Test Bank NSG 210 Introduction to the Respiratory System Questions & Answers & Rationale
1. You are caring for a client who is in respiratory distress.
... [Show More] The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from?
A) A puncture at the radial artery
B) The trachea and bronchi
C) The pleural surfaces
D) A catheter in the arm vein
Ans: A
Feedback:
ABGs determine the blood's pH; oxygen-carrying capacity; and levels of oxygen, CO2, and bicarbonate ion. Blood gas samples are obtained through an arterial puncture at the radial, brachial, or femoral artery. A client also may have an indwelling arterial catheter from which arterial samples are obtained. Blood gas samples are not obtained from the pleural surfaces or trachea and bronchi.
2. The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about?
A) Raised temperature in the affected limb
B) Excessive capillary refill
C) Absent distal pulses
D) Flushed feeling in the client
Ans: C
Feedback:
When monitoring clients after a pulmonary angiography, nurses must notify the physician about diminished or absent distal pulses, cool skin temperature in the affected limb, and poor capillary refill. Absent distal pulses may indicate damage to the artery or a clot.
When the contrast medium is infused, the client will sense a warm, flushed feeling.
3. You are a nurse in the radiology unit of your hospital. You are caring for a client who is scheduled for a lung scan. You know that lung scans need the use of radioisotopes and a scanning machine. Before the perfusion scan, what must the client be assessed for?
A) Bleeding
B) Iodine allergy
C) Dysrhythmias
D) Inflammation
Ans: B
Feedback:
During lung scans, a radioactive contrast medium is administered intravenously for the perfusion scan. Before the perfusion scan, nurses must assess the client to check for allergies to iodine. Laryngoscopy determines inflammation. Dysrhythmias and bleeding are possible complications of mediastinoscopy.
4. The nursing instructor is talking with senior nursing students about diagnostic procedures used in respiratory diseases. The instructor discusses thoracentesis, defining it as a procedure performed for diagnostic purposes or to aspirate accumulated excess fluid or air from the pleural space. What would the instructor tell the students purulent fluid indicates?
A) Cancer
B) Infection
C) Inflammation
D) Heart failure
Ans: B
Feedback:
Purulent fluid is the recommended diagnosis for infection. Serous fluid may be associated with cancer, inflammatory conditions, or heart failure.
5. Your client has just had an invasive procedure to assess the respiratory system. What do you know should be assessed on this client?
A) Watery sputum
B) Loss of consciousness
C) Respiratory distress
D) Masses in pleural space
Ans: C
Feedback:
After invasive procedures, the nurse must carefully check for signs of respiratory distress and blood-streaked sputum. Masses in the pleural space affect fremitus. General examination of overall health and condition includes assessing the consciousness of a client.
6. An 18-month-old child is brought to the emergency department by his parents who explain that their child swallowed a watch battery. Radiologic studies show that the battery is in the lungs. Which area of lung is the battery most likely to be in?
A) Right upper lung
B) Left upper lung
C) Right lower lung
D) Left lower lung
Ans: A
Feedback:
Aspiration of foreign objects is more likely in the right main stem bronchus and right upper lung. The right mainstem bronchus is slightly higher and more vertical than the left, which is why foreign articles are often aspirated here first.
7. What happens to the diaphragm during inspiration?
A) It relaxes and raises.
B) It contracts and flattens.
C) It relaxes and flattens.
D) It contracts and raises.
Ans: B
Feedback:
During inspiration, the diaphragm contracts and flattens, which expands the thoracic cage and increases the thoracic cavity.
8. You are studying for a physiology test over the respiratory system. What should you know about central chemoreceptors in the medulla?
A) They respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid.
B) They respond to changes in the O2 levels in the brain.
C) They respond to changes in CO2 levels in the brain.
D) They respond to changes in O2 levels and bicarbonate levels in the cerebrospinal fluid.
