Deck 25: Respiratory System Introduction

Question 1

What portion of the internal nose traps particles and kills bacteria?

A) Turbinates
B) Mucous membrane
C) Vestibular formations
D) Cilia

Answer 1

Mucous membrane

Question 2

What intervention should a nurse implement when providing tracheostomy care?

A) Wash and rinse the inner cannula in tap water and then dry it.
B) Use a sterile solution of normal saline or other solution to wash the inner cannula and then rinse with sterile water.
C) Clean the area around the stoma with tap water and a gentle soap.
D) Remove the inner cannula, wash both hands with a bactericidal soap, and then don sterile gloves to clean the inner cannula.

Answer 2

Use a sterile solution of normal saline or other solution to wash the inner cannula and then rinse with sterile water.

Question 3

A 68-year-old patient tells the nurse that her sense of smell is not as acute as before, her nose is drier, and she occasionally gets a nosebleed.What should the nurse suspect?

A) An infection
B) Normal age-related changes
C) A nasal defect
D) Allergies that are causing her symptoms

Answer 3

Normal age-related changes

Question 4

A nurse assesses wheezes in a patient with asthma.What should the nurse know is the cause of wheezes?

A) Increased thickness of respiratory secretions
B) Use of accessory muscles of respiration
C) Tachypnea and tachycardia
D) Movement of air through narrowed airways

Question 5

Which assessment should indicate the necessity for a nurse to suction a patient with a tracheostomy?

A) Becomes restless and has increases in vital signs
B) Has decreased peak airway pressure
C) Shows diaphoresis
D) Is coughing frothy mucus

Question 6

Which nursing intervention is inappropriate in the immediate post-procedure care of a patient who has had a fiberoptic bronchoscopy?

A) Place the patient in a semi-Fowler position.
B) Offer fluids to assess swallowing ability.
C) Assess for diminished breath sounds.
D) Assess for stridor.

Question 7

A worried patient asks the nurse to explain the advantage of a fluoroscopy.What is the nurse's best response regarding fluoroscopy?

A) Shows respiratory function in motion
B) Helps the physician evaluate ventilation-perfusion ratio
C) Allows the physician to take tissue samples
D) Facilitates the removal of fluid from the bronchi

Question 8

When a patient with sleep apnea says, "I'm not wearing that silly mask.I look like something out of Star Wars," what should the nurse remind the patient about the function of the mask?

A) Increases oxygen intake
B) Stimulates regular respirations
C) Sounds an alarm when the oxygen concentration drops
D) Uses positive pressure to keep the airway open

Question 9

A patient asks the nurse how air goes from the nose to the lung.The nurse draws the route according to which sequence?

A) Trachea, larynx, bronchi
B) Pharynx, trachea, bronchi, alveoli
C) Bronchi, trachea, bronchioles
D) Larynx, trachea, alveoli, bronchi

Question 10

A nurse charts that a patient has had periods of tachypnea during the night.What does this means in regard to the respiration rate?

A) Below 12 breaths/min
B) Uneven, with periods of apnea
C) Gradually deepening, then shallow, and then periods of apnea
D) Above 20 breaths/min

Question 11

What should the nurse exclude when documenting the findings in the functional assessment portion of the nursing assessment for a patient with a respiratory disorder?

A) Occupation
B) Usual diet
C) Smoking history
D) Previous respiratory disorders

Question 12

To auscultate breath sounds in the right middle lobe from the anterior aspect, the nurse should place the diaphragm of the stethoscope at which intercostal space?

A) Second
B) Third
C) Fourth
D) Fifth

Question 13

A 90-year-old patient complains to the nurse of shortness of breath after walking up a flight of stairs.What age-related change should the nurse explain results in this problem?

A) Flexible rib cage
B) High-arched diaphragm
C) Increased chest movement
D) Enlarged bronchioles

Question 14

A patient comes into the clinic complaining of waking up with a dry mouth and nose and asks if the dryness has caused the colds she has had in the past few months.What is the most appropriate suggestion for the nurse to suggest?

A) Use a humidifier at home.
B) Get a throat culture.
C) Get a nose culture.
D) Request an antibiotic.

Question 15

What should the nurse suspect regarding the bronchus when auscultating coarse crackles in the lower right lobe?

A) Partially filled with fluid
B) Narrowed by spasm
C) Partially filled with thick mucus
D) Completely obstructed

Question 16

What does age-related relaxation of the esophageal sphincter in a 70-year-old patient cause?

A) Excessive belching
B) Dumping syndrome
C) Tickling sensation, requiring frequent coughing
D) Burning in the throat when lying down

Question 17

A patient comes into the clinic complaining of a runny nose and facial pain.What should the nurse's initial assessment include?

A) Assessment for nasal drainage and sinus tenderness
B) Transillumination and nasal speculum examination
C) Palpation of the frontal and maxillary sinuses and tonsillar inspection
D) Turbinate assessment and assessment for patency of the nares

Question 18

Which position is the most appropriate for a patient returning from surgery with a nasal pack and mustache dressing?

A) Side-lying position to prevent aspiration of drainage
B) Semi-Fowler position and apply a warm compress to reduce pain
C) High Fowler position and apply a cold dressing to reduce swelling
D) Sims position and apply a cold dressing to facilitate drainage and reduce swelling

Question 19

What should patient education for a patient being given nose drops for the first time include?

A) Asking the patient to sit down and tip her head to the side to allow for a better angle for the instillation of the drops
B) Holding the dropper against the side of the nose so that all the medication flows into the nares
C) Asking the patient to return any unused medication to the bottle
D) Tipping the head back and holding the dropper over the nostril and then telling the patient to keep her head back for a few minutes

Question 20

The patient has had anterior nasal packing placed for severe epistaxis.The nurse notes that he is swallowing frequently.What should a nurse suspect?

