Ch 19: Management of Patients with Lower Respiratory Tract Disorders

1. A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patient's increased risk for what complication?

A) Acute respiratory distress syndrome (ARDS)

B) Atelectasis

C) Aspiration

D) Pulmonary embolism

B) Atelectasis

2. A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurse's assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do?

A) Increase oral fluids unless contraindicated.

B) Call the nurse for oral suctioning, as needed.

C) Lie in a low Fowler's or supine position.

D) Increase activity.

A) Increase oral fluids unless contraindicated.

3. The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurse's assessment findings would best corroborate this diagnosis?

A) The patient is experiencing painless hemoptysis.

B) The patients arterial blood gases (ABGs) are normal, but he demonstrates increased work of breathing.

C) The patients oxygen saturation level is below 88%, but he denies shortness of breath.

D) The patients pain intensifies when he coughs or takes a deep breath.

D) The patients pain intensifies when he coughs or takes a deep breath.

4. The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action?

A) Smoking decreases the amount of mucus production.

B) Smoke particles compete for binding sites on hemoglobin.

C) Smoking causes atrophy of the alveoli.

D) Smoking damages the ciliary cleansing mechanism.

D) Smoking damages the ciliary cleansing mechanism.

5. The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client's oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what?

A) Diminished or absent breath sounds on the affected side

B) Paradoxical chest wall movement with respirations

C) Sudden loss of consciousness

D) Muffled heart sounds

A) Diminished or absent breath sounds on the affected side

6. The nurse in the intensive care unit is caring for a client with pulmonary hypertension. Which finding should the nurse expect to assess?

A. Pulmonary artery pressure greater than 20 mm Hg

B. Flat neck veins

C. Dyspnea at rest

D. Enlarged spleen

C. Dyspnea at rest

7. A new employee asks the occupational health nurse about measures to prevent inhalation exposure of the substances. Which statement by the nurse will decrease the patient's exposure risk to toxic substances?

A) "Position a fan blowing on the toxic substances to prevent the substance from becoming stagnant in the air."

B) "Wear protective attire and devices when working with a toxic substance."

C) "Make sure that you keep your immunizations up to date to prevent respiratory diseases resulting from toxins."

D) "Always wear a disposable paper face mask when you are working with inhalable toxins."

B) "Wear protective attire and devices when working with a toxic substance."

8. An x-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patient's plan of care?

A) Initiate chest physiotherapy

B) Immobilize the ribs with an abdominal binder.

C) Prepare the patient for surgery.

D) Immediately sedate and intubate the patient.

A) Initiate chest physiotherapy

9. An adult patient has tested positive for tuberculosis (TB). While providing patient teaching, what information should the nurse prioritize?

A) The importance of adhering closely to the prescribed medication regimen

B) The fact that the disease is a lifelong, chronic condition that will affect ADLs

C) The fact that TB is self-limiting, but can take up to 2 years to resolve

D) The need to work closely with the occupational and physical therapists

A) The importance of adhering closely to the prescribed medication regimen

10. The nurse is assessing an adult patient following a motor vehicle accident. The nurse observes that the patient has an increased use of accessory muscles and is complaining of chest pain and shortness of breath. The nurse should recognize the possibility of what condition?

A) Pneumothorax

B) Anxiety

C) Acute bronchitis

D) Aspiration

A) Pneumothorax

11. The nurse is caring for a patient suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the patient's symptoms from those of a cardiac etiology?

A) Carboxyhemoglobin level

B) Brain natriuretic peptide (BNP) level

C) C-reactive protein (CRP) level

D) Complete blood count

B) Brain natriuretic peptide (BNP) level

12. The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis?

A) Incentive spirometry

B) Intermittent positive-pressure breathing (IPPB)

C) Positive end-expiratory pressure (PEEP)

D) Bronchoscopy

A) Incentive spirometry

13. While planning a patient's care, the nurse identifies nursing actions to minimize the patient's pleuritic pain. Which intervention should the nurse include in the plan of care?

A) Administer an analgesic before coughing and deep breathing

B) Ambulate the patient at least three times daily.

C) Arrange for a soft-textured diet and increased fluid intake.

D) Encourage the patient to speak as little as possible

A) Administer an analgesic before coughing and deep breathing

14. The perioperative nurse is writing a care plan for a patient who has returned from surgery 2 hours prior. Which measure should the nurse implement to most decrease the patient's risk of developing pulmonary emboli (PE)?