Ans: A
Feedback:
Central chemoreceptors in the medulla respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid. Central chemoreceptors do not respond to changes in the O2 levels in the brain, changes in CO2 levels in the brain, changes in O2 levels, and bicarbonate levels in the cerebrospinal fluid.
9. What is the difference between respiration and ventilation?
A) Ventilation is the process of gas exchange.
B) Ventilation is the movement of air in and out of the respiratory tract.
C) Ventilation is the process of getting oxygen to the cells.
D) Ventilation is the exchange of gases in the lung. Ans: B
Feedback:
Ventilation is the actual movement of air in and out of the respiratory tract. Respiration is the exchange of oxygen and CO2 between atmospheric air and the blood and between the blood and the cells. Therefore, options A, C, and D are incorrect.
10. Perfusion refers to blood supply to the lungs, through which the lungs receive nutrients and oxygen. What are the two methods of perfusion?
A) The two methods of perfusion are the bronchial and alveolar circulation.
B) The two methods of perfusion are the bronchial and capillary circulation.
C) The two methods of perfusion are the bronchial and pulmonary circulation.
D) The two methods of perfusion are the alveolar and pulmonary circulation. Ans: C
Feedback:
The two methods of perfusion are the bronchial and pulmonary circulation. There is no alveolar circulation. Capillaries are the vessels that performs the perfusion regardless of
which area of the lung they are in.
11.A nurse is caring for a client who has frequent upper respiratory infections. Which structure is most helpful in protecting against infection?
A) Cilia
B) Sinus cavity
C) Tonsils
D) Turbinates
Ans: C
Feedback:
Tonsils and adenoids do not contribute to respiration but protect against infection. Palatine tonsils are composed of lymphoid tissue. Cilia are fine hairs that move particles and liquid, preventing irritation and contamination of the airway. Sinuses are nasal cavity structures. Turbinates warm and add moisture to the inspired air.
12.The nurse is suctioning a client who is unable to expectorate respiratory secretions. At which point does the nurse expect the client to experience coughing?
A) When the catheter reaches the back of the pharynx
B) When the catheter enters the main bronchus of the lung
C) When the catheter reaches the point of the carina
D) When the catheter tickles the uvula
Ans: C
Feedback:
Upon the catheter stimulating the carina, coughing and even bronchospasm may occur. Productive secretions may be loosened and eliminated via the suction catheter. When the catheter reaches the back of the pharynx near the uvula, the gag reflex is initiated. The suction catheter does not reach the entrance of the lung.
13.A client arrived in the emergency department with a sharp object penetrating the diaphragm. When planning nursing care, which nursing diagnosis would the nurse identify as a priority?
A) Acute Pain
B) Potential for Infection
C) Impaired Gas Exchange
D) Ineffective Airway Clearance
Ans: C
Feedback:
The diaphragm separates the thoracic and abdominal cavities. On inspiration, the diaphragm contracts and moves downward, creating a partial vacuum. Without this vacuum, air is not as efficiently drawn into the thoracic cavity. Hypoxia or hypoxemia may occur from the poor availability of oxygen. Although the nursing diagnosis Acute Pain is probable, gas exchange is a higher priority. Ineffective Airway Clearance is the least concern because the problem is with ventilation.
14. The nurse is caring for an adolescent client injured in a snowboarding accident. The client has a head injury, a fractured right rib, and various abrasions and contusions. The client has a blood pressure of 142/88 mm Hg, pulse of 102 beats/minute, and respirations of 26 breaths/minute. Which laboratory test best provides data on a potential impairment in ventilation?
A) Blood gases
B) Complete blood count
C) Blood chemistry
D) Serum alkaline phosphate
Ans: A
Feedback:
Blood gases report the partial pressure of oxygen, which is dissolved in the blood. Normal readings are 80 to 100 mm Hg. By documenting oxygen levels in the blood, the nurse recognizes the current ventilation. The complete blood count provides information regarding number of blood cells, which can relate to the disease processes such as anemia and infection. The blood chemistry provides information on liver/renal function and electrolytes within the system. Serum alkaline phosphate is a laboratory test used to help detect liver disease and bone disorders.
