Ms Repiratory smu

7/17/2019 Ms Repiratory smu

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Unit VI

Respiratory Disorders

Critical Concepts

Assessment & Pathophysiology

Diagnostic Tests & Procedures

Upper Respiratory Disorders

Lower Respiratory Disorders

Pharmacology: Anti-tussives Mucolytics

!pectorants "ronchodilators

Anti-in#ectives

Identification

$% These are lipoproteins secreted y the alveolar cells which act to reduce sur#ace tension in

the lungs' preventing its collapse% (((((((

(((((((((((((((((((((((((((((((((((((((((((((((((((((((

)% These are cells in the respiratory passages that secrete mucus' providing protection to the

airways% ((((((((((((((((((((((((((

*% +t is the single most important ris, #actor #or respiratory disorders%

(((((((((((((((((((((((((((((((((((((((((((((((((((((((

% +t is the structure in etween the laryn! and the ronchi and is also called the windpipe%

((((((((((((((((((((((((((((((((((((((

.% The space in etween the pleural cavities that contains all thoracic tissues outside the lungs%

(((((((((((((((((((((((((((((((((((

/% +t is the site o# o!ygen and caron dio!ide e!change in the lungs%

(((((((((((((((((((((((((((((((((((((((((((((((((((((((

0% +t re#ers to the aility o# the lungs to distend' e!pand or stretch%

(((((((((((((((((((((((((((((((((((((((((((((((((((((((

1% This condition in the alveoli occurs i# there is a high ventilation 2 per#usion ratio%

((((((((((((((((((((((((((((((((((((((((((

3% The percentage o# the partial pressure o# o!ygen in atmospheric air%

((((((((((((((((((((((((((((((((((((((((((((((((((((

$4% +t is the respiratory center o# the rain% (((((((((((((((((((((

$$% +t is a symptom o# respiratory pathology that means e!pectoration o# lood #rom the

respiratory tract% (((((((((((((((



$)% +t is a test o# peripheral circulation per#ormed prior to collecting specimen #or arterial

lood gas analysis% ((((((((((((((((((((((

$*% +t is the inaility to reathe easily e!cept in an upright position%

(((((((((((((((((((((((((((((((((((((((((((((((((((((((

$% +t re#ers to the amount o# air that moves in and out o# the lungs in a normal respiration%

((((((((((((((((((((((((((((((((((((((

$.% +t re#ers to the closure or collapse o# the alveoli% (((((((((((((

(((((((((((((((((((((((((((((((((((((((((((((((((((((((

True or False

((((($% 5oreign odies are more li,ely to e dislodged and ostruct the le#t main ronchus%

((((()% The main #unction o# the laryn! is #or vocali6ation%

(((((*% The parietal pleura is a serous memrane covering the lungs%

(((((% 7ydrothora! and8or pneumothora! a##ect pulmonary #unction y increasing lung

compliance%

(((((.% The pulmonary veins receive lood #rom the right ventricle%

(((((/% The pulmonary artery delivers deo!ygenated lood%

(((((0% A shunt occurs i# there is low ventilation 2 per#usion ratio in the alveoli%

(((((1% A low o!ygen level is the primary stimulus #or reathing%

(((((3% An increase in caron dio!ide levels stimulates the peripheral chemoreceptors to

send signals to the rain to increase respiration%

((((( $4% 7yperventilation leads to respiratory al,alosis%

Matching Type

Set A. Anatomy !hysiology

Column A Column "

Anatomy Physiology

((((($% Laryn! A% involved in immune #unction

((((()% piglottis "% produces voice

(((((*% Trachea 9% passageway to the lungs and stomach

(((((% inuses D% lightens the s,ull



(((((.% Tonsils % windpipe

Set ". Assessment !athophysiology

Column A Column "

Assessment Pathophysiology

((((($% dyspnea A% severe o!ygen desaturation

((((()% cyanosis "% compensation #or hypo!emia

(((((*% pleuritic chest pain 9% increased respiratory e##ort

(((((% pin,' #rothy sputum D% ruing o# pleural layers

(((((.% tachycardia % rupture o# #luid-#illed alveoli

Set C. Diagnostic Tests

Column A Column "

Diagnostic Test Purpose / Indication

((((($% Arterial lood gas A% diagnoses pulmonary emolus

((((()% Laryngoscopy "% measures acidity or al,alinity

(((((*% 9hest !-ray 9% determines e!posure PT"

(((((% Pulmonary angiography D% detects cavitations in the lungs

(((((.% Mantou! test % visuali6es the laryn!

Set D. !harmacology

Column A Column "

Medications Indications/Purpose

((((($% Aminophylline A% ,ills microorganisms

((((()% 9romolyn sodium "% prevents asthmatic attac, (((((*% Methylprednisolone 9% reduces in#lammation

(((((% ryhtromycin D% dilates the ronchial tree

(((((.% De!tromethorphan 7"r % reduces coughing episodes

Set #. Respiratory Infections

Column A Column "

Infection Causative Agent

((((($% Pneumonia A% "ordetella pertussis

((((()% Tuerculosis "% 9och;s acillus (((((*% ore throat 9% Pneumococcus

(((((% 5lu D% +n#luen6a virus

(((((.% <hooping cough % =roup A eta-hemolytic

treptococcus

Set F. Respiratory Disorders I

Column A Column "

Respiratory Disorder Description

((((($% "ronchial asthma A% pus in the lungs and pleura

((((()% mphysema "% in#lammation o# the ronchi

(((((*% mpyema 9% overdistention o# the alveoli



(((((% "rochiectasis D% hyperactive airways

(((((.% "ronchitis % distention o# ronchial tree

Set $. Respiratory Disorders II

Column A Column "

Respiratory Disorder Description

((((($% 5lail chest A% air in the pleural space

((((()% Pleurisy "% in#lammation o# the pleura

(((((*% Pneumothora! 9% #luid in the pleural space

(((((% 7ydrothora! D% ri #racture with parado!ical

(((((.% ucutaneous movement o# the chest

emphysema % air in the #atty tissues

Multiple Choice

Choose the letter of the %est ans&er. Some items may ha'e multiple ans&ers.

