Respiratory Med-Surg Exam Review | Questions, Answers and Rationales The nurse explains that the purpose of mucus is to: a. warm the air entering the
... [Show More] lungs. b. trap particles and bacteria. c. protect the cilia. d. clean the sinus cavity. Mucus traps particles and bacteria that may be in the inspired air. A patient with emphysema presents to the emergency room with severe dyspnea; O2 saturation is 74%, pulse is 120, and respirations are 26. The nurse positions the patient in high Fowler. What action should the nurse take next? a. Collect a sputum specimen. b. Coach the patient in pursed-lip breathing. c. Give oxygen at 5 L/min by nasal cannula. d. Ensure patent intravenous (IV) access. Coaching in pursed-lip breathing will open the respiratory tree with negative pressure. Oxygen given at such a high concentration will cause an emphysemic patient to stop breathing. Collecting a sputum specimen and ensuring patent IV access are appropriate interventions that should be performed after the patient's dyspnea is addressed. The nurse explains that the mechanism that triggers rate and depth of respiration is based on which factor? a. Ease of respiration. b. Alveolar pressure. c. Patency of bronchi. d. Blood pH. Chemoreceptors in the brainstem and carotid arteries measure hydrogen concentration, as well as CO2 and O2, to trigger respiration rate to correct the excessive CO2. When creating a visual aid to show the mechanics of inhaling, the nurse correctly illustrates which scenario? a. The diaphragm moves downward. b. The negative pressure of the lung converts to positive pressure. c. The muscles contract and pull the rib cage downward. d. The bronchi enlarge. On inspiration, the diaphragm moves down, increasing the area of negative pressure, muscles pull the rib cage up, and the positive-pressure room air flows into the negative-pressure lungs. The nurse explains that the substance that decreases the surface tension of the alveolar walls is: a. plasma. b. surfactant. c. cilia. d. mucus. Surfactant is the substance that reduces the surface tension of the walls of the alveoli, making gas exchange more effective. Most of the inspired oxygen is carried to the tissues via which component of the body? a. Plasma b. Lymphatic system c. Red blood cells d. White blood cells The red blood cells carry 97% of the oxygen to the cells, attached to hemoglobin. The nurse is caring for a patient with an obstructive respiratory disorder. Which of these conditions is an example of an obstructive lung disorder? a. Atelectasis b. Lung cancer c. Guillain-Barré syndrome d. Chronic bronchitis Obstructive lung disease is related to the reduced ability to move air in and out of the lungs. Asthma, emphysema, and chronic bronchitis are classified as obstructive disorders. Atelectasis, lung cancer, and Guillain-Barré syndrome are restrictive disorders. When reviewing risk factors, the nurse correctly identifies which patient as having the greatest risk of throat cancer? a. The patient who drinks 4 cups of coffee per day. b. The patient who smokes 1 pack of cigarettes per week. c. The patient who drinks several carbonated drinks per day. d. The patient who drinks 4 vodka tonics per day. The combination of alcohol and cigarettes increases the risk for throat cancer. However, the patient consuming 4 vodka drinks per day is at a higher risk than the patient smoking 1 pack of cigarettes per week. Coffee and carbonated drink consumption has not been found to increase the risk of throat cancer. The nurse is preparing to administer the influenza immunization to four patients. Allergy to which substance should cause the nurse to question giving the immunization? a. Strawberries b. Ragweed c. Penicillin d. Eggs The influenza vaccine is cultured in chicken embryos, making anyone allergic to eggs probably allergic to the immunization. When the nurse places the diaphragm of the stethoscope over one of the main bronchi, the expected normal breath sound heard is: a. bronchovesicular. b. bronchial. c. rhonchi. d. vesicular. Bronchovesicular sounds are moderate hollow sounds that are equal on inspiration and expiration. The nurse is performing deep tracheal suctioning of a patient with a respiratory disorder. Which action demonstrates appropriate technique? a. The nurse maintains clean technique. b. The nurse places the patient in a side-lying position. c. The nurse suctions the patient for 10 to 15 seconds. d. The nurse reassures the patient that he will feel no discomfort. The suctioning, which is done during extraction of the suction tip, should not last more than 10 to 15 seconds as it deprives the patient of oxygen. Deep tracheal suction requires sterile tech-nique, and the patient should be positioned with the neck slightly extended to facilitate entrance into the trachea. Even though the procedure does not last for a long time, suctioning is uncom-fortable for the patient. The nurse is aware that the patient is in respiratory failure when the blood gas findings are a PaO2 of _____ mm Hg and a PaCO2 of _____ mm Hg. a. 46; 52 b. 50; 45 c. 52; 42 d. 55; 58 Respiratory failure is defined by blood gases that have a PaO2 level below 50 mm Hg and a Pa-CO2 level equal to or higher than 50 mm Hg. The nurse assesses a patient's respirations who was recently admitted with a traumatic head injury. The nurse expects to find which type of breathing during the assessment? a. Apneustic respiration b. Cheyne-Stokes c. Kussmaul's d. Biot's Biot's respirations are characterized by irregular periods of apnea followed by four to five breaths of identical depth. This pattern is associated with increased intracranial pressure, which