patient from the ventilator and manually ventilate the patient, because leaving the patient on the mechanical ventilator may be dangerous.

While caring for a client with an endotracheal tube, the nurse should normally provide suctioning how often? a. Every 2 hours when the client is awake b. When adventitious breath sounds are auscultated c. When there is a need to prevent the client from coughing d. When the nurse needs to stimulate the cough reflex

b It is usually necessary to suction the client'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 present. Unnecessary suctioning, such as scheduling every 2 hours, can initiate bronchospasm and cause trauma to the tracheal mucosa.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The client has been receiving high-flow oxygen therapy for an extended time. What symptoms would suggest that the client is experiencing oxygen toxicity? a. Bradycardia and frontal headache b. Dyspnea and substernal pain c. Peripheral cyanosis and restlessness d. Hypotension and tachycardia

b Oxygen toxicity can occur when clients receive too high a concentration of oxygen for an extended period. Symptoms of oxygen toxicity include dyspnea, substernal pain, restlessness, fatigue, and progressive respiratory difficulty. Bradycardia, frontal headache, cyanosis, hypotension, and tachycardia are not symptoms of oxygen toxicity.

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. Oxygen-induced atelectasis d. Hypoxia

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.

The nurse is caring for a client who is scheduled to have a thoracotomy. When planning preoperative teaching, what information should the nurse communicate to the client? a. How to milk the chest tubing b. How to splint the incision when coughing c. How to take prophylactic antibiotics correctly d. How to manage the need for fluid restriction

b Prior to thoracotomy, the nurse educates the client about how to splint the incision with the hands, a pillow, or a folded towel. The client is not taught how to milk the chest tubing because this is performed by the nurse. Prophylactic antibiotics are not normally used and fluid restriction is not indicated following thoracotomy.

The nurse has instructed a client on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which result? a. Promote more efficient and controlled ventilation and to decrease the work of breathing b. Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing c. Promote the strengthening of the client's diaphragm d. Promote the client's ability to take in oxygen

b Pursed-lip breathing, which improves oxygen transport, helps induce a slow, deep breathing pattern and assists the client to control breathing, even during periods of stress. This type of breathing helps prevent airway collapse secondary to loss of lung elasticity in emphysema.

The nurse working on a gerontology unit admits a 77-year-old with recent shortness of breath. The nurse knows that the amount of respiratory dead space increases with age. What do these changes result in? a. Increased diffusion of gases b. Decreased diffusion capacity for oxygen c. Decreased shunting of blood d. Increased ventilation

b The amount of respiratory dead space increases with age. These changes result in a decreased diffusion capacity for oxygen with increasing age, producing lower oxygen levels in the arterial circulation. Shunting does not typically decrease and ventilation does not increase.

The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse's priority? a. Medication allergies b. Swallow reflex c. Presence of carotid pulse d. Ability to deep breathe

b The physician sprays a local anesthetic into the client's throat before performing a bronchoscopy. The nurse must assess the swallow reflex when the client returns to the unit and before giving him anything by mouth. The nurse should also assess for medication allergies, carotid pulse, and deep breathing, but they aren't the priority at this time.

The nurse has explained to the client that after his thoracotomy, it will be important to adhere to a coughing schedule. The client is concerned about being in too much pain to be able to cough. What would be an appropriate nursing intervention for this client? a. Teach him postural drainage. b. Teach him how to perform huffing. c. Teach him to use a mini-nebulizer. d. Teach him how to use a metered dose inhaler.

b The technique of "huffing" may be helpful for the client with diminished expiratory flow rates or for the client who refuses to cough because of severe pain. Huffing is the expulsion of air through an open glottis. Inhalers, nebulizers, and postural drainage are not substitutes for performing coughing exercises.

While assessing a client who has pneumonia, the nurse has the client repeat the letter E while the nurses auscultates. The nurse notes that the client's voice sounds are distorted and that the letter A is audible instead of the letter E. How should this finding be documented? a. Bronchophony b. Egophony c. Whispered pectoriloquy d. Sonorous wheezes

b This finding would be documented as egophony, which can be best assessed by instructing the client to repeat the letter E. The distortion produced by consolidation transforms the sound into a clearly heard A rather than E. Bronchophony describes vocal resonance that is more intense and clearer than normal. Whispered pectoriloquy is a very subtle finding that is heard only in the presence of rather dense consolidation of the lungs. Sound is so enhanced by the consolidated tissue that even whispered words are heard. Sonorous wheezes are not defined as a voice sound, but rather as a breath sound.

