_____ m.Segmental bronchi
2. A 92-year-old female patient is being admitted to the emergency department with severe shortness of breath. Being aware of the patient's condition, what approach should the nurse use to assess the patient's lungs (select all that apply)?
a. Apex to base b. Base to apex c. Lateral sequence d. Anterior then posterior e. Posterior then anterior
3. What keeps alveoli from collapsing?
a. Carina b. Surfactant c. Empyema d. Thoracic cage
4. What accurately describes the alveolar sacs?
a. Line the lung pleura
b. Warm and moisturize inhaled air
c. Terminal structures of the respiratory tract
d. Contain dead air that is not available for gas exchange 5. What covers the larynx during swallowing?
a. Trachea b. Epiglottis c. Turbinates d. Parietal pleura
6. Priority Decision: A 75-year-old patient who is breathing room air has the following arterial blood gas (ABG) results: pH 7.40, PaO2 74 mm Hg, SaO2 92%, PaCO2 40 mm Hg. What is the most appropriate action by the nurse?
a. Document the results in the patient's record.
b. Repeat the ABGs within an hour to validate the findings.
c. Encourage deep breathing and coughing to open the alveoli.
d. Initiate pulse oximetry for continuous monitoring of the patient's oxygen status.
7. A patient's ABGs include a PaO2 of 88 mm Hg and a PaCO2 of 38 mm Hg, and mixed venous blood gases include a PvO2 of 40 mm Hg and PvCO2 of 46 mm Hg. What do these findings indicate?
a. Impaired cardiac output b. Unstable hemodynamics
c. Inadequate delivery of oxygen to the tissues d. Normal capillary oxygen–carbon dioxide exchange
8. Priority Decision: A pulse oximetry monitor indicates that the patient has a drop in SpO2 from 95% to 85% over several hours. What is the first action the nurse should take?
a. Order stat ABGs to confirm the SpO2 with a SaO2. b. Start oxygen administration by nasal cannula at 2 L/min.
c. Check the position of the probe on the finger or earlobe.
d. Notify the health care provider of the change in baseline PaO2.
9. Pulse oximetry may not be a reliable indicator of oxygen saturation in which patient?
a. Patient with a fever
b. Patient who is anesthetized
c. Patient in hypovolemic shock d. Patient receiving oxygen therapy
10. A 73-year-old patient has an SpO2 of 70%. What other assessment should the nurse consider before making a judgment about the adequacy of the patient's oxygenation?
a. What the oxygenation status is with a stress test b. Trend and rate of development of the hyperkalemia
c. Comparison of patient's SpO2 values with the normal values d. Comparison of patient's current vital signs with normal vital signs 11. Which values indicate a need for the use of continuous oxygen therapy?
a. SpO2 of 92%; PaO2 of 65 mm Hg b. SpO2 of 95%; PaO2 of 70 mm Hg c. SpO2 of 90%; PaO2 of 60 mm Hg d. SpO2 of 88%; PaO2 of 55 mm Hg
12. Why does a patient's respiratory rate increase when there is an excess of carbon dioxide in the blood?
a. CO2 displaces oxygen on hemoglobin, leading to a decreased PaO2.
b. CO2 causes an increase in the amount of hydrogen ions available in the body.
c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid.
d. CO2 directly stimulates chemoreceptors in the medulla to increase respiratory rate and volume.
13. Which respiratory defense mechanism is most impaired by smoking?
a. Cough reflex b. Filtration of air c. Mucociliary clearance d. Reflex bronchoconstriction
14. Which age-related changes in the respiratory system cause decreased secretion clearance (select all that apply)?
a. Decreased force of cough b. Decreased functional cilia c. Decreased chest wall compliance
d. Small airway closure earlier in expiration e. Decreased functional immunoglobulin A (IgA)
15. Identify one specific finding identified by the nurse during assessment of each of the patient's functional health patterns that indicates a risk factor for respiratory problems or a patient response to an actual respiratory problem.
