Lewis Chapter 28: Respiratory System

Question 1

The nurse is assessing a patient with shortness of breath for evidence of long-standing hypoxemia. Which of the following assessments should the nurse conduct?

A. Chest excursion
B. Spinal curvatures
C. Respiratory rate and pattern
D. Fingernails and their bases

Answer 1

D. Fingernails and their bases

Clubbing, a sign of long-standing hypoxemia, is evidenced by an increase in the angle between the base of the nail and the fingernail to 180 degrees or more, usually accompanied by an increase in the depth, bulk, and sponginess of the end of the finger.

Question 2

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) and pneumonia who has an order for arterial blood gases to be drawn. Which of the following is the minimum length of time the nurse should plan to hold pressure on the puncture site after the specimen has been obtained?

A. 2 minutes
B. 5 minutes
C. 10 minutes
D. 15 minutes

Answer 2

B. 5 Minutes

After obtaining an arterial blood gas, the nurse should hold pressure on the puncture site for 5 minutes by the clock to be sure that bleeding has stopped. An artery is an elastic vessel under much higher pressure than veins, and significant blood loss or hematoma formation could occur if the time is insufficient.

Question 3

A patient with a recent history of a dry cough has had a chest X-ray that revealed the presence of nodules. In an effort to determine whether the nodules are malignant or benign, which of the following tests is the primary care provider most likely to prescribe?

A. Thoracentesis
B. Pulmonary angiogram
C. Computed tomography (CT) scan of the patient’s chest
D. Positron emission tomography (PET)

Answer 3

D. PET

Positron emission tomography (PET) is used to distinguish benign and malignant pulmonary nodules. Because malignant lung cells have an increased uptake of glucose, the PET scan, which uses an IV radioactive glucose preparation, can demonstrate increased uptake of glucose in malignant lung cells. This differentiation cannot be made using computed tomography (CT), a pulmonary angiogram, or thoracentesis.

Question 4

The nurse is caring for a patient who has just had a bronchoscopy. Which of the following actions is a priority nursing action immediately following this procedure?

A. Monitoring the patient for laryngeal edema
B. Assessing the patient’s level of consciousness
C. Monitoring and controlling the patient’s pain
D. Assessing the patient’s heart rate and blood pressure

Answer 4

A. Monitoring the patient for laryngeal edema

Priorities for assessment are the patient’s airway and breathing, both of which may be compromised after bronchoscopy by laryngeal edema. These assessment parameters supersede the importance of loss of consciousness (LOC), pain, heart rate, and blood pressure, although the nurse should also be assessing these.

Question 5

The nurse is caring for a patient who has just had a thoracentesis completed. Which of the following procedural risks should the nurse continue to assess the patient for?

A. Pneumothorax
B. Bronchospasm
C. Pulmonary edema
D. Respiratory acidosis

Answer 5

A. Pneumothorax

Because thoracentesis involves the introduction of a catheter into the pleural space, there is a risk of pneumothorax. Thoracentesis does not carry a significant potential for causing pulmonary edema, respiratory acidosis, or bronchospasm.

Question 6

Which of the following is the mechanism that stimulates the release of surfactant?

a. Fluid accumulation in the alveoli

b. Alveolar collapse from atelectasis

c. Alveolar stretch from deep breathing

d. Air movement through the alveolar pores of Kohn

Answer 6

C.

Question 7

Which of the following causes air to enter the thoracic cavity during inspiration?

a. Contraction of the accessory abdominal muscles

b. Increased carbon dioxide and decreased oxygen in the blood

c. Stimulation of the respiratory muscles by the chemoreceptors

d. Decreased intrathoracic pressure relative to pressure at the airway

Answer 7

D.

Question 8

Which of the following measures the lungs’ ability to adequately oxygenate the arterial blood?

a. Arterial oxygen tension

b. Carboxyhemoglobin level

c. Arterial carbon dioxide tension

d. Venous carbon dioxide tension

Answer 8

A.

Question 9

Which of the following is the most important respiratory defence mechanism distal to the respiratory bronchioles?

a. Alveolar macrophage

b. Impaction of particles

c. Reflex bronchoconstriction

d. Mucociliary clearance mechanism

Answer 9

A.

Question 10

Which of the following is caused by a rightward shift of the oxygen–hemoglobin dissociation curve?

a. Metabolic alkalosis

b. Postoperative hypothermia

c. Release of oxygen at the tissue level

d. Greater affinity of oxygen for hemoglobin

Answer 10

C.