((((($% A school nurse is conducting a health education to a group o# high school students on

the e##ects o# smo,ing to the respiratory system% The school nurse is correct when she says'

>mo,ing:

A% decreases sputum production%?

"% increases sur#actant production in the lungs%?

9% promotes ciliary #unction in the respiratory passages%?

D% increases ris, to respiratory tract in#ections%?

((((()% The process o# movement o# o!ygen and caron dio!ide in and out o# the lungs is

called

A% respiration"% ventilation

9% e!cretion

D% per#usion

(((((*% +nternal respiration involves the e!change o# o!ygen and caron dio!ide etween the

A% lungs and the red lood cells

"% red lood cells and the ody tissues

9% atmosphere and the lungs

D% lungs and the heart

(((((% The process y which o!ygen and caron dio!ide moves #rom an area o# greater to

lower concentration is calledA% per#usion

"% o!ygenation

9% di##usion

D% osmosis

(((((.% Diphenhydramine 79l @"enadryl is prescried #or a patient with allergic rhinitis% An

e!pected physiological e##ect o# this medication is:

A% +ncreased respiratory secretions

"% Decreased respiratory rate

9% +ncreased mental alertness

D% Reduced nasal congestion

(((((/% A patient undergoes ronchoscopy in the morning% <hich o#



the #ollowing nursing interventions is the most appropriate e#ore the

procedureB

A% C##er the patient oral care in the morning%

"% Let the patient have a light rea,#ast%

9% othing y mouth a#ter midnight%

D% tart an intravenous access%

(((((0% <hich o# the #ollowing must e done prior to collecting specimen #or an arterial

lood gas analysisB

A% Per#orm the Allen test%

"% 9hec, the patient;s lood pressure%

9% <ithhold #oods and #luids #or at least hours%

D% Auscultate the patient;s reath sounds%

(((((1% The patient returns to the ward a#ter laryngoscopy% The most important nursing

responsiility is to

A% C##er ice chips and small sips o# water%

"% 9hec, the patient;s temperature%9% 9hec, #or the presence o# gag re#le!%

D% Assess #or leeding at the insertion site%

(((((3% The nurse suspects viral in#ection o# the respiratory tract i# the patient;s sputum or

drainage has which o# these characteristicsB

A% Eellowish and thic,

"% light rown and #oul-smelling

9% clear and mucoid

D% greenish and copious

((((($4% A patient who has chronic respiratory in#ection such as tuerculosis is e!pected to

have which o# these laoratory results #rom a di##erential 9"9 countBA% increased neutrophil count

"% decreased white lood cell count

9% increased asophil count

D% increased eosinophil count

((((($$% A patient with nasal congestion is ta,ing Pseudoephedrine

@uda#ed% <hich o# the #ollowing signs and symptoms should the

nurse assess as a side-e##ect o# this medicationB

A% +ncreased heart rate

"% Decreased lood pressure

9% Reduced lood glucose

D% +ncreased nasal secretions

((((($)% The nurse understands that mani#estations associated with acute sinusitis are a result

o#:

A% ostruction in the #low o# drainage #rom the nasal cavities

"% inaility o# the sinus cavities to e!pand to accommodate increasing drainage

9% destruction o# the one tissues surrounding the sinus cavities

D% lac, o# o!ygen entering the nasal cavities

((((($*% A priority nursing diagnosis #or a patient with allergic rhinitis is

A% Alteration in com#ort

"% +ne##ective airway clearance

9% Altered ody temperature: increased

D% Ris, #or altered nutrition



((((($% The nurse assesses #or signs and symptoms associated with acute sinusitis which

include @elect all that apply%:

A% headache

"% nasal congestion

9% #ever

D% otalgia

% odynophagia

((((($.% The presence o# which o# the #ollowing complaints #rom a patient suggests the

presence o# chronic sinusitisB

A% post-nasal drip

"% hoarseness

9% #inger cluing

D% on & o## #ever

((((( $/% <hich o# the #ollowing medications is an intranasal

glucocorticoidBA% 7ydro!y6ine 79l @Atara!

"% 5luticasone @5lonase

9% 5e!o#enadine @Allegra

D% Phenylephrine @eo-ynephrine

((((( $0% A patient with upper respiratory in#ection is given a

codeine preparation% <hich o# the #ollowing assessments indicates

that the patient is responding well to the medicationB

A% +ncreased production o# mucus

"% Reduced nasal congestion

9% Decreased #reFuency o# coughing

D% 5reFuent e!pectoration o# secretions

((((($1% A patient has increased mucus secretion due to respiratory

tract in#ection% <hich o# the #ollowing interventions helps to loosen

and e!pectorate the secretionsB

A% =ive small' #reFuent #eedings%

"% +ncrease oral #luid inta,e%

9% Position the patient in low-5owler;s

D% Administer ronchodilators' as ordered%

((((($3% A patient visits the clinic due to a low-grade #ever' nasal

congestion and productive cough% A diagnosis o# upper respiratory

tract in#ection is made% The patient is advised to ta,eDiphenhydramine hydrochloride @"enadryl ). mg talets po F/ prn%

<hich o# the #ollowing nursing instructions is most appropriate

#or patients ta,ing this medicationB

A% >+t is est to ta,e the medication in the morning%?

"% >Ma,e sure not to drive or operate heavy machines%?

9% >There is no harm i# you drin, wine with meals%?

D% >Eou can ta,e ) talets at night to help you sleep%?

((((()4% The nurse instructs the patient on correct techniFue o# collecting sputum specimen

#or culture and sensitivity% <hich o# these statements made y the nurse is inaccurateB

A% >Eou need to gargle with water e#ore you cough and e!pectorate%?

"% >Do this as soon as you wa,e up in the morning%?

9% >Ma,e sure you cough out directly in to this clean cup%?



D% >+t;s alright to eat a#ter + collect the specimen%?

