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

Question 1

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

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

Answer 1

Ask the patient to breathe deeply through the mouth.

Question 2

The nurse is reviewing the exchange of gases in the blood stream with a patient prescribed oxygen therapy.How should the nurse explain the transport of carbon dioxide in the blood?

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

Answer 2

As bicarbonate ions in plasma

Question 3

The nurse is providing care for a patient diagnosed with asthma.Which adventitious sound should the nurse expect when auscultating this patient's lung sounds?

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

Answer 3

Wheezes

Question 4

The nurse is reviewing the results of a patient's pulmonary function tests.Which result describes the air remaining in lungs after normal expiration?

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

Question 5

The nurse is coaching a patient to empty the lungs of all air before using a metered-dose inhaler.What air that is expired beyond tidal volume in a forceful exhalation is the nurse coaching the patient to remove from the lungs?

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

Question 6

A patient has a low oxygen level.Which body structure should the nurse consider as being responsible for this low level?

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

Question 7

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

Question 8

A patient with pulmonary edema has moist,bubbling lung sounds.How should the nurse describe this finding?

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

Question 9

The nurse is reviewing the arterial blood gas results for a patient with a respiratory disorder.What should the nurse recognize as being the most important chemical regulator of respiration?

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

Question 10

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

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

Question 11

A patient is having problems with oxygenation of body tissues.What is important for the nurse to consider about the transport of oxygen in the blood?

A) It is in blood plasma as free oxygen.
B) It travels on red blood cell membranes.
C) It is bonded to hemoglobin in blood plasma.
D) It is bonded to hemoglobin in red blood cells.

Question 12

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

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

Question 13

An adult patient has a respiratory rate of 36 breaths per minute.Which term should the nurse use to document this finding?

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

Question 14

The nurse is reviewing the physiology of the respiratory system with a patient being treated for pneumonia.What structure should the nurse identify as sweeping mucus and pathogens from the nasal cavities and trachea to the pharynx?

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

Question 15

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

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

Question 16

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

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

Question 17

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

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

Question 18

A patient is making a loud crowing sound caused by an obstruction of the airways by a foreign body.How should the nurse document this patient's lung sound?

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

Question 19

While providing care for a patient with asthma,the nurse notes the patient's shoulders are rising with each breath.What should the nurse realize this action represents?

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

Question 20

The nurse observes a patient who has periods of fast,deep respirations alternating with periods of apnea.What term should the nurse use to describe this pattern?

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

Question 21

After a bronchoscopic examination,the patient must remain NPO (nothing by mouth)until the return of the gag reflex.How can the nurse determine when the gag reflex has returned?

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

Question 22

The LPN is assigned to monitor a patient with chronic lung disease who is receiving oxygen via a non-rebreathing mask.Which observation indicates to the nurse that the system is functioning as expected?

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

Question 23

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

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

Question 24

The nurse is caring for a patient experiencing dyspnea.What should the nurse instruction the patient to breathe more effectively?

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

Question 25

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

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

Question 26

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 27

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

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

Question 28

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?

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

Question 29

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.What should the nurse do?

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

Question 30

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

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

Question 31

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

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

Question 32

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 nurse place the system?

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

Question 33

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

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

Question 34

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.What should the nurse do?

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

Question 35

A patient's oxygen saturation value is 92% on room air.What does this value mean to the nurse?

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

Question 36

A patient has a thoracentesis for dyspnea caused by a pleural effusion.The physician obtains 1000 mL of fluid.Which outcome indicates that the thoracentesis has been effective?

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

Question 37

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

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

Question 38

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

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

Question 39

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) Have the patient breathe into a paper bag.
D) Place the patient in a left side-lying position.

Question 40

A patient's oxygen saturation is 89%.Which actions should the nurse take first?

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

Question 41

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

Question 42

A patient being mechanically ventilated is prescribed peak end-expiratory pressure (PEEP).How does this setting assist the ventilated patient?

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

Question 43

The nurse is caring for an individual whose respiratory rate of 14 is even and easy; breath sounds are normal.Which terms should the nurse use in this patient's narrative note? (Select all that apply.)