Question 11

Which of the following are very early signs or symptoms of inadequate oxygenation?

a. Dyspnea and hypotension

b. Apprehension and restlessness

c. Cyanosis and cool, clammy skin

d. Increased urine output and diaphoresis

Answer 11

B.

Question 12

Which of the following should the nurse inquire about when assessing activity and exercise related to respiratory health?

a. Dyspnea during rest or exercise

b. Recent weight loss or weight gain

c. Ability to sleep through the entire night

d. Willingness to wear oxygen equipment in public

Answer 12

A.

Question 13

Which of the following is the best tool to assess for the vibration of tactile fremitus?

a. Palms

b. Fingertips

c. Stethoscope

d. Index fingers

Answer 13

A.

Question 14

Which of the following is an abnormal finding in the assessment of the respiratory system?

a. Presence of tactile fremitus

b. Inspiratory chest expansion of 2.5 cm

c. Percussion resonance over the lung bases

d. Symmetrical chest expansion and contraction

Answer 14

A.

Question 15

Which of the following is performed to remove pleural fluid for analysis?

a. Thoracentesis

b. Bronchoscopy

c. Pulmonary angiography

d. Sputum culture and sensitivity

Answer 15

A.

Question 16

Which anatomical structure is positioned where the trachea bifurcates into the right and left mainstem bronchi?

A. Adenoids

B. Carina

C. Epiglottis

D. Turbinates

Answer 16

B. Carina

The carina is a ridge of cartilage that is located at the point where the trachea bifurcates into the right and left mainstem bronchi.

Question 17

Which characteristic is associated with surfactant?

A. Secreted by the bronchioles

B. Increases the surface tension in the alveoli

C. Prevents the alveoli from collapsing

D. Produced by small, shallow breaths

Answer 17

C. Prevents the alveoli from collapsing

Surfactant decreases the tendency of the alveoli to collapse.

Question 18

Which event occurs during ventilation?

A. The diaphragm contracts on inspiration.

B. Gas flows from intrathoracic area to atmospheric area on inspiration.

C. High intrathoracic pressure encourages air to enter the lungs.

D. The intercostal muscles contract during expiration.

Answer 18

A. The diaphragm contracts on inspiration.

The diaphragm contracts to increase chest dimensions and decrease intrathoracic pressure.

Question 19

Which value is monitored through pulse oximetry?

A. PaO2

B. PaCO2

C. SpO2

D. HCO3–

Answer 19

C. SpO2

The SpO2 is the oxygen saturation value that is obtained by pulse oximetry.

The others are measured by an ABG or VBG

Question 20

In which way do chemoreceptors regulate ventilation?

A. Increase tidal volume when alkalosis is detected

B. Decrease tidal volume when H+ concentration increases

C. Decrease respiratory rate when H+ concentration increases

D. Increase respiratory rate when acidosis is detected

Answer 20

D. Increase respiratory rate when acidosis is detected

When the chemoreceptors detect acidosis, they increase the respiratory rate and tidal volume.

Question 21

Which statement is representative of the mucociliary clearance system?

A. Ciliary action is increased with smoking.

B. Cilia beat more rapidly in larger airways than further down the tracheobronchial tree.

C. Cilia are only present in the trachea and mainstem bronchi.

D. Each ciliated cell contains one cilia.

Answer 21

B. Cilia beat more rapidly in larger airways than further down the tracheobronchial tree.

The ciliary beat is rapid in the larger airways and slower farther down the tracheobronchial tree. Particles that penetrate more deeply into the airways are removed less rapidly.

Question 22

Which statement about alveolar macrophages is accurate?

A. Macrophages protect the lungs by constricting the bronchi.

B. Macrophages are attached to cilia in the alveoli.

C. Macrophages are more effective in response to smoking.

D. Some particles cannot be removed by macrophages.

Answer 22

D. Some particles cannot be removed by macrophages.

Some fine particles cannot be phagocytized by macrophages and remain indefinitely in the lungs.

Question 23

Which respiratory system change occurs with aging?

A. Decrease in elastic recoil.

B. Decrease in the chest’s anteroposterior diameter.

C. Increase in sensitivity to hypoxemia.

D. Increase in chest wall compliance.

Answer 23

A. Decrease in elastic recoil.

In response to aging, the elastic recoil of lung tissue decreases.

