Deck 21: Respiratory Care Modalities

Question 1

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient has been receiving high-flow oxygen therapy for an extended time. What symptoms should the nurse anticipate if the patient were experiencing oxygen toxicity?

A) Bradycardia and frontal headache
B) Dyspnea and substernal pain
C) Peripheral cyanosis and restlessness
D) Hypotension and tachycardia

Answer 1

Dyspnea and substernal pain

Question 2

The nurse caring for a patient with an endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage of endotracheal tubes?

A) Cognition is decreased.
B) Daily arterial blood gases (ABGs) are necessary.
C) Slight tracheal bleeding is anticipated.
D) The cough reflex is depressed.

Answer 2

The cough reflex is depressed.

Question 3

What would the critical care nurse recognize as a condition that may indicate a patients need to have a
Tracheostomy?

A) A patient has a respiratory rate of 10 breaths per minute.
B) A patient requires permanent ventilation.
C) A patient exhibits symptoms of dyspnea.
D) A patient has respiratory acidosis.

Answer 3

A patient requires permanent ventilation.

Question 4

The medical nurse is creating the care plan of an adult patient requiring mechanical ventilation. What nursing action is most appropriate?

A) Keep the patient in a low Fowlers position.
B) Perform tracheostomy care at least once per day.
C) Maintain continuous bedrest.
D) Monitor cuff pressure every 8 hours.

Question 5

The nurse is caring for a patient who is scheduled to have a thoracotomy. When planning preoperative teaching, what information should the nurse communicate to the patient?

A) How to milk the chest tubing
B) How to splint the incision when coughing
C) How to take prophylactic antibiotics correctly
D) How to manage the need for fluid restriction

Question 6

A nurse is educating a patient in anticipation of a procedure that will require a water-sealed chest drainage system. What should the nurse tell the patient and the family that this drainage system is used for?

A) Maintaining positive chest-wall pressure
B) Monitoring pleural fluid osmolarity
C) Providing positive intrathoracic pressure
D) Removing excess air and fluid

Question 7

A patient is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube?

A) To remove air from the pleural space
B) To drain copious sputum secretions
C) To monitor bleeding around the lungs
D) To assist with mechanical ventilation

Question 8

A patients plan of care specifies postural drainage. What action should the nurse perform when providing this noninvasive therapy?

A) Administer the treatment with the patient in a high Fowlers or semi-Fowlers position.
B) Perform the procedure immediately following the patients meals.
C) Apply percussion firmly to bare skin to facilitate drainage.
D) Assist the patient into a position that will allow gravity to move secretions.

Question 9

The critical care nurse is precepting a new nurse on the unit. Together they are caring for a patient who has a tracheostomy tube and is receiving mechanical ventilation. What action should the critical care nurse recommend when caring for the cuff?

A) Deflate the cuff overnight to prevent tracheal tissue trauma.
B) Inflate the cuff to the highest possible pressure in order to prevent aspiration.
C) Monitor the pressure in the cuff at least every 8 hours
D) Keep the tracheostomy tube plugged at all times.

Question 10

The acute medical nurse is preparing to wean a patient from the ventilator. Which assessment parameter is most important for the nurse to assess?

A) Fluid intake for the last 24 hours
B) Baseline arterial blood gas (ABG) levels
C) Prior outcomes of weaning
D) Electrocardiogram (ECG) results

Question 11

A patient recovering from thoracic surgery is on long-term mechanical ventilation and becomes very frustrated when he tries to communicate. What intervention should the nurse perform to assist the patient?

A) Assure the patient that everything will be all right and that remaining calm is the best strategy.
B) Ask a family member to interpret what the patient is trying to communicate.
C) Ask the physician to wean the patient off the mechanical ventilator to allow the patient to speak freely.
D) Express empathy and then encourage the patient to write, use a picture board, or spell words with an alphabet board.

Question 12

The physician has ordered continuous positive airway pressure (CPAP) with the delivery of a patients high-flow oxygen therapy. The patient asks the nurse what the benefit of CPAP is. What would be the nurses best response?

A) CPAP allows a higher percentage of oxygen to be safely used.
B) CPAP allows a lower percentage of oxygen to be used with a similar effect.
C) CPAP allows for greater humidification of the oxygen that is administered.
D) CPAP allows for the elimination of bacterial growth in oxygen delivery systems.

Question 13

The home care nurse is assessing a patient who requires home oxygen therapy. What criterion indicates that an oxygen concentrator will best meet the needs of the patient in the home environment?

A) The patient desires a low-maintenance oxygen delivery system that delivers oxygen flow rates up to $6 \mathrm{~L} / \mathrm{min}$ .
B) The patient requires a high-flow system for use with a tracheostomy collar.
C) The patient desires a portable oxygen delivery system that can deliver $2 \mathrm{~L} / \mathrm{min}$ .
D) The patients respiratory status requires a system that provides an $\mathrm{FiO}_{2}$ of $65 \%$ .

