respiratory chapter 21 questions
The nurse is preparing to perform chest physiotherapy (CPT) on a patient. Which of the following patient statements would indicate the procedure is contraindicated. a) "I just finished eating my lunch, I'm ready for my CPT now." b) "I just changed into my running suit; we can do my CPT now." c) "I received my pain medication 10 minutes ago, let's do my CPT now." d) "I have been coughing all morning and am barely bringing anything up."
a) "I just finished eating my lunch, I'm ready for my CPT now."
A client has a sucking stab wound to the chest. Which action should the nurse take first? a) Apply a dressing over the wound and tape it on three sides. b) Prepare a chest tube insertion tray. c) Prepare to start an I.V. line. d) Draw blood for a hematocrit and hemoglobin level.
a) Apply a dressing over the wound and tape it on three sides.
A nurse provides care for a client receiving oxygen from a nonrebreather mask. Which nursing intervention has the highest priority? a) Assessing the client's respiratory status, orientation, and skin color b) Posting a "No smoking" sign over the client's bed c) Applying an oil-based lubricant to the client's mouth and nose d) Changing the mask and tubing daily
a) Assessing the client's respiratory status, orientation, and skin color
Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? a) Assist-control b) IMV c) SIMV d) Pressure support
a) Assist-control
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) Assess the CO2 level to determine if the patient requires suctioning. c) Have the patient cough. d) Have the patient inform the nurse of the need to be suctioned.
a) Auscultate the lung for adventitious sounds.
For a client with an endotracheal (ET) tube, which nursing action is the most important? a) Auscultating the lungs for bilateral breath sounds b) Providing frequent oral hygiene c) Monitoring serial blood gas values every 4 hours d) Turning the client from side to side every 2 hours
a) Auscultating the lungs for bilateral breath sounds
A nurse is assigned to care for a client with a tracheostomy tube. How can the nurse communicate with this client? a) By supplying a magic slate or similar device b) By providing a tracheostomy plug to use for verbal communication c) By placing the call button under the client's pillow d) By suctioning the client frequently
a) By supplying a magic slate or similar device
The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique? a) Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes. b) Perform this measure with the client once a day. c) Use aerosol sprays to deodorize the client's environment after postural drainage. d) Administer bronchodilators and mucolytic agents following the sequence.
a) Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.
A patient has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the patient 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 toxicity b) Hypoxia c) Oxygen-induced atelectasis d) Oxygen-induced hypoventilation
a) Oxygen toxicity
The nurse is preparing to perform tracheostomy care on a patient with a newly inserted tracheostomy tube. Which of the following actions, if preformed by the nurse, indicates the need for further review of the procedure? a) Places clean tracheostomy ties, and removes soiled ties after the new ties are in place b) Dries and reinserts the inner cannula or replaces it with a new disposable inner cannula c) Cleans the wound and the plate with a sterile cotton tip moistened with hydrogen peroxide d) Puts on clean gloves; removes and discards the soiled dressing in a biohazard container
a) Places clean tracheostomy ties, and removes soiled ties after the new ties are in place
A client with supraglottic cancer undergoes a partial laryngectomy. Postoperatively, a cuffed tracheostomy tube is in place. When removing secretions that pool above the cuff, the nurse should instruct the client to: a) cough as the cuff is being deflated. b) hold the breath as the cuff is being reinflated. c) exhale deeply as the nurse reinflates the cuff. d) take a deep breath as the nurse deflates the cuff.
a) cough as the cuff is being deflated.
When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for which of the following time periods? a) 30 to 35 seconds b) 10 to 15 seconds c) 20 to 25 seconds d) 0 to 5 seconds
b) 10 to 15 seconds
Which of the following ranges of water pressure identifies the amount of pressure within the endotracheal tube cuff that is believed to prevent both injury and aspiration? a) 10 to 15 mm Hg b) 15 to 20 mm Hg c) 0 to 5 mm Hg d) 30 to 35 mm Hg
b) 15 to 20 mm Hg
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) 84 mm Hg c) 58 mm Hg d) 120 mm Hg
b) 84 mm Hg
Constant bubbling in the water seal of a chest drainage system indicates which of the following problems? a) Tension pneumothorax b) Air leak c) Increased drainage d) Tidaling
b) Air leak
Which of the following ventilator modes provides full ventilatory support by delivering a present tidal volume and respiratory rate? a) IMV b) Assist control c) Pressure support d) SIMV
b) Assist control
A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? a) Arterial blood gas (ABG) levels b) Auscultation c) Inspection d) Chest X-ray
b) Auscultation
Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain? a) Prior outcomes of weaning b) Baseline arterial blood gas (ABG) levels c) Electrocardiogram (ECG) results d) Fluid intake for the past 24 hours
b) Baseline arterial blood gas (ABG) levels
Which of the following is an adverse reaction that would require termination of the weaning process from the ventilator? a) Heart rate less than 100 b) Blood pressure increase of 20 mm Hg c) PaOgreater than 60 mmHg with a FiO less than 40% d) Vital capacity of 12 mL/kg
b) Blood pressure increase of 20 mm Hg
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) Stop the ventilator by pressing the off button, wait 15 seconds, and then turn it on again to see if the alarm stops. b) Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved. c) Suction the patient since the patient may be obstructed by secretions. d) 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.
