Question 1

The client is admitted to the emergency department with a pneumothorax.The nurse anticipates that the client will be experiencing:
A) Dyspnea
B) Eupnea
C) Fremitus
D) Orthopnea

Accepted Answer

The client with a pneumothorax (collapsed lung)will exhibit dyspnea and pain.Eupnea is normal,easy breathing.It would not be expected in the case of a pneumothorax.Fremitus is the vibration felt when the hand is placed on the client's chest and the client speaks (vocal fremitus).Fremitus would be decreased with a pneumothorax.Orthopnea is a condition in which the person must use multiple pillows when lying down or must sit with the arms elevated and leaning forward to breathe.The client with a pneumothorax would be exhibiting dyspnea.

Question 2

The nurse is working on a pulmonary unit at the local hospital.The nurse is alert to one of the early signs of hypoxia in the clients,which is:
A) Cyanosis
B) Restlessness
C) A decreased respiratory rate
D) A decreased blood pressure

Accepted Answer

Mental status changes are often the first signs of respiratory problems and may include restlessness and irritability.Cyanosis is a late sign of hypoxia.A decreased respiratory rate is not an early sign of hypoxia.The respiratory rate will increase as the body attempts to compensate for the decreased level of oxygen.As the hypoxia worsens,the respiratory rate may decline.During early stages of hypoxia the blood pressure is elevated unless the condition is caused by shock.

Question 3

The nurse identifies that the client is unable to cough to produce a sputum specimen,and the client's secretions must be suctioned.Which suctioning route is preferred for obtaining this specimen?
A) Nasopharyngeal
B) Nasotracheal
C) Oropharyngeal
D) Orotracheal

Accepted Answer

Nasotracheal suctioning is the preferred route for obtaining a sputum specimen when the client is unable to cough to produce a sputum specimen on his or her own.The nasopharyngeal route for suctioning is used when the client is able to cough but is unable to clear secretions by expectorating or swallowing.It is not the preferred route for obtaining a sputum specimen.The oropharyngeal route is used when the client is able to cough but is unable to clear secretions by expectorating or swallowing.It is not the preferred route for obtaining a sputum specimen.The orotracheal route is used when the client is unable to manage secretions by coughing.The nasotracheal route is preferred over the orotracheal route because stimulation of the gag reflex is minimal.

Question 4

The nurse is checking the client's overall oxygenation.In assessment of the presence of central cyanosis,the nurse will inspect the client's:
A) Palms and soles of the feet
B) Nail beds
C) Earlobes
D) Tongue

Accepted Answer

Central cyanosis is observed in the tongue,soft palate,and conjunctiva of the eye,where blood flow is high.Central cyanosis indicates hypoxemia.Peripheral cyanosis seen in the palms and soles of the feet,nail beds,or earlobes is often a result of vasoconstriction and stagnant blood flow.

Question 5

The client has experienced a myocardial infarction resulting in damage to the left ventricle.A possible complication the client may experience that the nurse is alert to is:
A) Jugular neck vein distention
B) Pulmonary congestion
C) Peripheral edema
D) Liver enlargement

Accepted Answer

Pulmonary congestion may be experienced in left-sided heart failure.Jugular neck vein distention is characteristic of right-sided heart failure.Peripheral edema is characteristic of right-sided heart failure.Hepatomegaly (liver enlargement)is characteristic of right-sided heart failure.

Question 6

A client with a suspected narcotic (heroin)overdose is brought to the emergency department by the police.The nurse anticipates that assessment findings will reveal:
A) Agitation
B) Hyperpnea
C) Restlessness
D) Decreased level of consciousness

Accepted Answer

With a narcotic overdose,the respiratory center is depressed,reducing the rate and depth of respiration and the amount of inhaled oxygen.The client may display signs of hypoventilation,such as a decreased level of consciousness.A narcotic (heroin)overdose would cause sedation and respiratory depression,not agitation.The client would experience bradypnea,not hyperpnea.A narcotic (heroin)overdose would cause sedation and respiratory depression,not restlessness.

Question 7

A 64-year-old client is seen in the emergency department for palpitations and mild shortness of breath.The electrocardiogram (ECG)reveals a normal P wave,P-R interval,and QRS complex with a regular rhythm and rate of 108 beats per minute.The nurse should recognize this cardiac dysrhythmia as:
A) Sinus dysrhythmia
B) Sinus tachycardia
C) Supraventricular tachycardia
D) Ventricular tachycardia

Accepted Answer

The client is experiencing sinus tachycardia.The rhythm is regular with a normal P wave,normal QRS complex,and a rate of 100 to 180 beats per minute.A sinus dysrhythmia has a rate of 60 to 100 beats per minute and slows during inspiration and increases with expiration.The client is not experiencing a sinus dysrhythmia.With supraventricular tachycardia,the heart rate is 150 to 250 beats per minute,the P wave may be buried in the preceding T wave,and the P-R interval is variable.This client is not experiencing supraventricular tachycardia.With ventricular tachycardia the rhythm is slightly irregular at a rate of 100 to 200 beats per minute,the P wave is absent,the P-R interval is absent,and the QRS complex is wide.This client is not experiencing ventricular tachycardia.

