Respiratory questions PDF

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2. A 92-year-old female patient is being admitted to the emergency department with severe shortness of breath. Being aware of the patient’s condition, what approach should the nurse use to assess the patient’s lungs (select all that apply)? a. Apex to base b. Base to apex c. Lateral sequence d. Anterior then posterior e. Posterior then anterior

3. What keeps alveoli from collapsing? a. Carina b. Surfactant c. Empyema d. Thoracic cage

4. What accurately describes the alveolar sacs? a. Line the lung pleura b. Warm and moisturize inhaled air c. Terminal structures of the respiratory tract d. Contain dead air that is not available for gas exchange

5. What covers the larynx during swallowing? a. Trachea b. Epiglottis c. Turbinates d. Parietal pleura

6. Priority Decision: A 75-year-old patient who is breathing room air has the following arterial blood gas (ABG) results: pH 7.40, partial pressure of oxygen in arterial blood (PaO2) 74 mm Hg, arterial oxygen saturation (SaO2) 92%, partial pressure of carbon dioxide in arterial blood (PaCO2) 40 mm Hg. What is the most appropriate action by the nurse? a. Document the results in the patient’s record. b. Repeat the ABGs within an hour to validate the findings. c. Encourage deep breathing and coughing to open the alveoli. d. Initiate pulse oximetry for continuous monitoring of the patient’s oxygen status.

7. A patient’s ABGs include a PaO2 of 88 mm Hg and a PaCO2 of 38 mm Hg, and mixed venous blood gases include a partial pressure of oxygen in venous blood (PvO2) of 40 mm Hg and partial pressure of carbon dioxide in venous blood (PvCO2) of 46 mm Hg. What do these findings indicate? a. Impaired cardiac output b. Unstable hemodynamics c. Inadequate delivery of oxygen to the tissues d. Normal capillary oxygen–carbon dioxide exchange

8. Priority Decision: A pulse oximetry monitor indicates that the patient has a drop in arterial oxygen saturation by pulse oximetry (SpO2) from 95% to 85% over several hours. What is the first action the nurse should take? a. Order stat ABGs to confirm the SpO2 with a SaO2. b. Start oxygen administration by nasal cannula at 2 L/min. c. Check the position of the probe on the finger or earlobe. d. Notify the health care provider of the change in baseline PaO2 .

9. Pulse oximetry may not be a reliable indicator of oxygen saturation in which patient? a. Patient with a fever b. Patient who is anesthetized c. Patient in hypovolemic shock d. Patient receiving oxygen therapy

10. A 73-year-old patient has an SpO2 of 70%. What other assessment should the nurse consider before making a judgment about the adequacy of the patient’s oxygenation? a. What the oxygenation status is with a stress test b. Trend and rate of development of the hyperkalemia c. Comparison of patient’s SpO2 values with the normal values d. Comparison of patient’s current vital signs with normal vital signs

11. Which values indicate a need for the use of continuous oxygen therapy? a. SpO2 of 92%; PaO2 of 65 mm Hg b. SpO2 of 95%; PaO2 of 70 mm Hg c. SpO2 of 90%; PaO2 of 60 mm Hg d. SpO2 of 88%; PaO2 of 55 mm Hg

12. Why does a patient’s respiratory rate increase when there is an excess of carbon dioxide in the blood? a. CO2 displaces oxygen on hemoglobin, leading to a decreased PaO2. b. CO2 causes an increase in the amount of hydrogen ions available in the body. c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid.g d. CO2 directly stimulates chemoreceptors in the medulla to increase respiratory rate and volume.

13. Which respiratory defense mechanism is most impaired by smoking? a. Cough reflex b. Filtration of air c. Mucociliary clearance d. Reflex bronchoconstriction

14. Which age-related changes in the respiratory system cause decreased secretion clearance (select all that apply)? a. Decreased force of cough b. Decreased functional cilia c. Decreased chest wall compliance d. Small airway closure earlier in expiration e. Decreased functional immunoglobulin A (IgA)

16. The abnormal assessment findings of dullness and hyperresonance are found with which assessment technique? a. Inspection b. Palpation c. Percussion d. Auscultation

17. Palpation is the assessment technique used to find which abnormal assessment findings (select all that apply)? a. Stridor b. Finger clubbing c. Tracheal deviation d. Limited chest expansion e. Increased tactile fremitus f. Use of accessory muscles

18. How does the nurse assess the patient’s chest expansion? a. Put the palms of the hands against the chest wall. b. Put the index fingers on either side of the trachea. c. Place the thumbs at the midline of the lower chest. d. Place 1 hand on the lower anterior chest and 1 hand on the upper abdomen.

19. When does the nurse record the presence of an increased anteroposterior (AP) diameter of the chest? a. There is a prominent protrusion of the sternum. b. The width of the chest is equal to the depth of the chest. c. There is equal but diminished movement of the 2 sides of the chest. d. The patient cannot fully expand the lungs because of kyphosis of the spine.