((((()$% The most important concern o# the nurse as soon as the patient arrives #rom

ronchoscopy is to assess the

A% urine output

"% pain level

9% color and consistency o# sputum

D% owel sounds

((((())% A patient with cough due to an upper respiratory tract

in#ection is given De!trometorphan romide @Roitussin' an

antitussive medication% Antitussives act y:

A% Decreasing nasal secretions

"% Loosening ronchial secretions

9% "loc,ing the e##ects o# histamine

D% uppressing the cough re#le!

((((()*% A patient is admitted to the D with an acute asthma-li,eattac, a#ter ingesting sea#ood #or lunch% The medication o# choice #or

relieving ronchospasms due to acute anaphyla!is is:

A% Atrovent with Aluterol @9omivent

"% pinephrine hydrochloride @Adrenalin

9% 9romolyn sodium @+ntal

D% Triamcinolone @A6macort

((((()% A patient in ronchospasm will have a priority nursing

diagnosis which is:

A% +mpaired gas e!change

"% +ne##ective reathing pattern

9% +ne##ective airway clearanceD% Activity intolerance

((((().% A patient with wea, pharyngeal muscles is at ris, #or which complicationB

A% aspiration

"% ronchospasm

9% hyperventilation

D% pneumonia

((((()/% A nurse admits an elderly patient and conducts a physical assessment% <hich o# the

#ollowing re#lects a normal physiologic change in the respiratory system associated with the

aging processB

A% reduced cough and gag re#le!"% increased si6e o# airways

9% reduced collagen o# alveolar walls

D% increased elasticity o# alveolar sacs

((((()0% A patient complains o# di##iculty o# reathing% <hich o# these pathophysiologic

mechanisms can lead to dyspneaB

A% reduced airway resistance

"% increased sur#actant production

9% reduced lung compliance

D% increased ciliary #unction

((((()1% A nurse notes the presence o# e!piratory whee6e in a patient during her morning

assessment% This may indicate:



A% tuerculosis

"% pneumonia

9% ronchial asthma

D% allergic rhinitis

((((()3% The nurse assesses a hypertensive patient complaining o# dry cough% Dry cough is a

side e##ect o# which medicationB A% =uia#enesin @Roitussin

"% 9aptopril @9apoten

9% Lano!in @Digo!in

D% alutamol @Gentolin

(((((*4% A patient is admitted with #ever' cough and chest pain that is aggravated y

coughing or movement% The nurse suspects this as

A% atelectasis

"% acute respiratory #ailure

9% pleuritis

D% pulmonary edema

(((((*$% The patient e!pectorates #oul-smelling sputum% This may e a sign o#

A% viral in#ection

"% lung ascess

9% lung tumor

D% pulmonary edema

(((((*)% The nurse monitors a patient admitted with acute e!aceration o# ronchial asthma

#or mani#estations o# hypo!ia% An early sign or symptom o# hypo!ia is

A% cyanosis

"% chest pain

9% restlessness

D% radycardia

(((((**% A patient is in the medical ward #or chronic ostructive pulmonary disease @9CPD%

A sign o# chronic hypo!ia is

A% tachycardia

"% cluing o# the #ingers

9% cyanosis

D% hemoptysis

(((((*% The nurse doing a physical e!amination notes a arrel chest on her patient% This is a

sign o#

A% pulmonary edema

"% emphysema9% pneumonia

D% ronchial asthma

(((((*.% <hich o# the #ollowing complications o# scoliosis would e the most concern o# the

nurseB

A% dis#igurement

"% respiratory distress

9% ac, pain

D% numness on the arms

(((((*/% A patient is admitted with slow respirations o# 1 reaths per minute% A possile

cause o# this slowed reathing is

A% hemorrhage



"% aspirin poisoning

9% increased intracranial pressure

D% pneumonia

(((((*0% A patient scheduled #or surgery ecomes moderately an!ious% The nurse e!pects to

see which reathing patternB

A% eupnea

"% radypnea

9% hypopnea

D% tachypnea

(((((*1% A patient with diaetic ,etoacidosis is e!hiiting Hussmaul;s respiration% This is

descried as

A% slow shallow reathing

"% deep rapid reathing

9% irregular reathing

D% asence o# reathing

(((((*3% The nurse reports to the physician that a patient has 9heyne-to,es respiration% This

type o# reathing is descried as

A% alternating periods o# apnea and deep reathing

"% hyperventilation with deep reaths

9% cycles o# reathes with varying depths and apnea

D% cessation o# reathing

(((((4% The nurse per#orms thoracic palpation to a patient with #ractured le#t ris% An

e!pected #inding is that the respiratory e!cursions are

A% increased

"% decreased

9% symmetricalD% asymmetrical

((((($% Cn a routine physical e!amination' the nurse #eels virations on the patient;s chest

wall on palpation% This #inding is

A% normal and should e documented as crepitus

"% anormal and the physician should e noti#ied

9% normal and should e documented as tactile #remitus

D% anormal and it needs #urther assessment

((((()% A patient with increased tactile #remitus most li,ely has

A% pneumothora!

"% pneumonia9% hydrothora!

D% emphysema

(((((*% <hen percussing the thora!' the nurse hears a hyperresonant sound% This may

possily indicate

A% pneumothora!

"% lung cancer

9% empyema

D% pulmonary edema

(((((% During physical assessment' the nurse as,s the patient to pronounce >ninety-nine?

then auscultates the lungs% The nurse hears a louder and clearer >ninety-nine?% This #inding is

,nown as



A% ronchophony

"% egophony

9% whispered pectoriloFuy

D% normal vocal resonance

(((((.% A patient with cough complains o# chest pain% The nurse auscultates the reath

sound and hears rhonchi% This is due to the presence o#

A% #luids

"% mass

9% air

D% secretions

(((((/% Prior to collecting specimen #or arterial lood gas @A"= analysis' the nurse should

noti#y the physician i# a patient has

A% chest pain

"% high-grade #ever

9% cough

D% peripheral circulation

(((((0% The nurse reviews the A"= result o# a patient complaining o# dyspnea and #inds

that it is normal% <hich o# the #ollowing is a normal A"= resultB

A% p7 2 0%)3' p9C) 2 .4' 79C* 2 *4

"% p7 2 0%*0' p9C) 2 *' 79C* 2 ).

