Title: Quiz: Lower Respiratory
Course: PRN 0092 Practical Nursing II > Section: Nursing Care of Clients with Respiratory Disorders

Q: A 68-year-old male patient has chronic obstructive pulmonary disease (COPD). He has a markedly increased need for protein and calories to maintain an adequate nutritional status. To help him get the nutrition he needs, the nurse would encourage him to
- eat three meals a day.
- rest 30 minutes before eating.
- drink fluids only with meals.
- perform bronchial drainage 30 minutes after eating.
A: rest 30 minutes before eating.
If right: The nurse can assist the patient in maintaining nutritional intake by advising rest for 30 minutes before eating.
If wrong: The nurse can assist the patient in maintaining nutritional intake by advising rest for 30 minutes before eating.

Q: The patient, age 72, is admitted with acute pulmonary edema. In pulmonary edema, the medical management will often include
- IV infusion of D_5LR at less than 30 mL/hr.
- intravenous sodium.
- supine position.
- atropine to decrease respiratory rate.
A: IV infusion of D_5LR at less than 30 mL/hr.
If right: Medications for acute pulmonary edema will include diuretics such as Lasix and a narcotic analgesic, usually morphine sulfate. A patent IV line must be maintained, usually at a very slow rate to keep the vein open for medication administration (i.e., 30 mL/hr) per infusion pump.
If wrong: Medications for acute pulmonary edema will include diuretics such as Lasix and a narcotic analgesic, usually morphine sulfate. A patent IV line must be maintained, usually at a very slow rate to keep the vein open for medication administration (i.e., 30 mL/hr) per infusion pump.

Q: An 83-year-old patient is admitted with a temperature of 102° F (38.8° C), chest pain, and fatigue. The chest radiograph reveals an accumulation of fluid in the pleural space, which the physician removes by performing a thoracentesis. The nurse correctly records the purulent exudate as:
- effusion.
- emphysema.
- sputum.
- empyema.
A: empyema.
If right: If the fluid between the lung and the membrane lining the pleural cavity becomes infected, it is called empyema.
If wrong: If the fluid between the lung and the membrane lining the pleural cavity becomes infected, it is called empyema.

Q: A patient, age 69, has emphysema. On assessing him, the nurse notes the presence of a “barrel chest.” This pathology results from a(n)
- increase in the lateromedial area from hypertrophy of mucous glands in the bronchi.
- increased anteroposterior diameter caused by overinflation of the alveoli.
- decrease in anteroposterior diameter caused by chronic dilation of the bronchi.
- widening of the sternocostal area secondary to chronic constriction of smooth muscles in the airways leading to bronchospasms.
A: increased anteroposterior diameter caused by overinflation of the alveoli.
If right: The patient will eventually appear barrel chested (an increased anteroposterior diameter caused by overinflation).
If wrong: The patient will eventually appear barrel chested (an increased anteroposterior diameter caused by overinflation).

Q: A patient, age 22, is admitted with acute asthma. It is important to monitor his oxygen saturation levels. The quickest way to assess his saturation of oxygen is to
- get arterial blood gases.
- use pulse oximetry.
- do a pulse pressure assessment.
- do a pulmonary function test.
A: use pulse oximetry.
If right: In acute asthma, oxygen therapy should be started immediately, and its administration should be monitored by pulse oximetry. Pulse oximetry is noninvasive and provides continuous monitoring of SaO_2.
If wrong: In acute asthma, oxygen therapy should be started immediately, and its administration should be monitored by pulse oximetry. Pulse oximetry is noninvasive and provides continuous monitoring of SaO_2.

Q: The appropriate nursing intervention for a patient, age 40, who is diagnosed with active tuberculosis would be to
- place the patient in drainage and secretion precautions.
- place the patient in acid-fast bacillus (AFB) isolation precautions.
- maintain the patient in enteric isolation.
- place the patient in any isolation precautions.
A: place the patient in acid-fast bacillus (AFB) isolation precautions.
If right: If TB is suspected, permission to place the patient in acid-fast bacilli (AFB) isolation precautions should be requested immediately.
If wrong: If TB is suspected, permission to place the patient in acid-fast bacilli (AFB) isolation precautions should be requested immediately.