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) Encourage the patient to try to stop coughing during and after using the spirometer. b) Encourage the patient to take approximately 10 breaths per hour, while awake. c) Have the patient lie in a supine position during the use of the spirometer. d) Inform the patient that using the spirometer is not necessary if the patient is experiencing pain.
b) Encourage the patient to take approximately 10 breaths per hour, while awake.
Which of the following would indicate a decrease in pressure with mechanical ventilation? a) Decrease in lung compliance b) Increase in compliance c) Kinked tubing d) Plugged airway tube
b) Increase in compliance
A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? a) A disconnected ventilator tube b) Kinking of the ventilator tubing c) An ET cuff leak d) A change in the oxygen concentration without resetting the oxygen level alarm
b) Kinking of the ventilator tubing
For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan? a) Stripping the chest tube every hour b) Measuring and documenting the drainage in the collection chamber c) Maintaining continuous bubbling in the water-seal chamber d) Keeping the collection chamber at chest level
b) Measuring and documenting the drainage in the collection chamber
A young male client has muscular dystrophy. His PaO2 is 42 mm Hg with a FiO2 of 80%. Which of the following treatments would be least invasive and most appropriate for this client? a) Continuous positive airway pressure (CPAP) b) Negative-pressure ventilator c) Bilevel positive airway pressure (Bi-PAP) d) Positive-pressure ventilator
b) Negative-pressure ventilator
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) PCO2 b) PaO2 c) HCO3 d) pH
b) PaO2
A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a) pH b) Partial pressure of arterial carbon dioxide (PaCO2) c) Bicarbonate (HCO3-) d) Partial pressure of arterial oxygen (PaO2)
b) Partial pressure of arterial carbon dioxide (PaCO2)
Positive end-expiratory pressure (PEEP) therapy has which effect on the heart? a) Increased blood pressure b) Reduced cardiac output c) Bradycardia d) Tachycardia
b) Reduced cardiac output
The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for: a) A scheduled time for deflation of the tracheal cuff b) Symmetry of the client's chest expansion c) Cool air humidified through the tube d) Tracheal cuff pressure set at 30 mm Hg
b) Symmetry of the client's chest expansion
A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a severe stroke. What action does the nurse anticipate the physician will take now that the patient has been intubated for this length of time? a) The patient will begin the weaning process. b) The patient will have an insertion of a tracheostomy tube. c) The patient will be extubated and another endotracheal tube will be inserted. d) The patient will be extubated and a nasotracheal tube will be inserted.
b) The patient will have an insertion of a tracheostomy tube
A client in acute respiratory distress is brought to the emergency department. After endotracheal (ET) intubation and initiation of mechanical ventilation, the client is transferred to the intensive care unit. Before suctioning the ET tube, the nurse hyperventilates and hyperoxygenates the client. What is the rationale for these interventions? a) They help prevent subcutaneous emphysema. b) They help prevent cardiac arrhythmias. c) They help prevent pulmonary edema. d) They help prevent pneumothorax.
b) They help prevent cardiac arrhythmias.
Which type of ventilator has a present volume of air to be delivered with each inspiration? a) Negative-pressure b) Volume-controlled c) Pressure-cycled d) Time-cycled
b) Volume-controlled
After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? a) Suction control chamber b) Water-seal chamber c) Air-leak chamber d) Collection chamber
b) Water-seal chamber
Hyperbaric oxygen therapy increases the blood's capacity to carry and deliver oxygen to compromised tissues. This therapy may be used for a client with: a) hyperthermia. b) a compromised skin graft. c) pneumonia. d) a malignant tumor.
b) a compromised skin graft.
A nurse is caring for a client who was intubated because of respiratory failure. The client is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The client has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as: a) assist-control (AC) ventilation. b) synchronized intermittent mandatory ventilation (SIMV). c) pressure support ventilation (PSV). d) continuous positive airway pressure (CPAP).
b) synchronized intermittent mandatory ventilation (SIMV).