9% p7 2 0%.' p9C) 2 ..' 79C* 2 *.

D% p7 2 0%.4' p9C) 2 *.' 79C* 2 $1

(((((1% A patient with pneumonia has the #ollowing A"= results: p7 2 0%**' p9C) 2 .0

mm7g' pC) 2 03 mm7g' 79C* 2 )/ meF8L% The nurse interprets this as:

A% respiratory acidosis

"% respiratory al,alosis

9% metaolic acidosisD% metaolic al,alosis

(((((3% The nurse cautions the high school students that during active e!ercise'

hyperventilation can lead to

A% respiratory acidosis

"% respiratory al,alosis

9% metaolic acidosis

D% metaolic al,alosis

(((((.4% A non-invasive method o# continuously monitoring the o!ygen saturation o#

hemogloin o# a patient is

A% arterial lood gas analysis"% pulse o!imetry

9% incentive spirometry

D% pulmonary #unction test

(((((.$% The nurse should noti#y the physician i# the patient;s o!ygen saturation as re#lected

in the pulse o!imetry is

A% $44I

"% 3.I

9% 3*I

D% 13I

(((((.)% The nurse monitors the o!ygen saturation @aC) o# a patient with pneumonia and

assesses it to e 34I% The initial nursing action is to



A% noti#y the physician

"% suction the patient

9% as, the patient to deep reathe

D% administer o!ygen right away

(((((.*% A patient is scheduled #or chest !-ray to evaluate pneumonia% The nurse should

instruct the patient to

A% e on PC /-1 hours e#ore the procedure

"% ta,e a deep reath then hold while !-ray is ta,en

9% cough e#ore !-ray is ta,en

D% sign an in#ormed consent

(((((.% The most important assessment prior to pulmonary angiography is to note #or

patient;s

A% history o# hypertension

"% hypersensitivity to shell#ish

9% previous e!posure to !-rays

D% perception o# the procedure

(((((..% The patient is scheduled #or thoracentesis due to a right hydrothora!% The nurse

should position the patient in

A% right side lying

"% le#t side lying

9% upright with arms at shoulder level

D% #lat on ed

(((((./% A physician per#orms thoracentesis on a patient with hydrothora!% The nurse ,nows

that the needle will e inserted in the

A% second or third intercostal space

"% #ourth or #i#th intercostal space9% si!th or seventh intercostal space

D% tenth or eleventh intercostal space

(((((.0% An important nursing instruction to a patient during thoracentesis is to

A% have deep reaths at regular intervals

"% cough regularly throughout the procedure

9% remain still throughout the procedure

D% hold reath throughout procedure

(((((.1% A patient returns to the ed a#ter a thoracentesis #or a le#t pyothora!% The nurse

positions the patient in

A% le#t side lying"% right side lying

9% prone

D% supine

(((((.3% The nurse noti#ies the physician i# the patient complains o# which o# these a#ter a

thoracentesisB

A% occasional coughs

"% di66iness and #eeling o# #ainting

9% itchiness around insertion site

D% e!pectorates clear sputum

(((((/4% A patient presents to the clinic with allergic rhinitis with rhinorrhea% Rhinorrhea

means



A% swelling o# the nasal mucous memranes

"% increased nasal discharge

9% e!cessive sputum production

D% sinus congestion

(((((/$% A patient calls the clinic and complains o# discom#ort due to runny nose' snee6ing

and nasal congestion as a result o# common colds% The nurse should advise the patient to

A% decrease oral #luid inta,e

"% snee6e with mouth closed

9% ta,e Diphenhydramine 79l @"enadryl

D% remain #lat on ed

(((((/)% The nurse per#orms transillumination to assess

A% pharyngitis

"% rhinitis

9% sinusitis

D% atelectasis

(((((/*% A patient with sinusitis should e assessed #or history o#

A% trauma to the nose

"% upper respiratory tract in#ection

9% genetic predisposition

D% nutritional inta,e

(((((/% Mani#estations o# acute sinusitis are due to

A% ostruction in the #low o# sinus drainage

"% e!cessive nasal discharge

9% #orce#ul coughing and snee6ing

D% destruction o# tissues around the sinuses

(((((/.% igns and symptoms o# sinusitis include: @elect all that apply%

A% otalgia

"% sore throat

9% #acial congestion

D% decreased sense o# smell

% #ever

(((((//% An appropriate nursing intervention #or patients with acute viral upper respiratory

tract in#ections includes

A% gargle with salt water

"% increase inta,e o# cold liFuids

9% e!ercise regularlyD% administer antiiotics as ordered

(((((/0% The nurse administers a decongestant to patient with upper respiratory tract

in#ection% The nurse should assess #or side-e##ects such as

A% decreased lood pressure

"% increased pulse rate

9% increased nasal discharge

D% decreased coughing

(((((/1% The most common cause o# acute pharyngitis is

A% viruses

"% acteria

9% allergies



D% ostruction

(((((/3% The patient with acute pharyngitis will most li,ely complain o#

A% di##iculty swallowing

"% chest pain

9% productive cough

D% nasal discharge

(((((04% A patient with pharyngitis complains o# sore throat% To relieve sore throat' the nurse

should

A% restrict inta,e o# lu,ewarm water

"% apply ice collar to the anterior nec,

9% withhold #oods and #luids #or ) hours

D% advise #reFuent throat clearing

(((((0$% A patient returns to the ward a#ter a tonsillectomy & adenoidectomy @T&A% The

priority goal o# post-operative care is

A% prevention o# post-op hemorrhage"% maintain airway patency

9% relieve pain

D% maintain normal vital signs

(((((0)% The nurse determines post-operative leeding on a patient who had a T&A y

assessing

A% complains o# nec, pain

"% pulse rate o# 34 eats per minute

9% #reFuent swallowing

D% drainage in the surgical dressing

(((((0*% To prevent hypostatic pneumonia' the nurse should instruct a post-T&A patient to

per#ormA% deep reathing e!ercise

"% coughing e!ercises

9% deep reathing and coughing e!ercises

D% leg e!ercises

(((((0% A patient with recent T&A surgery complains o# thirst% The nurse should o##er