Q: A patient, age 54, is on postoperative day 2 after undergoing an open cholecystectomy. Immediately after the surgery, she vomited and may have aspirated some emesis. The nurse is concerned that the patient will develop pneumonia. In planning for her care, the nurse suspects the patient may have
- bacterial pneumonia.
- aspiration pneumonia.
- viral pneumonia.
- atypical pneumonia.
A: aspiration pneumonia.
If right: Aspiration pneumonia occurs most commonly as a result of aspiration of vomitus when the patient is in an altered state of consciousness due to a seizure, drugs, alcohol, anesthesia, acute infection, or shock.
If wrong: Aspiration pneumonia occurs most commonly as a result of aspiration of vomitus when the patient is in an altered state of consciousness due to a seizure, drugs, alcohol, anesthesia, acute infection, or shock.

Q: The patient, age 91, has COPD and complains of dyspnea and fatigue. Activity intolerance, related to an imbalance between the oxygen supply and demand, is a nursing diagnosis for COPD. Which nursing intervention would be inappropriate?
- Teach pursed-lip breathing.
- Provide oxygen therapy as ordered.
- Plan care to provide optimum rest.
- Provide a cool shower.
A: Plan care to provide optimum rest.
If right: Nursing interventions will be directed at attempting to decrease the patient’s anxiety and promote optimal air exchange. The nurse should allow sufficient rest periods and should assist the patient in activities of daily living.
If wrong: Nursing interventions will be directed at attempting to decrease the patient’s anxiety and promote optimal air exchange. The nurse should allow sufficient rest periods and should assist the patient in activities of daily living.

Q: The patient has COPD. To teach him pursed-lip breathing, the nurse should instruct him to inhale slowly through his
- mouth, then exhale quickly through pursed lips.
- nose, then exhale more slowly through pursed lips.
- mouth, then make his exhalation last three times as long as his inhalation.
- nose, making his inhalation last three times as long as his exhalation.
A: nose, then exhale more slowly through pursed lips.
If right: The nurse should instruct the patient and family on effective breathing techniques (such as pursed-lip breathing) and relaxation exercises for anxiety control. The patient should inhale through the nose and exhale through pursed lips. The exhalation should be 2 – 3 times longer than the inhalation.
If wrong: The nurse should instruct the patient and family on effective breathing techniques (such as pursed-lip breathing) and relaxation exercises for anxiety control. The patient should inhale through the nose and exhale through pursed lips. The exhalation should be 2 – 3 times longer than the inhalation.

Q: A patient, age 68, has a long history of COPD and is admitted to the hospital with cor pulmonale. He says his doctor said his heart was failing and asks whether he is having a heart attack. Which explanation by the nurse is most correct?
- “You aren’t having a heart attack, but your heart has been damaged by changes in your lungs caused by your respiratory disease.”
- “It could be a heart attack, and when the heart is damaged it causes respiratory damage, too.”
- “It isn’t a heart attack, but your heart has gradually weakened over the years, causing respiratory disease.”
- “It is probably a heart attack, since cor pulmonale means that the heart isn’t getting enough blood and becomes too weak to pump effectively.”
A: “You aren’t having a heart attack, but your heart has been damaged by changes in your lungs caused by your respiratory disease.”
If right: COPD can lead to cor pulmonale, an abnormal cardiac condition characterized by hypertrophy of the right ventricle of the heart as a result of hypertension of the pulmonary circulation. Cor pulmonale results in the presence of edema in the lower extremities as well as in the sacral and perineal area, distended neck veins, and enlargement of the liver with ascites.
If wrong: COPD can lead to cor pulmonale, an abnormal cardiac condition characterized by hypertrophy of the right ventricle of the heart as a result of hypertension of the pulmonary circulation. Cor pulmonale results in the presence of edema in the lower extremities as well as in the sacral and perineal area, distended neck veins, and enlargement of the liver with ascites.

Q: The nurse identifies a nursing diagnosis of Ineffective airway clearance for a patient, age 64, who has undergone a pneumonectomy. A common etiology for this nursing diagnosis in patients who have had a pneumonectomy is
- thick, copious secretions.
- surgical incision pain.
- presence of chest tubes.
- mechanical ventilation.
A: surgical incision pain.
If right: Nursing interventions are often directed at postsurgical interventions, including facilitating recovery and preventing complications by promoting effective airway clearance through frequent repositioning, coughing, and deep breathing. Surgical incisional pain prevents the patient from breathing deeply and coughing effectively.
If wrong: Nursing interventions are often directed at postsurgical interventions, including facilitating recovery and preventing complications by promoting effective airway clearance through frequent repositioning, coughing, and deep breathing. Surgical incisional pain prevents the patient from breathing deeply and coughing effectively.

