Chapter 25- Respiratory Function Nursing School Test Banks

 

1.

A patient who is scheduled for a bronchoscopy has arrived at the clinical facility. When preparing for the test, the patient reports feeling hungry and asks the nurse when he will be able to eat. What information should be provided by the nurse?

A)

You will not be allowed to eat or drink until the physician has seen you.

B)

You may immediately resume your normal diet after the test.

C)

You will not be able to eat or drink until your gag reflex has returned.

D)

It will be at least 8 hours after the procedure before you are allowed to eat or drink.

Ans:

C

Feedback:

The bronchoscopy allows for the visualization of the airways. Nursing interventions for a bronchoscopy include ensuring informed consent, teaching before the procedure, and maintaining NPO status until the gag reflex returns after the procedure.

2.

The nursing assessment reveals reduced fremitus. This manifestation is consistent with which of the following conditions? Select all that apply.

A)

Right-sided heart failure

B)

Left-sided heart failure

C)

Pneumonia

D)

Pulmonary edema

E)

Bronchial obstruction

Ans:

B, D, E

Feedback:

Fremitus refers to the vibration of air movement through the chest wall. It is best felt by placing the balls of the palms of your hand on the patients back as he or she says 99. The intrascapular space is a good area to feel tactile fremitus because it diminishes as you move out in the lung fields. Decreased fremitus may occur with pleural effusion, pulmonary edema, emphysema, or bronchial obstruction. Left-sided heart failure will result in pulmonary edema, causing decreased fremitus.

3.

The nurse is reviewing the pulse oximeter readings from a postoperative patient. The nurse correctly recognizes that readings below what level indicate the need for oxygen therapy and further assessment?

A)

97%

B)

95%

C)

93%

D)

90%

Ans:

C

Feedback:

An SaO2 greater than 95% is considered normal, whereas values lower than 93% usually indicate the need for oxygen therapy and further assessment.

4.

The nurse is talking with a patient who has COPD. The patient reports her chest shape seems to have changed over the past year. What information should be provided by the nurse?

A)

Your chest diameter has increased as the musculature has matured in an effort to obtain increased amounts of oxygen.

B)

Your lung condition limits the ability of the lungs to fully exhale, causing this change in shape.

C)

Chronic lung conditions such as this are associated with fluid retention in the lower lung fields, causing the change in the chest shape.

D)

The corticosteroids prescribed to manage the condition have caused a change in the shape of the chest wall.

Ans:

B

Feedback:

In COPD, the patients chest becomes overinflated over time because of an inability to exhale fully. This increases the anteriorposterior chest diameter, resulting in a barrel-shaped appearance.

5.

A patient has edema of the feet and ankles, along with crackles in the lower lobes and a frothy, productive cough. The patient is suffering from

A)

Pulmonary embolism

B)

Myocardial infarction

C)

Lung cancer

D)

Congestive heart failure

Ans:

D

Feedback:

A patient who has edema and a cough that is productive with frothy sputum is manifesting heart failure.

6.

The patient has an increased anteroposterior chest diameter, dyspnea, and nasal flaring. The most appropriate nursing diagnosis is

A)

Hypoxia related to pneumonia and ineffective airway clearance related to dyspnea edema

B)

Ineffective breathing pattern related to hyperventilation related to increased anteroposterior diameter

C)

Risk for ineffective airway clearance related to infection as evidenced by dyspnea and yellow-green sputum

D)

Impaired gas exchange related to increased carbon dioxide and irritability

Ans:

B

Feedback:

Ineffective breathing pattern is the state in which a persons inspiration and/or expiration pattern does not provide adequate ventilation.

7.

A patient with chronic obstructive pulmonary disease requires low flow oxygen. How will the oxygen be administered?

A)

Nasal cannula

B)

Simple oxygen mask

C)

Venturi mask

D)

Partial rebreather mask

Ans:

A

Feedback:

Nasal cannula and tubing administers oxygen concentrations at 22% to 44%.

8.

When the emergency room nurse assesses the pulse oximeter on a patient and it reveals 105%, the nurse determines that the most likely explanation for the value is

A)

Carbon monoxide poisoning

B)

Edema at the sensor site

C)

High oxygen level

D)

Low carbon dioxide levels

Ans:

A

Feedback:

Carbon monoxide poisoning results in false high readings; edema at the sensor site produces false low readings.

9.

The home care nurse visits a patient with compromised lung function. She has greenish-yellow sputum with a musty odor. This is indicative of

A)

Allergy

B)

Congestive heart failure

C)

Asthma

D)

Infection

Ans:

D

Feedback:

Sputum that is yellow or greenish or has a musty odor usually indicates an infection. The sputum associated with congestive heart failure is frothy or pink tinged. Sputum associated with asthma is thick and mucoid, not yellow or green in color.