A nurse is caring for a client who was intubated because of respiratory failure. The client is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The client has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as: a) pressure support ventilation (PSV). b) synchronized intermittent mandatory ventilation (SIMV). c) continuous positive airway pressure (CPAP). d) assist-control (AC) ventilation.
b) synchronized intermittent mandatory ventilation (SIMV).
The nurse is preparing to assist the health care provider with the removal of a patient's chest tube. Which of the following instructions will the nurse correctly give the patient? a) "Exhale forcefully while the chest tube is being removed." b) "While the chest tube is being removed, raise your arms above your head." c) "When the tube is being removed, take a deep breath, exhale, and bear down." d) "During the removal of the chest tube, do not move because it will make the removal more painful."
c) "When the tube is being removed, take a deep breath, exhale, and bear down."
The nurse is caring for a patient in the ICU who required emergent endotracheal (ET) intubation with mechanical ventilation. The nurse receives an order to obtain arterial blood gases (ABGs) following the procedure. The nurse recognizes that ABGs should be obtained at which timeframe following the initiation of mechanical ventilation? a) 15 minutes b) 25 minutes c) 20 minutes d) 10 minutes
c) 20 minutes
A 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) 30 to 40 minutes. b) 15 to 60 seconds. c) 5 to 20 minutes. d) 45 to 60 minutes.
c) 5 to 20 minutes.
A client on long-term mechanical ventilation becomes very frustrated when he tries to communicate. Which intervention should the nurse perform to assist the client? a) Ask a family member to interpret what the client is trying to communicate. b) Assure the client that everything will be all right and that he shouldn't become upset. c) Ask the client to write, use a picture board, or spell words with an alphabet board. d) Ask the physician to wean the client off the mechanical ventilator to allow the client to talk.
c) Ask the client to write, use a picture board, or spell words with an alphabet board.
The nurse is caring for a patient following a thoracotomy. Which of the following findings requires immediate intervention by the nurse? a) Heart rate: 112 bpm b) Moderate amounts of colorless sputum c) Chest tube drainage of 190 mL/hr d) Pain of 5 on a 1 to 10 pain scale
c) Chest tube drainage of 190 mL/hr
A client is on a positive-pressure ventilator with a synchronized intermittent mandatory ventilation (SIMV) setting. The ventilator is set for 8 breaths per minute. The client is taking 6 breaths per minute independently. The nurse a) Consults with the physician about removing the client from the ventilator b) Contacts the respiratory therapy department to report the ventilator is malfunctioning c) Continues assessing the client's respiratory status frequently d) Changes the setting on the ventilator to increase breaths to 14 per minute
c) Continues assessing the client's respiratory status frequently
A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? a) Water-seal chest drainage set-up b) Oxygen analyzer c) Manual resuscitation bag d) Tracheostomy cleaning kit
c) Manual resuscitation bag
f the following oxygen administration devices, which has the advantage of providing high oxygen concentration? a) Catheter b) Venturi mask c) Non-rebreather mask d) Face tent
c) Non-rebreather mask
A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a) pH b) Partial pressure of arterial carbon dioxide (PaCO2) c) Partial pressure of arterial oxygen (PaO2) d) Bicarbonate (HCO3-)
c) Partial pressure of arterial oxygen (PaO2)
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 having a myocardial infarction. b) The patient is in a hypermetabolic state. c) The patient is hypoxic from suctioning. d) The patient is having a stress reaction.
c) The patient is hypoxic from suctioning.
A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? a) The client has a pneumothorax. b) The system is functioning normally. c) The system has an air leak. d) The chest tube is obstructed.
c) The system has an air leak.
n general, chest drainage tubes are not used for the patient undergoing a) wedge resection. b) lobectomy. c) pneumonectomy. d) segmentectomy.
c) pneumonectomy.