Q: During discharge teaching of a pulmonary emphysema patient who is going home with oxygen, what does the nurse emphasize?
- “Use the oxygen only when you experience shortness of breath.”
- “Use the maximum amount of oxygen that this unit will deliver.”
- “Use the oxygen only when exercising.”
- “Keep low flow oxygen at 1 to 2 L by nasal cannula.”
A: “Keep low flow oxygen at 1 to 2 L by nasal cannula.”
If right: Low-flow oxygen therapy is required for patients with COPD, because higher oxygen concentrations depress the body’s own respiratory regulatory centers.
If wrong: Low-flow oxygen therapy is required for patients with COPD, because higher oxygen concentrations depress the body’s own respiratory regulatory centers.

Q: The nurse is caring for a patient with bronchiectasis. Based on an understanding of the pathologic changes that occur with this disease, which intervention to promote clearance of respiratory secretions does the nurse plan?
- Postural drainage
- Intermittent positive pressure breathing
- Pursed-lip breathing
- Diaphragmatic breathing
A: Postural drainage
If right: Encourage postural drainage. Suction the patient as needed and provide assistance in turning, coughing, and deep breathing every 2 hours. Assist with chest physiotherapy.
If wrong: Encourage postural drainage. Suction the patient as needed and provide assistance in turning, coughing, and deep breathing every 2 hours. Assist with chest physiotherapy.

Q: Which test is a quick and reliable aid to diagnosis latent TB?
- PPD skin test
- Sputum smears
- QFT-G
- TB tine test
A: QFT-G
If right: Sputum smears, cultures and PPD skin test are still done. However, QFT-G offers a quick and reliable diagnosis for the patient and health care provider. The results of QFT-G are greater specificity and results are available 24 hours after the blood is collected.
If wrong: Sputum smears, cultures and PPD skin test are still done. However, QFT-G offers a quick and reliable diagnosis for the patient and health care provider. The results of QFT-G are greater specificity and results are available 24 hours after the blood is collected.

Q: Tuberculosis (TB) is treated with multiple drugs to which organisms are susceptible. How many drugs are usually preferred to increase the therapeutic effectiveness?
- One
- Two
- Three
- Four
A: Four
If right: At least four drugs, in combination, are used to prevent the emergence of organisms resistant to the others, thus increasing the therapeutic effectiveness.
If wrong: At least four drugs, in combination, are used to prevent the emergence of organisms resistant to the others, thus increasing the therapeutic effectiveness.

Q: The removal of fluid from the pleural space by thoracentesis presents a possible danger in removing fluid too rapidly. How much fluid removal is recommended at one time?
- 1,500 to 2,000 mL at one time
- 2,200 mL at one time
- 1,300 to 1,500 mL at one time
- Entire amount accumulated in less than 15 minutes
A: 1,300 to 1,500 mL at one time
If right: A possible danger from the thoracentesis procedure is removing fluid too rapidly; less than 1,300 to 1,500 mL at one time is recommended.
If wrong: A possible danger from the thoracentesis procedure is removing fluid too rapidly; less than 1,300 to 1,500 mL at one time is recommended.

Q: When a patient has experienced a pneumothorax, chest auscultation reveals
- equal breath sounds with rhonchi over the affected area.
- deep slowed respirations with equal chest movement.
- bilateral unequal breath sounds, with no breath sounds over the affected area.
- respiratory rate less than 16 breaths per minute.
A: bilateral unequal breath sounds, with no breath sounds over the affected area.
If right: Findings on auscultation are bilaterally unequal breath sounds, with no breath sounds over the affected area. A larger pneumothorax causes respiratory distress, including rapid shallow respirations, air hunger, dyspnea, and oxygen desaturation.
If wrong: Findings on auscultation are bilaterally unequal breath sounds, with no breath sounds over the affected area. A larger pneumothorax causes respiratory distress, including rapid shallow respirations, air hunger, dyspnea, and oxygen desaturation.

Q: A 52-year-old patient has had a laryngectomy in treatment of cancer. A nursing diagnosis for the patient with a laryngectomy would be social isolation related to impaired verbal communication related to removal of the larynx. The correct nursing intervention would be
- complete care quickly.
- provide a pad and pencil or magic slate available.
- refrain from conversations with the patient to reduce his stress level.
- offer books or jigsaw puzzles for entertainment.
A: provide a pad and pencil or magic slate available.
If right: Provide patient with implements for communication. Rapidly completing care and provision of solitary activities does not reduce social isolation.
If wrong: Provide patient with implements for communication. Rapidly completing care and provision of solitary activities does not reduce social isolation.

