Deck 14: Pulmonary Clinical Assessment and Diagnostic Procedures

Question 1

A patient is admitted to the critical care unit with acute respiratory failure.Upon auscultation, the health care provider hears creaking, leathery, coarse breath sounds in the lower anterolateral chest area during inspiration and expiration.The nurse suspects that the patient has a(n)

A) emphysema.
B) atelectasis.
C) pulmonary fibrosis.
D) pleural friction rub.

Answer 1

pleural friction rub.

Question 2

The adventitious breath sounds that sound like popping in the small airways or alveoli are

A) sonorous wheezes.
B) crackles.
C) sibilant wheezes.
D) pleural friction rubs.

Answer 2

crackles.

Question 3

The use of touch to judge the character of the body surface and underlying organs is known as

A) inspection.
B) palpation.
C) percussion.
D) auscultation.

Answer 3

palpation.

Question 4

Diminished to absent breath sounds on the right side, tracheal deviation to the left side, and asymmetrical chest movement are indicative of which of the following disorders?

A) Tension pneumothorax
B) Pneumonia
C) Pulmonary fibrosis
D) Atelectasis

Question 5

Which of the following is an example of a disorder with increased tactile fremitus?

A) Emphysema
B) Pleural effusion
C) Pneumothorax
D) Pneumonia

Question 6

A client just involved in a motor vehicle accident has sustained blunt chest trauma as part of his injuries.The nurse assessment reveals absent breath sounds in the left lung field.A left-sided pneumothorax is suspected and is further validated when assessment of the trachea reveals

A) a shift to the right.
B) a shift to the left.
C) no deviation.
D) subcutaneous emphysema.

Question 7

Normal anteroposterior (AP)diameter ranges from 1:2 to 5:7.An increase in AP diameter of the chest that is characterized by displacement of the sternum forward and the ribs outward is indicative of

A) a funnel chest.
B) a pigeon breast.
C) a barrel chest.
D) Harrison's groove.

Question 8

A patient is admitted to the critical care unit with acute respiratory failure secondary to COPD.The patient has a 15-year history of emphysema and bronchitis.On inspection, the nurse notes that the patient is experiencing air trapping.While auscultating his chest, you note the presence of coarse, rumbling, low-pitched sounds in the right middle and lower lobes.Which of the following best describes the patient's breathing pattern?

A) Deep sighing breaths without pauses
B) Rapid, shallow breaths
C) Normal breathing pattern interspersed with forced expirations
D) Irregular breathing pattern with both deep and shallow breaths

Question 9

A patient is admitted to the critical care unit with acute respiratory failure secondary to chronic obstructive pulmonary disease.The patient has a 15-year history of emphysema and bronchitis.On inspection, the nurse observes that the patient is experiencing air trapping.While auscultating the chest, the nurse notes the presence of coarse, rumbling, low-pitched sounds in the right middle and lower lobes.On further inspection of the patient, the nurse observes that his fingers appear discolored.This is a result of

A) clubbing.
B) central cyanosis.
C) peripheral cyanosis.
D) chronic tuberculosis.

Question 10

Which of the following lung sounds would be most likely heard in a client experiencing an asthma attack?

A) Coarse rales
B) Pleural friction rub
C) Fine crackles
D) Expiratory wheezes

Question 11

Why would the nurse perform an inspection of the oral cavity during a complete pulmonary assessment?

A) To provide evidence of hypoxia
B) To provide evidence of dyspnea
C) To provide evidence of dehydration
D) To provide evidence of nutritional status

Question 12

Which of the following describes the major difference between tachypnea and hyperventilation?

A) Tachypnea has increased rate; hyperventilation has decreased rate.
B) Tachypnea has decreased rate; hyperventilation has increased rate.
C) Tachypnea has increased depth; hyperventilation has decreased depth.
D) Tachypnea has decreased depth; hyperventilation has increased depth.

Question 13

A patient is admitted to the unit in respiratory distress secondary to pneumonia.The nurse knows that obtaining a history is very important.What is the appropriate intervention at this time for obtaining this data?

A) Collect an overview of past medical history, present history, and current health status.
B) Do not obtain any history at this time.
C) Curtail the history to just a few questions about the client's chief complaint and precipitating events.
D) Complete the history and then provide measures to assist the client to breathe easier.

Question 14

A patient presents with chest trauma from an MVA.Upon assessment, the nurse documents that the patient is complaining of dyspnea, shortness of breath, tachypnea, and tracheal deviation to the right.In addition, the client's tongue is blue-gray.Based on the following data, what the nurse would expect to find?

A) PaO₂ of 88 and PCO₂ of 55
B) Absent breath sounds in all right lung fields
C) Absent breath sounds in all left lung fields
D) Diminished breath sounds in all fields

Question 15

Diaphragmatic excursion is a measurement of the difference in the level of the diaphragm on inspiration and expiration determined by percussion.It is increased in

A) atelectasis and emphysema.
B) hepatomegaly and ascites.
C) atelectasis and paralysis.
D) pneumonia and pneumothorax.

