Respiratory System Review Questions

Respiratory System Review Questions Ana Corona, MSN, FNP-C Nursing Instructor September 2007

Question 1 • A client with hemophilia has epistaxis. Which nursing action is most appropriate to control the bleeding? • Place the client in a sitting position with the head hyperextended • Pack the nares tightly with gauze to apply pressure to the source of bleeding • Pinch the soft lower part of the nose for a minimum of 5 minutes • Apply ice packs to the forehead and back of the neck

Answer 1 • Answer C is correct. The client should be positioned upright and leaning forward, to prevent aspiration of blood. Answers A, B, and D are incorrect because direct pressure to the nose stops the bleeding, and ice packs should be applied directly to the nose as well. If a pack is necessary, the nares are loosely packed.

Question 2 • A client is admitted to the hospital with a temperature of 99.8°F, complaints of blood-tinged hemoptysis, fatigue, and night sweats. The client's symptoms are consistent with a diagnosis of: • Pneumonia • Reaction to antiviral medication • Tuberculosis • Superinfection due to low CD4 count

Answer 2 • Answer C is correct. A low-grade temperature, blood-tinged sputum, fatigue, and night sweats are symptoms consistent with tuberculosis. If the answer in A had said pneumocystis pneumonia, answer A would have been consistent with the symptoms given in the stem, but just saying pneumonia isn’t specific enough to diagnose the problem. Answers B and D are not directly related to the stem.

Question 3 • The client admitted 2 days earlier with a lung resection accidentally pulls out the chest tube. Which action by the nurse indicates understanding of the management of chest tubes? • Order a chest x-ray • Reinsert the tube • Cover the insertion site with a Vaseline gauze • Call the doctor

Answer 3 • Answer C is correct. If the client pulls the chest tube out of the chest, the nurse’s first action should be to cover the insertion site with an occlusive dressing. Afterward, the nurse should call the doctor, who will order a chest x-ray and possibly reinsert the tube. Answers A, B, and D are not the first action to be taken

Question 4 • A client with bacterial pneumonia is admitted to the pediatric unit. What would the nurse expect the admitting assessment to reveal? • High fever • Nonproductive cough • Rhinitis • Vomiting and diarrhea

Answer 4 • Answer A is correct. If the child has bacterial pneumonia, a high fever is usually present. Bacterial pneumonia usually presents with a productive cough, not a nonproductive cough, making answer B incorrect. Rhinitis is often seen with viral pneumonia, and vomiting and diarrhea are usually not seen with pneumonia, so answers C and D are incorrect.

Question 5 • The nurse is caring for a client admitted with epiglotitis. Because of the possibility of complete obstruction of the airway, which of the following should the nurse have available? • Intravenous access supplies • A tracheostomy set • Intravenous fluid administration pump • Supplemental oxygen

Answer 5 • Answer B is correct. For a patient with epiglotitis and the possibility of complete obstruction of the airway, emergency tracheostomy equipment should always be kept at the bedside. Intravenous supplies, fluid, and oxygen will not treat an obstruction; therefore, answers A, C, and D are incorrect.

Question 6 • The nurse is caring for an 80-year-old with chronic bronchitis. Upon the morning rounds, the nurse finds an O2 sat of 76%. Which of the following actions should the nurse take first? • Notify the physician • Recheck the O2 saturation level in 15 minutes • Apply oxygen by mask • Assess the child's pulse

Answer 6 • Answer C is correct. Remember the ABCs (airway, breathing, circulation) when answering this question. Before notifying the physician or assessing the pulse, oxygen should be applied to increase the oxygen saturation, so answers A and D are incorrect. The normal oxygen saturation is 95%–100%, making answer B incorrect.

Question 7 • The nurse is caring for a 30-year-old male admitted with a stab wound. While in the emergency room, a chest tube is inserted. Which of the following explains the primary rationale for insertion of chest tubes? • The tube will allow for equalization of the lung expansion. • Chest tubes serve as a method of draining blood and serous fluid and assist in reinflating the lungs. • Chest tubes relieve pain associated with a collapsed lung. • Chest tubes assist with cardiac function by stabilizing lung expansion.

