Chapter 29: Respiratory System Functions, Data Collection
"I should take deep breaths prior to coughing."
The LPN/LVN is teaching a patient about obtaining a sputum specimen. Which statement made by the patient indicates an understanding of the teaching? "I need to spit into the container to give you a sample." "I should not drink fluids before getting a sample." "It is best to obtain a sample after eating." "I should take deep breaths prior to coughing."
Setting a quit date Nicotine replacement therapy Techniques involving hypnosis
The LPN/LVN is teaching a patient about smoking cessation. Which of the following will the nurse include in the teaching? Select all that apply. Avoiding physical activity while attempting to quit Setting a quit date Nicotine replacement therapy Possible use of famotidine Techniques involving hypnosis
a. Place the end of the chest tube in a container of sterile saline.
1. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do? a. Place the end of the chest tube in a container of sterile saline. b. Apply an occlusive dressing and notify the physician. c. Clamp the chest tube immediately. d. Secure the chest tube with tape.
b. Pneumonia
2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza? a. Septicemia b. Pneumonia c. Meningitis d. Pulmonary edema
b. 5 to 20 minutes.
3. A female client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for: a. 15 to 60 seconds. b. 5 to 20 minutes. c. 30 to 40 minutes. d. 45 to 60 minutes.
a. Hypoxia
4. Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition? a. Hypoxia b. Delirium c. Hyperventilation d. Semiconsciousness
d. pH, 7.25; PaCO2 50 mm Hg
5. A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? a. pH, 5.0; PaCO2 30 mm Hg b. pH, 7.40; PaCO2 35 mm Hg c. pH, 7.35; PaCO2 40 mm Hg d. pH, 7.25; PaCO2 50 mm Hg
"There is a tracheostomy support group I can give you the number for."
A patient about to undergo a tracheostomy tells the LPN/LVN, "I never see anyone else with one of these ugly holes in their neck." Which response by the nurse is best? "You are correct; there are very few people with a tracheostomy." "There is a tracheostomy support group I can give you the number for." 'You won't need it for very long, and then you can let it close up." "It will be okay. You will get used to it."
Numbness in the extremities Lethargy Chest pain Nausea
A patient has been receiving oxygen at a concentration of 60% via Venturi mask and develops lung damage. The LPN/LVN should be aware of which of the following clinical manifestations of lung damage with oxygen therapy? Select all that apply. Numbness in the extremities Lethargy Chest pain Nausea Constipation
4. Examine the entire system and tubing for air leaks.
A patient with a chest drainage system is admitted to the medical-surgical unit. The nurse notes vigorous bubbling in the water seal chamber of the system. What should the nurse do? 1. Decrease the level of suction until bubbling ceases. 2. Ask the patient to splint the site and cough forcefully. 3. No action is necessary; this is an expected finding. 4. Examine the entire system and tubing for air leaks.
4. Place the patient in a Fowler's position. The patient's abnormally high PaCO2 should be reported but the patient's immediate needs must be met first. 2Removing the oxygen will exacerbate the PaCO2 levels. 3Breathing into a paper bag will exacerbate the PaCO2 levels via retention. 4Placing the patient into a Fowler's position will help with ventilation while contacting the HCP. The patient's immediate needs must be met first.
A patient's arterial blood gas analysis shows a PaCO2 of 68 mm Hg. What action should the nurse take first? 1. Notify the HCP. 2. Remove the patient's oxygen mask. 3. Have the patient breathe into a paper bag. 4. Place the patient in a Fowler's position.
Use of accessory muscles
The LPN/LVN is monitoring a patient and notes respiratory distress. Which clinical manifestation supports this finding? Use of accessory muscles Dry cough Pursed-lip breathing Diaphragmatic breathing
Use a water source to humidify the oxygen.