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

Question 44

The nurse is caring for a patient who has just had a chest tube inserted.What should the nurse ensure is available at the bedside while this chest tube is in place?

A) 2 padded clamps
B) Suture removal set
C) 1 L sterile normal saline
D) Suction catheter and equipment

Question 45

The nurse hears a ventilator alarm from the hallway.Which action should the nurse take first?

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

Question 46

A patient is diagnosed with respiratory acidosis.Which health problems should the nurse consider as causing this patient's diagnosis? (Select all that apply.)

A) Anxiety
B) Kidney failure
C) Hyperventilation
D) Shallow respirations
E) Chronic lung disease
F) Uncontrolled diabetes

Question 47

The nurse observes a patient place one hand on the abdomen and the other on the chest as the abdomen is pushed out with each breath.Which breathing technique did the nurse observe the client perform?

A) Huff coughing
B) Pursed-lip breathing
C) Controlled breathing
D) Diaphragmatic breathing

Question 48

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

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

Question 49

The nurse is reviewing the results of a patient's pulmonary function studies.Which result indicates the patient's tidal volume is within normal limits?

A) 100 to 200 mL
B) 400 to 600 mL
C) 800 to 1100 mL
D) 1500 to 2000 mL

Question 50

A patient is recovering after a bronchoscopy.Which action is a priority for this patient?

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

Question 51

A licensed practical nurse (LPN)is helping prepare a patient for a thoracentesis.What should the nurse include in the teaching? (Select all that apply.)

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

Question 52

The nurse coaches a patient with chronic obstructive pulmonary disease to make one long "huff" when performing huff coughing.What should the nurse explain as the purpose of the long huff when using this approach to clear the airway?

A) Increases oxygenation
B) Removes excess carbon dioxide
C) Ensures thorough lung expansion
D) Helps to open and clear smaller airways

Question 53

A patient is prescribed noninvasive positive-pressure ventilation (NIPPV).How can the nurse increase the patient's comfort when using this ventilation system?

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

Question 54

A patient's chest x-ray shows a suspicious area,and the physician plans a bronchoscopy.How should the nurse describe this procedure to the patient?

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

Question 55

A client who is being mechanically ventilated is admitted to the care area.What should the nurse do to prevent this patient from developing ventilator-assisted complications? (Select all that apply.)

A) Suction the airway when needed.
B) Ensure adequate nutritional intake.
C) Adjust ventilator alarms to promote rest.
D) Keep the head of the bed at a 45 degree angle.
E) Provide oral care with 0.12% chlorhexidine solution.

Question 56

The nurse observes a patient us accessory muscles while walking for the first time after hip surgery.Which muscles are commonly used in respiration during exercise or strenuous activity? (Select all that apply.)

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

Question 57

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

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

Question 58

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

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

Question 59

The nurse documents that a patient's chest is within normal limits.What does this statement mean?

A) The chest is deeper than it is wide.
B) The chest is equally wide and deep.
C) The chest is twice as wide as it is deep.
D) The chest is greater than 30 inches in diameter.

Question 60

The nurse is participating in the planning of care for a patient with a newly placed tracheostomy.Which interventions should the nurse identify as a priority for this patient? (Select all that apply.)

A) Restrict fluids.
B) Turn and reposition every shift.
C) Assess lung sounds every 4 hours.
D) Suction using sterile technique as needed.
E) Perform tracheostomy care according to policy.

Question 61

The nurse is preparing to suction a patient's tracheostomy Place in order the steps the nurse should take to complete this procedure.All options must be used.

A) ____ Connect oxygen source to manual resuscitation bag.
B) ____ Connect catheter to suction tubing, and turn on suction to level specified by institution policy.
C) ____ Pour saline into sterile container.
D) ____ Suction small amount of saline into catheter.
E) ____ Use thumb to stop suction, and insert catheter through tracheostomy tube until patient coughs or resistance is met.
F) ____ Oxygenate patient with three ventilations using a manual resuscitation bag connected to an oxygen source.
G) ____ Slowly withdraw catheter, suctioning intermittently while rotating it.