Med-Surg Exam 2 Respiratory | Questions and Answers (Complete Solutions) Which of the following is part of the respiratory tract? Choose all that apply.
... [Show More] A. Bronchi B. Pharynx C. Larynx D. Sinuses Because the pressure of CO2 is higher in the blood vessels than the pressure of CO2 in the lungs, the CO2 moves from the blood to the lungs. True False Which of the following would cause the medulla oblongata to increase the respiratory rate? A. Too much oxygen in blood stream B. Too much carbon dioxide in blood stream C. Decrease in metabolic needs The functional unit of the respiratory system is _______? Alveoli A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? A. Complete a full physical examination to determine the systemic effect of the respiratory distress. B. Obtain a comprehensive health history to determine the extent of any prior respiratory problems. C. Delay the physical assessment and ask family members about any history of respiratory problems. D. Perform a respiratory system assessment and ask specific questions about this episode of respiratory distress. On auscultation of a patient's lungs, you hear short, high-pitched sounds during exhalation in the lower 1/3 of both lungs. You should record this finding as A. expiratory crackles at the bases. B. expiratory wheezes in both lungs. C. abnormal lung sounds in the bases of both lungs. D. pleural friction rub in the right and left lower lobes. Wheezes are high-pitched sounds. In this case they are heard during the expiratory phase of the respiratory cycle. Abnormal breath sounds are either bronchial or bronchovesicular sounds heard in the peripheral lung fields. Crackles are low-pitched, "bubbling" sounds. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration You palpate the posterior chest while the patient says "99" and note that no vibration is felt. How should this be charted? A. Diminished expansion B. Dullness to percussion C. Absent tactile fremitus D. Decreased breath sounds To assess for tactile fremitus, the nurse should use the palms of the hands to assess for vibration when the patient repeats a word or phrase such as "99." Different techniques are used to assess for dullness to percussion, decreased breath sounds, and diminished expansion. When auscultating a patient's chest while the patient takes a deep breath, you hear loud, high-pitched, "blowing" sounds at both lung bases. You will document these as A. normal sounds. B. vesicular sounds. C. abnormal sounds D. adventitious sounds The description indicates that you hear bronchial breath sounds that are abnormal when heard at the lung base. Adventitious sounds are extra breath sounds such as crackles, wheezes, rhonchi, and friction rubs. Vesicular sounds are low-pitched, soft sounds heard over all lung areas except the major bronchi. Which of the following respiratory physiological changes occur as a result of aging? A. Increase elastic recoil B. Decrease functioning alveoli C. Increase cough force D. Increase response to high CO2 level When assessing the respiratory system of a 78-year-old patient, which finding indicates that you should take immediate action? A. The chest appears barrel shaped. B. The patient has a weak cough effort. C. Crackles are heard from the lung bases to the midline. D. Hyperresonance is present across both sides of the chest. A patient with complicated deviated septum is hospitalized to have septoplasty. Which of the following findings must you report to the surgeon before the surgery? A. Serum sodium is 134 mEq/L. B. PT 12 seconds. C. Serum potassium is 4.8 mEq/L. D. Platelets counts is 120,000/ L Low platelets= high risk for bleeding (NL 150,000-400,000 per microliter) After a patient has undergone a septoplasty, which nursing intervention will be included in the plan of care? A. Educate the patient about how to safely remove and reapply nasal splint. B. Reassure the patient that the nose will look normal when the swelling subsides C. Instruct the patient to keep the head elevated for 48 hours to minimize swelling and pain. D. Teach the patient to use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control. Maintaining the head in an elevated position will decrease the amount of nasal swelling. NSAIDs increase the risk for postoperative bleeding and should not be used postoperatively. The patient would not be taught to remove or reapply nasal packing, which is usually removed by the surgeon on the day after surgery. Although return to a preinjury appearance is the goal of the surgery, it is not always possible to achieve this result. Which action should you take first when a patient develops