MED-SURG II
RESPIRATORY QUESTIONS
Cara Allen, John Wildgust & Saheel Patel
1. A nurse is instructing a hospitalized
client with a diagnosis of emphysema
about measures that will enhance the
effectiveness of breathing during dyspneic
periods. Which of the following positions
will the nurse instruct the client to
assume?
a.
b.
c.
d.
Sitting up in bed
Side-lying in bed
Sitting in a recliner chair
Sitting on the side of the bed and leaning on
an over-bed table
Correct Answer is D
Rationale:
Positions that will assist the client with emphysema with
breathing include sitting up and leaning on an overbed
table, sitting up and resting the elbows on the knees, and
standing and leaning against the wall.
Level of Cognitive Ability - Application
Client Needs - Physiological Integrity
Integrated Process - Teaching and Learning
Content Area - Adult Health—Respiratory
“Assume the position!”
Strategy
Use the process of elimination. Eliminate options 1 and 3
first because they are comparative or alike. Next, eliminate
option 2 because this position will not enhance breathing.
If you had difficulty with this question, review the
positions that will decrease the work of breathing in a
client with emphysema.
2.
A nurse performs an admission
assessment on a client with a
diagnosis of tuberculosis. The nurse
reviews the results of which
diagnostic test that will confirm this
diagnosis?
a.
b.
c.
d.
Bronchoscopy
Sputum culture
Chest X-ray
Tuberculin skin test
Correct Answer is B
Rationale:
Tuberculosis is definitively diagnosed through culture and
isolation of Mycobacterium tuberculosis. A presumptive
diagnosis is made based on a tuberculin skin test, a sputum
smear that is positive for acid-fast bacteria, a chest x-ray,
and histological evidence of granulomatous disease on
biopsy.
Level of Cognitive Ability - Analysis
Client Needs - Physiological Integrity
Integrated Process - Nursing Process—Assessment
Content Area - Adult Health—Respiratory
Strategy
Note the strategic word confirm in the question.
Confirmation is made by identifying M. tuberculosis. If you
had difficulty with this question, review the diagnostic
procedures related to tuberculosis.
3.
A nurse is caring for a client with
emphysema who is receiving
oxygen. The nurse assesses the
oxygen flow rate to ensure that it
does not exceed:
a.
b.
c.
d.
1 L/min
2 L/min
6 L/min
10 L/min
Correct Answer is B
Rationale:
Oxygen is used cautiously and should not exceed 2 L/min.
Because of the long-standing hypercapnia that occurs in
emphysema, the respiratory drive is triggered by low
oxygen levels rather than increased carbon dioxide levels,
as is the case in a normal respiratory system.
Level of Cognitive Ability - Analysis
Client Needs - Physiological Integrity
Integrated Process - Nursing Process—Assessment
Content Area - Adult Health—Respiratory
Strategy
Use the process of elimination, focusing on the client's
diagnosis. Recalling that in the client with emphysema,
respiratory drive is triggered by low oxygen levels will
direct you to option 2. If you are unfamiliar with this
important concept, review this content.
4.
Which of the following arterial blood
gas results indicates metabolic alkalosis?
a. pH of 7.34, Pco2 of 50mm Hg,
32 mEq/L , PO2 of 70mm Hg
b. pH of 7.46, Pco2 of 30mm Hg,
26 mEq/L , PO2 of 80mm Hg
c. pH of 7.38, Pco2 of 45mm Hg,
22 mEq/L , PO2 of 50mm Hg
d. pH of 7.47, Pco2 of 40mm Hg,
36 mEq/L , PO2 of 78mm Hg
HCO3 of
HCO3 of
HCO3 of
HCO3 of
Correct Answer is D
Rationale:
In a metabolic alkalosis, the pH is elevated, along with the
bicarbonate level (HCO3). Option 4 is the only option that
reflects these values.
Level of Cognitive Ability - Analysis
Client Needs - Physiological Integrity
Integrated Process - Nursing Process—Analysis
Content Area - Adult Health—Respiratory
Strategy
Remember that when an alkalotic condition exists, the pH
will be elevated. This will assist in eliminating options 1 and
3. Next, recall that in a metabolic condition, the HCO3 will
move in the same direction as the pH. The only option that
represents these conditions is option 4. Review the process
of blood gas analysis if you had difficulty with this question.