A client is undergoing testing to see if he has a pleural effusion. Which of the nurse's respiratory assessment findings would be most consistent with this diagnosis? a. Increased tactile fremitus, egophony, and a dull sound upon percussion of the chest wall b. Decreased tactile fremitus, wheezing, and a hyperresonant sound upon percussion of the chest wall c. Lung fields dull to percussion, absent breath sounds, and a pleural friction rub d. Normal tactile fremitus, decreased breath sounds, and a resonant sound upon percussion of the chest wall

c Assessment findings consistent with a pleural effusion include affected lung fields being dull to percussion and absence of breath sounds. A pleural friction rub may also be present. The other listed signs are not typically associated with a pleural effusion.

What finding by the nurse may indicate that the client has chronic hypoxia? a. Crackles b. Peripheral edema c. Clubbing of the fingers d. Cyanosis

c Clubbing of the fingers is a change in the normal nail bed. It appears as sponginess of the nail bed and loss of the nail bed angle. It is a sign of lung disease that is found in patients with chronic hypoxic conditions, chronic lung infections, or malignancies of the lung. The other signs listed may represent only a temporary hypoxia.

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

c Constant bubbling in the chamber often indicates an air leak and requires immediate assessment and intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.

A client arrives in the emergency department reporting shortness of breath. She has 3+ pitting edema below the knees, a respiratory rate of 36 breaths per minute, and heaving respirations. The nurse auscultates the client's lungs to reveal coarse, moist, high-pitched, and non-continuous sounds that do not clear with coughing. The nurse will document these sounds as which type? a. Wheezes b. Rhonchi c. Crackles d. Pleural rub

c Crackles are adventitious breath sounds that are high-pitched, discontinuous, and popping; they may or may not clear with coughing and are moist. Often crackles are associated with heart failure.

The critical care nurse is precepting a new nurse on the unit. Together they are caring for a client who has a tracheostomy tube and is receiving mechanical ventilation. What action should the critical care nurse recommend when caring for the cuff? a. Deflate the cuff overnight to prevent tracheal tissue trauma. b. Inflate the cuff to the highest possible pressure in order to prevent aspiration. c. Monitor the pressure in the cuff at least every 8 hours d. Keep the tracheostomy tube plugged at all times.

c Cuff pressure must be monitored by the respiratory therapist or nurse at least every 8 hours by attaching a handheld pressure gauge to the pilot balloon of the tube or by using the minimal leak volume or minimal occlusion volume technique. Plugging is only used when weaning the client from tracheal support. Deflating the cuff overnight would be unsafe and inappropriate. High cuff pressure can cause tissue trauma.

While conducting the physical examination during assessment of the respiratory system, which conditions does the nurse assess by inspecting and palpating the trachea? a. Evidence of exudate b. Color of the mucous membranes c. Deviation from the midline d. Evidence of muscle weakness

c During the physical examination, the nurse must inspect and gently palpate the trachea to assess for placement and deviation from the midline. The nurse examines the posterior pharynx and tonsils with a tongue blade and light, and notes any evidence of swelling, inflammation, or exudate, as well as changes in color of the mucous membranes. The nurse also examines the anterior, posterior, and lateral chest walls for any evidence of muscle weakness.

A nurse is teaching a client about a loss of lung compliance and the effect with ventilation. What client condition is the nurse teaching the client about? a. Atelectasis b. Pulmonary edema c. Emphysema d. Pleural effusion

c Emphysema, most commonly caused by smoking cigarettes, results in a loss of lung elasticity, which destroys the capillaries that supply the alveoli. Decreased compliance occurs if the lungs and the thorax are "stiff." Conditions associated with decreased compliance include morbid obesity, pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS). This causes airway collapse during expiration, dyspnea, and eventually cyanosis.

A client in the ICU has had an endotracheal tube in place for 3 weeks. The health care provider has ordered that a tracheostomy tube be placed. The client's family wants to know why the endotracheal tube cannot be left in place. What would be the nurse's best response? a. "The physician may feel that mechanical ventilation will have to be used long-term." b. "Long-term use of an endotracheal tube diminishes the normal breathing reflex." c. "When an endotracheal tube is left in too long it can damage the lining of the windpipe." d. "It is much harder to breathe through an endotracheal tube than a tracheostomy."

c Endotracheal intubation may be used for no longer than 2 to 3 weeks, 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. The need for long-term ventilation would not be the primary rationale for this change in treatment. Endotracheal tubes do not diminish the breathing reflex.