a nosebleed? A. Pack both nares tightly with 1/2-inch ribbon gauze. B. Pinch the lower portion of the nose for 10 minutes. C. Prepare supplies that will be needed for cauterization. D. Apply ice compresses over the patient's nose and cheeks. The first nursing action for epistaxis is to apply direct pressure by pinching the nostrils. Application of cold packs may decrease blood flow to the area somewhat, but will not be sufficient to stop bleeding. Cauterization or nasal packing may be needed if pressure to the nares does not stop bleeding, but these are not the first actions to take for nosebleed. You are caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed. Which of the following assessment findings will require the most immediate action? A. The patient complains of level 7 (0 to 10 scale) pain. B. The patient's temperature is 100.1° F (37.8° C). C. The nose appears red and swollen. D. The oxygen saturation is 89%. Older patients with nasal packing are at risk of aspiration or airway obstruction. An O2 saturation of 89% should alert the nurse to assess further for these complications. The other assessment data also indicate a need for nursing action but not as immediately as the fall in O2 saturation. When teaching the patient with allergic rhinitis about management of the condition, you should explain that A. over-the-counter (OTC) antihistamines cause sedation, so prescription antihistamines are usually ordered. B. corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use. C. Identification and avoidance of environmental triggers are the best way to avoid symptoms. D. Use of oral antihistamines for a few weeks before the allergy season may prevent reactions. After discussing management of upper respiratory infections (URI) with a patient who has acute viral rhinitis, you determine that additional teaching is needed when the patient says: A. "I can take acetaminophen (Tylenol) to treat discomfort." B. "I will drink lots of juices and other fluids to stay hydrated." C. "I can use my nasal decongestant spray until the congestion is all gone." D. "I will watch for changes in nasal secretions or the sputum that I cough up." You obtain the following assessment data in a 76-year-old patient who has influenza. Which information will be most important to communicate to the health care provider? A. Fever of 100.4° F (38° C) B. Diffuse crackles in the lungs C. Sore throat and frequent cough D. Myalgia and persistent headache You are reviewing the charts for four patients who are scheduled for their yearly physical examinations in October. Which of the following patients will require the inactivated influenza vaccination? A. A 56-year-old patient who is allergic to eggs B. A 24-year-old patient who has allergies to penicillin and the cephalosporins C. A 30-year-old patient who takes corticosteroids for rheumatoid arthritis D. A 24-year-old patient who has allergies to penicillin and the cephalosporins The teaching plan for a patient with acute sinusitis will need to include of the following interventions EXCEPT A. Taking a hot shower will increase sinus drainage and decrease pain. B. Over-the-counter (OTC) antihistamines can be used to relieve congestion and inflammation. C. Saline nasal spray can be made at home and used to wash out secretions. D. Blowing the nose forcefully should be avoided to decrease nosebleed risk. A client is admitted to the hospital with a diagnosis of atrial fibrillation, and the practitioner suspects mitral valve stenosis. When obtaining a health history, the nurse determines that it is most significant if the client presents a history of: A. Cystitis at age 28 B. Pleurisy at age 20 C. Strep throat at age 12 D. German measles at age 6 You are obtaining a health history from a 67-year-old patient with a 40 pack-year smoking history, complaints of hoarseness and tightness in the throat, and difficulty swallowing. Which question is most important to ask? A. "How much alcohol do you drink in an average week?" B. "Do you have a family history of head or neck cancer?" C. "Have you had frequent streptococcal throat infections?" D. "Do you use antihistamines for upper airway congestion?" Prolonged alcohol use and smoking are associated with the development of laryngeal cancer, which the patient's symptoms and history suggest. Family history is not a risk factor for head or neck cancer. Frequent antihistamine use would be asked about if the nurse suspected allergic rhinitis, but the patient's symptoms are not suggestive of this diagnosis. Streptococcal throat infections also may cause these clinical manifestations, but patients also will complain