Deck 29: Respiratory System Function, Assessment, and Therapeutic Measures

Question 1

What structure sweeps mucus and pathogens from the nasal cavities and trachea to the pharynx?

A)Ciliated epithelium
B)Simple squamous epithelium
C)Alveolar macrophages
D)Elastic connective tissue

Answer 1

Elastic connective tissue

Question 2

During the admission assessment of an individual admitted to the medical respiratory unit, the nurse notes the patient has a barrel-shaped chest. Which of the following assessments should the nurse perform next?

A)Assess the patient's rate and character of respirations
B)Palpate the patient's thorax to determine presence of tenderness
C)Obtain a blood sample for arterial blood gas (ABG) to detect respiratory acidosis
D)Ask the patient about presence of a productive cough

Answer 2

Palpate the patient's thorax to determine presence of tenderness

Question 3

The nurse observes a patient who has periods of fast, deep respirations alternating with periods of apnea. What term best describes this pattern?

A)Hyperventilation
B)Kussmaul's
C)Tachypnea
D)Cheyne-Stokes

Answer 3

Hyperventilation

Question 4

Which term describes a respiratory rate of 36 breaths per minute in an adult?

A)Tachypnea
B)Bradypnea
C)Apnea
D)Within normal limits

Question 5

How is most carbon dioxide transported in the blood?

A)As bicarbonate ions in plasma
B)As hydrogen ions in red blood cells
C)As CO₂ in plasma
D)As part of hemoglobin in red blood cells

Question 6

A laboratory technician has just completed drawing arterial blood gases from a patient. What action should the nurse take first?

A)Notify the physician that the blood is in the laboratory for analysis.
B)Hold pressure on the puncture site for 5 minutes.
C)Increase the patient's oxygen to 4 L/min.
D)Have the patient hold his or her hand in a fist for 2 to 3 minutes.

Question 7

A patient with pneumonia is having difficulty raising secretions for a sputum culture. Which of the following actions should the nurse take first?

A)Encourage the patient to take deep breaths.
B)Suction the patient to obtain a specimen.
C)Administer a bronchodilator.
D)Obtain the specimen with a cotton-tipped swab.

Question 8

The nurse is providing care for a patient diagnosed with asthma. Which of the following adventitious sounds is anticipated?

A)Crackles
B)Wheezes
C)Diminished breath sounds
D)Pleural friction rub

Question 9

Which of the following is the most important chemical regulator of respiration?

A)The blood level of oxygen
B)The amount of hemoglobin in red blood cells
C)The blood level of carbon dioxide
D)The blood level of nitrogen

Question 10

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?

A)Have the physician listen and verify what the nurse is hearing.
B)Listen to the corresponding area in the patient's right lower lobe.
C)Call another nurse to listen to the patient's lungs.
D)Ask the patient if this has ever occurred in the past.

Question 11

The nurse is auscultating a patient's lungs but is unable to hear much air movement. What is the nurse's next step in the attempt to most effectively hear the lung sounds?

A)Try another stethoscope.
B)Have the patient assume a side-lying position.
C)Ask the patient to breathe deeply through the mouth.
D)Have the patient rest between breaths.

Question 12

A patient with pulmonary edema has moist, bubbling lung sounds. What is the best way to describe this finding?

A)Coarse crackles
B)Fine crackles
C)Wheezing
D)Pleural friction rub

Question 13

The nurse is providing care for a patient who suffered an ischemic stroke and now requires respiratory support with mechanical ventilation. The nurse recognizes that the stroke most likely occurred in which part of the brain?

A)Cerebrum
B)Hypothalamus
C)Medulla
D)Cerebellum

Question 14

While providing care for a patient with asthma, the nurse notes the patient's shoulders are rising with each breath. The nurse recognizes this action most likely represents which of the following?

A)Shoulder muscle fatigue related to difficulty breathing
B)The use of accessory muscles to aid breathing
C)Hyperinflation of the chest
D)Effective use of a breathing exercise to increase ventilation

Question 15

Which of the following terms describes the air remaining in lungs after normal expiration?