10.

Which of the following medications are administered in the home or the hospital to relieve inflammation in the lung tissue?

A)

Antibiotics

B)

Bronchodilators

C)

Expectorants

D)

Corticosteroids

Ans:

D

Feedback:

In many cases, bronchodilators and corticosteroids are required to open airways and ease breathing. Corticosteroids relieve inflammation.

11.

When the patient demonstrates loud, coarse breath sounds on inspiration, the nurse documents the breath sounds heard as

A)

Crackles

B)

Vesicular

C)

Wheezes

D)

Rales

Ans:

A

Feedback:

A coarse crackle is a low-pitched, rumbling sound in airways. When they are coarse and loud and occur with severe dyspnea, crackles may be a telling sign of pulmonary fibrosis, congestive heart failure, and pulmonary edema.

12.

What skin disorder is associated with asthma?

A)

Seborrhea

B)

Psoriasis

C)

Abrasions

D)

Eczema

Ans:

D

Feedback:

The patient with asthma often recalls childhood allergies and eczema.

13.

The nurse is assessing a patient with lung cancer. What manifestations may be noted that are indicative of hypoxia?

A)

Edema

B)

Cyanosis

C)

Constipation

D)

Clubbing

Ans:

D

Feedback:

Clubbing refers to the rounding and enlargement of the tips of the fingers and toes. It is a common phenomenon seen in many patients with respiratory or cardiac disease. Clubbing is believed to be caused by long-term tissue hypoxia which causes the release of a substance that causes dilation of the vessels of the fingertips (Lewis, et al., 2007). Clubbing occurs in lung cancer, cystic fibrosis, and lung diseases such as lung abscess and chronic obstructive pulmonary disease.

14.

A child is admitted to the pediatric division with an acute asthma attack. The nurse assesses the lung sounds and respiratory rate. The mother asks the nurse, Why is his chest sucking in above his stomach? The nurses most accurate response is

A)

He will require additional testing to determine the cause.

B)

He is using his chest muscles to help him breathe.

C)

His infection is causing him to breathe harder.

D)

His lung muscles are swollen so he is using abdominal muscles.

Ans:

B

Feedback:

The patient will use accessory muscles to ease dyspnea and improve breathing.

15.

The home care nurse visits a patient who has dyspnea. The nurse notes the patient has pitting edema in his feet and ankles. What additional assessment would the nurse expect to observe?

A)

Crackles in the lower lobes

B)

Inspiratory stridor

C)

Expiratory stridor

D)

Wheezing in the upper lobes

Ans:

A

Feedback:

People with chronic congestive heart failure often experience shortness of breath because of excess fluid in the lungs and low oxygen levels. Stridor is associated with respiratory infections such as croup. Wheezing may be heard in individuals who use tobacco products.

16.

A patient suffering from chronic obstructive pulmonary disease complains that it is hard to cough up secretions and they are thick and sticky. The nurse should instruct the patient to

A)

Increase her fluid intake to thin secretions

B)

Eat small frequent meals to conserve energy

C)

Decrease exercise and increase rest periods

D)

Take a cough suppressant to decrease coughing

Ans:

A

Feedback:

When a cough is productive, it is important to establish the source of the sputum and assess its color, volume, consistency, and other noteworthy characteristics. The nurse should instruct the patient to increase fluid intake to thin secretions.

17.

A woman comes to the emergency room with her 2-year-old. She states he woke up and had a loud barking cough. The child is suffering from

A)

Atelectasis

B)

Pulmonary fibrosis

C)

Asthma

D)

Croup

Ans:

D

Feedback:

Croup and epiglottitis are common in young children. The child has an obstruction of the upper airways, with swelling of the throat tissue. Atelectasis results when the lungs collapse as a result of the alveoli being unable to expand. Symptoms include difficulty breathing and discomfort. Pulmonary fibrosis is a condition in which the lung tissue becomes stiff and unable to expand appropriately. Asthma is a condition associated with bronchoconstriction. The symptoms include nonproductive cough, dyspnea, and wheezing.

18.

The nurse is caring for a postoperative adult patient who has developed pneumonia. The nurse should assess the patient frequently for symptoms of

A)

Atelectasis

B)

Bronchospasm

C)

Croup

D)

Epiglottitis

Ans:

A

Feedback:

Stiffer lungs tend to collapse and their alveoli also collapses. This condition is called atelectasis.

19.

Which of the following dietary guidelines would be appropriate for the elderly homebound patient with advanced respiratory disease who informs the nurse that she has no energy to eat?