The LPN/LVN is monitoring a patient with chronic obstructive pulmonary disease (COPD) receiving oxygen via nasal cannula. The patient is reporting dry nasal membranes. Which intervention should the nurse implement? Change the patient to a simple face mask. Increase the amount of oxygen the patient is receiving. Use a water source to humidify the oxygen. Apply petroleum jelly to the nares.
Respiratory acidosis
The LPN/LVN is monitoring a patient with chronic obstructive pulmonary disease (COPD). This patient is at risk for developing which condition? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
The nurse swabs the interior cheek
The LPN/LVN is performing a throat culture on a patient with suspected strep throat. Which of the following needs correction by the charge nurse? The nurse warns the patient that they may gag The nurse uses a tongue blade to hold down the tongue The nurse swabs the interior cheek The nurse place is the specimen in a sterile container and send it to the laboratory
Leaking chest tube -a leaking chest tube can cause subcutaneous emphysema
The LPN/LVN feels crepitus around the insertion site of a patient with a chest tube. This can be indicative of which of the following? Bronchitis Lung cancer Leaking chest tube Pneumonia
Wheezing (wheezing is a common lung sound in a patient with asthma) -pleural friction rub is heard in patients with pleurisy, lung cancer, pneumonia, or pleural irritation -coarse crackles or heard typically in pulmonary edema, bronchitis, pneumonia -absent lung sounds can be heard in a patient with a pneumothorax, pneumonectomy, pleural effusion
The LPN/LVN is auscultating the lungs of a patient with exacerbation of asthma. Which lung sounds should the nurse expect to hear? Wheezing Pleural friction rub Coarse crackles Absent lung sounds
A 60-year-old 40-pack-per-year smoker with dyspnea
The LPN/LVN is caring for a group of patients. Which patient does the nurse conclude is at highest risk for lung disease? A 30-year-old who drinks beer socially and has sinusitis A 40-year-old who takes medication for attention deficit-hyperactivity disorder (ADHD) with laryngitis A 50-year-old alcoholic with epistaxis A 60-year-old 40-pack-per-year smoker with dyspnea
Provide a pencil and paper Read expressions and body language Place the call light within reach Provide a picture board
The LPN/LVN is caring for a patient who is mechanically ventilated. To promote effective communication, which of the following should the nurse implement? Ask open-ended questions Provide a pencil and paper Read expressions and body language Place the call light within reach Provide a picture board
Respiratory Therapy Speech Therapy
The LPN/LVN is caring for a patient who will undergo a tracheostomy. Which disciplines should the nurse expect to be directly involved in the patient's care? Select all that apply. Respiratory Therapy Physical Therapy Wound Care Pharmacy Speech Therapy
3. Contact the respiratory therapist (RT) for guidance.
The LPN/LVN is caring for a patient with COPD who is using oxygen therapy at 2 L/min. The patient becomes short of breath and requests that the oxygen flow rate to be increased. What is the LPN/LVN's next step? 1. Increase the flow rate by 2 L. 2. Increase the flow rate by 1 L. 3. Contact the respiratory therapist (RT) for guidance. 4. Instruct the patient on huff coughing.
Check for leaks and notify the registered nurse (RN)
The LPN/LVN is caring for a patient with a chest tube and notes continuous bubbling. Which action should the nurse implement? Add water to the water seal chamber Place the drainage system above chest level Change the collection chamber Check for leaks and notify the registered nurse (RN)
4. If tubing appears to be occluded, consult with the HCP for specific orders.
The LPN/LVN is caring for a patient with a chest tube and notices that the tubing appears to be occluded with clots. What is the LPN/LVN's next step with this issue? 1. Gently squeeze portions of the tubing form the patient to the system until the clots are moved to the system. 2. Hold the proximal end of the tubing between two fingers while sliding the fingers toward the system. 3. Document the findings and prepare to assist the HCP for removal of the chest tube. 4. If tubing appears to be occluded, consult with the HCP for specific orders.