15. The nurse is analyzing a client's blood pH of 7.1. Which symptom would indicate that the patient's body is working to stabilize?
A) Respirations are increasing.
B) Urine output is decreased.
C) Heart rate is regular.
D) WBC count is within normal limits.
Ans: A
Feedback:
Increased CO2 mechanism, which is present in body fluids primarily as carbonic acid, causes the pH to decrease below 7.4. As a homeostatic mechanism to normalize pH, the lungs eliminate carbonic acid by blowing off more CO2. Respirations increase to normalize pH. None of the other symptoms note a reflection of stabilizing blood pH.
16. The nurse is providing health education on the body's ability to exchange oxygen and carbon dioxide through the alveolar capillary membrane. Which statement, provided by the nurse, is most correct when asked about diffusion during inspiration?
A) During inspiration, the concentration of oxygen is equal in both the alveoli and the capillaries.
B) During inspiration, oxygen diffuses from the arterial system through to the alveolar capillary membrane.
C) During inspiration, carbon dioxide provides the basis for all diffusion gradients.
D) During inspiration, oxygen is greater in the alveoli than in the capillaries. Ans: D
Feedback:
During inspiration, oxygen-rich air from the environment enters the pulmonary system. During inspiration, the concentration of inspired oxygen is higher in the alveoli than in the capillaries, causing diffusion from the alveoli to the capillaries. Thus, the concentration of oxygen is not equal in the alveoli and capillaries. There is no diffusion from the arterial system after the oxygen diffuses from the alveoli to the capillaries.
Carbon dioxide does not provide the basis for all diffusion gradients.
17. The nurse is caring for clients on the neurological unit. Which triad of neurological mechanisms does the nurse identify as most responsible when there is abnormality in ventilation control?
A) Medulla oblongata, cerebellum, and heart rate
B) Pons, cerebellum, and oxygen receptors
C) Medulla oblongata, mitral valve, and central receptors
D) Aortic arch, pons, and CO2 receptor sites
Ans: D
Feedback:
Several mechanisms control ventilation. The respiratory center in the medulla oblongata and pons control rate and depth of respirations. The central chemoreceptors in the medulla and peripheral chemoreceptors in the aortic arch also provide a mechanism for detecting abnormalities and signal changes to alter the pH and levels of oxygen in the blood. The other options have an incorrect piece of the triad.
18. The nurse is caring for a client with hypoxemia of unknown cause. Which of the following oxygen transport considerations does the nurse identify as crucial to circulate oxygen in the body system? Select all that apply.
A) Oxygen is dissolved.
B) High blood pressure disrupts oxygen transport.
C) Oxyhemoglobin circulates to the body tissue.
D) All systemic oxygen is available for diffusion.
E) Adequate red blood cells are needed for oxygen transport. Ans: A, C, E
Feedback:
Oxygen transport occurs by dissolving oxygen in the water in the plasma and combining oxygen with red blood cells (oxyhemoglobin). Normal red blood cell count is needed for oxygen transport. High blood pressure does not disrupt transport unless there is disruption in perfusion via a bleeding or occlusion. Dissolved oxygen is the only form which can diffuse across cell membranes.
19. The nurse is caring for a client with chronic obstructive pulmonary disease. The client calls the doctor and states having difficulty breathing and overall feeling fatigued. The nurse realizes that this client is at high risk for which condition?
A) Respiratory alkalosis
B) Respiratory acidosis
C) Metabolic acidosis
D) Metabolic alkalosis
Ans: B
Feedback:
Respiratory acidosis occurs when the body is unable to blow off CO2 due to the hypoventilation of disease processes such as COPD. An increase in blood carbon dioxide concentration occurs and a decreased pH causing acidosis. Respiratory alkalosis is a decrease in acidity of the blood and often caused by hyperventilation. Metabolic acidosis/alkalosis are disorders that affect the bicarbonate.