20. The patient is admitted with pneumonia, and the nurse hears a grating sound when she assesses the patient. How should the nurse document this sound? a. Stridor b. Bronchophony c. Course crackles d. Pleural friction rub

21. Match the descriptions or possible causes with the appropriate abnormal assessment findings.

22. A nurse has been caring for a patient with tuberculosis (TB) and has a TB skin test performed. When is the nurse considered infected? a. There is no redness or induration at the injection site. b. There is an induration of only 5 mm at the injection site. c. A negative skin test is followed by a negative chest x-ray. d. Testing causes a 10-mm red, indurated area at the injection site.

23. What is a primary nursing responsibility after obtaining a blood specimen for ABGs? a. Add heparin to the blood specimen. b. Apply pressure to the puncture site for 2 full minutes. c. Take the specimen immediately to the laboratory in an iced container. d. Avoid any changes in oxygen intervention for 15 minutes following the procedure.

24. What should the nurse do when preparing a patient for a pulmonary angiogram? a. Assess the patient for iodine allergy. b. Implement NPO orders for 6 to 12 hours before the test. c. Explain the test before the patient signs the informed consent form. d. Inform the patient that radiation isolation for 24 hours after the test is necessary.

25. The nurse is preparing the patient for and will assist the health care provider with a thoracentesis in the patient’s room. Number the following actions in the order the nurse should complete them. Use 1 for the first action and 7 for the last action. ____6___ a. Verify breath sounds in all fields. ____1___ b. Obtain the supplies that will be used. ____7___ c. Send labeled specimen containers to the laboratory. ____2___ d. Direct the family members to the waiting room. ____5___ e. Observe for signs of hypoxia during the procedure. ____4___ f. Instruct the patient not to talk during the procedure. ____3___ g. Position the patient sitting upright with the elbows on an over-the-bed table.

26. After which diagnostic study should the nurse observe the patient for symptoms of a pneumothorax? a. Thoracentesis b. Pulmonary function test c. Ventilation-perfusion scan d. Positron emission tomography (PET) scan

27. The health care provider orders a pulmonary angiogram for a patient admitted with dyspnea and hemoptysis. For which problem is this test most commonly used as a diagnostic measure? a. TB b. Cancer of the lung c. Airway obstruction d. Pulmonary embolism

28. Match the following pulmonary capacities and function tests with their descriptions.

3. What does the nurse teach the patient with intermittent allergic rhinitis is the most effective way to decrease allergic symptoms? a. Undergo weekly immunotherapy. b. Identify and avoid triggers of the allergic reaction. c. Use cromolyn nasal spray prophylactically year-round. d. Use over-the-counter antihistamines and decongestants during an acute attack. 6. A patient with an acute pharyngitis is seen at the clinic with fever and severe throat pain that affects swallowing. On inspection, the throat is reddened and edematous with patchy yellow exudates. The nurse anticipates that interprofessional management will include a. treatment with antibiotics. b. treatment with antifungal agents. c. a throat culture or rapid strep antigen test. d. treatment with medication only if the pharyngitis does not resolve in 3 to 4 days.

7. While the nurse is feeding a patient, the patient appears to choke on the food. Which symptoms indicate to the nurse that the patient has a partial airway obstruction (select all that apply)? a. Stridor b. Cyanosis c. Wheezing d. Bradycardia e. Rapid respiratory rate

8. What is an advantage of a tracheostomy over an endotracheal (ET) tube for long-term management of an upper airway obstruction? a. A tracheostomy is safer to perform in an emergency. b. An ET tube has a higher risk of tracheal pressure necrosis. c. A tracheostomy tube allows for more comfort and mobility. d. An ET tube is more likely to lead to lower respiratory tract infection.

9. What are the characteristics of a fenestrated tracheostomy tube (select all that apply)? a. The cuff passively fills with air. b. Cuff pressure monitoring is not required. c. It has two tubings with one opening just above the cuff. d. Patient can speak with an attached air source with the cuff inflated. e. Airway obstruction is likely if the exact steps are not followed to produce speech. f. Airflow around the tube and through the window allows speech when the cuff is deflated and the plug is inserted.

10. During care of a patient with a cuffed tracheostomy, the nurse notes that the tracheostomy tube has an inner cannula. To care for the tracheostomy appropriately, what should the nurse do? a. Deflate the cuff, then remove and suction the inner cannula. b. Remove the inner cannula and replace it per institutional guidelines. c. Remove the inner cannula if the patient shows signs of airway obstruction. d. Keep the inner cannula in place at all times to prevent dislodging the tracheostomy tube.

