Deck 9: Care of the Patient With a Respiratory Disorder

Question 1

A patient, age 69, has emphysema. On assessing him, the nurse notes the presence of a "barrel chest." This pathology results from a(n)

A) increase in the lateromedial area from hypertrophy of mucous glands in the bronchi.
B) increased anteroposterior diameter caused by overinflation of the alveoli.
C) decrease in anteroposterior diameter caused by chronic dilation of the bronchi.
D) widening of the sternocostal area secondary to chronic constriction of smooth muscles in the airways leading to bronchospasms.

Answer 1

increased anteroposterior diameter caused by overinflation of the alveoli.

Question 2

A 52-year-old patient has had a laryngectomy in treatment of cancer. A nursing diagnosis for the patient with a laryngectomy would be social isolation related to impaired verbal communication related to removal of the larynx. The correct nursing intervention would be

A) complete care quickly.
B) provide a pad and pencil or magic slate available.
C) refrain from conversations with the patient to reduce his stress level.
D) offer books or jigsaw puzzles for entertainment.

Answer 2

provide a pad and pencil or magic slate available.

Question 3

A patient, age 68, has a long history of COPD and is admitted to the hospital with cor pulmonale. He says his doctor said his heart was failing and asks whether he is having a heart attack. Which explanation by the nurse is most correct?

A) "You aren't having a heart attack, but your heart has been damaged by changes in your lungs caused by your respiratory disease."
B) "It could be a heart attack, and when the heart is damaged it causes respiratory damage, too."
C) "It isn't a heart attack, but your heart has gradually weakened over the years, causing respiratory disease."
D) "It is probably a heart attack, since cor pulmonale means that the heart isn't getting enough blood and becomes too weak to pump effectively."

Answer 3

"You aren't having a heart attack, but your heart has been damaged by changes in your lungs caused by your respiratory disease."

Question 4

The patient, age 91, has COPD and complains of dyspnea and fatigue. Activity intolerance, related to an imbalance between the oxygen supply and demand, is a nursing diagnosis for COPD. Which nursing intervention would be inappropriate?

A) Teach pursed-lip breathing.
B) Provide oxygen therapy as ordered.
C) Plan care to provide optimum rest.
D) Provide a cool shower.

Question 5

Which instruction by the nurse is inappropriate for teaching the proper technique for collection a sputum specimen?

A) Bring the sputum up from the lungs.
B) Maintain adequate fluid intake.
C) Collect specimens after meals.
D) Notify the staff as soon as the specimen is collected so it can be sent to the laboratory without delay.

Question 6

A patient, age 22, is admitted with acute asthma. It is important to monitor his oxygen saturation levels. The quickest way to assess his saturation of oxygen is to

A) get arterial blood gases.
B) use pulse oximetry.
C) do a pulse pressure assessment.
D) do a pulmonary function test.

Question 7

The patient, age 72, is admitted with acute pulmonary edema. In pulmonary edema, the medical management will often include

A) IV infusion of D5LR at less than 30 mL/hr.
B) intravenous sodium.
C) supine position.
D) atropine to decrease respiratory rate.

Question 8

An 83-year-old patient is admitted with a temperature of 102° F (38.8° C), chest pain, and fatigue. The chest radiograph reveals an accumulation of fluid in the pleural space, which the physician removes by performing a thoracentesis. The nurse correctly records the purulent exudate as:

A) effusion.
B) emphysema.
C) sputum.
D) empyema.

Question 9

The patient has COPD. To teach him pursed-lip breathing, the nurse should instruct him to inhale slowly through his

A) mouth, then exhale quickly through pursed lips.
B) nose, then exhale more slowly through pursed lips.
C) mouth, then make his exhalation last three times as long as his inhalation.
D) nose, making his inhalation last three times as long as his exhalation.

Question 10

The nurse identifies a nursing diagnosis of Ineffective airway clearance for a patient, age 64, who has undergone a pneumonectomy. A common etiology for this nursing diagnosis in patients who have had a pneumonectomy is

A) thick, copious secretions.
B) surgical incision pain.
C) presence of chest tubes.
D) mechanical ventilation.

Question 11

The surgeon administers nasal epinephrine to a patient after nasal surgery. The nurse explains to the patient that this is done primarily to

A) anesthetize the nares.
B) reduce the possibility of bleeding.
C) enhance respiration
D) dry up the nasal mucus.

Question 12

A patient is on postoperative day 4 after undergoing a total hip replacement. He is diagnosed as having a pulmonary embolism. Pulmonary embolism may occur as a postoperative complication of

A) arterial thrombosis.
B) venous thrombosis.
C) shallow, ineffective respirations.
D) rapid infusion of intravenous fluids.

Question 13

The appropriate nursing intervention for a patient, age 40, who is diagnosed with active tuberculosis would be to

A) place the patient in drainage and secretion precautions.
B) place the patient in acid-fast bacillus (AFB) isolation precautions.
C) maintain the patient in enteric isolation.
D) place the patient in any isolation precautions.

Question 14

The patient has been admitted for possible carcinoma of the larynx. The first sign or symptom that may be present in carcinoma of the larynx is often

A) pain in the larynx.
B) hemoptysis.
C) persistent hoarseness.
D) dysphagia.

Question 15

Which position is the most beneficial for a patient after surgery for creation of a tracheostomy?

A) Trendelenburg
B) Dorsal recumbent
C) Lithotomy
D) Mid-Fowler's

Question 16

A patient, age 54, is on postoperative day 2 after undergoing an open cholecystectomy. Immediately after the surgery, she vomited and may have aspirated some emesis. The nurse is concerned that the patient will develop pneumonia. In planning for her care, the nurse suspects the patient may have

A) bacterial pneumonia.
B) aspiration pneumonia.
C) viral pneumonia.
D) atypical pneumonia.

