Question 1

Obesity is associated with higher risk for which of the following conditions that affect the pulmonary and cardiovascular systems? Select all that apply.
A) Reduced alveolar-capillary gas exchange
B) Lower respiratory tract infections
C) Sleep apnea
D) Hypertension

Accepted Answer

Obesity causes multiple health problems,many of which affect the lungs,heart,and circulation.Large abdominal fat stores press upward on the diaphragm,preventing full chest expansion and leading to hypoventilation and dyspnea on exertion.The risk for respiratory infection increases because lower lung segments are poorly ventilated,and secretions are not removed effectively.When an obese person lies down,chest expansion is limited even more.Excess neck girth and fat stores in the upper airway often lead to obstructive sleep apnea.Obesity also increases the risk of developing atherosclerosis and hypertension.Obesity does not cause reduced alveolar-capillary gas exchange.

Question 2

The nurse is caring for a patient with an acute asthma event.What classification of medications would the nurse anticipate administering to this patient? Select all that apply.
A) Expectorant
B) Corticosteroid
C) Bronchodilator
D) Cough suppressant
E) Antibiotic

Accepted Answer

Expectorants help to mobilize secretions and would not be an anticipated classification of medication to be administered to this patient.Corticosteroids reduce inflammation of tissues in the airway and are often administered during acute asthma events.Bronchodilators help to expand airways and are usually a primary classification of medication administered to patients experiencing an acute asthma event.Cough suppressants help to reduce the cough reflex and would not be appropriate to administer to a patient experiencing an acute asthma event because it does not treat the cause of the problem.Antibiotics would not be anticipated unless the event was triggered by a bacterial event.Because most asthma attacks are not the result of bacterial infections,this would be an unlikely medication classification to be administered.

Question 3

Which procedure can the nurse safely delegate to the certified nursing assistant who is knowledgeable and experienced in the procedure?
A) Suctioning the newly placed tracheostomy tube
B) Suctioning the endotracheal tube
C) Suctioning the laryngopharynx
D) Suctioning the oropharynx

Accepted Answer

Suctioning a new tracheostomy requires sterile technique,which cannot be delegated to a certified nursing assistant (CNA).Suctioning an endotracheal tube requires sterile technique,which cannot be delegated to a CNA.Deep (laryngopharyngeal)suctioning requires a nurse,owing to the risk of the procedure and complexity of care.The CNA would be capable of performing oral suctioning or assisting a patient to suction his own mouth.

Question 4

When providing safety education to the mother of a toddler,you would inform the mother that,based on the child's developmental stage,he is at high risk for which of the following factors that influence oxygenation? Select all that apply.
A) Frequent, serious respiratory infections
B) Airway obstruction from aspiration of small objects
C) Drowning in small amounts of water around the home
D) Development of asthma

Accepted Answer

As a toddler's respiratory and immune systems mature,the risk for frequent and serious infections is less than it is in infancy.Most children recover from upper respiratory infections without difficulty.Toddlers' airways are relatively short and small and may be easily obstructed,and they often put objects in their mouth as part of exploring their environment,thus increasing their risk for aspiration and airway obstruction.In addition,toddlers are at high risk for drowning in very small amounts of water around the home (e.g.,in a bucket of water or toilet bowl).The risk for developing asthma is not significantly influenced by the child's developmental stage.

Question 5

Which of the following factors influence normal lung volumes and capacities? Select all that apply.
A) Age
B) Race
C) Body size
D) Activity level

Accepted Answer

Normal lung volumes and capacities vary with body size,age,and exercise level.Volumes and capacities are higher in men,in large people,and in athletes.Race does not influence normal lung volumes and capacities.

Question 6

The nurse admits a patient to the surgical unit from the postanesthesia care unit.The patient has an oral airway in place and awakens only to painful stimuli.What is the priority nursing action?
A) Remove the oral airway and elevate the head of the bed.
B) Position the patient with the head turned to the side.
C) Measure vital signs and check surgical dressing.
D) Call the surgeon and obtain postoperative prescriptions.

Accepted Answer

The oral airway should not be removed until the patient is more awake,and elevating the head of the bed is not appropriate until the patient is more responsive.The most important priority is to position the patient with the head turned to the side to prevent aspiration of secretions or emesis if the patient should vomit.Vital signs and dressing checks are important but not the highest priority.Postsurgical prescriptions are written when the patient is in postanesthesia care and come to the floor with the patient.

Question 7

Which of the following is/are accurate about nasotracheal suctioning? Select all that apply.
A) Apply suction for no longer than 15 sec during a single pass.
B) Apply suction while inserting and removing the catheter.
C) Reapply oxygen between suctioning passes for ventilator patients.
D) Gently rotate the suction catheter as you remove it.