3. Reinforce the dressing and contact the HCP and assist with the changing of the dressing.
The LPN/LVN is caring for a patient with a chest tube. The nurse notes that the dressing over the insertion site is soiled. What is the most appropriate step for the nurse to take? 1. Change the dressing with sterile petroleum gauze and label the dressing with date and initials. 2. Cleanse the area after removing the old dressing and apply a sterile petroleum gauze over the site. 3. Reinforce the dressing and contact the HCP and assist with the changing of the dressing. 4. Apply the two padded clamps at the bedside and change the dressing using sterile technique
Right side-lying position
The LPN/LVN is caring for a patient with lung disease of the left lung. The nurse should instruct the patient to lie in which position? High Fowler's position Right side-lying position Semi-Fowler's position Left side-lying position
Check the patient.
The LPN/LVN is caring for a ventilated patient. The alarm on the ventilator begins to sound. Which action should the nurse take first? Check the patient. Change the ventilator settings. Notify the health-care provider (HCP). Suction the patient.
1. Check the order 2. Obtain a sterile container 3. Instruct the patient to inhale deeply 4. Instruct the patient to cough deeply from the lungs 5. Send the specimen to the laboratory immediately
The LPN/LVN is collecting a sputum specimen from a patient with suspected pneumonia. Place in order the steps the nurse should take when performing this task. Instruct the patient to inhale deeply Instruct the patient to cough deeply from the lungs Check the order Send the specimen to the laboratory immediately Obtain a sterile container
1. Twist the canister into the inhaler unit and shake the inhaler. 2. Exhale 3. Place the inhaler mouthpiece in your mouth 4. Press the canister down to deliver a dose of medication and breathe in. 5. Hold your breath for 5-10 seconds.
The LPN/LVN is teaching a patient how to use a metered-dose inhaler. Place in order the steps the nurse will use for instruction. Place the inhaler mouthpiece in your mouth Exhale Hold your breath for 5-10 seconds. Press the canister down to deliver a dose of medication and breathe in. Twist the canister into the inhaler unit and shake the inhaler.
Instruct the patient to cough deeply
The LPN/LVN notes course crackles when auscultating lung sounds of a patient. Which intervention should the nurse implement? Instruct the patient to cough deeply Suction the patient check oxygen saturation obtain a sputum specimen
4. Helps to open and clear smaller airways
The nurse instructs the patient with chronic obstructive pulmonary disease (COPD) on methods to lower the risk of lung complications. One technique is the "long huff" cough. What is the rationale for this type of coughing exercise? 1. Increases oxygenation 2. Removes excess carbon dioxide 3. Ensures thorough lung expansion 4. Helps to open and clear smaller airways
1. Barrel chest 4. Nail clubbing 5. Weight loss
The nurse is assessing a patient who has a history of COPD. What are some of the expected findings during the assessment? (Select all that apply.) 1. Barrel chest 2. Bradypnea 3. Chronic cough 4. Nail clubbing 5. Weight loss
1. Coarse crackles
The nurse is assessing the patient diagnosed with pulmonary edema and hears lung sounds, and moist bubbling sounds are heard on inspiration and expiration. What medical term best defines the sound? 1. Coarse crackles 2. Fine crackles 3. Pleural friction rub 4. Wheezing
4. Listen to the corresponding area in the patient's right lower lobe.
The nurse is auscultating a patient's chest and hears an adventitious sound in the left lower lobe. What is the first step in determining whether this is an abnormality? 1. Ask the patient to cough and note the characteristics of secretions. 2. Ask the patient to drink some water and then reassess the breath sounds. 3. Have the HCP listen and verify what the nurse is hearing. 4. Listen to the corresponding area in the patient's right lower lobe.
2. Assist the patient to sit at the edge of the bed to lean over the bedside table.
The nurse is caring for a patient who becomes dyspneic, which the patient states is a "6 out of 10" on the dyspnea scale. Which action should the nurse do first? 1. Contact the health care provider (HCP) for an order for supplemental oxygen. 2. Assist the patient to sit at the edge of the bed to lean over the bedside table. 3. Apply nasopharyngeal suction intermittently until the airway is cleared. 4. Apply supplemental oxygen and notify the HCP of this action.