Question 17

Which nursing intervention does the nurse add to the care plan to help a patient with thick sputum mobilize and expectorate those secretions?

A) Drink salty fluids such as broth and bouillon.
B) Drink 3 to 4 L of water a day.
C) Inhale cool mist from a vaporizer for 15 minutes four times a day.
D) Sit in a tub of hot water three times a day.

Question 18

A 62-year-old patient is seen in the emergency department with an epistaxis. When a patient has an epistaxis, the correct nursing interventions would be

A) place the patient in Fowler's position with the head forward.
B) place the patient in low-Fowler's position with the head hyperextended.
C) compress the nostrils tightly below the bone and hold for 1 minute.
D) place hot compresses over the nose.

Question 19

A 68-year-old male patient has chronic obstructive pulmonary disease (COPD). He has a markedly increased need for protein and calories to maintain an adequate nutritional status. To help him get the nutrition he needs, the nurse would encourage him to

A) eat three meals a day.
B) rest 30 minutes before eating.
C) drink fluids only with meals.
D) perform bronchial drainage 30 minutes after eating.

Question 20

The circulation of the lungs is through the

A) coronary arteries and coronary veins.
B) celiac arteries and celiac veins.
C) pulmonary arteries and pulmonary veins.
D) carotid arteries and jugular veins.

Question 21

Identify the purposes of chest drainage: (Select all that apply)

A) Drains air, blood and fluid from pleural space
B) Restores positive pressure in chest cavity
C) Restores negative intrapleural pressure
D) Allows lung to collapse and rest
E) Allows route for medication administration

Question 22

Interventions that contribute to comfort in patients experiencing dyspnea include: (Select all that apply)

A) Breathing exercises
B) Bed rest
C) Acupuncture
D) Visualization
E) Limiting the amount of oxygen usage
F) Massage

Question 23

What does a nurse teach an adult male who has had a tonsillectomy?

A) Eat solid food during the first 24 hours.
B) Do not eat or drink anything for the first 24 hours.
C) Apply a heating pad to the neck during the first 24 hours.
D) Avoid coughing and clearing the throat during the first week postoperatively.

Question 24

The nurse is caring for a patient with a diagnosis of pleural effusion. The physician is most likely to order a ______________ to remove fluid from around the lungs so that the patient may breathe more easily.

Question 25

During discharge teaching of a pulmonary emphysema patient who is going home with oxygen, what does the nurse emphasize?

A) "Use the oxygen only when you experience shortness of breath."
B) "Use the maximum amount of oxygen that this unit will deliver."
C) "Use the oxygen only when exercising."
D) "Keep low flow oxygen at 1 to 2 L by nasal cannula."

Question 26

Which interventions are health promotions to prevent pneumonia? (Select all that apply.)

A) Position patient on the back to prevent aspiration.
B) Encourage elder patients to receive influenza and pneumococcal vaccines.
C) Provide for good health habits (nutrition, hygiene, exercise).
D) Allow new stroke patients to feed themselves to encourage self-care.
E) Check for placement before administering tube feedings.

Question 27

Prevention of acute respiratory complications in surgical patients is a nursing goal that involves which intervention?

A) Obtaining baseline pulmonary function tests for all preoperative patients.
B) Teaching all preoperative patients how to use incentive spirometers and how to cough and deep breathe effectively.
C) Obtaining baseline arterial blood gases for all preoperative patients over the age of 65.
D) Keeping at-risk patients in an upright position during the postoperative course.

Question 28

Which expected outcome(s) would indicate improvement in a patient with emphysema? (Select all that apply.)

A) Patent airway
B) Increased rhonchi and wheezes
C) Normal arterial blood gases (for this patient)
D) Increasing oxygen concentrations
E) Decreased breathe sounds
F) Decreased dyspnea

Question 29

Which are routes in which the anthrax bacterium may enter the body? (Select all that apply.)

A) Eyes
B) Lungs
C) Ears
D) Skin
E) Intestine
F) Perineum

Question 30

The _________ are the structures of the lung in which gas exchange occurs.

Question 31

Tuberculosis (TB) is treated with multiple drugs to which organisms are susceptible. How many drugs are usually preferred to increase the therapeutic effectiveness?

A) One
B) Two
C) Three
D) Four

Question 32

Which are signs of respiratory distress?

A) Nasal flaring, symmetrical chest wall expansion
B) Substernal retracting, SaO₂ 97%
C) Abdominal breathing, SaO₂ 89%
D) Symmetrical chest wall expansion, substernal retraction

Question 33

When a patient has experienced a pneumothorax, chest auscultation reveals

A) equal breath sounds with rhonchi over the affected area.
B) deep slowed respirations with equal chest movement.
C) bilateral unequal breath sounds, with no breath sounds over the affected area.
D) respiratory rate less than 16 breaths per minute.

Question 34

The nurse is caring for a patient with bronchiectasis. Based on an understanding of the pathologic changes that occur with this disease, which intervention to promote clearance of respiratory secretions does the nurse plan?

A) Postural drainage
B) Intermittent positive pressure breathing
C) Pursed-lip breathing
D) Diaphragmatic breathing

Question 35

Which test is a quick and reliable aid to diagnosis latent TB?

A) PPD skin test
B) Sputum smears
C) QFT-G
D) TB tine test

Question 36

The removal of fluid from the pleural space by thoracentesis presents a possible danger in removing fluid too rapidly. How much fluid removal is recommended at one time?

A) 1,500 to 2,000 mL at one time
B) 2,200 mL at one time
C) 1,300 to 1,500 mL at one time
D) Entire amount accumulated in less than 15 minutes