A% a cup o# water with straw

"% a strawerry-#lavored popsicle

9% a #ew pieces o# ice chips

D% a owl o# soup

(((((0.% The nurse in the recovery room should position a patient a#ter T&A inA% supine with head turned to the side

"% le#t side lying

9% right side lying

D% prone with head turned to the side

(((((0/% The est intervention to prevent swelling and leeding on the surgical site in a

patient who underwent T&A is #or the nurse to

A% o##er ice cold #luids

"% apply ice collar

9% position the patient supine

D% inspect surgical dressing #reFuently

(((((00% The nurse providing discharge instructions to a patient who had a T&A should

advise the patient to ta,e which #oodB



A% mil, and8or yogurt

"% rice and por, chop

9% citrus #ruits and vegetales

D% gelatin and soup

(((((01% A patient with acute viral laryngitis is most li,ely to have

A% a high-grade #ever

"% hoarseness

9% chest soreness

D% cough productive o# yellow sputum

(((((03% An important nursing intervention #or patients with laryngitis is to

A% limit smo,ing

"% whisper when tal,ing

9% rest the voice

D% avoid respiratory irritants

(((((14% <hich o# the #ollowing data #rom a patient ta,en during admission is a ris, #actor#or ostructive sleep apneaB The patient is

A% a 4-year old #emale

"% wor,s in a #actory

9% is oese

D% a smo,er

(((((1$% Patients with ostructive sleep apnea are prone to develop

A% lung cancer

"% pneumonia

9% myocardial ischemia

D% hypotension

(((((1)% <hich o# these mechanical devices is used in the management o# patients with sleep

apneaB

A% mechanical ventilator

"% ivalve positive airway pressure @"iPAP machine

9% incentive spirometer

D% pulse o!imeter

(((((1*% The emergency management o# individuals with epista!is or noseleeding is

A% tilt the head ac,wards

"% let the person low the nose gently

9% apply direct pressure on the Hisselach;s ple!us

D% place a nasal pac,

(((((1% An important nursing intervention #or a patient with posterior nasal pac, is to:

A% provide oral care

"% remove the pac,ing a#ter / hours

9% press the midline anterior nose

D% provide o!ygen per nasal cannula

(((((1.% The nurse is on rea, at the canteen when she oserves a person cho,ing #rom an

ingested #ood% The nurse should initially

A% call #or help

"% as, i# the patient can spea,

9% per#orm 7eimlich maneuver

D% call a physician



(((((1/% +n per#orming a 7eimlich maneuver in a conscious adult patient' the nurse should

A% position the patient #lat on the #loor

"% per#orm downward adominal thrust

9% place one arm on the patient;s waist

D% position hersel# ehind the patient

(((((10% The nurse conducting a health teaching in#orms the participants that most cases o#

laryngeal cancer occur in the

A% supraglottic area

"% glottic area

9% suglottic area

D% pharyngeal area

(((((11% The nurse e!plains to a group o# adult smo,ers that an early sign o# laryngeal

cancer is

A% throat pain

"% di##iculty swallowing

9% hoarsenessD% dyspnea

(((((13% An important aspect o# pre-operative teaching #or a patient scheduled #or total

laryngectomy is to e!plore ways o#

A% pain relie#

"% preventing complications

9% airway management

D% alternative means o# communication

(((((34% The most common post-operative prolem o# a patient with supraglottic

laryngectomy is

A% di##iculty swallowing"% massive leeding

9% hypostatic pneumonia

D% asence o# voice

(((((3$% <hich o# the #ollowing statements made y a patient a#ter a heath teaching

regarding total laryngectomy needs clari#icationB

A% >+ need to adJust to a new airway%?

"% >My sense o# smell will e a##ected y the surgery%?

9% >+ will lose my voice temporarily%;

D% >+ will have a stoma in my nec, a#ter surgery%?

(((((3)% The nurse instructs the patient who is #or discharge a#ter a total laryngectomy that

he canA% use shower ath instead o# a tu ath

"% still pursue swimming as his #avorite sport

9% engage in recreation and e!ercise

D% only have his laryngeal stoma cleaned y a nurse

(((((3*% The nurse is per#orming a respiratory assessment on her patients% <hich o# these

patients is most at ris, #or atelectasisB

A% A )-year-old athletic patient on acute asthmatic attac,

"% A *.-year-old patient with upper adominal surgery

9% A /-year-old patient who has spinal surgery

D% A //-year-old patient with diaetic neuropathy



(((((3% The nurse prevents the development o# atelectasis in her patient who had spinal

cord inJury y

A% positioning the patient upright

"% encouraging the patient to deep reath and cough

9% turn the patient every shi#t using log-roll techniFue

D% suctioning the patient #reFuently

(((((3.% The nurse is concerned aout atelectasis in a patient i# assessment reveals

A% asence o# reath sounds

"% increased rate o# reathing

9% e!pectoration o# yellowish sputum

D% resonant sound on chest percussion

(((((3/% A patient is rought to the ward a#ter surgery% Prior to administering Morphine

sul#ate' the nurse should chec, the patient;s

A% pulse rate

"% temperature

9% urine outputD% respiratory rate

(((((30% A patient with pneumonia develops atelectasis% The nurse assesses central cyanosis

in the

A% sclera and conJunctiva

"% mouth and tongue

9% #ingers and toes

D% chest and adomen

(((((31% A patient is admitted #or pneumonia% The nurse ,nows that pneumonia is a

respiratory in#ection characteri6ed y

A% presence o# pus in the thoracic cavity

"% consolidation o# secretions in the lung tissues9% increased secretion o# mucus in the air passages

D% acute in#lammation o# the trachea and ronchial tree

(((((33% The nurse suspects pneumonia in a patient i# she notes which physical assessment

#indingB

A% low-grade #ever

"% pin, #rothy sputum

9% increased tactile #remitus

D% decreased vocal resonance

((((($44% A patient with pneumonia is prescried Ampicillin .44 mg po F/h% The nurse

should emphasi6e to the patient the need toA% ta,e the medication with #ood or #luids