5.
A nurse instructs a client to us the
purse-lip method of breathing and the
client asks the nurse about he purpose of
this type of breathing. The nurse
responds, knowing that the primary
purpose of purse-lip breathing is to:
a.
b.
c.
d.
Promote oxygen intake
Strengthen the diaphragm
Strengthen the intercostals muscles
Promote carbon dioxide elimination
Correct Answer is D
Rationale:
Pursed-lip breathing facilitates maximal expiration for clients with
obstructive lung disease. This type of breathing allows better
expiration by increasing airway pressure that keeps air passages
open during exhalation. Options 1, 2, and 3 are not the purposes
of this type of breathing.
Level of Cognitive Ability - Comprehension
Client Needs - Physiological Integrity
Integrated Process - Teaching and Learning
Content Area - Adult Health—Respiratory
Strategy
Visualize the use of this procedure to assist you in answering
correctly. Knowledge regarding the respiratory conditions in which
this type of breathing is helpful also will assist in directing you to
option 4. Review the purpose of this breathing technique, if you
had difficulty with this question.
6.
A nurse is caring for a client after
a bronchoscopy and biopsy. Which
of the following signs, if noted in
the signs, if noted in the client,
should be reported immediately to
the physician?
a.
b.
c.
d.
Dry cough
Hematuria
Bronchospasm
Blood-streaked sputum
Correct Answer is C
Rationale:
If a biopsy was performed during a bronchoscopy, blood-streaked sputum
is expected for several hours. Frank blood indicates hemorrhage. A dry
cough may be expected. The client should be assessed for signs of
complications, which would include cyanosis, dyspnea, stridor,
bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias.
Hematuria is unrelated to this procedure.
Level of Cognitive Ability - Analysis
Client Needs - Physiological Integrity
Integrated Process - Nursing Process—Implementation
Content Area - Adult Health—Respiratory
Strategy
Use the process of elimination. Eliminate option 2 first because it is
unrelated to the procedure. Next, eliminate option 1 because a dry cough
may be expected. Noting that a biopsy has been performed will assist in
eliminating option 4, because blood-streaked sputum would be expected.
Note that option 3, the correct option, relates to the airway. If you had
difficulty with this question, review postprocedure care following
bronchoscopy with biopsy.
7. A nurse is suctioning fluids from a
client via tracheostomy tube. When
suctioning, the nurse must limit the
suctioning time to a maximum of:
a. 1 minute
b. 5 seconds
c. 10 seconds
d. 30 seconds
Correct Answer is C
Rationale:
Hypoxemia can be caused by prolonged suctioning, which
stimulates the pacemaker cells in the heart. A vasovagal response
may occur, causing bradycardia. The nurse must preoxygenate the
client before suctioning and limit the suctioning pass to 10
seconds.
Level of Cognitive Ability - Application
Client Needs - Physiological Integrity
Integrated Process - Nursing Process—Implementation
Content Area - Adult Health—Respiratory
Strategy
Use the process of elimination. Recall that during suctioning, the
client's airway is blocked; therefore, you should be able to
eliminate options 1 and 4 easily. From the remaining options,
eliminate option 2 because of the short time frame. Five seconds
does not seem reasonable to achieve removal of secretions.
Review the procedure for suctioning if you had difficulty with this
question.
1. Which of the following needs immediate
medical attention and emergency
intervention? The client who:
a. complains of sharp pain upon taking a
deep breath and excessive coughing
b. exhibits yellow, productive sputum, lowgrade fever, and crackles
c. has a shift of the trachea to the left, with
no breath sounds on the right
d.has asthma, and complains of inability to
“catch her breath” after exercise
2. A postoperative client has a sudden
onset of shortness of breath. What initial
action by the nurse is indicated?
a. notify the physician
b. assess the oxygen saturation using pulse
oximetry
c. assist the client to a high fowler’s position
d. auscultate the heart and lungs
3.