A)Forced vital capacity
B)Expiratory reserve
C)Tidal volume
D)Functional residual capacity

Question 16

Which term describes air that is expired beyond tidal volume in a forceful exhalation?

A)Forced vital capacity
B)Peak expiratory flow rate
C)Tidal volume
D)Expiratory reserve

Question 17

Gas exchange occurs in which of the following structures?

A)Bronchi
B)Larynx
C)Nasal passages
D)Alveoli

Question 18

How is most oxygen transported in the blood?

A)On red blood cell membranes
B)Bonded to hemoglobin in blood plasma
C)Bonded to hemoglobin in red blood cells
D)In blood plasma as free oxygen

Question 19

Which term describes a loud crowing sound that results from obstruction of the airways by a tumor or foreign body?

A)Crackles
B)Wheeze
C)Stridor
D)Pleural friction rub

Question 20

A nurse is providing care for a patient who complains of difficulty breathing. Which of the following assessments will best help the nurse determine the severity of the patient's dyspnea?

A)Ask the patient to describe the dyspnea.
B)Observe the patient throughout two to three respirations.
C)Count the patient's respiratory rate.
D)Have the patient rate the dyspnea on a 0 to 10 scale.

Question 21

Which of the following instructions is appropriate when teaching a dyspneic patient how to breathe effectively?

A)"Take four quick, panting breaths, and then blow out for 6 seconds."
B)"Use deep breathing, and exhale as forcefully as you are able."
C)"Breathe using your abdominal muscles, and blow out slowly through pursed lips."
D)"Hold your breath for 3 seconds after each exhalation to empty all the alveoli."

Question 22

What is the rationale for placing a dyspneic patient in Fowler's position?

A)Fowler's position allows maximum lung expansion.
B)Fowler's position increases use of accessory muscles.
C)Fowler's position relieves stress on the back and chest.
D)Fowler's position helps dilate diseased bronchioles.

Question 23

A nurse is providing discharge instructions for a patient who is to use an adrenergic bronchodilator metered dose inhaler (MDI). Which of the following would be included in the teaching?

A)"Take two puffs whenever you feel wheezy but no more than six puffs per day."
B)"Avoid using the MDI at night."
C)"Take one puff every 5 minutes until your symptoms are relieved."
D)"Using the MDI more often than prescribed can result in worsening symptoms."

Question 24

A patient's arterial blood gas analysis shows a PaCO2 of 68 mm Hg. What action should the nurse take first?

A)Notify the physician.
B)Remove the patient's oxygen mask.
C)Place the patient in a left side-lying position.
D)Have the patient breathe into a paper bag.

Question 25

A patient has a thoracentesis for dyspnea caused by a pleural effusion. The physician obtains 1,000 mL of fluid. Which of the following indicates that the thoracentesis has been effective?

A)The patient states that the dyspnea has lessened.
B)The fluid is sent to the laboratory in a timely manner.
C)No cancer cells are found in the fluid.
D)No bleeding at the site is noted.

Question 26

A patient with cancer in the left lung is acutely short of breath. Which position should the nurse suggest the patient assume?

A)Supine
B)Prone
C)Left side-lying
D)Right side-lying

Question 27

A patient returns to the medical unit after a pulmonary angiogram. Which of the following instructions by the nurse would help prevent complications from the test?

A)"Don't eat or drink anything for 6 hours after the test because your gag reflex may not be intact."
B)"Try not to cough for 6 hours because this could cause irritation and bleeding."
C)"Stay in Fowler's position to help excrete the radioactive gas."
D)"Lie flat for 8 hours so the injection site does not bleed."

Question 28

After providing chest physiotherapy, the nurse notes the patient has loose secretions and a slight rattle with expiration. Which of the following actions should the nurse take first?

A)Encourage the patient to cough and deep breathe.
B)Administer an expectorant.
C)Suction the patient's airway.
D)Keep the patient on bedrest for 4 hours.