Question 8

The unit manager is orienting a new staff nurse and evaluates which of the following as an appropriate technique for nasotracheal suctioning?
A) Placing the client in a supine position
B) Preparing for a clean or nonsterile technique
C) Suctioning the oropharyngeal area first,then the nasotracheal area
D) Applying intermittent suction for 10 seconds during catheter removal

Accepted Answer

Intermittent suction for up to 10 to 15 seconds should be applied during catheter removal to prevent injury to the mucosa.The client is not placed in a supine position.The client is usually placed in a semi-Fowler's position.The client's head is turned to the right to help the nurse suction the left mainstem bronchus,and the client's head is then turned to the left to help the nurse suction the right mainstem bronchus.Nasotracheal suctioning is a sterile procedure.The nasotracheal area should be suctioned first,then the oropharyngeal area.The mouth and pharynx contain more bacteria than the trachea.

Question 9

A client has recently had mitral valve replacement surgery.To prevent excess serosanguineous fluid buildup,the nurse anticipates that care will include:
A) Increased oxygen therapy
B) Frequent chest physiotherapy
C) Incentive spirometry on a regularly scheduled basis
D) Chest tube placement in the thoracic cavity

Accepted Answer

Chest tubes are inserted to remove air and fluids from the pleural space,to prevent air or fluid from reentering the pleural space,and to reestablish normal intrapleural and intrapulmonic pressures.The client who had mitral valve replacement surgery would be expected to have a chest tube postoperatively to prevent excess fluid buildup in the pleural space.Increased oxygen will not prevent excess fluid buildup.Frequent chest physiotherapy may help facilitate removal of secretions but will not prevent excess fluid buildup.Incentive spirometry is used to promote deep breathing and to prevent or treat atelectasis in the postoperative client.It will not prevent excess fluid buildup.

Question 10

All of the following clients are experiencing increased respiratory secretions and require intervention to assist in their removal.Chest percussion is indicated and appropriate for the client experiencing:
A) Thrombocytopenia
B) Cystic fibrosis
C) Osteoporosis
D) Spinal fracture

Accepted Answer

Chest percussion is indicated and appropriate for the client with cystic fibrosis to assist in mobilizing the thick pulmonary secretions.Percussion is contraindicated in clients with bleeding disorders,such as the client with thrombocytopenia.Percussion is also contraindicated in the client with osteoporosis and the client with a spinal fracture or with fractured ribs.

Question 11

The client has chest tubes in place following thoracic surgery.In working with a client who has a chest tube,the nurse should:
A) Clamp the tubes except during client assessments
B) Remove the tubing from the connection to check for adequate suction power
C) Milk or strip the tubes every 15 to 30 minutes to maintain drainage
D) Coil and secure excess tubing next to the client

Accepted Answer

If the client is in a chair and the tubing is coiled,the tubing should be lifted every 15 minutes to promote drainage.Care should be taken to ensure the tubing remains secure.Clamping the tubes except during client assessments is an inaccurate statement.Clamping a chest tube is contraindicated when the client is ambulating or being transported.In a water-sealed system,gentle bubbling in the suction-control chamber indicates it is functioning.The suction source may be checked to verify it is on the appropriate setting.In a waterless system,the suction control (float ball)indicates the amount of suction the client's intrapleural space is receiving.The tubing should not be disconnected.The chest tube should be stripped or milked only if indicated (e.g. ,there is clotted drainage in the tube)(check institutional policy).It is believed that stripping the tube greatly increases intrapleural pressure,which could damage the pleural tissue and cause or worsen an existing pneumothorax.Milking causes less of a pressure change.

Question 12

A client develops acute renal failure and a resulting metabolic acidosis.The nurse recognizes that the respiratory system compensates through: A) Hypoventilation and increase of bicarbonate levels in the bloodstream B) Alternating periods of deep versus shallow breaths to maintain homeostasis of the serum pH C) Hyperventilation to decrease the serum CO₂ level and thereby raise the pH D) Expansion of the lung tissues to their fullest,which increases the inspiratory reserve volumes to provide more oxygen to the tissues

Accepted Answer

The respiratory system tries to correct metabolic acidosis by increasing ventilation to reduce the amount of carbon dioxide and thereby raise the pH.The respiratory system would compensate for metabolic acidosis with increased respirations,not hypoventilation.Bicarbonate is the renal component of acid-base balance,not the respiratory component.The pH measures hydrogen ion concentration.Alternating deep versus shallow breaths is not a compensating mechanism of the respiratory system for metabolic acidosis.The respiratory system does not compensate by expanding the lung tissues to their fullest.In metabolic acidosis,the respiratory system compensates by exhaling a greater amount of carbon dioxide.