is common with a traumatic head injury. Apneustic respirations are indicative of damage to the respiratory centers in the brain. Cheyne-Stokes respirations are often seen in patients in a coma resulting from a disorder affecting the central nervous system. Kussmaul's respiration is an ab-normal breathing pattern often seen in patients with diabetic acidosis and coma. The nurse is caring for a postoperative patient. After instructing the patient to cough and deep-breathe, what action should the nurse take next? a. Offer a warm drink. b. Perform mouth care. c. Deliver oxygen by mask. d. Take the patient's temperature. Mouth care should be offered after deep breathing and coughing to clear the mouth of unpleasant taste. A patient is admitted to the medical unit with an acute illness accompanied by a fever for the last 3 days. What will likely be the patient's respiratory response? a. Hypercarbia b. Respiratory alkalosis c. Kussmaul respirations d. Respiratory acidosis Respiratory alkalosis, or hypocapnia, results from the patient's respiratory rate being elevated for a prolonged period due to the persistent fever. The patient blows off too much CO2 as a result. Hypercarbia and respiratory acidosis are the same and result from disorders that cause hypoven-tilation. Kussmaul respirations are an abnormal breathing pattern. The nurse is caring for a patient with COPD who has been in the hospital for several days. The patient complains of shortness of breath and asks the nurse to turn up his oxygen to compensate for his labored breathing. What is the best nursing response? a. Turn up the patient's oxygen flow by 1 liter. b. Call the physician for an order to turn up the oxygen. c. Assess the patient in an attempt to identify the cause of the shortness of breath. d. Ask the patient what he usually keeps his oxygen set on at home. The nurse should assess the patient for possible causes of the shortness of breath before calling the physician. The nurse may be able to implement nursing interventions, or may need to contact the physician for orders based on the assessment findings. Since the COPD patient's respiratory drive is lowering levels of PO2, turning up the oxygen may take away his incentive to breathe. Asking the patient about his home oxygen is not helpful at this point. The nurse uses a visual aid to show the "hinged door" that helps prevent aspiration. This "hinged door" is the __________. Fill in the blanks with correct word epiglottis The epiglottis is the "hinged door" that closes upon swallowing and opens when breathing. Rapid opening and closing of the glottis combined with movement of the mouth, lips, and tongue is what makes _____________. Fill in the blanks with correct word speech or words The rapid opening and closing of the glottis combined with the movement of the mouth, lips, and tongue is what makes speech/ Words The nurse describes the ability of the lungs to respond to change in the volume and pressure of inhaled air by expanding as lung __________. Fill in the blanks with correct word compliance The lungs normal expansion in response to inhaled air is known as lung expansion. Lung com-pliance first increases and then decreases with age as the lungs become stiffer and the chest wall becomes more rigid. The nurse clarifies that when interstitial edema occurs in the lung tissue, it inhibits ventilation by causing which problem(s)? (Select all that apply.) a. Thickening alveolar membranes b. Pus formation c. Alveoli filling with fluid d. Evaporating surfactant e. Gas failing to diffuse across membrane Interstitial edema will cause problems that affect the alveoli: thickened walls and filling with fluid that obstructs gas exchange across the thickened walls. Pus formation is associated with infection. Surfactant decreases surface tension on the alveolar wall, allowing it to expand more easily with inspiration and preventing alveolar collapse on expiration. Which manifestation(s) are age-related changes that alter the respiratory system? (Select all that apply.) a. Weakened cough b. Kyphosis c. Increased ciliary movement d. Decrease in body fluid e. Muscle weakness Age-related changes in the respiratory system include weakened cough, kyphosis, decreased bodily fluids, and increased muscle weakness. Age often decreases ciliary movement. For which individual(s) does U.S. Public Health Service recommend the influenza immunization? (Select all that apply.) a. Physicians b. Compromised infants c. Older adults d. Chronically ill e. Nurses Health care workers, older adults, and chronically ill individuals are at risk for contracting influenza and should be immunized. Compromised infants should not be immunized. The nurse notes physical signs of labored breathing, which include: (Select all that apply.) a. grunting on expiration. b. elevating shoulders and ribs on inspiration. c. tensing neck and shoulder muscles. d. substernal retraction. e. productive cough. Productive cough is not a sign of labored breathing. All other options are often seen with laboring respirations. The nurse explains that anorexia in the patient with a respiratory disorder may be attributed to: (Select all that apply.) a. increased sense of taste. b. bad taste in mouth. c. fear that eating will exacerbate coughing. d. fatigue. e. altered sense of smell. The sense of taste is usually altered in the patient with a respiratory disorder. All of the other factors contribute to lack of appetite in the patient with a respiratory disorder. The nurse reminds the patient that a cold is contagious for about _____ days. a. 2 b. 3 c. 4 d. 7 The contagion period of a viral cold is about 3 days. The nurse is