Accepted Answer

Limiting suctioning to 15 seconds or less and reapplying oxygen between suctioning passes prevent hypoxia.Suction should be applied only while withdrawing the catheter,using a continuous rotating motion to prevent trauma to the airway.Endotracheal suctioning is used when the patient is being mechanically ventilated,and most ventilator patients have in-line suctioning,so there is no need to reapply oxygen.

Question 8

The student nurse observes the staff nurse providing care to a patient with a chest tube.Which of the nurse's actions should the student recognize as incorrect and report to the nursing instructor?
A) Recording drainage from chest tube as output
B) Securing the chest tube to the chest tube dressing
C) Checking the water seal chamber for bubbling
D) Milking the chest tube to promote drainage

Accepted Answer

Recording drainage from the chest tube as output would be an appropriate nursing action.Securing the chest tube to the chest tube dressing helps to prevent dislocation or removal of the chest tube and is an appropriate nursing action.A lack of bubbling in the water seal chamber indicates air is no longer being evacuated,so it is an appropriate nursing assessment.Milking the chest tube,or squeezing it from the patient to the drainage collection device,is not an evidence-based practice and should not be done.Seeing a nurse doing this would indicate the need for corrective action,which should not be provided by a student.

Question 9

The nurse,working in the postanesthesia care unit inserts an oral airway into the semiconscious patient to prevent airway obstruction.When should the airway be removed?
A) When the patient can be aroused
B) When the patient is 24 hours postoperative
C) When the patient removes it
D) When the provider prescribes that it be removed

Accepted Answer

A semiconscious patient can be aroused but is not awake enough to have the airway removed.Maintaining an airway in place for 24 hours would cause trauma to the airway and is longer than the patient will need this to be in place.When the patient is awake enough to find the airway annoying,the patient will remove it and that will be the safest time.If the provider were to write a prescription specifying when to remove the airway,it would be based on the patient's level of alertness.

Question 10

The nurse is teaching a patient about her chest drainage system.Which of the following should the nurse include in the teaching? Select all that apply.
A) Perform frequent coughing and deep-breathing exercises.
B) Sit up in a chair but do not walk while the drainage system is in place.
C) Get out of bed without assistance as often as possible.
D) Immediately notify the nurse if she experiences increased shortness of breath.

Accepted Answer

Patients should regularly perform coughing and deep-breathing exercises to promote lung reexpansion.The nurse should also encourage the patient to be as active as her condition permits,rather than telling her not to walk.Chest drainage systems are bulky,but patients with disposable systems can still get out of bed and ambulate.However,the patient will need assistance from one or two staff members to protect and monitor the system and to monitor her responses to activity; she should not get out of bed on her own.If a patient with a chest drainage system becomes acutely short of breath,the patient should immediately notify the nurse so that the nurse can check for occlusion of the system,which can result in a tension pneumothorax.

Question 11

The nurse is caring for a patient requiring a mechanical ventilator.When checking the inline thermometer,the nurse finds what temperature acceptable?
A) 78°F
B) 96°F
C) 105°F
D) 84°F

Accepted Answer

A temperature of 78°F would be too cold and could result in hypothermia.The temperature should be near body temperature,so 96°F would be acceptable.A temperature of 105°F is too high and could cause damage to the respiratory tract.A temperature of 84°F is too cold and could result in hypothermia.

Question 12

Of the following interventions,which is/are likely to reduce the risk of postoperative atelectasis? Select all that apply.
A) Administer bronchodilators.
B) Apply low-flow oxygen.
C) Encourage coughing and deep breathing.
D) Administer pain medication.

Accepted Answer

Pain alters the rate and depth of respirations.Often,patients in pain breathe shallowly,which puts them at risk for atelectasis.Regularly assess all patients for pain.Once you have medicated the patient,reassess breath sounds and encourage the patient to cough and breathe deeply.This will help to open air sacs and mobilize secretions in the airways.

Question 13

The nurse is caring for a patient with a chest tube.What outcome would indicate the chest tube can be discontinued?
A) No further bubbling is seen in the water seal chamber.
B) No further drainage is measured from the chest tube.
C) Chest x-ray shows the lungs are fully inflated.
D) The patient's respirations are regular and unlabored.

Accepted Answer

When the pleural space is free of air,and there is no longer air leaking into the pleural space,bubbling in the water seal chamber will stop,indicating the chest tube can be discontinued.It is expected that the largest quantity of drainage will occur when the chest tube is first placed.Although reduced drainage is a positive sign,this is not an adequate sign to discontinue the chest tube.Chest x-rays will often reflect a fully inflated lung shortly after the chest tube is placed,indicating the chest tube is doing its job.Premature discontinuation will cause the affected lung to collapse again.Respirations should ease as soon as the chest tube is placed,and this is not an indication the chest tube can be removed.