Question 13

On admitting a client,the nurse finds that there is a history of myocardial ischemia.The most disconcerting dysrhythmia for electrocardiography to reveal is:
A) Sinus bradycardia
B) Sinus dysrhythmia
C) Ventricular tachycardia
D) Atrial fibrillation

Accepted Answer

Ventricular tachycardia would be the most disconcerting dysrhythmia of the four options.Ventricular tachycardia results in a decreased cardiac output;it may lead to severe hypotension and loss of pulse rate and consciousness.Sinus bradycardia would not be of concern for this client.It is of no clinical significance unless it is associated with signs and symptoms of a decreased cardiac output.Sinus dysrhythmia is of no clinical significance unless dizziness occurs with a decreased rate.Atrial fibrillation is not as detrimental as ventricular tachycardia.

Question 14

At a community health fair the nurse informs the residents that the influenza vaccine is recommended for clients:
A) Only older than age 65
B) 40 to 60 years of age
C) In any age-group who have a chronic disease
D) Who have an acute febrile illness

Accepted Answer

Annual influenza vaccine is recommended for clients of any age with a chronic disease.Annual influenza vaccine is recommended for clients older than age 65,but this is not the only group.Annual influenza vaccine is recommended for any age-group,including those age 40 to 60,who have a chronic disease of the heart,lung,or kidneys;clients with diabetes;clients with immunosuppression or severe forms of anemia;or those in close or frequent contact with anyone in a high-risk group.Clients with an acute febrile illness should not be vaccinated.

Question 15

A client recently fractured his spinal cord at the C3 level and is at great risk for developing pneumonia primarily because the:
A) Resulting paralysis immobilizes him,and secretions will increase in his lungs
B) Innervation to the phrenic nerve is absent,preventing chest expansion
C) Resulting abnormal chest shape disallows efficient ventilatory movement
D) Trauma decreases the ability of his red blood cells to carry oxygen

Accepted Answer

Cervical trauma at C3 to C5 can result in paralysis of the phrenic nerve,preventing chest expansion.Although the increase in lung secretions as a result of immobility is a risk factor,the client's greatest risk is related to the level of his fracture.There is no mention of an abnormal chest shape.This client's greatest risk for developing pneumonia is related to the level of his fracture.If the client were anemic as a result of blood loss from trauma,his oxygen-carrying capacity of blood would be decreased.There is no mention of excessive blood loss,nor would this place him at great risk for developing pneumonia.

Question 16

The client with a chronic obstructive respiratory disease is receiving oxygen via a nasal cannula.Which of the following interventions does the nurse plan to include in the client's care?
A) Assess nares for skin breakdown every 6 hours.
B) Check patency of the cannula every 2 hours.
C) Inspect the mouth every 6 hours.
D) Check oxygen flow every 24 hours.

Accepted Answer

The nurse caring for the client with a nasal cannula should plan to assess the client's nares and superior surface of both ears for skin breakdown every 6 hours.The nurse should check patency of the cannula every 8 hours.The nurse does not need to check the client's mouth in relation to the client's use of a nasal cannula.The nurse should continue providing oral hygiene and may assess the mouth (i.e. ,tongue)for cyanosis,along with other assessment measures.Oxygen flow should be checked every 8 hours,not every 24 hours.

Question 17

The nurse is working on a respiratory care unit in the hospital.Upon entering the room of a client with emphysema,it is noted that the client is experiencing respiratory distress.The nurse should:
A) Instruct the client to breathe rapidly
B) Provide 20% oxygen at 2 L/min via nasal cannula
C) Place the client in the supine position
D) Go to contact the health care provider

Accepted Answer

The nurse should provide a low concentration of oxygen to the client.The client should be instructed to use pursed-lip breathing.The most effective position for the client with cardiopulmonary disease is the 45-degree semi-Fowler's position,using gravity to assist in lung expansion and reduce pressure from the abdomen on the diaphragm.The nurse's first priority should be to attend to the client who is in respiratory distress,not to contact the health care provider.

Question 18

The nurse has reviewed information about the cardiovascular system before caring for a client with heart disease.The nurse knows that which of the following statements is true concerning the physiology of the cardiovascular system?
A) Stimulating the parasympathetic system would cause the heart rate to go up.
B) When a person has heart muscle disease,the heart muscles stretches as far as is necessary to maintain function.
C) The QRS interval on the electrocardiogram represents the electrical impulses passing through the ventricles.
D) When stroke volume decreases,there is a resultant decrease in heart rate.