Question 16

On assessment of a client, you note fremitus over the trachea but not in the lung periphery.You know that this most likely represents

A) bilateral pleural effusion.
B) bronchial obstruction.
C) a normal finding.
D) apical pneumothorax.

Question 17

Voice sounds such as bronchophony, egophony, and whispering pectoriloquy are increased in

A) pneumonia with consolidation.
B) pneumothorax.
C) asthma.
D) bronchiectasis.

Question 18

A patient is admitted to the critical care unit with acute respiratory failure secondary to COPD.The patient has a 15-year history of emphysema and bronchitis.On inspection, the nurse observes that the patient is experiencing air trapping.While auscultating the chest, the nurse notes the presence of coarse, rumbling, low-pitched sounds in the right middle and lower lobes.On percussion of the lung fields, a patient with emphysema will predictably exhibit which tone?

A) Resonance
B) Hyperresonance
C) Tympany
D) Dullness

Question 19

Auscultation of the anterior chest should be performed using which of the following sequences?

A) Right side, top to bottom, then left side, top to bottom
B) Left side, top to bottom, then right side, top to bottom
C) Side to side, bottom to top
D) Side to side, top to bottom

Question 20

While conducting a physical assessment, you note that the patient's breathing is rapid and shallow.This type of breathing pattern is known as

A) hyperventilation.
B) tachypnea.
C) obstructive breathing.
D) bradypnea.

Question 21

A patient with chronic obstructive pulmonary disease requires intubation.After the physician intubates the patient, the nurse auscultates for breath sounds.Breath sounds are questionable in this patient.Which action would best assist in determining endotracheal tube placement in this patient?

A) Stat chest radiographic examination
B) End-tidal CO₂ monitor
C) V/Q scan
D) Pulmonary artery catheter insertion

Question 22

V/Q scans are ordered to evaluate the possibility of which of the following?

A) Pulmonary emboli
B) Acute myocardial infarction
C) Emphysema
D) Acute respiratory distress syndrome

Question 23

Severe coughing and shortness of breath during a thoracentesis are indicative of which of the following complications?

A) Re-expansion pulmonary edema
B) Pleural infection
C) Pneumothorax
D) Hemothorax

Question 24

Determination of oxygenation status by oxygen saturation alone is inadequate.What other value must be known?

A) pH
B) PaCO₂
C) HCO₃^-
D) Hemoglobin (Hgb)

Question 25

On admission, a patient presents as follows: pH, 7.38; respiratory rate, 24 breaths/min, regular, pursed-lip breathing; PaO₂, 66 mm Hg; heart rate, 112 beats/min, sinus tachycardia; PaCO₂, 52 mm Hg; blood pressure, 110/68 mm Hg; HCO₃^- , 24 mEq/L; and SpO₂, 90% on O₂ 2 L/min nasal cannula.Which of the following diagnoses would be most consistent with the above arterial blood gas values?

A) Acute pulmonary embolism
B) Acute myocardial infarction
C) Congestive heart failure
D) Chronic obstructive pulmonary disease

Question 26

Which of the following conditions will commonly reveal breath sounds with inspiration greater than expiration on assessment?
1)Normal lung
2)Bronchiectasis
3)Emphysema
4)Acute bronchitis
5)Diffuse pulmonary fibrosis
6)Consolidating pneumonia

A) 1, 2, 5
B) 3, 5, 6
C) 2, 3, 4
D) 1, 2, 4

Question 27

Which of the following chest radiography findings is consistent with a left pneumothorax?

A) Flattening of the diaphragm
B) Shifting of the mediastinum to the right
C) Presence of a gastric air bubble
D) Increased radiolucency of the left lung field

Question 28

A patient's pulse oximeter alarm goes off.The monitor reads 82%.What is the first action the nurse should perform?

A) Prepare to intubate.
B) Assess the patient's condition.
C) Turn off the alarm and reapply the oximeter sensor.
D) Increase O? level to 4L/NC.

Question 29

A patient's assessment data present as follows: pH, 7.10; PaCO₂, 60 mm Hg; PaO₂, 40 mm Hg; HCO₃, 24 mEq/L; RR, 34 breaths/min; HR, 128 beats/min; and BP, 180/92 mm Hg.This condition is best described as

A) uncompensated respiratory acidosis.
B) uncompensated metabolic acidosis.
C) compensated metabolic acidosis.
D) compensated respiratory acidosis.

Question 30

The creation of sound waves across the body surface to determine abnormal densities is known as

A) inspection.
B) palpation.
C) percussion.
D) auscultation.

Question 31

On admission, a patient presents as follows: pH, 7.38; respiratory rate, 24 breaths/min, regular, pursed-lip breathing; PaO₂, 66 mm Hg; heart rate, 112 beats/min, sinus tachycardia; PaCO₂, 52 mm Hg; blood pressure, 110/68 mm Hg; HCO₃, 24 mEq/L; and SpO₂, 90% on O₂ 2 L/min nasal cannula.What treatment would the physician or nurse practitioner likely order for this patient?