A) The patient's throat is dry.
B) Posterior packing is uncomfortable.
C) The patient is bleeding.
D) The patient's saliva production is excessive.

Question 21

What should the postoperative care of a patient who has had nasal surgery include? (Select all that apply.)

A) Changing the nasal packing when saturated
B) Placing the patient in a semi-Fowler position without a pillow
C) Giving frequent oral hygiene
D) Providing humidification for dry mucous membranes
E) Assessing the back of the throat for bleeding

Question 22

A nurse performs an Allen test before performing the arterial stick for an arterial blood gas.What does this test assess?

A) Respiratory function
B) Tidal volume
C) Concentration of oxygen
D) Perfusion of the hand

Question 23

Which nursing assessment indicates a positive reading of a tuberculin (TB)skin test?

A) 1 day after injection with a 10-mm area of redness and swelling
B) 2 days after injection with a 5-mm area of redness and swelling
C) 4 days after injection with a 3-mm area of redness and swelling
D) 5 days after injection with a 2-mm area of redness and swelling

Question 24

What assessment findings would indicate respiratory dysfunction when examining a patient with respiratory difficulty? (Select all that apply.)

A) Flushed facial skin
B) Cyanotic nail beds
C) Abdominal distention
D) Curved spine
E) Clubbed fingers

Question 25

What is the importance of the nurse closely monitoring bilateral breath sounds and chest movement after a thoracentesis?

A) Fluid may quickly accumulate as a result of inflammation.
B) The lung may have been punctured during the procedure.
C) Severe bronchospasm may cause atelectasis.
D) Asthma may result after the procedure.

Question 26

What should a nurse do when taking a specimen for a throat culture? _____ (Place the appropriate actions in the correct sequence.Do not separate answers with a space or punctuation.Example: ABCD.)

A)Depress the tongue with a tongue blade.
B)Place the applicator in a culture tube.
C)Ask the patient to tilt the head back.
D)Swab the back of the throat and tonsils.

Question 27

Which instructions should a nurse provide to a patient just before a scheduled spirometry test? (Select all that apply.)

A) Avoid smoking 4 to 6 hours before test.
B) Do not use bronchodilator medications for at least 4 hours.
C) Exercise for a few minutes.
D) Drink 2 glasses of fluid.
E) Avoid eating.

Question 28

The patient has had anterior nasal packing placed for severe epistaxis.The nurse notes that he is swallowing frequently.What should a nurse suspect?

A) The patient's throat is dry.
B) Posterior packing is uncomfortable.
C) The patient is bleeding.
D) The patient's saliva production is excessive.

Question 29

How should a nurse position a patient during a thoracentesis?

A) Side-lying with bed in a Trendelenburg position
B) High Fowler position with feet elevated
C) Sitting on the side of the bed bent over bedside table
D) Prone with the bed elevated

Question 30

How should a nurse position a patient who had a left pneumonectomy in the morning in an effort to enhance gas exchange?

A) On the right side
B) On the left side
C) In a semi-Fowler position
D) In a flat position with a small pillow

Question 31

A patient who is severely dyspneic and cyanotic enters the emergency department.What rate should a nurse administer oxygen to the patient?

A) 2 L to preserve the hypoxic drive
B) 6 L to relieve the dyspnea
C) 8 L, humidified, to liquefy secretions
D) 10 L, humidified aerosol, to dilate the bronchi

Question 32

How should a nurse explain that the breathing pattern has been altered when a patient complains of tachypnea? (Select all that apply.)

A) Increased pH levels stimulate chemoreceptors in the aorta and carotid arteries, which stimulates the phrenic nerve.
B) Decreased oxygen level signals the phrenic nerve to alter the respiration rate.
C) Muscles of respiration respond to the stimulus.
D) The brain has become hypoxic and causes an alteration in the respiration rate.
E) Deflated lung tissue results in an altered respiration rate.

Question 33

Which assessment by the nurse at the bedside of a patient with a chest tube attached to a water seal drainage device should require intervention?

A) Dependent loops in the chest tube
B) Patient in a semi-Fowler position
C) Changing level of water in the water seal chamber
D) Increased level of drainage to 20 mL in 8 hours

Question 34

What instructions should a nurse give to a patient when teaching deep breathing and coughing techniques? _____ (Place the options in the appropriate sequence.Do not separate answers with a space or punctuation.Example: ABCD.)

A)Place the hand on the abdomen to check the rise and fall.
B)Inhale through the nose, pause 1 to 3 seconds, and then exhale through the mouth.
C)Assume a semi-Fowler position.
D)Take 4 to 6 deep breaths.
E)Cough deeply.

Question 35

Which assessment indicates to the nurse that the chest tube in a water seal drainage device is working correctly?

A) Constant bubbling in the suction control chamber
B) Decrease of accumulation in the drainage chamber
C) Fluctuation of the column of water in the water seal
D) Constant bubbling in the water seal chamber

Question 36

A home health nurse who is caring for an 88-year-old patient with severe hypertension in addition to a respiratory problem notices several drugs on the bedside table.Which medication should the nurse suggest the patient avoid?

A) Aspirin
B) Colace
C) Expectorant
D) Decongestant

Question 37

How does the ventilator function of positive end-expiratory pressure assist the patient?

A) Keeps pressure in the lungs after expiration
B) Delivers 100% oxygen on inspiration
C) Allows the patient to control expiratory pressure
D) Delivers an inhalant medication under positive pressure

Question 38

A nurse computes the number of "pack-years" of a 24-year-old man who has smoked packs of cigarettes every day since he was 15 years old.This patient has _____ pack-years.(Use only numeric characters.If the answer is not a whole number, use decimals instead of fractions.)