Question 14

While caring for a patient with an endotracheal tube, the nurses recognizes that suctioning is required how often?

A) Every 2 hours when the patient is awake
B) When adventitious breath sounds are auscultated
C) When there is a need to prevent the patient from coughing
D) When the nurse needs to stimulate the cough reflex

Question 15

The nurse is caring for a patient who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning the patient from a ventilator, the nurse is aware that the weaning of the patient will progress in what order?

A) Removal from the ventilator, tube, and then oxygen
B) Removal from oxygen, ventilator, and then tube
C) Removal of the tube, oxygen, and then ventilator
D) Removal from oxygen, tube, and then ventilator

Question 16

The nurse has admitted a patient who is scheduled for a thoracic resection. The nurse is providing preoperative teaching and is discussing several diagnostic studies that will be required prior to surgery. Which study will be performed to determine whether the planned resection will leave sufficient functioning lung tissue?

A) Pulmonary function studies
B) Exercise tolerance tests
C) Arterial blood gas values
D) Chest x-ray

Question 17

The nurse is discussing activity management with a patient who is postoperative following thoracotomy. What instructions should the nurse give to the patient regarding activity immediately following discharge?

A) Walk 1 mile 3 to 4 times a week.
B) Use weights daily to increase arm strength.
C) Walk on a treadmill 30 minutes daily.
D) Perform shoulder exercises five times daily.

Question 18

A patient with a severe exacerbation of COPD requires reliable and precise oxygen delivery. Which mask will the nurse expect the physician to order?

A) Non-rebreather air mask
B) Tracheostomy collar
C) Venturi mask
D) Face tent

Question 19

The nurse is caring for a patient who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between $89 \%$ and $91 \%$ . What method of oxygen delivery is most appropriate for the patients needs?

A) Non-rebreathing mask
B) Nasal cannula
C) Simple mask
D) Partial-rebreathing mask

Question 20

A critical care nurse is caring for a client with an endotracheal tube who is on a ventilator. The nurse knows that meticulous airway management of this patient is necessary. What is the main rationale for this?

A) Maintaining a patent airway
B) Preventing the need for suctioning
C) Maintaining the sterility of the patients airway
D) Increasing the patients lung compliance

Question 21

The nurse is preparing to suction a patient with an endotracheal tube. What should be the nurses first step in the suctioning process?

A) Explain the suctioning procedure to the patient and reposition the patient.
B) Turn on suction source at a pressure not exceeding $120 \mathrm{~mm} \mathrm{Hg}$ .
C) Assess the patients lung sounds and $\mathrm{SAO}_{2}$ via pulse oximeter.
D) Perform hand hygiene and don nonsterile gloves, goggles, gown, and mask.

Question 22

The critical care nurse and the other members of the care team are assessing the patient to see if he is ready to be weaned from the ventilator. What are the most important predictors of successful weaning that the nurse should identify?

A) Stable vital signs and ABGs
B) Pulse oximetry above $80 \%$ and stable vital signs
C) Stable nutritional status and ABGs
D) Normal orientation and level of consciousness

Question 23

The OR nurse is setting up a water-seal chest drainage system for a patient who has just had a thoracotomy. The nurse knows that the amount of suction in the system is determined by the water level. At what suction level should the nurse set the system?

A) $\quad 20 \mathrm{~cm} \mathrm{H}_{2} \mathrm{O}$
B) $\quad 15 \mathrm{~cm} \mathrm{H}_{2} \mathrm{O}$
C) $\quad 10 \mathrm{~cm} \mathrm{H}_{2} \mathrm{O}$
D) $\quad 5 \mathrm{~cm} \mathrm{H}_{2} \mathrm{O}$

Question 24

The nurse is preparing to discharge a patient after thoracotomy. The patient is going home on oxygen
Therapy and requires wound care. As a result, he will receive home care nursing. What should the nurse include in discharge teaching for this patient?

A) Safe technique for self-suctioning of secretions
B) Technique for performing postural drainage
C) Correct and safe use of oxygen therapy equipment
D) How to provide safe and effective tracheostomy care

Question 25

The nurse is performing patient education for a patient who is being discharged on mini-nebulizer treatments. What information should the nurse prioritize in the patients discharge teaching?

A) How to count her respirations accurately
B) How to collect serial sputum samples
C) How to independently wean herself from treatment
D) How to perform diaphragmatic breathing

Question 26

The nurse is caring for a client with an endotracheal tube who is on a ventilator. When assessing the client, the nurse knows to maintain what cuff pressure to maintain appropriate pressure on the tracheal wall?