Question 24

Which outcome is the result of surfactant secretion?

A. Decreasing the surface tension of the alveoli

B. Raising the respiratory rate in response to acidosis

C. Providing lubrication for the pleural sacs

D. Binding to oxygen to deliver to the tissues

Answer 24

A. Decreasing the surface tension of the alveoli

Surfactant decreases surface tension in the alveoli to prevent them from collapsing.

Question 25

Which statement describes the respiratory system? A. The left mainstem bronchus is shorter and wider than the right one. B. Respiratory bronchioles are the functional unit of gas exchange. C. Part of the air it contains is not available for gas exchange. D. Ciliated cells are found throughout the entire lower respiratory system.

Answer 25

C. Part of the air it contains is not available for gas exchange. The area from the nose to the respiratory bronchioles is a conducting pathway, and not all air is available for gas exchange. This is called the anatomical dead space.

Question 26

Which statement would the nurse include when educating a patient with asthma? A. “This is your body’s way of moving small particles out of your lungs.” B. “Asthma exacerbations make inhaling more laboured.” C. “Avoid wearing strong scents such as perfume or cologne.” D. “Patients with asthma have chronically high levels of CO2 in their blood.”

Answer 26

C. “Avoid wearing strong scents such as perfume or cologne.” Strong odours can induce the hyperreactive bronchi to constrict; therefore, the nurse would inform the patient to avoid these.

Question 27

Which statement describes the effect of smoking on the respiratory defence mechanisms? A. Smoking makes the lungs more susceptible to other particles. B. Inhaling high oxygen concentrations can prevent respiratory damage from smoking. C. Smoking does not impact the respiratory defence mechanisms. D. Smoking increases the efficiency of the mucociliary clearance system.

Answer 27

A. Smoking makes the lungs more susceptible to other particles. Smoking inhibits alveolar macrophage activity, which can increase damage from inhaled particles.

Question 28

Which statement describes the relationship between oxygen and hemoglobin? A. All oxygen that is carried by the blood is bound to hemoglobin. B. If hemoglobin has a low affinity for oxygen, more oxygen is released to the tissues. C. When hemoglobin is desaturated, less oxygen is released to the tissues. D. Hemoglobin has a consistent affinity for oxygen.

Answer 28

B. If hemoglobin has a low affinity for oxygen, more oxygen is released to the tissues. When hemoglobin has a low affinity for oxygen, less oxygen is picked up in the lungs, but more is released to the tissues.

Question 29

Which statement accurately describes pulse oximetry? A. Pulse oximetry provides information about acid-base balance. B. The pulse oximeter may display an unreliable number when the SpO2 is below 80%. C. One method of pulse oximetry involves placing a pulmonary artery catheter. D. Pulse oximetry values may be less reliable for patients with darker skin.

Answer 29

D. Pulse oximetry values may be less reliable for patients with darker skin. Dark skin colour can reduce the reliability of pulse oximetry. Other factors that reduce the reliability of pulse oximetry measurements include motion, low perfusion, anemia, bright fluorescent lights, intravascular dyes, and thick acrylic nails. If there is any doubt at the accuracy of pulse oximetry readings, they should be followed up by an arterial blood gas.

Question 30

Which assessment finding supports a diagnosis of a pneumothorax? A. Air in the pleural space B. Blood in the pleural space C. Purulent pleural fluid D. Excessive amounts of pleural fluid

Answer 30

A. Air in the pleural space A pneumothorax occurs when air is present in the pleural space.

Question 31

Which term describes shortness of breath? A. Hemoptysis B. Dyspnea C. Stridor D. Wheezing

Answer 31

B. Dyspnea Dyspnea describes shortness of breath.

Question 32

Which assessment finding indicates respiratory dysfunction? A. Capillary refill takes approximately five seconds to return. B. The patient is breathing approximately 18 times per minute. C. The anteroposterior diameter is less than the transverse diameter. D. Palpable vibrations are equal on both sides when the patient speaks.

Answer 32

A. Capillary refill takes approximately five seconds to return. Capillary refill should take one to two seconds, so five seconds is delayed and indicates respiratory and cardiovascular dysfunction.

Question 33

Which statement accurately describes thoracentesis? A. This procedure can be performed by a nurse. B. The patient should be positioned prone during the procedure. C. The purpose of this procedure is to obtain pericardial fluid for diagnosis. D. The procedure should be followed by a chest radiograph.