20. The nurse is caring for a client with a decrease in airway diameter causing airway resistance. The client experiences coughing and mucus production. Upon lung assessment, which adventitious breath sounds are anticipated?
A) Crackles
B) Rhonchi
C) Rubs
D) Wheezes
Ans: D
Feedback:
A decrease in airway diameter, such as in asthma, produces breath sounds of wheezes. Wheezes are a whistling type of sound relating to the narrowing on the airway. A wheeze can have a high-pitched or low-pitched quality. Crackles, also noted as rales, are crackling or rattling sounds signifying fluid or exudate in the lung fields. Rhonchi are a course rattling sound similar to snoring usually caused by secretion in the bronchial tree. Rubs are secretions that can be heard in the large airway.
21. The client is returning from the operating room following a bronchoscopy. Which action, performed by the nursing assistant, would the nurse stop if began prior to nursing assessment?
A) The nursing assistant is assisting the client to a semi-Fowler's position.
B) The nursing assistant is assisting the client to the side of the bed to use a urinal.
C) The nursing assistant is pouring a glass of water to wet the client's mouth.
D) The nursing assistant is asking a question requiring a verbal response. Ans: C
Feedback:
When completing a procedure which sends a scope down the throat, the gag reflex is anesthetized to reduce discomfort. Upon returning to the nursing unit, the gag reflex must be assessed before providing any food or fluids to the client. The client may need assistance following the procedure for activity and ambulation but this is not restricted in the post procedure period.
22. The nurse is performing a physical assessment on a client who has a history of a
respiratory infection. Which documentation, completed by the nurse, indicates the resolution of the infection? Select all that apply.
A) Lung fields documented as clear in the bases.
B) Palpable vibrations over the chest wall when the client speaks.
C) Decreased fremitus when the client speaks “99.”
D) Dull sounds percussed over the lung tissue.
E) Bronchovesicular sounds heard over the upper lung fields. Ans: A, B, E
Feedback:
The question asks for resolution or clearing of the infection; thus, normal respiratory status should be assessed. Lungs will return to clear breath sounds. Palpable vibrations will be felt as there is no blockage in the transmission. Bronchovesicular sounds will be noted over the upper lung fields. An increased fremitus is noted as the client speaks “99.” Dull percussed sounds indicate an area of consolidation.
23. The student nurse is learning breath sounds while listening to a client in the physician's office. An experienced nurse is assisting and notes air movement over the trachea to the upper lungs. The air movement is noted equally on inspiration as expiration. Which breath sounds would the nurse document?
A) Abnormal vesicular sounds
B) Normal bronchial sounds
C) Normal bronchovesicular sounds
D) Abnormal bronchial sounds
Ans: C
Feedback:
Air movement over the trachea and upper lungs is a normal finding for bronchovesicular sounds. The air movement is noted equally on inspiration as expiration. The other choices do not match type of breath sound for the location in question.
24.A client, experiencing respiratory distress, is ordered blood to be drawn for arterial blood gases (ABGs) via the radial artery. Before the blood is drawn, which circulation is assessed?
A) Carotid circulation
B) Ulnar circulation
C) Femoral circulation
D) Temporal circulation
Ans: B
Feedback:
Ulnar circulation is assessed using the Allen's test. The Allen's test is completed to assess blood supply through the ulnar and radial arteries. Noting both circulations is helpful when using an artery for the ABG draw. It is important to ensure adequate secondary blood flow to the hand other than through the radial artery in case the artery were to be damaged. No other circulation is assessed.
25.A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO – of 28 mEq/L. The nurse reports to the physician which finding?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Ans: A
Feedback:
Respiratory acidosis would be reported to the physician citing the lab values. Analysis of the blood gases reveals that the client is acidotic with a pH under 7.35. Also noted is the PCO2 above the normal range of 30 to 40 mm Hg. The HCO – is slightly elevated because the normal level is 22 to 26 mEq/L.
26. The nurse is caring for a client whose respiratory status has declined since shift report.
The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first?
