Deck 7: Pulmonary

Question 1

Two hours ago the client had a left thoracotomy with a lobe resection. The sanguineous drainage in the chest tube collection chamber is 325 mL. The nurse recognizes that this is:

A)Normal chest tube drainage
B)Indicative of a pneumothorax
C)Chyle drainage
D)A sign of hemorrhage

Answer 1

A sign of hemorrhage

Question 2

The nurse is assigned to care for a 20 year old who has just had chest tubes inserted. An important nursing action is to:

A)Place a hemostat nearby in case of an air leak.
B)Check the chest tubes every 2 hours for air leaks.
C)Coil the tubes carefully to prevent kinking, which could result in an air leak.
D)Keep the client flat to avoid leaks in the tubing.

Answer 2

Place a hemostat nearby in case of an air leak.

Question 3

The nurse recognizes that the pattern of pulmonary dysfunction reflected by increased total lung capacity (TLC), functional residual capacity (FRC), and residual volume (RV) is characteristic of:

A)Restrictive lung disease
B)Obstructive lung disease
C)Vascular lung disease
D)A combination of restrictive and obstructive lung disease

Answer 3

Obstructive lung disease

Question 4

A client has active tuberculosis (TB). Which of the following symptoms will he exhibit?

A)Chest and lower back pain
B)Chills, fever, night sweats, and hemoptysis
C)Fever of more than 104°F and nausea
D)Headache and photophobia

Question 5

A client who is diagnosed with respiratory failure is intubated and is being mechanically ventilated. The client pulls out the endotracheal tube. What is the priority action of the nurse to take?

A)Administer oxygen via a 100% nonrebreather mask.
B)Ensure that the client's airway is open.
C)Prepare for reintubation.
D)Provide nasotracheal suctioning.

Question 6

In a client with right lung pneumonia, the nurse should encourage which position to facilitate optimal oxygenation?

A)Prone position
B)Supine position with head elevated at 30 degrees
C)Positioned with the right side dependent
D)Positioned with the left side dependent

Question 7

Which assessment finding by the nurse has the most serious implication for a 70-year-old client with emphysema?

A)Increased anterior-posterior diameter of the chest
B)Bilateral crackles throughout the lung fields
C)Pursed-lip breathing
D)Circumoral cyanosis

Question 8

A postoperative client with emphysema is receiving oxygen at 2L/min via nasal cannula when he/she complains of feeling dyspneic. The spouse asks the nurse to increase the oxygen intake to help him/her breathe easier. Which response by the nurse is appropriate?

A)Switch the oxygen to a 100% non-rebreathing mask
B)Explain to the spouse that a high concentration of oxygen may depress breathing
C)Ask the spouse to leave the room to let the client get some sleep
D)Administer pain medication

Question 9

In a client with new rib fractures, which assessment finding would best alert the nurse to the possible development of a pneumothorax?

A)Pink, frothy sputum
B)Hoarseness
C)Decreased breath sounds on affected side
D)Dullness to percussion on the affected side

Question 10

A client has a right chest tube following a thoracotomy. When assisting the client to ambulate, what measure is appropriate to maintain the water seal?

A)Keep the collection device below the level of the chest
B)Clamp the chest tube before assisting the client out of bed
C)Milk the chest tube when the client returns to bed and assess patency
D)Connect the collection device to a portable suction machine

Question 11

To safely transport a client who has chest tube drainage to the X-ray department to assess the degree of lung re-expansion, the nurse would:

A)Remove the chest tubes, immediately covering the incision site with sterile petrolatum gauze to prevent air from entering the chest
B)Disconnect the drainage bottles from the chest tubes, covering the catheter tip with a sterile dressing to prevent contamination
C)Send the client to X-ray with the chest tube clamped, but still attached to the drainage system to prevent air from entering the chest wall if the bottles are accidentally broken
D)Send the client to X-ray with the chest tube attached to the drainage system, taking precautions to prevent interruption in the system

Question 12

Nick Haegan has a smoking history of 25 years and a recent episode of 5 days of increased breathlessness. The client has a barrel chest, medium-pitched crackles, and wheezes in the right upper lobe and both lower lung lobes. The nurse observes he demonstrates the "increased work of breathing" during this acute period by:

A)Increasing the rate and depth of respirations
B)Increasing diaphragmatic excursion
C)Using pursed-lip exhalations
D)Using accessory muscles for ventilation

Question 13

Chronic obstructive pulmonary disease can progress to respiratory failure. A client with emphysema becomes increasingly drowsy, tachypneic, and tachycardic. The nurse should first:

A)Prepare IV aminophylline
B)Position the client in high-Fowler's
C)Give 2 liters of O₂ per nasal cannula
D)Administer 60% O₂ via mask

Question 14

Eddie, a plane crash victim, undergoes endotracheal intubation and positive pressure ventilation. The most immediate nursing intervention for him at this time would be to:

A)Facilitate his verbal communication
B)Maintain sterility of the ventilation system
C)Assess his response to the equipment
D)Prepare him for emergency surgery

Question 15

The nurse is conducting an education session for a group of smokers in a "stop smoking" class. Which finding would the nurse state as a common symptom of lung cancer?

A)Dyspnea on exertion
B)Foamy, blood-tinged sputum
C)Wheezing sound on inspiration
D)Cough or change in a chronic cough

Question 16

Which of the following measures best determines that a chest tube is no longer needed for a client who had pneumothorax?

A)The drainage from the chest tube is minimal.
B)Arterial blood gas levels are obtained to ensure proper oxygenation.
C)It's removed and the client is assessed to see if he's breathing adequately.
D)No fluctuation in the water seal chamber occurs when no suction is applied.

Question 17

Which of the following interventions should be done before a chest tube is removed?

A)Disconnect the drainage system from the tube.
B)Obtain a chest X-ray to document re-expansion.
C)Obtain an arterial blood gas to document oxygen status.
D)Sedate the client and the physician will slip the tube out without warning the client.

Question 18

A client with fat embolism is receiving 100% FiO₂ on a mechanical ventilator and continues to be hypoxic. Which of the following measures can improve his oxygenation?

A)Add positive end-expiratory pressure (PEEP)
B)Give beta blockers
C)Give diuretics
D)Increase the FiO₂ on the ventilator

Question 19

A client has been diagnosed with emphysema and has dyspnea with minimal exertion. The nurse understands that this client is at risk for developing which of the following?

A)Respiratory acidosis
B)Respiratory alkalosis
C)Metabolic acidosis
D)Metabolic alkalosis

Question 20

What is a normal tidal volume for a client on a ventilator?

A)5-7 ml/kg
B)7-9 ml/kg
C)9-11 ml/kg
D)11-13 ml/kg

Question 21

The nurse receives a lab value indicating a theophylline level of 23 ug/ml for a client. What is the nurse's expected action?

A)Hold the client's morning dose of theophylline.
B)Inform the physician that the blood level is below the desired therapeutic range.
C)Have the lab redraw the blood level for verification.
D)Increase the dose of theophylline for effectiveness.

Question 22

It is highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons?

A)All clients are recommended to have these vaccines.
B)These vaccines produce bronchodilation and improve oxygenation.
C)These vaccines help reduce the tachypnea these clients experience.
D)Respiratory infections can cause severe hypoxia and possibly death in these clients.

Question 23

Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?

A)It enables cardiovascular fitness.
B)It improves respiratory muscle strength.
C)It reduces the number of acute attacks.
D)It worsens respiratory function and is discouraged.

Question 24

Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection?

A)Emotional
B)Extrinsic
C)Intrinsic
D)Mediated