of pain and fever. A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks you, "How will I talk after the surgery?" Your best response is: A. "You will breathe through a permanent opening in your neck, but you will not be able to communicate orally." B. "You won't be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed." C. "You won't be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally." D. "You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration." Voice rehabilitation is planned after a total laryngectomy, and a variety of assistive devices are available to restore communication. Although the ability to communicate orally is changed, it would not be appropriate to tell a patient that this ability would be lost. Artificial voice devices do not permit normal-sounding speech. In a total laryngectomy, the vocal cords are removed, so normal speech is impossible. A patient who had a total laryngectomy has a nursing diagnosis of hopelessness related to loss of control of personal care. Which information obtained by the nurse is the best indicator that the problem identified in this nursing diagnosis is resolving? A. The patient lets the spouse provide tracheostomy care. B. The patient allows the nurse to suction the tracheostomy. C. The patient asks how to clean the tracheostomy stoma and tube. D. The patient uses a communication board to request "No Visitors." Independently caring for the laryngectomy tube indicates that the patient has regained control of personal care and hopelessness is at least partially resolved. Letting the nurse and spouse provide care and requesting no visitors may indicate that the patient is still experiencing hopelessness. Which of these nursing actions can the RN working in a long-term care facility delegate to an experienced LPN/LVN who is caring for a patient with a permanent tracheostomy? A. Assessing the patient's risk for aspiration B. Suctioning the tracheostomy when needed C. Educating the patient about self-care of the tracheostomy D. Determining the need for replacement of the tracheostomy tub Suctioning of a stable patient can be delegated to LPN/LVNs. Assessments and patient teaching should be done by the RN. The most reliable and sensitive test of gas exchange is: A. Pulse Oxymetry B. ABG C. Chest X- ray D. Respiration rate The parent of a child diagnosed with sickle-cell anemia asks the nurse about air travel with the child. Which of the following is the best response? A. "Flying at high altitudes can be associated with less available oxygen, causing increased sickling." B. "Flying will present a risk for infection secondary to crowds." C. "Flying does not pose any particular risks for the child with SCA." D. "Air travel is not recommended, because of the unavailability of emergency medical care while in flight." A 75-year-old patient breathing room air has the following arterial blood gas (ABG) results: pH 7.40, PaO2 72 mm Hg, SaO2 92%, PaCO2 40 mm Hg. An appropriate action by the nurse is to A. encourage deep breathing and coughing to open the alveoli. B. repeat the ABGs within an hour to validate the findings. C. document the results in the patient's record D. initiate pulse oximetry for continuous monitoring of the patient's oxygen status. Patient #1: J.D. 24 year-old male. J.D. is a boxer and he just had a boxing match that resulted in an injury to the nose D/t a heavy nosebleed he was sent to the emergency room (ER) J.D. is alert and oriented and did not lose consciousness during the injury. Patient reports 10/10 pain to his nose. No other symptoms reported at this time. In which position should you place J.D.? A. Semi-Fowler's B. Leaning slightly forward C. Sim's position D. Supine What would you expect to be TRUE about J.D.'s vital signs? (Select all that apply) A. Increased BP B. Decreased BP C. Increased HR D. Decreased RR A before B because body will constrict causing increased blood pressure, and pain causes increased blood pressure. But if circulatory status is not restored, then B, then C. C increased HR due to 10/10 pain and compensating for blood loss. Increased RR because body is trying to oxygenate as much blood as possible. How do you differentiate between anterior and posterior nasal bleeding? (Select all that apply) A. Anterior bleeding is easily visualized. B. Anterior bleeding account for 90% of nose bleeding. C. Posterior bleeding is more life-threatening. D. Posterior bleeding usually stops spontaneously. Posterior bleeds do not usually stop spontaneously, anterior bleeds do. You review J.D.'s pain medication options on the MAR. Which medication(s) should you QUESTION? (Select all that