A) Early ambulation

B) Increased dietary intake of protein

C) Maintaining the patient in a supine position

D) Administering aspirin with warfarin

A) Early ambulation

15.. The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response related to risk for lung cancer in smokers is most accurate?

A) "The younger you are when you start smoking, the higher your risk of lung cancer."

B) "The risk for lung cancer never decreases once you have smoked, which is why smokers need annual chest x-rays."

C) "The risk for lung cancer is determined mostly by what type of cigarettes you smoke."

D) "The risk for lung cancer depends primarily on the other risk factors for cancer that you have."

A) "The younger you are when you start smoking, the higher your risk of lung cancer."

16. The nurse is assessing a patient who has a 35 pack-year history of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the patient for further assessment?

A) "Lately, I have this cough that just never seems to go away."

B) "I find that I don't have nearly the stamina that I used to."

C) "I seem to get nearly every cold and flu that goes around my workplace."

D) "I never used to have any allergies, but now I think I'm developing allergies to dust and pet hair."

A) "Lately, I have this cough that just never seems to go away."

17. A client presents to the walk-in clinic complaining of a dry, irritating cough and production of a minute amount of mucus-like sputum. The patient complains of soreness in her chest in the sternal area. The nurse should suspect that the primary care provider will assess the patient for what health problem?

A) Pleural effusion

B) Pulmonary embolism

C) Tracheobronchitis

D) Tuberculosis

C) Tracheobronchitis

18. A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP?

A) Administration of prophylactic antibiotics

B) Administration of pneumococcal vaccine to vulnerable individuals

C) Obtaining culture and sensitivity swabs from all newly admitted patients

D) Administration of antiretroviral medications to patients over age 65

B) Administration of pneumococcal vaccine to vulnerable individuals

19. When assessing for substances that are known to harm workers' lungs, the occupational health nurse should assess their potential exposure to which of the following?

A) Organic acids

B) Propane

C) Asbestos

D) Gypsum

C) Asbestos

20. A patient presents to the ED stating she was in a boating accident about 3 hours ago. Now the patient has complaints of headache, fatigue, and the feeling that he "just can't breathe enough." The nurse notes that the patient is restless and tachycardic with an elevated blood pressure. This patient may be in the early stages of what respiratory problem?

A) Pneumoconiosis

B) Pleural effusion

C) Acute respiratory failure

D) Pneumonia

C) Acute respiratory failure

21. The nurse is caring for a 46-year-old patient recently diagnosed with the early stages of lung cancer. The nurse is aware that the preferred method of treating patients with non-small cell tumors is what?

A) Chemotherapy

B) Radiation

C) Surgical resection

D) Bronchoscopic opening of the airway

C) Surgical resection

22. A patient is receiving thrombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the patient's oxygenation status at the bedside?

A) Obtain serial ABG samples.

B) Monitor pulse oximetry readings.

C) Test pulmonary function.

D) Monitor incentive spirometry volumes.

B) Monitor pulse oximetry readings.

23. A patient with thoracic trauma is admitted to the ICU. The nurse notes the patient's chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated?

A) A chest tube

B) A tracheostomy

C) An endotracheal tube

D) A feeding tube

B) A tracheostomy

24. . The occupational health nurse is assessing new employees at a company. What would be important to assess in employees with a potential occupational respiratory exposure to a toxin? Select all that apply.

A) Time frame of exposure

B) Type of respiratory protection used

C) Immunization status

D) Breath sounds

E) Intensity of exposure

A, B, D, E

A) Time frame of exposure

B) Type of respiratory protection used

D) Breath sounds

E) Intensity of exposure

25. A 54-year-old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurse's response?

A) The cells in small cell cancer of the lung are not large enough to visualize in surgery.

B) Small cell lung cancer is self-limiting in many patients and surgery should be delayed.

C) Patients with small cell lung cancer are not normally stable enough to survive surgery.

D) Small cell cancer of the lung grows rapidly and metastasizes early and extensively.

D) Small cell cancer of the lung grows rapidly and metastasizes early and extensively.

26. A patient who involved in a workplace accident suffered a penetrating wound of the chest that led to acute respiratory failure. What goal of treatment should the care team prioritize when planning this patient's care?