Question 14

The nurse admits a patient diagnosed with pneumonia.Which data findings indicate that the patient is not oxygenating adequately? Select all that apply.
A) Oxygen saturation 87%
B) Arterial blood gas pH 7.33
C) Respiratory rate 52 breaths/min
D) Fine rales in the left lower lobe
E) Cyanosis of the nailbeds and lips

Accepted Answer

An oxygen saturation of 87% is below the accepted range and indicates inadequate oxygenation.A pH of 7.33 indicates acidosis,but further information is needed to determine whether the cause is respiratory or metabolic.A respiratory acidosis indicates poor gas exchange,but oxygenation may be adequate with inadequate carbon dioxide exchange.A respiratory rate of 52 breaths/min does not allow adequate time for gas exchange and would contribute to a finding of inadequate oxygenation.Fine rales indicates an altered airway,but alone is not adequate for indicating lack of oxygenation.Cyanosis is caused by lack of oxygen to the tissues and is a good indicator of inadequate oxygenation.

Question 15

A patient has a history of COPD.His pulse oximetry reading is 97%.What other findings would indicate adequate tissue and organ oxygenation? Select all that apply.
A) Normal urine output
B) Strong peripheral pulses
C) Clear breath sounds bilaterally
D) Normal muscle strength

Accepted Answer

To determine adequacy of tissue oxygenation,assess respiration,circulation,and tissue/organ function.Good peripheral circulation is characterized by strong peripheral pulses.Impaired tissue oxygenation to the kidneys would result in abnormal kidney function (e.g.,poor urine output).Hypoxic limb tissue would result in abnormal muscle functioning (e.g.,muscle weakness and pain with exercise).Adequacy of tissue oxygenation cannot be determined by assessing pulmonary ventilation alone; circulation must also be assessed.

Question 16

The nurse is counseling a 17-year-old girl on smoking cessation.The nurse should include which of the following helpful tips in her education? Select all that apply.
A) "Keep healthy snacks or gum available to chew instead of smoking a cigarette."
B) "Don't tell your friends and family you are trying to quit, until you feel confident that you'll be successful."
C) "Plan a time to quit when you will not have many other demands or stressors in your life."
D) "Reward yourself with an activity you enjoy when you quit smoking."

Accepted Answer

People who are trying to quit smoking often are more successful when they are accountable to other people who are encouraging and supportive.Having something to chew (e.g.,carrot sticks,gum,nuts,or seeds)can distract from the desire to smoke a cigarette.Setting a date to stop smoking and choosing a time of low stress are two strategies that help people be more successful with smoking cessation.Self-reward for meeting goals is a form of positive reinforcement.

Quiz 36: Oxygenation

Obesity is associated with higher risk for which of the following conditions that affect the pulmonary and cardiovascular systems? Select all that apply.

The nurse is caring for a patient with an acute asthma event.What classification of medications would the nurse anticipate administering to this patient? Select all that apply.

Which procedure can the nurse safely delegate to the certified nursing assistant who is knowledgeable and experienced in the procedure?

When providing safety education to the mother of a toddler,you would inform the mother that,based on the child's developmental stage,he is at high risk for which of the following factors that influence oxygenation? Select all that apply.

Which of the following factors influence normal lung volumes and capacities? Select all that apply.

The nurse admits a patient to the surgical unit from the postanesthesia care unit.The patient has an oral airway in place and awakens only to painful stimuli.What is the priority nursing action?

Which of the following is/are accurate about nasotracheal suctioning? Select all that apply.

The student nurse observes the staff nurse providing care to a patient with a chest tube.Which of the nurse's actions should the student recognize as incorrect and report to the nursing instructor?

The nurse,working in the postanesthesia care unit inserts an oral airway into the semiconscious patient to prevent airway obstruction.When should the airway be removed?

The nurse is teaching a patient about her chest drainage system.Which of the following should the nurse include in the teaching? Select all that apply.

The nurse is caring for a patient requiring a mechanical ventilator.When checking the inline thermometer,the nurse finds what temperature acceptable?

Of the following interventions,which is/are likely to reduce the risk of postoperative atelectasis? Select all that apply.

The nurse is caring for a patient with a chest tube.What outcome would indicate the chest tube can be discontinued?

The nurse admits a patient diagnosed with pneumonia.Which data findings indicate that the patient is not oxygenating adequately? Select all that apply.

A patient has a history of COPD.His pulse oximetry reading is 97%.What other findings would indicate adequate tissue and organ oxygenation? Select all that apply.

The nurse is counseling a 17-year-old girl on smoking cessation.The nurse should include which of the following helpful tips in her education? Select all that apply.