Answer 33

D. The procedure should be followed by a chest radiograph. A chest radiograph must be obtained after the procedure to evaluate for pneumothorax.

Question 34

Which action would the nurse take when caring for a patient undergoing a pulmonary angiography study? A. Ensure all metal objects are removed to avoid magnetic pull. B. Place the patient on isolation precautions due to radioactivity. C. Assess the insertion site for excessive bleeding. D. Prepare heated blankets for chills from contrast medium.

Answer 34

C. Assess the insertion site for excessive bleeding. Excessive bleeding is a concern when patients have received a pulmonary angiography. A pressure dressing is appliedat the insertion site, which the nurse should evaluate.

Question 35

Which statement would the nurse include when teaching a patient about a tuberculin skin test? A. “Your test needs to be read within the next five to seven days.” B. “If you received a vaccine for tuberculosis, it may change your skin test results.” C. “If you develop redness at the injection site, you have a positive test result.” D. “A positive test result is when the diameter of the reaction is ≥2 mm.”

Answer 35

B. “If you received a vaccine for tuberculosis, it may change your skin test results.” Previous bacille Calmette-Guérin vaccination will modify tuberculin skin testing results.

Question 36

Which statement would the nurse provide to a patient who will receive a pulmonary function test? A. “You will take a deep breath and exhale as hard and long as possible.” B. “You will inhale as deeply as possible to measure your inspiration.” C. “You will take a regular inhalation and exhale as slowly as possible.” D. “You will take a regular inhalation and exhale forcefully for 10 seconds.”

Answer 36

A. “You will take a deep breath and exhale as hard and long as possible.” Patients receiving a pulmonary function test should take a deep breath and exhale as long, hard, and fast as possible into a spirometer.

Question 37

Which statement about tidal volume (VT) is accurate? A. The total amount of air that is inhaled and exhaled per minute B. The amount of air inhaled and exhaled with each breath C. The maximum volume of air that the lungs can contain D. The amount of air remaining in the lungs after a forced expiration

Answer 37

B. The amount of air inhaled and exhaled with each breath Tidal volume is the amount of air inhaled and exhaled with each breath and describes only a small proportion of total capacity of the lungs.

Question 38

Which assessment finding indicates a tuberculosis infection? A. Erythema at tuberculin skin test site B. Rust-coloured sputum C. Bloody nasal discharge D. Resonant sound on percussion

Answer 38

B. Rust-coloured sputum Rust-coloured sputum can indicate a tuberculosis infection.

Question 39

Which statement accurately describes a bronchoscopy? A. Bronchoscopy can be used to collect biopsy samples. B. Bronchoscopy is used to evaluate the mediastinum. C. Patients can have regular diet prior to bronchoscopy. D. A chest tube may be inserted during the procedure.

Answer 39

A. Bronchoscopy can be used to collect biopsy samples. Biopsy samples can be collected through the bronchoscope.

Question 40

Which diagnostic study is used to assess a pulmonary embolism? A. Acid-fast smear and culture B. Bronchoscopy C. Thoracentesis D. Ventilation-perfusion scan

Answer 40

D. Ventilation-perfusion scan A ventilation-perfusion scan is used to evaluate for the presence of a pulmonary embolus.

Question 41

Which pulmonary function measure is used to assess a patient’s ability to inhale deeply and cough? A. Forced vital capacity B. Peak expiratory flow rate C. Maximal voluntary ventilation D. Maximum inspiratory pressure

Answer 41

D. Maximum inspiratory pressure Maximum inspiratory pressure, or negative inspiratory force, is the amount of negative pressure generated on inspiration and is used to assess the ability to deeply breathe and cough.

Question 42

Which assessment finding indicates that a patient is splinting? A. Leaning forward supported by the arms B. Taking frequent shallow breaths C. Has a bluish coloration of nail beds D. Breathing eight times per minute

Answer 42

B. Taking frequent shallow breaths Splinting describes when a patient is taking in smaller tidal volumes, meaning that the volume of air inhaled and exhaled with each breath is reduced.

Question 43

Which assessment finding would indicate severe acute respiratory distress? A. Intercostal retractions B. Increased anteroposterior chest diameter C. Trachea positioned at midline D. Clubbing of the fingernails

Answer 43

A. Intercostal retractions Intercostal retractions indicate severe respiratory distress.