Accepted Answer

The QRS complex indicates that the electrical impulse has traveled through the ventricles.Stimulating the parasympathetic system would cause the heart rate to decrease,not increase.In the diseased heart,the stretch of the myocardium is beyond the heart's physiological limits.When stroke volume is decreased,there is an increase in heart rate.

Question 19

It is suspected that the client's oxygenation status is deteriorating.The nurse is aware that the abnormal assessment finding that represents the most serious indication of the client's decreased oxygenation is:
A) Poor skin turgor
B) Clubbing of the nails
C) Central cyanosis
D) Pursed-lip breathing

Accepted Answer

Central cyanosis is the most serious finding because it indicates hypoxemia.Poor skin turgor indicates dehydration.It is not an indication of the client's decreased oxygenation.Clubbing of the nails is found in clients with prolonged oxygen deficiency,endocarditis,and congenital heart defects.It is a change that occurs over time and is not an indication of the client's current deterioration in oxygenation status.Pursed-lip breathing is used to slow expiratory flow.It is not the most serious indication of a client's decreased oxygenation.

Question 20

In teaching a client about an upcoming diagnostic test,the nurse identifies that which one of the following uses an injection of contrast material?
A) Holter monitor
B) Echocardiography
C) Cardiac catheterization
D) Exercise stress test

Accepted Answer

A cardiac catheterization involves the injection of contrast material in order to visualize the cardiac chambers,valves,the great vessels,and coronary arteries.It also is used to measure the pressures and volumes within the chambers of the heart.A Holter monitor is a portable ECG worn by the client.It does not require contrast media.An echocardiography is a noninvasive measure that graphically depicts overall cardiac performance.An exercise stress test evaluates the cardiac response to the physical stress of the client on a treadmill.Contrast material is not used for this test.

Quiz 40: Oxygenation

The client is admitted to the emergency department with a pneumothorax.The nurse anticipates that the client will be experiencing:

The nurse is working on a pulmonary unit at the local hospital.The nurse is alert to one of the early signs of hypoxia in the clients,which is:

The nurse identifies that the client is unable to cough to produce a sputum specimen,and the client's secretions must be suctioned.Which suctioning route is preferred for obtaining this specimen?

The nurse is checking the client's overall oxygenation.In assessment of the presence of central cyanosis,the nurse will inspect the client's:

The client has experienced a myocardial infarction resulting in damage to the left ventricle.A possible complication the client may experience that the nurse is alert to is:

A client with a suspected narcotic (heroin) overdose is brought to the emergency department by the police.The nurse anticipates that assessment findings will reveal:

A 64-year-old client is seen in the emergency department for palpitations and mild shortness of breath.The electrocardiogram (ECG) reveals a normal P wave,P-R interval,and QRS complex with a regular rhythm and rate of 108 beats per minute.The nurse should recognize this cardiac dysrhythmia as:

The unit manager is orienting a new staff nurse and evaluates which of the following as an appropriate technique for nasotracheal suctioning?

A client has recently had mitral valve replacement surgery.To prevent excess serosanguineous fluid buildup,the nurse anticipates that care will include:

All of the following clients are experiencing increased respiratory secretions and require intervention to assist in their removal.Chest percussion is indicated and appropriate for the client experiencing:

The client has chest tubes in place following thoracic surgery.In working with a client who has a chest tube,the nurse should:

A client develops acute renal failure and a resulting metabolic acidosis.The nurse recognizes that the respiratory system compensates through:

On admitting a client,the nurse finds that there is a history of myocardial ischemia.The most disconcerting dysrhythmia for electrocardiography to reveal is:

At a community health fair the nurse informs the residents that the influenza vaccine is recommended for clients:

A client recently fractured his spinal cord at the C3 level and is at great risk for developing pneumonia primarily because the:

The client with a chronic obstructive respiratory disease is receiving oxygen via a nasal cannula.Which of the following interventions does the nurse plan to include in the client's care?

The nurse is working on a respiratory care unit in the hospital.Upon entering the room of a client with emphysema,it is noted that the client is experiencing respiratory distress.The nurse should:

The nurse has reviewed information about the cardiovascular system before caring for a client with heart disease.The nurse knows that which of the following statements is true concerning the physiology of the cardiovascular system?

It is suspected that the client's oxygenation status is deteriorating.The nurse is aware that the abnormal assessment finding that represents the most serious indication of the client's decreased oxygenation is:

In teaching a client about an upcoming diagnostic test,the nurse identifies that which one of the following uses an injection of contrast material?