Question 29

After a bronchoscopic examination, the patient must remain NPO until the return of the gag reflex. How can the nurse determine when the gag reflex has returned?

A)Give the patient a sip of water.
B)Ask the patient to swallow.
C)Touch the roof of the mouth with a gloved finger.
D)Touch the back of the throat with a cotton swab.

Question 30

The LPN is assigned to monitor a patient with chronic lung disease who is receiving oxygen via a nonrebreathing mask. Which of the following observations tells the nurse that the system is functioning as expected?

A)Both side vents closed, reservoir bag inflated
B)Both side vents closed, reservoir bag deflated
C)Both side vents open, reservoir bag inflated
D)Both side vents open, reservoir bag deflated

Question 31

A patient with a tracheostomy is dyspneic and has coarse crackles anteriorly on auscultation. What should the nurse do first?

A)Ask the patient to take a deep breath and cough.
B)Suction the tracheostomy.
C)Perform routine tracheostomy care.
D)Administer a prn nebulized mist treatment.

Question 32

Which of the following best describes an oxygen saturation value?

A)The partial pressure of the oxygen in the blood
B)The percentage of hemoglobin that is saturated with oxygen
C)The amount of oxygen saturating the lymphocytes
D)The percentage of oxygen in the lungs

Question 33

The nurse is examining a chest drainage system on a patient with a pneumothorax and notes the water level in the water seal chamber fluctuating with each of the patient's respirations. How should the nurse respond?

A)Examine the entire system and tubing for leaks.
B)Clamp the tubing and call for help.
C)Have the patient take a deep breath.
D)No action is necessary; this is an expected finding.

Question 34

A patient with a tracheostomy requires suctioning. How many seconds can the nurse suction safely with each pass of the catheter?

A)3 seconds
B)15 seconds
C)30 seconds
D)60 seconds

Question 35

A patient's arterial blood gas analysis shows a pH of 7.28. The PaCO₂ is high. Which of the following acid-base imbalances is the patient experiencing?

A)Respiratory alkalosis
B)Respiratory acidosis
C)Metabolic alkalosis
D)Metabolic acidosis

Question 36

A patient enters the emergency department with a stab wound to the chest. The physician places 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 system be placed?

A)1 inch higher than the head of the bed
B)At the level of the patient's heart
C)At the level of the patient's diaphragm
D)Below the patient's chest

Question 37

A patient's oxygen saturation is 89%. Which of the following actions has the highest priority?

A)Raise the head of the patient's bed.
B)No action; this is a normal oxygen saturation.
C)Call the respiratory therapist STAT.
D)Place the patient in a supine position.

Question 38

A patient is being taught to administer nebulized mist treatments (NMTs) at home. Which outcome best helps the nurse know that the patient is able to administer the treatments?

A)The patient states understanding of the importance of administering the NMTs during periods of shortness of breath.
B)The patient demonstrates the correct procedure for administering the NMT.
C)The patient verbalizes all the steps in the NMT procedure correctly.
D)The patient lists the side effects of the medications that are administered via the NMT.

Question 39

A patient with a chest drainage system is admitted to the respiratory unit. The nurse notes vigorous bubbling in the water seal chamber of the system. Which of the following actions by the nurse is correct?

A)Examine the entire system and tubing for air leaks.
B)Lower the level of suction.
C)Ask the patient to cough forcefully.
D)No action is necessary; this is an expected finding.

Question 40

A postoperative patient is taking shallow breaths because of fear of incisional pain. Which of the following actions should the nurse take first?

A)Contact the physician to request nebulized mist treatments (NMTs).
B)Instruct the patient on the use of an incentive spirometer.
C)Call respiratory therapy to provide a metered-dose inhaler (MDI).
D)Measure peak expiratory flow rate with a peak flow meter.

Question 41

An LPN is helping prepare a patient for a thoracentesis. Which of the following would the nurse include in the teaching? (Select all that apply.?