2. Chronic obstructive pulmonary disease
The nurse is caring for a patient who has been diagnosed with respiratory acidosis. Which of the following medical condition would be the contributing factor? 1. Acetaminophen overdose 2. Chronic obstructive pulmonary disease 3. End-stage renal disease 4. Acute hypoxemia due to high altitudes
4. The tubing is obstructed.
The nurse is caring for a patient who is on a ventilator and the high-pressure alarm sounds. What should the nurse consider as the cause for this alarm? 1. The patient is being weaned. 2. The tubing is disconnected. 3. The electricity is interrupted. 4. The tubing is obstructed.
3. Both side vents closed on inspiration, reservoir bag inflated
The nurse is caring for a patient with chronic lung disease who is receiving oxygen via a nonrebreathing mask. Which observation indicates to the nurse that the system is functioning as expected? 1. Both side vents open on expiration, reservoir bag inflated 2. Both side vents open on inspiration, reservoir bag deflated 3. Both side vents closed on inspiration, reservoir bag inflated 4. Both side vents closed on expiration, reservoir bag deflated
1. Assess the patient.
The nurse is caring for patients in a respiratory unit and hears a ventilator alarm from the hallway. Which action should the nurse take first? 1. Assess the patient. 2. Call a code blue. 3. Check the machine. 4. Suction the patient
4. It can deliver oxygen at a concentration from 40 to 60 percent.
The nurse is caring for the patient receiving oxygen therapy. Which of the following is correct regarding a simple face mask? 1. Is can deliver a precise percentage of oxygen therapy. 2. It can be worn while the patient is eating or drinking. 3. It is less claustrophobic for the patient than the other masks. 4. It can deliver oxygen at a concentration from 40 to 60 percent.
2. It occurs when air leaks into the subcutaneous tissues.
The nurse is caring for the patient who has recently recovered from a spontaneous pneumothorax. The nurse palpates the patient's left shoulder area and feels a "Rice Krispies" presence under the skin. What best describes this symptom? 1. It is a sign of recovery from a pneumothorax. 2. It occurs when air leaks into the subcutaneous tissues. 3. It is a symptom of a pending recurrence of a pneumothorax. 4. It is a sign that the chest tube was removed too soon.
1. Decrease in peak airflow and gas exchange 2. Weakening of respiratory muscles 4. Decline of effectiveness of lung defense mechanisms
Which of the following are effects of aging on the respiratory system? (Select all that apply.) 1. Decrease in peak airflow and gas exchange 2. Weakening of respiratory muscles 3. Increased lung surfactant levels 4. Decline of effectiveness of lung defense mechanisms 5. Increased tidal lung capacity
A patient with chronic obstructive pulmonary disease (COPD)
Which of the following patients should the LPN/LVN instruct pursed-lip breathing? A patient with chronic obstructive pulmonary disease (COPD) A patient with laryngitis A patient with a tracheostomy A patient with tonsillitis
2. "I will be able cover the site with a loose scarf or collar." The catheter should be removed and cleaned two to three times a day to remove mucous obstructions. 2This is an alternative to a face mask as the patient may cover the site with a loose scarf or collar. 3The nasal cannula will not deliver a high flow rate and the transtracheal catheter does not obstruct the nose or mouth. 4The catheter should be removed and cleaned two to three times a day to remove mucous obstructions.
The nurse is coaching a patient who is using a transtracheal catheter. The nurse recognizes that the patient understands the care for the catheter by which of the following statements? 1. "I will clean the catheter once a day to prevent mucous obstructions." 2. "I will be able cover the site with a loose scarf or collar." 3. "I will use a nasal cannula when I want to eat or drink." 4. "I will not remove the catheter until the site is healed."