A)

Snack on high-carbohydrate foods frequently

B)

Eat smaller meals that are high in protein

C)

Contact the physician for Ensure

D)

Eat one large meal at noon

Ans:

B

Feedback:

The patient should consume a diet in which the body can produce plasma proteins. The patient should have sufficient caloric and protein intake for respiratory muscle strength.

20.

A nurse is volunteering at a day camp. A child is stung by a bee and develops wheezing in the upper airways. The child is experiencing

A)

A bronchospasm

B)

Bronchitis

C)

Bronchiectasis

D)

Bronchiolitis

Ans:

A

Feedback:

When allergic responses take place in the lungs, breathing difficulties are far more severe. Small airways become edematous, mucous production increases, and inflammatory chemical mediators cause bronchospasm.

21.

Which one of the following problems occurs among individuals exposed to automobile pollutants

A)

Atelectasis

B)

Bronchitis

C)

Bronchiectasis

D)

Croup

Ans:

B

Feedback:

Air pollution and high humidity are respiratory irritants. Pollutants cause increased mucous production and contribute to bronchitis and asthma.

22.

It is a red air-quality day in your city. This means the air is stagnant, with high pollution levels and high humidity. Which patient is most likely to experience shortness of breath?

A)

Child with asthma

B)

Middle-aged adult with hypertension

C)

Teenager with contact dermatitis

D)

Young adult without disease

Ans:

A

Feedback:

Air pollution and high humidity are respiratory irritants. Pollutants cause increased mucous production and contribute to bronchitis and asthma. While pollution is not good for any group of individuals it would be less of an impact on the person with hypertension or dermatitis.

23.

A patient with chronic obstructive pulmonary disease complains of severe shortness of breath when it is raining. The nurse instructs the patient

A)

The airway becomes occluded during periods of rain.

B)

The air is thicker or more viscous with humidity, thus it is harder for you to breathe.

C)

You should use your inhaler during this time to help your breathing.

D)

Have you had a stress test to determine if your airway is obstructed?

Ans:

B

Feedback:

People with chronic respiratory diseases often find breathing more difficult when the weather is hot and humid because humidity contributes to air viscosity.

24.

During a routine prenatal care visit, a pregnant woman in her last trimester of pregnancy complains of shortness of breath. The nurse instructs her that:

A)

Her breathing is normal but if it continues to call her physician.

B)

If she has pneumonia she should have a chest X-ray.

C)

The nurse will assess her lung sounds and determine presence of congestion.

D)

Her breathing will become increasingly difficult as the diaphragm is displaced upward.

Ans:

D

Feedback:

During the last weeks of pregnancy, breathing may become increasingly difficult in a supine position because the fetus displaces the diaphragm upward.

25.

The nurse determines that the student who has been instructed about lung function and smoking requires additional teaching when the student says

A)

A physically fit athlete breathes more slowly than a sedentary person.

B)

Smoking only once in a while will not make a person addicted to smoking.

C)

An older person may breathe more shallowly than a younger person.

D)

An upright position will help someone breathe with less effort.

Ans:

B

Feedback:

During adolescence, more than 3000 young men and women begin smoking every day, and most will become addicted before age 20. One reason for this finding is that adolescents dont believe they will become addicted to tobacco when they start to smoke.

26.

The nurse is assessing a newborn in the nursery. The nurse notes the infant has episodes in which breathing ceased for 20 seconds on twooccasions . The nurse correctly recognizes this condition as which of the following?

A)

Dyspnea

B)

Apnea

C)

Orthopnea

D)

Hypercapnea

Ans:

B

Feedback:

The newborns breathing pattern is characterized by occasional pauses of several seconds between breaths. This periodic breathing is normal during the first 3 months of life, but frequent or prolonged periods of apnea (cessation of breathing 20 seconds or longer) are abnormal. Dyspnea refers to a shortness of breath. Orthopnea refers to difficulty breathing when lying flat. An excess of carbon monoxide is termed hypercapnea.

27.

When the nurse observes a newborn infant demonstrating an irregular abdominal breathing pattern, with a respiratory rate of 50 breaths/minute with occasional pauses in breathing of 5-second durations, the most appropriate action by the nurse is to

A)

Begin resuscitation efforts

B)

Elevate the head of the crib

C)

Continue to assess the infant

D)

Position the infant side-lying

Ans:

C

Feedback:

Newborns breathe rapidly at 30 to 60 breaths per minute and may have occasional pauses of several seconds between breaths.

28.

Oxygen and carbon dioxide move between the alveoli and the blood by

A)

Osmosis

B)

Hyperosmolar pressure

C)

Diffusion

D)

Negative pressure

Ans:

C

Feedback:

Oxygen and carbon dioxide move between the alveoli and the blood by diffusion, the process in which molecules move from an area of greater concentration or pressure to an area of lower concentration or pressure.

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