11. Which actions prevent the dislodgement of a tracheostomy tube in the first 3 days after its placement (select all that apply)? a. Provide tracheostomy care every 24 hours. b. Keep the patient in the semi-Fowler’s position at all times. c. Keep a same-size or larger replacement tube at the bedside. d. Tracheostomy ties are not changed for 24 hours after tracheostomy procedure. e. Suction the tracheostomy tube when there is a moist cough or a decreased arterial oxygen saturation by pulse oximetry (SpO2) f. A physician performs the first tracheostomy tube change 2 days after the tracheostomy. 12. Collaboration: In planning the care for a patient with a tracheostomy who has been stable and is to be discharged later in the day, the registered nurse (RN) may delegate which interventions to the licensed practical/vocational nurse (LPN/VN) (select all that apply)? a. Suction the tracheostomy. b. Provide tracheostomy care.t c. Determine the need for suctioning. d. Assess the patient’s swallowing ability. e. Teach the patient about home tracheostomy care. 13. What is included in the nursing care of the patient with a cuffed tracheostomy tube? a. Change the tube every 3 days. b. Monitor cuff pressure every 8 hours. c. Perform mouth care every 12 hours. d. Assess arterial blood gases every 8 hours.

14. Priority Decision: A patient’s tracheostomy tube becomes dislodged with vigorous coughing. What should be the nurse’s first action? a. Attempt to replace the tube. b. Notify the health care provider. c. Place the patient in high Fowler’s position. d. Ventilate the patient with a manual resuscitation bag until the health care provider arrives.

1. How do microorganisms reach the lungs and cause pneumonia (select all that apply)? a. Aspiration b. Lymphatic spread c. Inhalation of microbes in the air d. Touch contact with the infectious microbes e. Hematogenous spread from infections elsewhere in the body

2. Why is the classification of pneumonia as community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP) clinically useful? a. Atypical pneumonia syndrome is more likely to occur in HAP. b. Diagnostic testing does not have to be used to identify causative agents. c. Causative agents can be predicted, and empiric treatment is often effective. d. IV antibiotic therapy is necessary for HAP, but oral therapy is adequate for CAP.

4. Which microorganisms are associated with both CAP and HAP (select all that apply)? a. Klebsiella b. Acinetobacter c. Staphylococcus aureus d. Mycoplasma pneumoniae e. Pseudomonas aeruginosa f. Streptococcus pneumoniae

5. Place the most common pathophysiologic stages of pneumonia in order. Number the first stage with 1 and the last stage with 4.

____4____ a. Macrophages lyse the debris and normal lung tissue and function is restored. ____3____ b. Mucus production increases and can obstruct airflow and further decrease gas exchange. ____1____ c. Inflammatory response in the lungs with neutrophils is activated to engulf and kill the offending organism. ____2____ d. Increased capillary permeability contributes to alveolar filling with organisms and neutrophils leading to hypoxia.

6. When obtaining a health history from a 76-year-old patient with suspected CAP, what does the nurse expect the patient or caregiver to report? a. Confusion b. A recent loss of consciousness c. An abrupt onset of fever and chills d. A gradual onset of headache and sore throat

7. What is the initial antibiotic treatment for pneumonia based on? a. The severity of symptoms b. The presence of characteristic leukocytes c. Gram stains and cultures of sputum specimens d. History and physical examination and characteristic chest x-ray findings

8. Priority Decision: After the health care provider sees a patient hospitalized with a stroke who developed a fever and adventitious lung sounds, the following orders are written. Which order should the nurse implement first?

a. Anterior/posterior and lateral chest x-rays b. Start IV levofloxacin 500 mg every 24 hr now c. Complete blood count (CBC) with differential d. Sputum specimen for Gram stain and culture and sensitivity

9. Identify 4 clinical situations in which hospitalized patients are at risk for aspiration pneumonia and 1 nursing intervention for each situation that is indicated to prevent pneumonia. Clinical Situation Nursing Intervention

10. Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of impaired gas exchange based on which finding? a. Arterial oxygen saturation by pulse oximetry (SpO2) of 86% b. Crackles in both lower lobes c. Temperature of 101.4° F (38.6° C) d. Production of greenish purulent sputum

11. A patient with pneumonia is having difficulty clearing the airway because of pain, fatigue, and thick secretions. What is an expected outcome for this patient?

a. SpO2 is 90% b. Lungs clear to auscultation c. Patient tolerates walking in hallway d. Patient takes 3 to 4 shallow breaths before coughing to minimize pain

12. During an annual health assessment of a 66-year-old patient at the clinic, the patient tells the nurse he has not had the pneumonia vaccine. What should the nurse advise him about the best way for him to prevent pneumonia? a. Obtain a pneumococcal vaccine now and get a booster 12 months later. b. Seek medical care and antibiotic therapy for all upper respiratory infections. c. Obtain the pneumococcal vaccine if he is exposed to individuals with pneumonia. d. Obtain only the influenza vaccine every year because he should have immunity to the pneumococcus because of his age.

35. Priority Decision: Two days after undergoing pelvic surgery, a patient develops marked dyspnea and anxiety. What is the first action that the nurse should take? a. Raise the head of the bed. b. Notify the health care provider. c. Take the patient’s pulse and blood pressure. d. Determine the patient’s SpO2 with an oximeter.

36. A pulmonary embolus is suspected in a patient with a deep vein thrombosis who develops dyspnea, tachycardia, and chest pain. Diagnostic testing is scheduled. Which test should the nurse plan to teach the patient about?

a. D-dimer b. Chest x-ray c. Spiral (helical) CT scan d. Ventilation-perfusion lung scan...