A) Between 10 and $15 \mathrm{~mm} \mathrm{Hg}$
B) Between 15 and $20 \mathrm{~mm} \mathrm{Hg}$
C) Between 20 and $25 \mathrm{~mm} \mathrm{Hg}$
D) Between 25 and $30 \mathrm{~mm} \mathrm{Hg}$

Question 27

The decision has been made to discharge a ventilator-dependent patient home. The nurse is developing a teaching plan for this patient and his family. What would be most important to include in this teaching plan?

A) Administration of inhaled corticosteroids
B) Assessment of neurologic status
C) Turning and coughing
D) Signs of pulmonary infection

Question 28

The nurse has explained to the patient that after his thoracotomy, it will be important to adhere to a coughing schedule. The patient is concerned about being in too much pain to be able to cough. What would be an appropriate nursing intervention for this client?

A) Teach him postural drainage.
B) Teach him how to perform huffing.
C) Teach him to use a mini-nebulizer.
D) Teach him how to use a metered dose inhaler.

Question 29

A nurse educator is reviewing the indications for chest drainage systems with a group of medical nurses. What indications should the nurses identify? Select all that apply.

A) Post thoracotomy
B) Spontaneous pneumothorax
C) Need for postural drainage
D) Chest trauma resulting in pneumothorax
E) Pleurisy

Question 30

The home care nurse is visiting a patient newly discharged home after a lobectomy. What would be most important for the home care nurse to assess?

A) Resumption of the patients ADLs
B) The familys willingness to care for the patient
C) Nutritional status and fluid balance
D) Signs and symptoms of respiratory complications

Question 31

A patient has been discharged home after thoracic surgery. The home care nurse performs the initial visit and finds the patient discouraged and saddened. The client states, I am recovering so slowly. I really thought I would be better by now. What nursing action should the nurse prioritize?

A) Provide emotional support to the patient and family.
B) Schedule a visit to the patients primary physician within 24 hours.
C) Notify the physician that the patient needs a referral to a psychiatrist.
D) Place a referral for a social worker to visit the patient.

Question 32

A patient is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what?

A) Correct use of a ventilator
B) Correct use of incentive spirometry
C) Correct use of a mini-nebulizer
D) Correct technique for rhythmic breathing

Question 33

A patient in the ICU has had an endotracheal tube in place for 3 weeks. The physician has ordered that a tracheostomy tube be placed. The patients family wants to know why the endotracheal tube cannot be left in place. What would be the nurses best response?

A) The physician may feel that mechanical ventilation will have to be used long-term.
B) Long-term use of an endotracheal tube diminishes the normal breathing reflex.
C) When an endotracheal tube is left in too long it can damage the lining of the windpipe.
D) It is much harder to breathe through an endotracheal tube than a tracheostomy.

Question 34

The home care nurse is planning to begin breathing retraining exercises with a client newly admitted to the home health service. The home care nurse knows that breathing retraining is especially indicated if the patient has what diagnosis?

A) Asthma
B) Pneumonia
C) Lung cancer
D) COPD

Question 35

The nurse is performing nasotracheal suctioning on a medical patient and obtains copious amounts of secretions from the patients airway, even after inserting and withdrawing the catheter several times. How should the nurse proceed?

A) Continue suctioning the patient until no more secretions are obtained.
B) Perform chest physiotherapy rather than nasotracheal suctioning.
C) Wait several minutes and then repeat suctioning.
D) Perform postural drainage and then repeat suctioning.

Question 36

A nurse has performed tracheal suctioning on a patient who experienced increasing dyspnea prior to a procedure. When applying the nursing process, how can the nurse best evaluate the outcomes of this intervention?

A) Determine whether the patient can now perform forced expiratory technique (FET).
B) Percuss the patients lungs and thorax.
C) Measure the patients oxygen saturation.
D) Have the patient perform incentive spirometry.

Question 37

Postural drainage has been ordered for a patient who is having difficulty mobilizing her bronchial secretions. Before repositioning the patient and beginning treatment, the nurse should perform what health assessment?

A) Chest auscultation
B) Pulmonary function testing
C) Chest percussion
D) Thoracic palpation

Question 38

A nurse is teaching a patient how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the patient?

A) Hold the spirometer at your lips and breathe in and out like you normally would.
B) When youre ready, blow hard into the spirometer for as long as you can.
C) Take a deep breath and then blow short, forceful breaths into the spirometer.
D) Breathe in deeply through the spirometer, hold your breath briefly, and then exhale.

Question 39

The nurse is assessing a patient who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the patients respirations. How should the nurse best respond to this assessment finding?

A) Gently reinsert the chest tube 1 to $2 \mathrm{~cm}$ and observe if the water level stabilizes.
B) Inform the physician promptly that there is in imminent leak in the drainage system.
C) Encourage the patient to do deep breathing and coughing exercises.
D) Document that the chest drainage system is operating as it is intended.