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. 84 mm Hg d. 120 mm Hg

c 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 is caring for an elderly client in the PACU. The client has had a bronchoscopy, and the nurse is monitoring for complications related to the administration of lidocaine. For what complication related to the administration of large doses of lidocaine in the elderly should the nurse assess? a. Decreased urine output and hypertension b. Headache and vision changes c. Confusion and lethargy d. Jaundice and elevated liver enzymes

c Lidocaine may be sprayed on the pharynx or dropped on the epiglottis and vocal cords and into the trachea to suppress the cough reflex and minimize discomfort during a bronchoscopy. After the procedure, the nurse will assess for confusion and lethargy in the elderly, which may be due to the large doses of lidocaine given during the procedure. The other listed signs and symptoms are not specific to this problem.

The ED nurse is assessing the respiratory function of a teenage girl who presented with acute shortness of breath. Auscultation reveals continuous wheezes during inspiration and expiration. This finding is most suggestive of what? a. Pleurisy b. Emphysema c. Asthma d. Pneumonia

c Sibilant wheezes are commonly associated with asthma. They do not normally accompany pleurisy, emphysema, or pneumonia.

The nurse is caring for a client who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning, the nurse should anticipate that the weaning of the client will progress in what order? a. Removal from the ventilator, tube, and then oxygen b. Removal from oxygen, ventilator, and then tube c. Removal of the tube, oxygen, and then ventilator d. Removal from oxygen, tube, and then ventilator

a The process of withdrawing the client from dependence on the ventilator takes place in three stages: the client is gradually removed from the ventilator, then from the tube, and, finally, oxygen.

A client has been discharged home after thoracic surgery. The home care nurse performs the initial visit and finds the client discouraged and saddened. The client states, "I am recovering so slowly. I really thought I would be better by now." What nursing action should the nurse prioritize? a. Provide emotional support to the client and family. b. Schedule a visit to the client's primary physician within 24 hours. c. Notify the physician that the client needs a referral to a psychiatrist. d. Place a referral for a social worker to visit the client.

a The recovery process may take longer than the client had expected, and providing support to the client is an important task for the home care nurse. It is not necessary, based on this scenario, to schedule a visit with the physician within 24 hours, or to get a referral to a psychiatrist or a social worker.

A 4 year-old client has had recurrent episodes of bronchitis during the winter months. The client spends a significant amount of time outdoors enjoying the snow and breathes primarily through the mouth. What suggestion would the nurse most likely make to the client's mother? a. Help the client learn to breathe through her nose. b. Keep the client indoors. c. Increase the client's vitamin dosage. d. None of the options is correct.

a The vascular and ciliated mucous lining of the nasal cavities warms and humidifies inspired air. The lining of the sinuses is continuous with the mucous-membrane lining of the nasal cavity. Mucus traps particles that cilia sweep toward the pharynx. Immunoglobulin A (IgA) antibodies in the mucus protect the lower respiratory tract from infection. The turbinates are bones that change the flow of inspired air to moisturize and warm it better.

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

a To maintain normal pH in critically ill clients, the lungs eliminate carbonic acid by blowing off more CO2. To maintain normal pH in critically ill clients, the lungs conserve CO2 by slowing respiratory volume. The lungs would retain more CO2 during an acid-base imbalance in cases of metabolic alkalosis. The kidneys would retain more HCO3 to compensate during an acid-base imbalance in cases of metabolic acidosis.

A client is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what? a. Correct use of a ventilator b. Correct use of incentive spirometry c. Correct use of a mini-nebulizer d. Correct technique for rhythmic breathing

b Instruction in the use of incentive spirometry begins before surgery to familiarize the client with its correct use. You do not teach a client the use of a ventilator; you explain that he may be on a ventilator to help him breathe. Rhythmic breathing and mini-nebulizers are unnecessary.

Not every structure in the upper airway has a purpose in respiration. There are some structures whose role is immunological. Which structures protect against infection? Select all that apply. a. palantine tonsils b. pharyngeal tonsils c. epiglottis d. nasopharynx

a, b Adenoids, or pharyngeal tonsils, also composed of lymphoid tissue, are found in the nasopharynx. They do not contribute to respiration but instead protect against infection.