Answer 7 • Answer B is correct. Chest tubes work to reinflate the lung and drain serous fluid. The tube does not equalize expansion of the lungs. Pain is associated with collapse of the lung, and insertion of chest tubes is painful, so answers A and C are incorrect. Answer D is true, but this is not the primary rationale for performing chest tube insertion.

Question 8 • A patient is getting discharged from a SNF facility. The patient has a history of severe COPD and PVD. The patient is primarily concerned about their ability to breath easily. Which of the following would be the best instruction for this patient? A: Deep breathing techniques to increase O2 levels. B: Cough regularly and deeply to clear airway passages. C: Cough following bronchodilator utilization D: Decrease CO2 levels by increase oxygen take output during meals.

Answer 8 • (C) The bronchodilator will allow a more productive cough.

Question 9 • The nurse is changing the ties of the client with a tracheotomy. The safest method of changing the tracheotomy ties is to: • Apply the new tie before removing the old one. • Have a helper present. • Hold the tracheotomy with the nondominant hand while removing the old tie. • Ask the doctor to suture the tracheostomy in place.

Answer 9 • Answer A is correct. The best method and safest way to change the ties of a tracheotomy is to apply the new ones before removing the old ones. Having a helper is good, but the helper might not prevent the client from coughing out the tracheotomy. Answer C is not the best way to prevent the client from coughing out the tracheotomy. Asking the doctor to suture the tracheotomy in place is not appropriate.

Question 10 • The nurse is monitoring a client following a lung resection. The hourly output from the chest tube was 300mL. The nurse should give priority to: • Turning the client to the left side • Milking the tube to ensure patency • Slowing the intravenous infusion • Notifying the physician

Answer 10 • Answer D is correct. The output of 300mL is indicative of hemorrhage and should be reported immediately. Answer A does nothing to help the client. Milking the tube is done only with an order and will not help in this situation, and slowing the intravenous infusion is not correct; thus, answers B and C are incorrect.

Question 11 • Which of the following conditions would a nurse not administer erythromycin? A: Campylobacterial infection B: Legionnaire’s disease C: Pneumonia D: Multiple Sclerosis

Answer 11 • (D) Erythromycin is used to treat conditions A-C.

Question 12 • The nurse in the out-patient clinic evaluates the Mantoux test of a 36-year-old woman. The woman’s history indicates that she has been treated during the past year for an AIDS-related infection. The nurse should document that there was a positive reaction if there was an area of induration measuring what? • 3 mm • 7 mm • 11 mm • 15 mm

Answer 12 • Answer is B • Explanation of Answer:A measurement greater than a 5 mm area is positive for patient with an HIV-infection history.

Question 13 • The nurse is observing a student nurse care for a patient with a tracheostomy tube. The nurse would intervene if which of the following was observed? • The student nurse uses clean gloves to remove the tracheostomy dressing. • The student nurse cleans the inner canula by soaking it in hydrogen peroxide. • The student nurse replaces the dressing with a folded gauze 4 X 4. • The student nurse removes the soiled trach ties then replaces with clean ties.

Answer 13 • Answer is D • Explanation of Answer:The student nurse should apply new ties prior to removing old ties to prevent dislodgment of the trach.

Question 14 • A 25-year-old man is being treated for Pneumocystis carinii pneumonia. The nurse should intervene in which of the following situations? • A housekeeper cleans up spilled blood with a bleach solution. • A nursing student takes the patient’s blood pressure wearing a mask and gloves. • A technician wears gloves to perform a venipuncture. • A nurse attendant allows visitors to enter his room without masks.

Answer 14 • Answer is B • Explanation of Answer:The mask and gloves are necessary only when possibility of contact with blood and body fluids. When taking a BP, there is very low risk for contact with blood and body fluids. Behavior insensitivity to a patient’s feelings, does not promote trust.

Question 15 • A 67-year-old patient with emphysema becomes restless and confused. Which of the following actions, if taken by the nurse, is BEST? • Encourage the patient to perform pursed lip breathing. • Check the patient’s temperature. • Assess the patient’s potassium level. • Increase the patient’s oxygen flow rate to 5 L/min.

Answer 15 • Answer is A • Explanation of Answer:This prevents collapse of lung unit and helps the patient control the rate and depth of breathing.