"% ta,e the #ull course o# the prescried medicine

9% have a sputum culture a#ter completing the treatment

D% decrease #luid inta,e to prevent #luid overload

((((($4$% A priority nursing diagnosis #or a patient with pneumonia is

A% Acute chest pain

"% +ne##ective airway clearance

9% +ne##ective reathing pattern

D% Activity intolerance

((((($4)% An important preventive measure #or pneumonia among the elderly is to

A% avoid going to overcrowded places

"% receive regular pneumococcal vaccine



9% increase oral #luid inta,e up to * liters daily

D% ta,e prophylactic antiiotics

((((($4*% Prior to per#orming postural drainage' the nurse should

A% assess the vital signs

"% auscultate the reath sounds

9% withhold #oods and #luids

D% determine urine output

((((($4% The nurse should plan to per#orm postural drainage

A% e#ore meals

"% a#ter meals

9% at night

D% in the evening

((((($4.% An important nursing intervention a#ter postural drainage is to provide

A% good oral hygiene

"% adeFuate #luid inta,e9% rest and privacy

D% pain relie#

((((($4.% The nurse per#orms postural drainage to a patient with pneumonia% During the

procedure' the patient complains o# di##iculty reathing' chest pain and palpitation% The nurse

should initially

A% chec, the vital signs

"% stop the treatment

9% call the physician

D% position patient upright

((((($4/% The principle involved in postural drainage isA% osmosis

"% di##usion

9% per#usion

D% gravity

((((($40% The nurse notes that postural drainage is e##ective i# a#ter the procedure' the patient

A% has chest pain

"% e!pectorates more sputum

9% is dyspneic

D% has a pulse rate o# $$4 pm

((((($41% A patient with a chronic lung ascess should have a diet that isA% high in calories and protein

"% high in carohydrates and low in protein

9% low in calories and high in protein

D% low in carohydrates and low in protein

((((($43% A patient has empyema and needs antiiotics instilled into the pleural cavity% The

instillation o# medications in the pleural cavity to treat an in#ection is a treatment ,nown as

A% diapedesis

"% pleurodesis

9% paracentesis

D% thoracentesis

((((($$4% <hich o# these statements made y a patient suggests the presence o# pleurisyB



A% >My reathing is #aster than usual%?

"% >+ have a dull chest pain radiating to my shoulder%?

9% >My chest hurts move when + ta,e a deep reath%?

D% >+ have more sputum than normal%?

((((($$$% An important pain management #or a patient with pleurisy is the administration o#

A% Acetaminophen @Tylenol

"% +ndomethacin @+ndocin

9% Meperidine hydrochloride @Demerol

D% 7ydrocodone @Gicodin

((((($$)% The nurse helps in reducing chest pain in a patient with pleuritis y encouraging

the patient to

A% hold his reath #reFuently

"% ta,e slow deep reaths

9% splint the ri cage when reathing

D% lay down on the una##ected side

((((($$*% A patient with shortness o# reath undergoes an !-ray% The result shows anaccumulation o# #luids in the pleural cavity ,nown as

A% pleural e##usion

"% hydrothora!

9% pyothora!

D% pneumothora!

((((($$% The nurse assessing a patient with pleural e##usion is e!pected to #ind

A% asent reath sounds

"% increased vocal resonance

9% increased tactile #remitus

D% tracheal deviation towards the a##ected side

((((($$.% The nurse ,nows that pulmonary edema is most li,ely to occur as a complication i#

a patient has which pre-e!isitng medical consitionB

A% heart #ailure

"% atelectasis

9% hemorrhage

D% chronic ronchitis

((((($$/% Assessment #indings in a patient with pulmonary edema are @elect all that apply:

A% crac,les

"% pin,' #rothy sputum

9% reduced reath sounds

D% increased tactile #remitus% whispered pectoriloFuy

((((($$0% A patient with pulmonary edema has chest pain% The nurse should prepare to

administer

A% Morphine sul#ate @M

"% 5urosemide @Lasi!

9% Lano!in @Digo!in

D% Acetylsalicylic acid @Aspirin

((((($$1% ursing interventions #or a patient with pulmonary edema includes:

A% position the patient upright

"% maintain #luid inta,e at ) liters8day

9% provide so#t #oods such as pasta and soups



D% encourage #reFuent amulation

((((($$3% The e!pected arterial lood gas result #or a patient with acute respiratory #ailure is

A% p7 2 0%*4' p9C) 2 /4 mm7g' pC) 2 3 mm 7g

"% p7 2 0%*)' p9C) 2 .. mm7g' pC) 2 04 mm7g

9% p7 2 0%*' p9C) 2 3 mm7g' pC) 2 14 mm7g

D% p7 2 0%4' p9C) 2 4 mm7g' pC) 2 1. mm7g

((((($)4% <hich o# these patients is least prone to develop acute respiratory #ailureB A

patient with

A% multiple sclerosis

"% hyperthyroidism

9% sedative overdose

D% poliomyelitis

((((($)$% The nurse identi#ies respiratory distress i# the patient e!hiits @elect all that

apply:

A% nasal #laring"% chest retractions

9% use o# accessory muscles o# respiration

D% lethargy

% diaphoresis

((((($))% A patient with atelectasis develops acute respiratory #ailure% The nurse anticipates

that this patient needs

A% deep reathing and coughing e!ercises

"% #reFuent oropharyngeal and tracheal suctioning

9% o!ygen per nasal cannula at / liters per minute

D% intuation and mechanical ventilation

((((($)*% A patient with pneumonia develops acute respiratory distress syndrome @ARD%