A) Arterial blood gases
B) Pulmonary function test
C) Pulse oximetry
D) Chest x-ray
Ans: C
Feedback:
Pulse oximetry is a noninvasive method to determine arterial oxygen saturation. Normal values are 95% and above. Using this diagnostic test first provides rapid information of the client's respiratory system. All other options vary in amount of time and patient participation in determining further information regarding the respiratory system.
27. The nurse is caring for a client with an exacerbation of COPD and scheduled for pulmonary function studies using a spirometer. Which client statement would the nurse clarify?
A) “My study is scheduled for 10 AM, several hours after I eat.”
B) “I brought comfortable clothes and shoes for the test.”
C) “I am ordered a bronchodilator to note lung improvement following use.”
D) “I will breathe in through my mouth and out through my nose.” Ans: D
Feedback:
The nurse would clarify the client's statement of improper breathing technique. During a pulmonary function test using a spirometer, a nose clip prevents air from escaping through the client's nose when blowing into the spirometer. All other statements are correct.
28.A client presents to the emergency department in respiratory compromise. The client's temperature is 102.4° F, heart rate 88 beats/minute and regular, and blood pressure 138/76 mm Hg. The client is dyspneic, pale, and expectorating green-tinged sputum. The physician orders medications including antibiotics, antipyretics, nebulizer treatments, and IV fluids. A chest x-ray and sputum culture are to be completed. Which physician order would the nurse complete before beginning antibiotic therapy?
A) Chest x-ray
B) Sputum culture
C) Nebulizer treatments
D) Initiating IV fluids
Ans: B
Feedback:
The nurse would obtain a sputum culture for sensitivity before beginning antibiotic therapy. Obtaining a sputum culture after beginning antibiotics can skew results. Once the sputum culture results are returned, the antibiotic can be closely aligned to kill the organism, if present. The other orders can be prioritized according to client needs.
29.A nurse is obtaining a health history from a client who reports hemoptysis for the past 2 months. The client reports occasional dyspnea. Which imaging study, ordered by the physician, will view the thoracic cavity while in motion?
A) Fluoroscopy
B) Chest x-ray
C) Magnetic resonance imaging (MRI)
D) Computed tomography (CT) scan
Ans: A
Feedback:
Fluoroscopy enables the physician to view the thoracic cavity with all of its contents in motion. A fluoroscopy more precisely diagnoses the location of a tumor or lesion. An x- ray shows the size, shape, and position of the lungs. An MRI and CT produce axial views of the lungs.
30. The nurse is instructing the client on the normal sensations, which can occur when contrast medium is infused during pulmonary angiography. Which statement, made by the client, demonstrates an understanding?
A) “I will feel a dull pain when the catheter is introduced.”
B) “I will feel light-headed when the contrast medium is introduced.”
C) “I will feel waves of nausea throughout the procedure.”
D) “I will feel warm and an urge to cough.”
Ans: D
Feedback:
During a pulmonary angiography a contrast medium is injected into the femoral artery. When the medium is infused, the client will feel a sense of warm and flushed with an urge to cough. The client will feel a pressure when the catheter is inserted. The client does not typically feel light-headed or nauseated during the procedure.
31. The nurse is working on a busy respiratory unit. In caring for a variety of clients, the nurse must be knowledgeable of diagnostic studies. With which diagnostic studies would the nurse screen the client for an allergy to iodine? Select all that apply.
A) Lung scan
B) Chest x-ray
C) Fluoroscopy
D) Pulmonary angiography
E) Bronchoscopy
F) Pulmonary functions test
Ans: A, C, D
Feedback:
The nurse must be well educated in screening clients before diagnostic procedures which include contrast medium for an allergy to iodine. A lung scan, fluoroscopy and pulmonary angiography all require contrast medium.
32. The nurse is caring for a client who states, “I am really worried about the thoracentesis. I know I won't be able to sleep tonight.” Which statement is most helpful to the client at this time?
A) “Tell me what you are worried about.”
B) “Is there something that I can help you with?”