The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. What method of oxygen delivery is most appropriate for the client's needs? a. Non-rebreathing mask b. Nasal cannula c. Simple mask d. Partial-rebreathing mask

b A nasal cannula is used when the client requires a low to medium concentration of oxygen for which precise accuracy is not essential. The Venturi mask is used primarily for clients with COPD because it can accurately provide an appropriate level of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The client's respiratory status does not require a partial- or non-rebreathing mask.

During a preadmission assessment, for what diagnosis would the nurse expect to find decreased tactile fremitus and hyperresonant percussion sounds? a. Bronchitis b. Emphysema c. Atelectasis d. Pulmonary edema

b Emphysema is associated with decreased tactile fremitus and hyperresonant percussion sounds. Bronchitis is associated with normal tactile fremitus and resonant percussion sounds. Atelectasis is associated with absent tactile fremitus and dull percussion sounds. Pulmonary edema is associated with normal tactile fremitus and resonant percussion sounds.

A medical client rings her call bell and expresses alarm to the nurse, stating, "I've just coughed up this blood. That can't be good, can it?" How can the nurse best determine whether the source of the blood was the client's lungs? a. Obtain a sample and test the pH of the blood, if possible. b. Try to see if the blood is frothy or mixed with mucus. c. Perform oral suctioning to see if blood is obtained. d. Swab the back of the client's throat to see if blood is present.

b Though not definitive, blood from the lung is usually bright red, frothy, and mixed with sputum. Testing the pH of nonarterial blood samples is not common practice and would not provide important data. Similarly, oral suctioning and swabbing the client's mouth would not reveal the source.

The term for the volume of air inhaled and exhaled with each breath is a. residual volume. b. tidal volume. c. vital capacity. d. expiratory reserve volume.

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.

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

b With volume-cycled 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.

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

c 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.

Computed tomography of a patient's chest is suggestive of a malignancy, but these results are not conclusive. As a result, the patient has been scheduled for a bronchoscopy. What patient education should the nurse provide for this patient regarding this diagnostic procedure? a. "The care team will likely give you a general anesthetic for your bronchoscopy." b. "Your doctor will probably instill a contrast solution into your lungs to aid visualization." c. "We'll monitor you closely after the procedure, especially until your gag reflex returns." d. "You won't be able to swallow solid food for a day or two after the procedure."

c After a bronchoscopy, it is important that the patient takes nothing by mouth until the cough reflex returns, because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing for several hours. However, this normally takes a few hours, not one or two days. Bronchoscopy is normally performed under conscious sedation. Contrast solution is not used.

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

c After the procedure, the client must take nothing by mouth until the cough reflex returns, because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing. Once the client demonstrates a cough reflex, the nurse may offer ice chips and eventually fluids. The client is sedated during the procedure, not afterward. The client is not required to maintain bed rest following the procedure.

The home care nurse is planning to begin breathing retraining exercises with a client newly admitted to the home health service. The home care nurse knows that breathing retraining is especially indicated if the client has what diagnosis? a. Asthma b. Pneumonia c. Lung cancer d. COPD

d Breathing retraining is especially indicated in clients with COPD and dyspnea. Breathing retraining may be indicated in clients with other lung pathologies, but not to the extent indicated in clients with COPD.

The nurse has assessed a patient's pulse, temperature, blood pressure, and respiratory rate and is now measuring the patient's oxygenation by pulse oximetry. The nurse understands that this assessment finding is based on: a. The ratio of oxygen to carbon dioxide in arterial blood b. The amount of oxygen dissolved in blood plasma c. The saturation of hemoglobin by oxygen molecules d. The quantity of free oxygen in arterial blood

c Pulse oximetry is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin (SaO2). When oxygen saturation is measured with pulse oximetry, it is referred to as SpO2. Although pulse oximetry does not replace arterial blood gas (ABG) measurement, it is an effective tool to monitor for subtle or sudden changes in oxygen saturation. It does not measure the ratio of oxygen to carbon dioxide, the quantity of free oxygen in arterial blood, or the amount of blood dissolved in plasma.

The nurse is performing client education for a client who is being discharged on mini-nebulizer treatments. What information should the nurse prioritize in the client's discharge teaching? a. How to count her respirations accurately b. How to collect serial sputum samples c. How to independently wean herself from treatment d. How to perform diaphragmatic breathing

d Diaphragmatic breathing is a helpful technique to prepare for proper use of the small-volume nebulizer. Client teaching would not include counting respirations and the client should not wean herself from treatment without the involvement of her primary care provider. Serial sputum samples are not normally necessary.