Nutritional recommendations for
the client with chronic obstructive
pulmonary disease (COPD) should
include which of the following?
a.
b.
c.
d.
weight-reduction guidelines
identification of foods that are calorie –dense
avoidance of between-meal snacks
more than 50% of intake as carbohydrates
Rationale
Answer is B
COPD pts are often underweight due
to fatigue associated with eating and
hence need to eat foods that help
ingest more calories with less effort
for eating.
4.
Which medication is most
effective for providing quick relief in
patients with acute episodes of
asthma?
a. Corticosteroid via metered-dose
inhaler as needed
b. Beta-agonist via metered does-inhaler
c. Anti-inflammatory via metered-dose
inhaler
d. Daily use of bronchodilator inhaler
Rationale
Answer is B
Mild and acute episodes are treated
with an anti-inflammatory and SABA
(Short Acting Beta Agonist). The
others are good for severe and more
frequent episodes.
5.
A client has a new chest tube located
at the base of thoracic cavity. Which
activity is expected during nursing care?
The nurse should:
a. Teach the client to clamp the tube before
ambulating
b. Palpate the chest wall for crepitus near the
insertion site
c. Change the dressing daily, to decrease
infection
d. Empty the drainage chamber at the end of the
shifts
Rationale
Answer is B
Crepitus is air bubbles under the skin
that can occur around the chest tube.
Dressing changes are not done daily
since the sealed system needs to be
maintained and there is additional
risk of tube displacement with
dressing changes
6.
A client is admitted to the hospital with
the medical diagnosis of traumatic brain
injury. From the assessment finding of
slow, shallow respirations, the nurse
concludes that which area of the brain is
affected by the injury?
a. Anterior pituitary
b. Hypothalamus
c. Medulla
d. Cerebral cortex
Rationale
Answer is C
The medulla and pons are the areas
of brain tissue that control breathing.
Injury to these tissues would
produce alterations in the client’s
breathing rate and pattern.
7.
Following placement of a central
venous line, which of the following data
should the nurse report immediately to
the physician?
a.
b.
c.
d.
Pain at the insertion site
Fever
Increased heart rate and/or respiratory rate
Diminished breath sounds in lung bases
Rationale
Answer is C
These are symptoms of a
pneumothorax caused by puncture of
the pleura. None of the others are
potentially life-threatening initially
ARDS
1. ARDS (acute respiratory distress
sydrome) is a form of cardiogenic
pulmonary edema that can quickly
lead to respiratory failure.
a. True
b. False
ANSWER
False. It is non cardiogenic
ARDS
2. Different types of treatments for
ARDS usually include all BUT…
a. IV fluid administration to maintain
BP
b. Sedatives, opiods, neuromuscular
blockers during mechanical
ventilation
c. PEEP
d. 2 liters of Oxygen NC
ANSWER
2 liters of O2 NC
Asthma
3. Mast cell stabilizers are used in the
treatment of asthma to:
a. Decrease bronchoconstriction
b. Block acetylcholine
c. Liquify secretions
d. Bock acute obstructive effects of
antigen exposure
ANSWER
Mast cell stabilizers block the acute
obstructive effects of antigen
exposure. They inhibit degranulation
of mast cells.
SARS (Severe Acute
Respiratory Syndrome)
4.
a.
b.
c.
d.
SARS is caused by
Coronavirus
Mycobacterium
Adenocarcinoma
Deficiency of alpha antitrypsin
ANSWER
Coronavirus
Pulmonary Embolism
5. All symptoms are usually associated
with a pulmonary embolism BUT…
a. Tachycardia
b. Low-grade fever
c. L. sided heart failure
d. Chest pain
ANSWER
Left side heart failure. Right sided
heart failure can be seen.
6.
a.
b.
c.
d.
e.
S/S commonly manifested in a patient with a PE
include all BUT :
Crackles
Chest pain
Tachypnea
Pulmonary hypertention
bradycardia
ANSWER
Bradycardia. Tachycaria is a
common symptom.
7. All are common findings in
ARDS patients except…
a.
b.
c.
d.
Low Po2 levels
Abnormal lung sounds
Intercostal retractions
Pulmonary Infiltrates on X-ray
ANSWER
Abnormal lung sounds.