A) Facilitation of long-term intubation

B) Restoration of adequate gas exchange

C) Attainment of effective coping

D) Self-management of oxygen therapy

B) Restoration of adequate gas exchange

27. A patient is brought to the ED by ambulance after a motor vehicle accident in which the patient received blunt trauma to the chest. The patient is in acute respiratory failure, is intubated, and is transferred to the ICU. What parameters of care should the nurse monitor most closely? Select all that apply.

A) Coping

B) Level of consciousness

C) Oral intake

D) Arterial blood gases

E) Vital signs

B) Level of consciousness

D) Arterial blood gases

E) Vital signs

28. A patient has just been diagnosed with lung cancer. After the physician discusses treatment options and leaves the room, the patient asks the nurse how the treatment is decided upon. What would be the nurse's best response?

A) "The type of treatment depends on the patient's age and health status."

B) "The type of treatment depends on what the patient wants when given the options."

C) "The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the patient's health status."

D) "The type of treatment depends on the discussion between the patient and the physician of which treatment is best."

C) "The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the patient's health status."

29. A firefighter was trapped in a fire and is admitted to the ICU for smoke inhalation. After 12 hours, the firefighter is exhibiting signs of ARDS and is intubated. What other supportive measures are initiated in a patient with ARDS?

A) Psychological counseling

B) Nutritional support

C) High-protein oral diet

D) Occupational therapy

B) Nutritional support

30. An 87-year-old patient has been hospitalized with pneumonia. Which nursing action would be a priority in this patient's plan of care?

A) Nasogastric intubation

B) Administration of probiotic supplements

C) Bedrest

D) Cautious hydration

D) Cautious hydration

31. The nurse caring for a client with an endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage of endotracheal tubes?

A. Cognition is decreased

B. Daily arterial blood gases (ABGs) are necessary.

C. Slight tracheal bleeding is anticipated.

D. The cough reflex is depressed.

D. The cough reflex is depressed.

32. The medical nurse is creating the care plan of a client with a tracheostomy requiring mechanical ventilation. Which nursing action is most appropriate?

A. Keep the client in a low Fowler position.

B. Perform tracheostomy care at least once per day.

C. Maintain continuous bed rest.

D. Monitor cuff pressure every 8 hours.

D. Monitor cuff pressure every 8 hours.

33. A nurse is educating a client in anticipation of a procedure that will require a water-sealed chest drainage system. What should the nurse tell the client and the family that this drainage system is used for?A. Maintaining positive chest-wall pressureB. Monitoring pleural fluid osmolarityC. Providing positive intrathoracic pressureD. Removing excess air and fluid

34. The nurse is preparing to wean a client from the ventilator. Which assessment parameter is most important for the nurse to assess?

A. Fluid intake for the last 24 hours

B. Arterial blood gas (ABG) levels

C. Prior outcomes of weaning

D. Electrocardiogram (ECG) results

B. Arterial blood gas (ABG) levels

35. While assessing the client, the nurse observes constant bubbling in the water-seal chamber of the client's closed chest-drainage system. Which conclusion should the nurse reach?

A. The system is functioning normally.

B. The client has a pneumothorax.

C. The system has an air leak.

D. The chest tube is obstructed.

C. The system has an air leak.

36. While caring for a client with an endotracheal tube, the nurse should normally provide suctioning how often?

A. Every 2 hours when the client is awake

B. When adventitious breath sounds are auscultated

C. When there is a need to prevent the client from coughing

D. When the nurse needs to stimulate the cough reflex

D. When the nurse needs to stimulate the cough reflex

37. The nurse is discussing activity management with a client who is postoperative following thoracotomy. What instructions should the nurse give to the client regarding activity immediately following discharge?

A. Walk 1 mile (1.6 km) 3 to 4 times a week.

B. Use weights daily to increase arm strength.

C. Walk on a treadmill 30 minutes daily.

D. Perform shoulder exercises five times daily.

D. Perform shoulder exercises five times daily.

38. A critical care nurse is caring for a client with an endotracheal tube who is on a ventilator. The nurse knows that meticulous airway management of this client is necessary. What is the main rationale for this?

A. Maintaining a patent airway

B. Preventing the need for suctioning

C. Maintaining the sterility of the client's airway

D. Increasing the client's lung compliance

A. Maintaining a patent airway

39. The critical care nurse and the other members of the care team are assessing the client to see if the client is ready to be weaned from the ventilator. What are the most important predictors of successful weaning that the nurse should identify?