Question 16 • Mr. Robert Bacchus is a 63-year-old retired business executive who comes to the emergency room with complaints of dyspnea, shortness of breath, and chest pain radiating to the left arm. The nurse caring for Mr. Bacchus should implement which of the following actions FIRST? A. Administer prescribed pain medication B.. Apply oxygen per nasal cannula as ordered C. Assess vital signs D. Apply electrocardiogram electrodes to the patient's chest

Answer 16 • The intended response is C, since vital sign assessment will provide baseline data of vital cardiac and respiratory function, which will then serve as a guideline for diagnosis and therapy measures.

Question 17 • A 38-year-old male is admitted with an upper-respiratory infection has an order for O2 saturation via pulse oximeter. To ensure an accurate reading, the nurse should: • Place the probe on the patient’s abdomen • Recalibrate the oximeter at the beginning of each shift • Apply the probe and wait 15 minutes before obtaining a reading • Place the probe on the patient’s finger

Answer 17 • Answer D is correct. The pulse oximeter should be placed on the patient’s finger or earlobe because blood flow to these areas is most accessible for measuring oxygen concentration. Answer A is incorrect because the probe cannot be secured to the abdomen. Answer B is incorrect because it should be recalibrated before application. Answer C is incorrect because a reading is obtained within seconds, not minutes.

Question 18 • The nurse should observe for side effects associated with the use of bronchodilators. A common side effect of bronchodilators is: • Tinnitus • Nausea • Ataxia • Hypotension

Answer 18 • Answer B is correct. A side effect of bronchodilators is nausea. Answers A and C are not associated with bronchodilators; therefore, they are incorrect. Answer D is incorrect because hypotension is a sign of toxicity, not a side effect.

Question 19 • Which finding is the best indication that a client with ineffective airway clearance needs suctioning? • Oxygen saturation • Respiratory rate • Breath sounds • Arterial blood gases

Answer 19 • Answer C is correct. Changes in breath sounds are the best indication of the need for suctioning in the client with ineffective airway clearance. Answers A, B, and D are incorrect because they can be altered by other conditions.

Question 20 • A client with tuberculosis has a prescription for Myambutol (ethambutol HCl). The nurse should tell the client to notify the doctor immediately if he notices: • Gastric distress • Changes in hearing • Red discoloration of bodily fluids • Changes in color vision

Answer 20 • Answer D is correct. An adverse reaction to Myambutol is change in visual acuity or color vision. Answer A is incorrect because it does not relate to the medication. Answer C is incorrect because it is an adverse reaction to Streptomycin. Answer C is incorrect because it is a side effect of Rifampin.

Question 21 • A client with tuberculosis asks the nurse how long he will have to take medication. The nurse should tell the client that: • Medication is rarely needed after 2 weeks. • He will need to take medication the rest of his life. • The course of therapy is usually 18–24 months. • He will be re-evaluated in 1 month to see if further medication is needed.

Answer 21 • Answer C is correct. The usual course of treatment requires that medication be given for 18 months to 2 years. Answers A and D are incorrect because the treatment time is too brief. Answer B is incorrect because the medication is not needed for life

Question 22 • A client who was admitted with chest pain and shortness of breath has a standing order for oxygen via mask. Standing orders for oxygen mean that the nurse can apply oxygen at: • 2L per minute • 6L per minute • 10L per minute • 12L per minute

Answer 22 • Answer B is correct. With standing orders, the nurse can administer oxygen at 6L per minute via mask. Answer A is incorrect because the amount is too low to help the client with chest pain and shortness of breath. Answers C and D have oxygen levels requiring a doctor’s order.

Question 23 • Which of the following information corresponds with a negative TB test? • 4 mm induration at 48 hours • 10 mm induration at 72 hours • 10 mm induration at 48 hours • 7 mm induration at 18 hours

Answer 23 • The right answer is A: 4 mm induration at 48 hours.

Question 24 • Which of the following is the most common type of lung cancer? • Large cell • Adenocarcinoma • Oat cell • Squamous cell

Answer 24 • The right answer D: Squamous cell.

Question 25 • What cell type secrets surfactant? • Plasma cell • Type I alveolar cell • Type II alveolar cell • Type III alveolar cell

Respiratory System Review Questions