Which of the following is a correct endotracheal tube cuff pressure? a) 25 mm Hg b) 13 mm Hg c) 21 mm Hg d) 17 mm Hg
d) 17 mm Hg
A patient with COPD requires oxygen administration. What method of delivery does the nurse know would be best for this patient? a) A nasal cannula b) A nonrebreathing mask c) An oropharyngeal catheter d) A Venturi mask
d) A Venturi mask
A patient is to receive an oxygen concentration of 70%. What is the best way for the nurse to deliver this concentration? a) A Venturi mask b) A nasal cannula c) An oropharyngeal catheter d) A partial rebreathing mask
d) A partial rebreathing mask
The nurse is caring for a patient following a wedge resection. While the nurse is assessing the patient's chest tube drainage system, constant bubbling is noted in the water seal chamber. This finding indicates which of the following problems? a) Increased drainage b) Tidaling c) Tension pneumothorax d) Air leak
d) Air leak
A patient is brought into the emergency department with carbon monoxide poisoning after escaping a house fire. What should the nurse monitor this patient for? a) Stagnant hypoxia b) Histotoxic hypoxia c) Hypoxic hypoxia d) Anemic hypoxia
d) Anemic hypoxia
Which of the following is a potential complication of a low pressure in the ET cuff? a) Tracheal ischemia b) Tracheal bleeding c) Pressure necrosis d) Aspiration pneumonia
d) Aspiration pneumonia
The nurse is caring for a patient in the ICU who is receiving mechanical ventilation. Which of the following nursing measures are implemented in an effort to reduce the patient's risk of developing ventilator-associated pneumonia (VAP)? a) Turning and repositioning the patient every 4 hours b) Ensuring that the patient remains sedated while intubated c) Maintaining the patient in a high Fowler's position d) Cleaning the patient's mouth with chlorhexidine daily
d) Cleaning the patient's mouth with chlorhexidine daily
The nurse is caring for a patient with an endotracheal tube (ET). Which of the following nursing interventions is contraindicated? a) Ensuring that humidified oxygen is always introduced through the tube b) Deflating the cuff prior to tube removal c) Checking the cuff pressure every 6 to 8 hours d) Deflating the cuff routinely
d) Deflating the cuff routinely
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) Delirium b) Semiconsciousness c) Hyperventilation d) Hypoxia
d) Hypoxia
A nurse is caring for a client after a thoracotomy for a lung mass. Which nursing diagnosis should be the first priority? a) Anxiety b) Deficient knowledge: Home care c) Impaired physical mobility d) Impaired gas exchange
d) Impaired gas exchange
A young male client has muscular dystrophy. His PaO2 is 42 mm Hg with a FiO2 of 80%. Which of the following treatments would be least invasive and most appropriate for this client? a) Continuous positive airway pressure (CPAP) b) Positive-pressure ventilator c) Bilevel positive airway pressure (Bi-PAP) d) Negative-pressure ventilator
d) Negative-pressure ventilator
The nurse is teaching the client in respiratory distress ways to prolong exhalation to improve respiratory status. The nurse tells the client to a) Sit in an upright position only. b) Initially inhale through the mouth. c) Hold the breath for 5 seconds and then exhale. d) Purse the lips when exhaling air from the lungs.
d) Purse the lips when exhaling air from the lungs.
A client undergoes a tracheostomy after many failed attempts at weaning him from a mechanical ventilator. Two days after tracheostomy, while the client is being weaned, the nurse detects a mild air leak in the tracheostomy tube cuff. What should the nurse do first? a) Call the physician. b) Add more air to the cuff. c) Remove the malfunctioning cuff. d) Suction the client, withdraw residual air from the cuff, and reinflate it.
d) Suction the client, withdraw residual air from the cuff, and reinflate it.
A nurse is caring for a client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is: a) preventing him from developing an infection. b) encouraging him to perform activities of daily living (ADLs). c) helping him communicate. d) keeping his airway patent.
d) keeping his airway patent.
The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.) a) Decreases patient anxiety b) Prevents aspiration c) Decreases hypoxemia d) Increases oxygen consumption e) Sustains positive end expiratory pressure (PEEP)
• Decreases hypoxemia • Decreases patient anxiety • Sustains positive end expiratory pressure (PEEP)
A client with COPD has been receiving oxygen therapy for an extended period. What symptoms would be indicators that the client is experiencing oxygen toxicity? Select all that apply. a) Bradycardia b) Dyspnea c) Fatigue d) Substernal pain e) Mood swings
• Substernal pain • Dyspnea • Fatigue
A patient is being mechanically ventilated with an oral endotracheal tube in place. The nurse observes that the cuff pressure is 25 mm Hg. The nurse is aware of what complications that can be caused by this pressure? (Select all that apply.) a) Tracheal bleeding b) Pressure necrosis c) Tracheal aspiration d) Tracheal ischemia e) Hypoxia
• Tracheal ischemia • Tracheal bleeding • Pressure necrosis
Which of the following are indicators that a client is ready to be weaned from a ventilator? Select all that apply. a) Vital capacity of 13 mL/kg b) Rapid/shallow breathing index of 112 breaths/min c) Tidal volume of 8.5 mL/kg d) FiO2 45% e) PaO2 of 64 mm Hg
• Vital capacity of 13 mL/kg • Tidal volume of 8.5 mL/kg • PaO2 of 64 mm Hg