caring for a patient with suspected sinusitis. Which assessment finding supports this diagnosis? a. Maxillary sinuses nontender on percussion. b. Generalized pain in the upper teeth. c. Clear drainage from the ear. d. Ear pain when lying down Sinusitis is an inflammation of the mucosal lining of the sinuses. Exudate accumulates in the sinuses and pressure builds, which causes pain. Symptoms include painful upper teeth, tenderness over the sinuses, purulent drainage from the nose, nasal obstruction, and sometimes a nonproductive cough. Drainage from the ear and ear pain when supine are findings likely consistent with an ear infection. The nurse is caring for a patient who has had a cold for 1 week. The patient questions why the health care provider issued a prescription for an antibiotic. Which explanation is best? a. "The antibiotic will cure your cold." b. "The antibiotic will help to reduce your symptoms." c. "The antibiotic will treat the secondary bacterial infection that has developed." d. "The antibiotic will decrease the amount of time for which you are contagious. If a cold persists for more than a week to 10 days without improvement, a bacterial infection is present and requires medical treatment. While the etiology of a cold is viral in nature, antibiotics are necessary to this secondary bacterial infection. No cure exists for a cold. Antibiotics will not reduce symptoms of a cold or decrease the contagion period for a cold. A 6 year old had a tonsillectomy today. When the nurse goes into the room to give him his antibiotics, she finds him irritable, coughing, nauseated, and swallowing repeatedly. What is the next action the nurse should take? 1. Assess for signs of frank red blood in the mouth and nose and get a complete set of vital signs. 2. Ask the child for a pain score and if he would like a popsicle with his pain medicine. 3. Suction mouth vigorously to avoid aspiration of blood, and then hang antibiotic. 4. Take a complete set of vital signs and divert the child's attention to the cartoon on TV. Feedback 1. This intervention assesses for bleeding. 2. An assessment for blood needs to occur because the child continues to swallow. 3. Suctioning can cause clots to loosen and increases bleeding. It should be avoided. 4. Vital signs are needed and a focused assessment needs to be completed in order to identify complications. The nurse is caring for a patient with sleep apnea. The patient complains that he is constantly fatigued. Which response is most appropriate for the nurse to make? a. "Patients with sleep apnea experience oxygen overloads, which lead to drowsiness." b. "Patients with sleep apnea often wake frequently during the night." c. "Patients with mild sleep apnea benefit from a small amount of red wine right before bed." d. "All patients have difficulty sleeping properly in the hospital." Periods of apnea followed by abrupt intake of air frequently awaken the patient and reduce the amount of rapid eye movement (REM) sleep. Patients with sleep apnea experience oxygen deficiency. Mild apnea may be treated with conservative measures like avoiding alcohol 4 to 6 hours before bed. Telling the patient that all patients sleep poorly in the hospital ignores the patient's concern and makes an overgeneralization based on the nurse's bias. The nurse is caring for a patient during the immediate postoperative period following a rhinoplasty. The nurse is most concerned with which assessment finding? a. The patient complains of being cold and chilled. b. The patient complains of nausea. c. The nurse notices the patient swallowing frequently. d. The patient has a decreased fluid intake. Frequent swallowing indicates bleeding that is trickling down the back of the throat. Feeling cold and chilly is a common symptom with surgery and is related to anesthetic and the cool surgical environment. Nausea may be experienced by some patients due to anesthetic. Fluid intake is not a symptom. The nurse instructs the laryngectomized patient that, in order to warm the inspired air during cold weather, the patient should: a. place hand over stoma. b. use scarf to cover stoma. c. wear moist dressing over stoma. d. stay in area of humidified air. The fold of the scarf retains body heat and can warm air as the air passes through the scarf. The nurse is caring for a patient who underwent a laryngectomy. Which need should the nurse address first? a. Pain control b. Family support c. Communication method d. Plan for long-term care Pain control and family support are important, but the need of a method of communication is paramount for a new tracheostomy patient to allay anxiety, ensure accurate communication between the patient and the nurse, and make the patient comfortable that nursing staff are attentive. The need for long-term care may not be necessary. When teaching a patient about esophageal speech, which technique should the nurse instruct the patient to use first? a. Coordinate lip and tongue movements with produced sound. b. Relax the diaphragm to allow air into the esophagus. c. Cough to express air. d. Swallow air and force it back up through the esophagus. Many people are able to learn esophageal speech. First, the patient should master the art of swallowing air and then moving it forcibly back up through the esophagus. Next, the patient should learn to coordinate lip and tongue movements with the sound produced by the air passing over vibrating folds of the esophagus. The sounds may be somewhat hoarse, but are more natural than the sounds produced by an artificial larynx. Relaxing the diaphragm and coughing to ex-press air are not methods to achieve esophageal speech. [Show Less]