The maJor characteristic o# ARD is

A% insidious onset o# pulmonary edema

"% reduced amount o# pulmonary in#iltrates

9% hypo!emia unresponsive to o!ygen therapy

D% increased lung compliance

((((($)% The medical +9U nurse recalls that the main pathophysiology o# ARD is

A% lea,age o# #luid into alveolar interstitial spaces

"% severe smooth muscle contraction o# the ronchi

9% accumulation o# secretions in the lung tissues

D% reduced per#usion into the lung tissues

((((($).% An essential component o# ARD medical management is the use o#

A% continuous positive airway pressure @9PAP

"% ivalve positive airway pressure @"iPAP

9% positive end-e!piratory pressure @PP

D% pulmonary artery wedge pressure @PA<P

((((($)/% Prior to mechanical ventilation the nurse may administer

A% Methocaramol @Roa!in

"% Pancuronium @Pavulon

9% Lora6epam @Ativan

D% 7aloperidol @7aldol



((((($)0% A patient with 4-pac, years o# smo,ing history undergoes a series o# diagnostic

tests% <hich o# the #ollowing procedures determines the presence o# pulmonary hypertensionB

A% intra-arterial lood pressure monitoring

"% pulmonary artery pressure monitoring

9% central venous pressure monitoring

D% continuous o!ygen saturation monitoring

((((($)1% A nurse wor,ing at the pulmonary unit ,nows that the most common cause o#

secondary pulmonary hypertension is

A% ronchogenic carcinoma

"% chronic ostructive pulmonary disease

9% sucutaneous emphysema

D% rheumatic heart disease

((((($)3% The nurse notes cor pulmonale secondary to pulmonary hypertension in a patient i#

he e!hiits

A% chronic cough

"% distended nec, veins9% chest pain

D% rhonchi

((((($*4% A patient with 9CPD and pulmonary hypertension can develop which

complicationB

A% myocardial in#arction

"% cererovascular accident

9% right ventricular hypertrophy

D% le#t ventricular hypertrophy

((((($*$% The most appropriate intervention #or a patient with pulmonary hypertension

includes

A% administration o# intravenous #luids"% o!ygen therapy

9% mechanical ventilation

D% pain management

((((($*)% A patient who developed pulmonary #at emolism may have had a history o#

recent

A% streptococcal in#ection

"% #racture o# the #emur

9% prolonged con#inement in ed

D% dehydration

((((($**% ssential nursing interventions to prevent pulmonary emolism include: @elect allthat apply%

A% turn patient #rom side to side every ) hours

"% passive leg e!ercises

9% ensure adeFuate oral and intravenous #luid inta,e

D% deep reathing and coughing e!ercises

% encourage early amulation

5% use o# elastic stoc,ings

((((($*% The nurse suspects that a patient is developing pulmonary emolism i# she

oserves

A% tachycardia and chest pain

"% hypertension and #ever

9% hemoptysis and radypnea



D% productive cough and radycardia

((((($*.% To accurately evaluate the presence and location o# a pulmonary emolus' the

physician needs to order which diagnostic testB

A% chest !-ray

"% 9T scan o# the chest

9% electrocardiography

D% coronary angiography

((((($*/% A medical intervention to prevent pulmonary emolism involves the

administration o#

A% no!aparin sodium @Loveno!

"% trepto,inase

9% AFuamephyton @Gitamin H

D% Protamine sul#ate

((((($*0% A patient with pulmonary emolism is started on 7eparin sul#ate ).'444 units

diluted in a ).4 cc o# De!trose in .I <ater% The physician orders the 7eparin drip to run at$.44 units per hour% The nurse should regulate the 7eparin drip at a rate o#

A% $4 cc8hr

"% $. cc8hr

9% )4 cc8hr

D% ). cc8hr

((((($*1% The nurse caring #or a patient on 7eparin drip needs to order which laoratory

testB

A% prothromin time

"% activated partial thromoplastin time

9% clotting time

D% complete lood count

((((($*3% The nurse should have which o# the #ollowing medications at the edside when a

patient is on 7eparin therapyB

A% <ar#arin sodium @9oumadin

"% Atropine sul#ate

9% Protamine sul#ate

D% Gitamin H

((((($4% A patient discharged a#ter treatment o# pulmonary

emolism is prescried <ar#arin sodium @9oumadin . mg po daily%

The nurse instructs the patient to avoid

A% rushing his teeth"% eating green lea#y vegetales

9% using an electric ra6or

D% any type o# sports

((((($$% <hich o# the #ollowing statements is true aout anticoagulants such as 7eparin

sul#ateB Anticoagulants:

A% prevent arterial lood clots%

"% prevent venous lood clots%

9% dissolve e!isting lood clots%

D% decrease leeding time%

((((($)% A nurse has #our patients% <hich o# the #ollowing patients should not receive

7eparin sul#ateB The patient with



A% hemorrhagic stro,e

"% pulmonary emolism

9% myocardial in#arction

D% disseminated intravascular coagulation

((((($*% 7eparin sul#ate can e given in which o# these routesB @elect all that apply%

A% intramuscular route

"% sucutaneous route

9% intravenous route

D% intradermal route

((((($% +# heparin is given y inJection' which among these sites

will the nurse use to administer the medicationB

A% Lateral aspect o# upper arm

"% Adominal area

9% Cuter aspect o# the thigh

D% =luteal area

((((($.% The nurse is accurate in preparing and administering

heparin inJection i# she

A% Uses a $-ml syringe with )$ gauge needle

"% +nJects the needle at a .-34 degree angle #rom the s,in

9% Aspirates the medication prior to inJecting the drug

D% Massage the inJection site a#ter giving the drug

((((($/% An important nursing consideration #or patients ta,ing

heparin is to

A% Administer other medications y intramuscular inJections

"% Monitor prothromin time and complete lood count

9% Assess #or signs and symptoms o# leedingD% Restrict #luid inta,e and activity level

((((($0% <hat is the mechanism o# action o# <ar#arin sodium

@9oumadinB

A% +t inhiits the hepatic synthesis o# Gitamin H%

"% +t prevents the conversion o# #irinogen into #irin%

9% +t dissolves any e!isting lood clots%

D% +t prevents platelet aggregation%

((((($1% A patient ta,ing <ar#arin sodium @9oumadin has an +R o# .%% The antidote o#

<ar#arin sodium @9oumadin is:

A% Protamine sul#ate"% Gitamin H

9% trepto,inase

D% Gitamin ")