A)"The doctor will collect fluid from the space between your lung and your chest wall."
B)"You will assume a sitting position at the side of the bed."
C)"You will need to be NPO for 6 hours."
D)"You will need to sign a consent form for the procedure."
E)"You will need to take frequent deep breaths during the procedure."
F)"This is a sterile procedure, so the site will be covered in a drape."

Question 42

The nurse hears a ventilator alarm from the hallway. Which of the following actions should the nurse take first?

A)Call for help.
B)Check the ventilator.
C)Check the patient.
D)Turn off the alarm.

Question 43

The nurse is asked to assist with intubation of a confused patient with respiratory failure. What should the nurse do first?

A)Obtain necessary equipment according to institution policy.
B)Ask the patient to sign a consent form.
C)Place the patient in a supine position with neck extended.
D)Check the patient's advance directives.

Question 44

How can the nurse increase the comfort of a patient using noninvasive positive-pressure ventilation (NIPPV)?

A)Retape the tube to the opposite side of the mouth every 24 hours.
B)Use a skin barrier on the area where the mask comes in contact with the skin.
C)Remove the unit while the patient is sleeping.
D)Administer opioid analgesics.

Question 45

A patient with ineffective airway clearance is being discharged home. Which home therapy will help the patient loosen and expectorate secretions?

A)Capnography
B)Water-seal chest drainage
C)Transtracheal oxygenation
D)Vibratory positive expiratory pressure device
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 46

Exhaled air typically contains ____________________% oxygen.

Question 47

The nurse is caring for an individual whose respiratory rate of 14 is even and easy; breath sounds are normal. Which of the following terms would be included in a narrative note? (Select all that apply.?

A)Eupnea
B)Apnea
C)Clear to auscultation
D)Inspiratory crackles
E)Bradypnea
F)Rhonchi

Question 48

The LPN is providing care for an 88-year-old patient. Which of the following age-related assessment findings would the nurse expect? (Select all that apply.?

A)Weakened cough due to atrophied respiratory muscles
B)Increased risk of respiratory infection due to decreased ciliary activity
C)Large peak expiratory flow rate due to increased lung elasticity
D)Decreased gas exchange due to decreased number of alveoli
E)Increased nasal discharge due to increased number of cilia
F)Peripheral cyanosis due to reduced gas exchange

Question 49

Which of the following nursing actions takes priority after a bronchoscopy?

A)Order a meal because the patient has been NPO for 8 hours.
B)Encourage oral fluids.
C)Monitor the patient for return to consciousness.
D)Check for swallow and gag reflexes.

Question 50

Which of the following muscles are commonly used in respiration during exercise or strenuous activity? (Select all that apply.?

A)Diaphragm
B)Intercostal muscles
C)Vastus lateralis
D)Sternocleidomastoid
E)Scalene
F)Abdominal

Question 51

How does peak end-expiratory pressure (PEEP) assist a ventilated patient?

A)It provides positive pressure on expiration to keep small airways open.
B)It provides positive pressure on inspiration and expiration to increase oxygenation.
C)It delivers a breath in a set pattern regardless of the patient's respiratory pattern.
D)It delivers a breath only if the patient does not breathe spontaneously.

Question 52

The nurse is caring for a patient with myasthenia gravis who is on a ventilator. The high-pressure alarm sounds. What is the most likely cause of this?

A)The tubing is disconnected.
B)The electricity is interrupted.
C)The patient is fatigued.
D)The patient needs to be suctioned.

Question 53

A patient's chest x-ray shows a suspicious area, and the physician plans a bronchoscopy. Which of the following explanations of a bronchoscopy should the nurse provide to the patient?

A)"The physician will place a small tube through your nose or mouth and into the bronchi to look at your airways."
B)"You will be asked to use a mouthpiece to blow into a machine."
C)"You will need to drink a thick white liquid that will be opaque on the x-rays."
D)"A dye will be injected to help visualize the structures of the bronchioles. Do you have any allergies?"