apply) A. Acetaminophen (Tylenol) B. Ibuprofen (Advil) C. Aspirin (ASA) D. Morphine Due to blood thinning characteristics J.D.'s epistaxis is now controlled. You observe a clear fluid draining from J.D.'s left ear. What might this indicate? A. J.D. is receiving too much IV fluid. B. J.D. had a pre-existing ear infection. C. J.D. may have sustained a skull fracture. D. This is a normal finding after epistaxis is controlled. May be cerebrospinal fluid. J.D. is discharging home with nasal packing in place. What teaching should you include? A. Remove the nasal packing later this evening. B. Use aspirin for pain relief. C. Skip your next dose of hypertension medication. D. Avoid vigorous nose blowing and strenuous activity. Patient #2: M.J. is a 32 year-old female; hx: persistent allergic rhinitis Which of the following is NOT a common clinical manifestation of allergic rhinitis? A. Sneezing B. Watery eyes C. Purulent nasal discharge D. Watery nasal discharge M.J. is prescribed Flunisolide spray (intranasal corticosteroid). Which of the following statements from M.J. requires CORRECTION by the nurse? A. This medication may take several days or weeks to have maximum effect. B. I should continue taking Flunisolide if I develop a sinus infection. C. I should use Flunisolide on a daily basis for it to work properly. D. There might be mild nasal burning and stinging when I use Flunisolide. Pt should STOP taking corticosteroids during an infection because they decrease immune response M.J. has been prescribed Benadryl (diphenhydramine) to manage symptoms. Which of the following is true concerning the use of Benadryl? (Select all that apply) A. Benadryl is a 1st-generation antihistamine. B. Using Benadryl may cause bradycardia. C. Operating machinery and driving may be dangerous because of sedative effect. D. Use of this medication may cause constipation and dry mouth. E. Benadryl may also cause paradoxic stimulation Benadryl can cause tachycardia M.J.'s symptoms have become worse and montelukast (Singulair) is added to her medication list. Before M.J. can begin taking Singulair, which lab test should the prescriber check FIRST? A. WBCs B. LFTs C. H/H D. Urinalysis Patient #3: C.D. 27 year-old male professional swimmer 2-day hx of purulent nasal drainage, congestion, fever, headache DX: Bacterial sinusitis You are discharging C.D. from the ED. Which of the following will you include in discharge instructions? (Select all that apply) A. It is OK to smoke or be around smoke. B. Drink 6-8 glasses of water daily to loosen secretions and stay hydrated. C. Report a temperature of over 38C. D. Perform vigorous exercise to increase circulation to the area. E. Take hot showers or use a humidifier to promote drainage of secretions. Patient #4: S.M. is a 19 year-old female complaining of "scratchy throat" You perform an examination and acute pharyngitis is suspected You see white patches and swollen, red tonsils You initiate steps to rule out strep infection in S.M. If left untreated, a Group A beta-hemolytic streptococcal infection may result in: (Select all that apply) A. Peritonsillar abscess B. Rheumatic fever C. Sepsis D. Cancer Patient #5: S.G. 63 year-old male. Mr. S.G. has been diagnosed with laryngeal cancer S.G. has had his total laryngectomy and you are his nurse on the floor. Which of the following is TRUE concerning his post-op care? A. He should be placed in a lateral, supine position. B. He will be receiving nutrition via nasogastric tube once bowel sounds return. C. You will be using the numeric pain scale to rate his pain. D. You will change his dressings if they are visibly soiled. S.G. is discharging home with a tracheostoma valve. What will you include in your teaching? (Select all that apply) A. Wash around the stoma daily with a moist cloth B. A scarf or loose shirt can be used to hide the stoma C. He may return to his daily swimming routine D. A bedside humidifier should be used to keep air moist E. Do not cover the stoma when coughing or shaving Who of the following is at highest risk to acquire pneumonia? a. Patient who has been using corticosteroid for 3 days. b. Patient who is 45 year and has COPD. c. Patient who has been a smoker for 5 years. d. Patient whose WBC counts is 2,000/mm3 post chemotherapy. Which of the following should be a priority nursing diagnosis for a patient who acquired bacterial pneumonia? a. Impaired gas exchange b. Fatigue c. Fluid volume excess d. Anxiety Pneumocystis pneumonia is a pulmonary fungal infection commonly seen is: a. Patients with lung cancer b. Patients with AIDS c. Patients with cystic fibrosis d. Patients with COPD [Show Less]