A. Stable vital signs and arterial blood gases (ABGs)

B. Pulse oximetry above 80% and stable vital signs

C. Stable nutritional status and ABGs

D. Normal level of consciousness

A. Stable vital signs and arterial blood gases (ABGs)

40. The OR nurse is setting up a water-seal chest drainage system for a client who has just had a thoracotomy. The nurse knows that the amount of suction in the system is determined by the water level. At what suction level should the nurse set the system?

A. 20 cm H2O

B. 15 cm H2O

C. 10 cm H2O

D. 5 cm H2O

A. 20 cm H2O

41. The nurse is preparing to discharge a client after thoracotomy. The client is going home on oxygen therapy and requires wound care. As a result, the client will receive home care nursing. Which information should the nurse include in discharge teaching for this client?

A. Safe technique for self-suctioning of secretions

B. Technique for performing postural drainage

C. Correct and safe use of oxygen therapy equipment

D. How to provide safe and effective tracheostomy care

D. How to provide safe and effective tracheostomy care

The nurse is reviewing the electronic health record of a patient with an empyema. What health problem in the patient's history is most likely to have caused the empyema?

A) Smoking

B) Asbestosis

C) Pneumonia

D) Lung cancer

C) Pneumonia

The home care nurse is monitoring a patient discharged home after resolution of a pulmonary embolus. For what potential complication would the home care nurse be most closely monitoring this patient?

A) Signs and symptoms of pulmonary infection

B) Swallowing ability and signs of aspiration

C) Activity level and role performance

D) Residual effects of compromised oxygenation

D) Residual effects of compromised oxygenation

A patient in the ICU is status post embolectomy after a pulmonary embolus. What assessment parameter does the nurse monitor most closely on a patient who is postoperative following an embolectomy?

A) Pupillary response

B) Pressure in the vena cava

C) White blood cell differential

D) Pulmonary arterial pressure

D) Pulmonary arterial pressure

A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe?

A) Older adults have less compliant lung tissue than younger adults.

B) Older adults are not normally candidates for pneumococcal vaccination.

C) Older adults often lack the classic signs and symptoms of pneumonia.

D) Older adults often cannot tolerate the most common antibiotics used to treat pneumonia.

C) Older adults often lack the classic signs and symptoms of pneumonia.

1The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration?

A) A resident who suffered a severe stroke several weeks ago

B) A resident with mid-stage Alzheimer's disease

C) A 92-year-old resident who needs extensive help with ADLs

D) A resident with severe and deforming rheumatoid arthritis

A) A resident who suffered a severe stroke several weeks ago

The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should the nurse best assess whether the patient is hypoxemic?

A) Assess the patient's level of consciousness (LOC).

B) Assess the patient's extremities for signs of cyanosis.

C) Assess the patient's oxygen saturation level.

D) Review the patient's hemoglobin, hematocrit, and red blood cell levels.

C) Assess the patient's oxygen saturation level.

The nurse is caring for a patient in the ICU admitted with ARDS after exposure to toxic fumes from a hazardous spill at work. The patient has become hypotensive. What is the cause of this complication to the ARDS treatment?

A) Pulmonary hypotension due to decreased cardiac output

B) Severe and progressive pulmonary hypertension

C) Hypovolemia secondary to leakage of fluid into the interstitial spaces

D) Increased cardiac output from high levels of PEEP therapy

C) Hypovolemia secondary to leakage of fluid into the interstitial spaces

The nurse is caring for an 82-year-old patient with a diagnosis of tracheobronchitis. The patient begins complaining of right-sided chest pain that gets worse when he coughs or breathes deeply. Vital signs are within normal limits. What would you suspect this patient is experiencing?

A) Traumatic pneumothorax

B) Empyema

C) Pleuritic pain

D) Myocardial infarction

C) Pleuritic pain

The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client?

A) Coumadin will continue to break up the clot over a period of weeks

B) Coumadin must be taken concurrent with ASA to achieve anticoagulation.

C) Anticoagulant therapy usually lasts between 3 and 6 months.

D) He should take a vitamin supplement containing vitamin K

C) Anticoagulant therapy usually lasts between 3 and 6 months.

A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate?

A) Preparing to assist with intubating the patient

B) Setting up oxygen at 5 L/minute by nasal cannula

C) Performing deep suctioning

D) Setting up a nebulizer to administer corticosteroids

A) Preparing to assist with intubating the patient