Functional Health Pattern Risk Factor for or Response to Respiratory Problem Health perception–health management
Nutritional-metabolic Elimination Activity-exercise Sleep-rest Cognitive-perceptual Self-perception–self-concept Role-relationship Sexuality-reproductive Coping–stress tolerance Value-belief
16. The abnormal assessment findings of dullness and hyperresonance are found with which assessment technique?
a. Inspection b. Palpation c. Percussion d. Auscultation
17. Palpation is the assessment technique used to find which abnormal assessment findings (select all that apply)?
a. Stridor
b. Finger clubbing c. Tracheal deviation d. Limited chest expansion e. Increased tactile fremitus f. Use of accessory muscles
18. How does the nurse assess the patient's chest expansion?
a. Put the palms of the hands against the chest wall.
b. Put the index fingers on either side of the trachea.
c. Place the thumbs at the midline of the lower chest.
d. Place one hand on the lower anterior chest and one hand on the upper abdomen.
19. When does the nurse record the presence of an increased anteroposterior (AP) diameter of the chest?
a. There is a prominent protrusion of the sternum.
b. The width of the chest is equal to the depth of the chest.
c. There is equal but diminished movement of the two sides of the chest.
d. The patient cannot fully expand the lungs because of kyphosis of the spine.
20. The patient is admitted with pneumonia, and the nurse hears a grating sound when she assesses the patient. How should the nurse document this sound?
a. Stridor
b. Bronchophony c. Course crackles d. Pleural friction rub
21. Match the descriptions or possible etiologies with the appropriate abnormal assessment findings.
_____ a. Finger clubbing _____ b. Stridor _____ c. Wheezes _____ d. Pleural friction rub _____ e. Increased tactile fremitus _____ f. Hyperresonance _____ g. Fine crackles _____ h. Absent breath sounds
1. Lung consolidation with fluid or exudate 2. Air trapping
3. Atelectasis 4. Interstitial edema 5. Bronchoconstriction
6. Partial obstruction of trachea or larynx 7. Chronic hypoxemia
8. Pleurisy
22. A nurse has been caring for a patient with tuberculosis (TB) and has a TB skin test performed.
When is the nurse considered infected?
a. There is no redness or induration at the injection site.
b. There is an induration of only 5 mm at the injection site.
c. A negative skin test is followed by a negative chest x-ray.
d. Testing causes a 10-mm red, indurated area at the injection site.
23. What is a primary nursing responsibility after obtaining a blood specimen for ABGs?
a. Add heparin to the blood specimen.
b. Apply pressure to the puncture site for 2 full minutes.
c. Take the specimen immediately to the laboratory in an iced container.
d. Avoid any changes in oxygen intervention for 15 minutes following the procedure.
24. What should the nurse do when preparing a patient for a pulmonary angiogram?
a. Assess the patient for iodine allergy.
b. Implement NPO orders for 6 to 12 hours before the test.
c. Explain the test before the patient signs the informed consent form.
d. Inform the patient that radiation isolation for 24 hours after the test is necessary.
25. The nurse is preparing the patient for and will assist the health care provider with a
thoracentesis in the patient's room. Number the following actions in the order the nurse should complete them. Use 1 for the first action and 7 for the last action.
_____ a. Verify breath sounds in all fields.
_____ b. Obtain the supplies that will be used.
_____ c. Send labeled specimen containers to the lab.
_____ d. Direct the family members to the waiting room.
_____ e. Observe for signs of hypoxia during the procedure.
_____ f. Instruct the patient not to talk during the procedure.
_____ g. Position the patient sitting upright with the elbows on an over-the-bed table.
26. After which diagnostic study should the nurse observe the patient for symptoms of a pneumothorax?
a. Thoracentesis
b. Pulmonary function test c. Ventilation-perfusion scan
d. Positron emission tomography (PET) scan
27. The health care provider orders a pulmonary angiogram for a patient admitted with dyspnea and hemoptysis. For which problem is this test most commonly used as a diagnostic measure?
a. Tuberculosis (TB) b. Cancer of the lung c. Airway obstruction d. Pulmonary embolism
28. Match the following pulmonary capacities and function tests with their descriptions.
_____ a. Vt _____ b. RV _____ c. TLC _____ d. VC _____ e. FVC _____ f. PEFR _____ g. FEV1 _____ h. FRC
1. Amount of air exhaled in first second of forced vital capacity 2. Maximum amount of air lungs can contain
3. Volume of air inhaled and exhaled with each breath
4. Maximum amount of air that can be exhaled after maximum inspiration 5. Amount of air that can be quickly and forcefully exhaled after maximum inspiration 6. Maximum rate of airflow during forced expiration
7. Amount of air remaining in lungs after forced expiration 8. Volume of air in lungs after normal exhalation