((((($3% To determine the e##ectiveness o# 9oumadin therapy' the

nurse should evaluate the patient;s @elect all that apply

A% Prothromin time @PT

"% +nternational normali6ed ratio @+R

9% Partial thromoplastin time @PTTK

D% Activated partial thromoplastin time @aPTT

((((($.4% A patient is on 7eparin drip at $) cc8hr on a .4-04

protocol% The latest laoratory result shows an aPTT level o# 01



seconds% The nurse;s most appropriate action ased on an ordered

protocol is to:

A% Do nothing since it is within therapeutic range

"% +ncrease the rate and chec, aPTT a#ter / hours

9% Decrease the rate and chec, aPTT a#ter / hours

D% 9all the physician and reFuest #or another aPTT level

((((($.$% A patient is admitted in the emergency room with chest pain and di##iculty

reathing% The nurse reviews the patient;s medical record and #inds that the patient has a

=reen#ield #ilter% The nurse ,nows that the patient has a history o#

A% 9CPD

"% Pulmonary emolism

9% Lung cancer

D% "ronchial asthma

((((($.)% A patient complains o# #atigue' dyspnea' hemoptysis and cough% A transronchial

iopsy reveals a noncaseating granuloma% This indicates the presence o#

A% pulmonary tuerculosis"% sarcoidosis

9% pneumoconioses

D% pneumonia

((((($.*% A patient presents to the clinic with lac,-colored sputum% The nurse should ta,e

the history y as,ing which relevant FuestionB

A% ><hat type o# #ood did you Just eatB?

"% ><hat type o# wor, do you doB?

9% >7ow many pac,s o# cigarette do you smo,e dailyB?

D% >Do you thin, that is loodB?

((((($.% A patient who is not a smo,er was shoc,ed to #ind out that he has lung cancer% Thenurse e!plains to the patient that other than smo,ing' ris, #actor #or lung cancer includes

A% diet low in #ruits and vegetales

"% living in the rural areas

9% e!posure to #resh air

D% educational attainment

((((($..% The pulic health nurse in#orms the community aout the early warning sign o#

lung cancer which is

A% chest pain

"% chronic cough

9% di##iculty reathing

D% hemoptysis

((((($./% A patient with di##use cancer o# the lungs needs to have his entire le#t lung

removed surgically% This procedure is called

A% segmental resection

"% wedge resection

9% loectomy

D% pneumonectomy

((((($.0% A patient with lung cancer is on chemotherapy% <hich o# the #ollowing

medications is an anti-neoplastic drugB

A% Do!oruicin @Adriamycin

"% +praptropium romide @Atrovent

9% pironolactone @Aldactone



D% Montelu,ast sodium @Advair

((((($.1% ssential nursing interventions to promote airway clearance in a patient with lung

cancer include which o# the #ollowingB elect all that apply%

A% Deep reathing e!ercises

"% 9hest physiotherapy

9% uctioning

D% Administration o# ronchodilators

% "ronchoscopy

((((($.3% <hich o# the #ollowing assessments indicate that the nurse;s interventions #or a

patient with dyspnea due to lung cancer is e##ectiveB The patient or patient;s

A% ecomes restless and #idgety

"% respiration is ). per minute

9% pulse rate is 11 eats per minute

D% e!pectorates yellowish sputum

((((($/4% A 9CPD patient is scheduled to receive +pratropium romide @Atrovent inhalerFh prn% <hich o# the #ollowing is the e!pected physiological e##ect o# AtroventB

A% Reduces in#lammation in the respiratory tract

"% Promotes dilation o# respiratory passages

9% Prevents the release o# histamines

D% Reduces naso-pharyngeal secretions

((((($/$% Aminophylline @Theophylline is usually prescried among 9CPD patients in an

attempt to:

A% Reverse ronchospasms

"% Decrease respiratory secretions

9% Reduce ronchodilation

D% Decrease in#lammation in the lungs

((((($/)% The nurse is giving instructions to one o# her 9CPD

patients on actions and side-e##ects o# Acetylcysteine' @Mucomyst%

The nurse is correct i# she states:

A% >This medication helps loosen the secretions in your lungs%?

"% >This drug will ma,e you reathe easier y dilating your airways%?

9% >Eou will #eel di66y or sleepy a#ter ta,ing this medication%?

D% >This drug ma,es your mouth dry ecause it decreases oral secretions%?

((((($/*% A mother is as,ing Fuestions to her *-year-old son;s

nurse aout the newly prescried 9romolyn sodium @+ntal #or her

son;s asthma% <hich o# the #ollowing nurse;s statements accuratelyaddresses the mother;s concernB

A% >+t is the drug o# choice #or asthma caused y severe acute anaphyla!is%?

"% >+t is a potent ronchodilator there#ore easing respirations%?

9% >+t is e##ective as a preventive measure #or #uture asthmatic attac,s%?

D% >+t increases the e##ects o# histamine on the lungs%?

((((($/% A patient with 9CPD complains o# a sudden onset

di##iculty o# reathing% The nurse auscultates the patient;s reath

sounds and hears whee6ing sounds upon e!piration% <hich o# the

#ollowing group o# medications is e!pected to e administered to

help the patient reathB

A% Adrenergic loc,ing agents

"% anthine derivatives



9% Leu,otreine synthesis inhiitors

D% 7istamine-type ) receptor antagonists

((((( $/.% Methylprednisolone @olu-medrol is one o# the

medications used in 9CPD management% The purpose o# giving this

is to

A% Reduce the in#lammatory process within the lung tissues

"% Prevent constriction o# the airways

9% Promote ma!imum dilation o# the ronchi

D% Decrease the e##ects o# histamine and leu,otrienes in the lungs

((((($//% A patient with 9CPD is receiving +soproterinol @+suprel'

a eta-$ and eta-) adrenergic agent% <hich o# the #ollowing should

the nurse watch out #or as a common side e##ect o# this medicationB

A% Decrease in the lood sugar

"% Reduction in the lood pressure

9% +ncrease in heart rate

D% +ncrease in nasal congestion

Ms Repiratory smu

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Transcript of Ms Repiratory smu