C) “Is there someone that you would like me to call to be with you?”
D) “The physician will see you before the procedure and can answer any questions.” Ans: A
Feedback:
A thoracentesis is performed by inserting a needle into the wall under local anesthesia. The thoracentesis is often done at the bedside. Providing support to the client before, during, and after the treatment is a nursing responsibility. When the client states that he is worried, asking an open-ended question promotes communication and is most therapeutic. Asking if there is something that a nurse can do is a closed-ended question. Asking about calling someone to be with the patient makes the nurse seem uninterested. Talking with the physician closes communication with the nurse, making the nurse seem uninterested.
33. The nurse is caring for a client in the immediate post–thoracentesis period. In which position is the client placed?
A) In the supine position
B) Lying on the unaffected side
C) In the high Fowler's position
D) Prone with a pillow under the head
Ans: B
Feedback:
Following a thoracentesis, the client remains on bed rest and typically lies on the
unaffected side for at least 1 hour to promote expansion of the lung on the affected side. Lying flat in a supine position or prone does not promote expansion of the lung.
34. The nurse receives an order to obtain a sputum sample from a client with hemoptysis.
When advising the client of the physician's order, the client states not being able to produce sputum. Which suggestion, offered by the nurse, is helpful in producing the sputum sample?
A) Tickle the back of the throat to produce the gag reflex.
B) Drink 8 oz of water to thin the secretions for expectoration.
C) Use the secretions present in the oral cavity.
D) Take deep breaths and cough forcefully.
Ans: D
Feedback:
Taking deep breaths moves air around the sputum and coughing forcefully moves the sputum up the respiratory tract. Once in the pharynx, the sputum can be expectorated into a specimen container. Producing a gag reflex elicits stomach contents and not respiratory sputum. Dilute and thinned secretions are not helpful in aiding expectoration. A sputum culture is not a component of oral secretions.
35.A client arrives at the physician's office stating 2 days of febrile illness, dyspnea, and cough. Upon assisting the client into a gown, the nurse notes that the client's sternum is depressed, especially on inspiration. Crackles are noted in the bases of the lung fields. Based on inspection, which will the nurse document?
A) The client has a funnel chest.
B) The client has chronic respiratory disease.
C) The client has pneumonia in the bases.
D) The client needs a cough suppressant.
Ans: A
Feedback:
The question asks for a documentation based on inspection. A funnel chest, known as pectus excavatum, has the sternum depressed from the second intercostal space, and it is more pronounced on inspiration. The nurse would not diagnose chronic respiratory disease or pneumonia. The client would also not prescribe a cough suppressant.
36.A client arrives at the physician's office stating dyspnea; a productive cough for thick, green sputum; respirations of 28 breaths/minute, and a temperature of 102.8° F. The nurse auscultates the lung fields, which reveal poor air exchange in the right middle lobe. The nurse suspects a right middle lobe pneumonia. To be consistent with this anticipated diagnosis, which sound, heard over the chest wall when percussing, is anticipated?
A) Tympanic
B) Resonant
C) Hyperresonant
D) Dull
Ans: D
Feedback:
A dull percussed sound, heard over the chest wall, is indicative of little or no air movement in that area of the lung. Lung consolidation such as in pneumonia or fluid accumulation produces the dull sound. A tympanic sound is a high-pitched sound commonly heard over the stomach or bowel. A resonant sound is noted over normal lung tissue. A hyperresonant sound is an abnormal lower pitched sound that occurs when free air exists in disease processes such as pneumothorax.
37.A client experiences a head injury in a motor vehicle accident. The client's level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client's respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth?
A) The pons
B) The frontal lobe
C) Central sulcus
D) Wernicke's area
Ans: A
Feedback:
The pons in the brainstem controls rate and depth of respirations. When injury occurs or increased intracranial pressure results, respirations are slowed. The frontal lobe completes executive functions and cognition. The central sulcus is a fold in the cerebral cortex called the central fissure. The Wernicke's area is the area linked to speech. [Show Less]