A) Increase O₂ to 6 L/min.
B) Prepare for emergency intubation.
C) Administer 1 ampule of sodium bicarbonate.
D) Repeat ABG testing in 4 hours.

Question 32

A patient presents moderately short of breath and dyspneic.A chest radiographic examination reveals a large right pleural effusion with significant atelectasis.The physician or nurse practitioner would be most likely to order which of the following procedures?

A) Thoracentesis
B) Bronchoscopy
C) Ventilation/perfusion (V/Q) scan
D) Repeat chest radiograph

Question 33

For which of the following conditions is a bronchoscopy indicated?

A) Pulmonary edema
B) Ineffective clearance of secretions
C) Upper gastrointestinal bleed
D) Instillation of surfactant

Question 34

Which blood gas parameter is the acid-base component that reflects kidney function?

A) pH
B) PaO₂
C) PaCO₂
D) HCO₃^-

Question 35

Which of the following patients would be considered hypoxemic?

A) A 70-year-old man with a PaO₂ of 72
B) A 50-year-old woman with a PaO₂ of 65
C) An 84-year-old man with a PaO₂ of 96
D) A 68-year-old woman with a PaO₂ of 80

Question 36

The use of observation for assessment is known as

A) inspection.
B) palpation.
C) percussion.
D) auscultation.

Question 37

A patient presents with the following values: pH, 7.20; paO₂, 106 mm Hg; paCO₂, 35 mm Hg; and HCO₃^-, 11 mEq/L.These values are most consistent with

A) uncompensated respiratory acidosis.
B) uncompensated metabolic acidosis.
C) uncompensated metabolic alkalosis.
D) uncompensated respiratory alkalosis.

Question 38

A patient is intubated, and sputum for culture and sensitivity is ordered.Which of the following is important for obtaining the best specimen?

A) After the specimen is in the container, dilute thick secretions with sterile water.
B) Apply suction when the catheter is advanced to obtain secretions from within the endotracheal tube.
C) Do not apply suction while the catheter is being withdrawn because this can contaminate the sample with sputum left in the endotracheal tube.
D) Do not clear the endotracheal tube of all local secretions before obtaining the specimen.

Question 39

On admission, a patient presents as follows: pH, 7.38; respiratory rate, 24 breaths/min, regular, pursed-lip breathing; PaO₂, 66 mm Hg; heart rate, 112 beats/min, sinus tachycardia; PaCO₂, 52 mm Hg; blood pressure, 110/68 mm Hg; HCO₃, 34 mEq/L; and SpO₂, 90% on O₂ 2 L/min nasal cannula.These gases show

A) uncompensated metabolic alkalosis.
B) uncompensated respiratory acidosis.
C) compensated respiratory acidosis.
D) compensated respiratory alkalosis.

Question 40

In a patient who is hemodynamically stable, which procedure can be used to estimate the PaCO₂ levels?

A) PaO₂/FIO₂ ratio
B) A-a gradient
C) Residual volume (RV)
D) End-tidal CO₂

Question 41

Which of the following regarding the client history will assist the nurse in developing the plan of management?

A) Provides direction for the rest of the assessment
B) Exposes key clinical manifestations
C) Aids in developing the plan of care
D) The degree of the client's distress determines the extent of the interview
E) Determines length of stay in the hospital setting

Question 42

Nursing management of a patient undergoing a diagnostic procedure involves

A) positioning the patient for the procedure.
B) monitoring the patient's responses to the procedure.
C) monitoring vital signs.
D) teaching the patient about the procedure.
E) medicating the patient before and after procedure.
F)None of above

Question 43

Deviation of the trachea occurs in which of the following conditions?

A) Pneumothorax
B) Pulmonary fibrosis
C) Chronic obstructive pulmonary disease
D) Emphysema
E) Pleural effusion

Question 44

Place the steps for analyzing arterial blood gases in the proper order. 1. Assess HCO₃^- level for metabolic abnormalities.
2) Assess PaO₂ for hypoxemia.
3) Examine PaCO₂ for acidosis or alkalosis.
4) Re-examine pH to determine level of compensation.
5) Examine pH for acidemia or alkalemia.

A) 5, 1, 2, 4, 3
B) 5, 3, 1, 4, 2
C) 1, 2, 4, 3, 5
D) 1, 3, 4, 5, 2

Question 45

Risk factors that need to be considered with a thoracentesis include

A) coagulation defects.
B) intra-aortic balloon pump.
C) pleural effusion.
D) uncooperative patient.
E) empyema.

Question 46

A patient is admitted with acute respiratory failure attributable to pneumonia.Smoking history reveals that the patient smoked two packs of cigarettes a day for 25 years, stopping 10 years ago.ABG values on the current ventilator settings are pH, 7.37; PaCO₂, 50 mm Hg; and HCO₃^-, 27 mEq/L.Chest radiograph reveals a large right pleural effusion.Intrapulmonary shunting value of 35% indicates

A) normal gas exchange of venous blood.
B) an abnormal finding indicative of a shunt-producing disorder.
C) a serious and potentially life-threatening condition.
D) metabolic alkalosis.