The nurse is assessing a client who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the client's respirations. How should the nurse best respond to this assessment finding? a. Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes. b. Inform the physician promptly that there is in imminent leak in the drainage system. c. Encourage the client to do deep breathing and coughing exercises. d. Document that the chest drainage system is operating as it is intended.

d Fluctuation of the water level in the water seal shows effective connection between the pleural cavity and the drainage chamber and indicates that the drainage system remains patent. No further action is needed.

The nurse is caring for a client who has been scheduled for a bronchoscopy. How should the nurse prepare the client for this procedure? a. Administer a bolus of IV fluids. b. Arrange for the insertion of a peripherally inserted central catheter. c. Administer nebulized bronchodilators every 2 hours until the test. d. Withhold food and fluids for several hours before the test.

d Food and fluids are withheld for 4 to 8 hours before the test to reduce the risk of aspiration when the cough reflex is blocked by anesthesia. IV fluids, bronchodilators, and a central line are unnecessary.

A client is scheduled to have excess pleural fluid aspirated with a needle in order to relieve her dyspnea. The client inquires about the normal function of pleural fluid. What should the nurse describe? a. It allows for full expansion of the lungs within the thoracic cavity. b. It prevents the lungs from collapsing within the thoracic cavity. c. It limits lung expansion within the thoracic cavity. d. It lubricates the movement of the thorax and lungs.

d The visceral pleura cover the lungs; the parietal pleura line the thorax. The visceral and parietal pleura and the small amount of pleural fluid between these two membranes serve to lubricate the thorax and lungs and permit smooth motion of the lungs within the thoracic cavity with each breath. The pleura do not allow full expansion of the lungs, prevent the lungs from collapsing, or limit lung expansion within the thoracic cavity.

The nurse caring for a client with an endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage of endotracheal tubes? a. Cognition is decreased. b. Daily arterial blood gases (ABGs) are necessary. c. Slight tracheal bleeding is anticipated. d. The cough reflex is depressed.

d There are several disadvantages of an endotracheal tube. Disadvantages include suppression of the client's cough reflex, thickening of secretions, and depressed swallowing reflexes. Ulceration and stricture of the larynx or trachea may develop, but bleeding is not an expected finding. The tube should not influence cognition and daily ABGs are not always required.

Following a chest X-ray, a patient has been diagnosed with a pleural effusion. The care team has concluded that the quantity of fluid in the patient's intrapleural space necessitates thoracentesis. What patient education should the nurse provide in anticipation of this procedure? a. "You can move around as normal after the procedure is finished, and I've applied a bandage over the site." b. "The doctor will ask you to cough a few times to facilitate the insertion of the needle." c. "If you're unable to lie on your side, you can sit upright and support yourself on your overbed table." d. "It's very important that you remain still while the doctor is performing the procedure."

d To prevent pneumothorax, it is imperative that a patient remain immobile during thoracentesis. The patient should remain on bed rest after the procedure and should not cough during thoracentesis. The preferred positioning is with the patient upright; if this is not possible, side-lying may be used as an alternative.

A patient exhibited signs of an altered ventilation-perfusion ratio. The nurse is aware that adequate ventilation but impaired perfusion exists when the patient has which of the following conditions? a. Atelectasis b. Infective process c. Tumor d. Pulmonary embolism

d When a blood clot exists in a pulmonary vessel (embolus), impaired perfusion results. However, ventilation is adequate. With the other choices, ventilation is impaired but perfusion is adequate.

A client has been newly diagnosed with emphysema. The nurse should explain to the client that by definition, ventilation: a. is breathing air in and out of the lungs. b. is when the body changes oxygen into CO2. c. provides a blood supply to the lungs. d. helps people who cannot breathe on their own.

a Ventilation is the actual movement of air in and out of the respiratory tract. Diffusion is the exchange of oxygen and CO2 through the alveolar-capillary membrane. Pulmonary perfusion refers to the provision of blood supply to the lungs. A mechanical ventilator assists patients who are unable to breathe on their own.

A client has been diagnosed with heart failure that has not yet responded to treatment. What breath sound should the nurse expect to assess on auscultation? a. Expiratory wheezes b. Inspiratory wheezes c. Rhonchi d. Crackles

d Crackles reflect underlying inflammation or congestion and are often present in such conditions as pneumonia, bronchitis, and congestive heart failure. Rhonchi and wheezes are associated with airway obstruction, which is not a part of the pathophysiology of heart failure.