Notify the HCP immediately
The nurse is monitoring oxygen saturation for a patient with lung disease who is currently receiving oxygen 3 L/min via nasal cannula and obtains a repeat reading of 70%. Which action should the nurse take? Increase the oxygen to 4 L per minute via nasal cannula Document this finding as normal Notify the HCP immediately Instruct the patient to cough and deep breath
3. Continue with the cleaning of the tracheostomy.
The nurse is preparing to perform a routine cleaning of the patient's cuffed tracheostomy. The nurse notes that the cuff has been deflated since the patient's weaning off of the mechanical ventilator. What is the nursing intervention at this time? 1. Contact the HCP for further orders. 2. Do not start the cleaning until the cuff is properly inflated. 3. Continue with the cleaning of the tracheostomy. 4. Contact the RT to have the cuff inflated.
1. Numbness in the extremities 5. PaO2 greater than 100 mm Hg
The nurse is providing care to a patient who has been receiving high oxygen concentration therapy for 36 hours. Which of the following symptoms, if exhibited by the patient, should the nurse contact the HCP for suspected lung damage from this therapy? (Select all that apply.) 1. Numbness in the extremities 2. Hypoactive bowel sounds 3. Crepitus in the scapular area 4. Dry cough, and chest pain 5. PaO2 greater than 100 mm Hg
3. "Using the MDI more often than prescribed can result in worsening symptoms."
The nurse is providing discharge instructions for a patient who is to use an adrenergic bronchodilator. Which of the following responses would best demonstrate the patient's understanding? 1. "The metered-dose inhaler (MDI) may keep me up at night, so I will avoid using the MDI at night." 2. "If my symptoms are not relieved, I may take one puff every 5 minutes until I feel better." 3. "Using the MDI more often than prescribed can result in worsening symptoms." 4. "Whenever I feel short of breath, I will take 2 puffs, but no more than 12 puffs a day."
3. It is the air remaining in the lungs after normal expiration.
The nurse is reviewing a patient's pulmonary function tests. Which of the following best describes functional residual capacity? 1. It is the air inspired and expired in one breath. 2. It is the maximum amount of air beyond tidal volume. 3. It is the air remaining in the lungs after normal expiration. 4. It is the amount of air expired forcefully after maximum inspiration.
2. 400 to 600 mL
The nurse is reviewing the results of a patient's pulmonary function studies. Which result indicates the patient's resting tidal volume is within normal limits? 1. 200 to 400 mL 2. 400 to 600 mL 3. 600 to 800 mL 4. 800 to 1,000 mL
2. Fowler's position allows maximum lung expansion.
The nurse places a patient who is experiencing dyspnea in the Fowler's position. What is the rationale for the nurse to use this position? 1. Fowler's position moves the tonsils from the back of the throat. 2. Fowler's position allows maximum lung expansion. 3. Fowler's position augments the use of accessory muscles. 4. Fowler's position relieves stress on the abdominal cavity.
3. The patient's low hemoglobin count provides less surface for the adherence of oxygen.
The nurse recognizes that the elderly patient's poor perfusion of body tissues is due to the patient's diagnosis of a blood disorder. Which of the following would best explain the patient's issue? 1. The patient's dehydration prevents circulation of free oxygen in the blood plasma. 2. The patient's low red blood cell (RBC) count prevents oxygen from adhering to the membranes. 3. The patient's low hemoglobin count provides less surface for the adherence of oxygen. 4. The patient's high white blood cell (RBC) count signifies an infection and need for more oxygen.
Below the level of the patient's chest
The patient arrives to the emergency department with a stab wound to the chest. The HCP places two chest tubes to drain air and blood from the patient's thoracic cavity. The nurse sets up the chest tube drainage system. Where should the nurse place the system? 1. Attached to the foot of the bed 2. Along the side of the patient's knee 3. Below the level of the patient's chest 4. At the level of the patient's clavicle