Q: A patient, age 22, is admitted with acute asthma. It is important to monitor his oxygen saturation levels. The quickest way to assess his saturation of oxygen is to
- get arterial blood gases.
- use pulse oximetry.
- do a pulse pressure assessment.
- do a pulmonary function test.
A: use pulse oximetry.
If right: In acute asthma, oxygen therapy should be started immediately, and its administration should be monitored by pulse oximetry. Pulse oximetry is noninvasive and provides continuous monitoring of SaO_2.
If wrong: In acute asthma, oxygen therapy should be started immediately, and its administration should be monitored by pulse oximetry. Pulse oximetry is noninvasive and provides continuous monitoring of SaO_2.

Q: A patient, age 54, is on postoperative day 2 after undergoing an open cholecystectomy. Immediately after the surgery, she vomited and may have aspirated some emesis. The nurse is concerned that the patient will develop pneumonia. In planning for her care, the nurse suspects the patient may have
- bacterial pneumonia.
- aspiration pneumonia.
- viral pneumonia.
- atypical pneumonia.
A: aspiration pneumonia.
If right: Aspiration pneumonia occurs most commonly as a result of aspiration of vomitus when the patient is in an altered state of consciousness due to a seizure, drugs, alcohol, anesthesia, acute infection, or shock.
If wrong: Aspiration pneumonia occurs most commonly as a result of aspiration of vomitus when the patient is in an altered state of consciousness due to a seizure, drugs, alcohol, anesthesia, acute infection, or shock.

Q: A patient is on postoperative day 4 after undergoing a total hip replacement. He is diagnosed as having a pulmonary embolism. Pulmonary embolism may occur as a postoperative complication of
- arterial thrombosis.
- venous thrombosis.
- shallow, ineffective respirations.
- rapid infusion of intravenous fluids.
A: venous thrombosis.
If right: Venous status, venous wall injury, and increased coagulability of blood cause the formation of a venous thrombosis. The thrombus (usually in the deep veins of the lower extremities) dislodges and travels through the venous circulation; it passes through the right side of the heart and enters the pulmonary artery, where it becomes lodged.
If wrong: Venous status, venous wall injury, and increased coagulability of blood cause the formation of a venous thrombosis. The thrombus (usually in the deep veins of the lower extremities) dislodges and travels through the venous circulation; it passes through the right side of the heart and enters the pulmonary artery, where it becomes lodged.

Q: The patient has COPD. To teach him pursed-lip breathing, the nurse should instruct him to inhale slowly through his
- mouth, then exhale quickly through pursed lips.
- nose, then exhale more slowly through pursed lips.
- mouth, then make his exhalation last three times as long as his inhalation.
- nose, making his inhalation last three times as long as his exhalation.
A: nose, then exhale more slowly through pursed lips.
If right: The nurse should instruct the patient and family on effective breathing techniques (such as pursed-lip breathing) and relaxation exercises for anxiety control. The patient should inhale through the nose and exhale through pursed lips. The exhalation should be 2 – 3 times longer than the inhalation.
If wrong: The nurse should instruct the patient and family on effective breathing techniques (such as pursed-lip breathing) and relaxation exercises for anxiety control. The patient should inhale through the nose and exhale through pursed lips. The exhalation should be 2 – 3 times longer than the inhalation.

Q: The nurse is caring for a patient with bronchiectasis. Based on an understanding of the pathologic changes that occur with this disease, which intervention to promote clearance of respiratory secretions does the nurse plan?
- Postural drainage
- Intermittent positive pressure breathing
- Pursed-lip breathing
- Diaphragmatic breathing
A: Postural drainage
If right: Encourage postural drainage. Suction the patient as needed and provide assistance in turning, coughing, and deep breathing every 2 hours. Assist with chest physiotherapy.
If wrong: Encourage postural drainage. Suction the patient as needed and provide assistance in turning, coughing, and deep breathing every 2 hours. Assist with chest physiotherapy.

Q: When a patient has experienced a pneumothorax, chest auscultation reveals
- equal breath sounds with rhonchi over the affected area.
- deep slowed respirations with equal chest movement.
- bilateral unequal breath sounds, with no breath sounds over the affected area.
- respiratory rate less than 16 breaths per minute.
A: bilateral unequal breath sounds, with no breath sounds over the affected area.
If right: Findings on auscultation are bilaterally unequal breath sounds, with no breath sounds over the affected area. A larger pneumothorax causes respiratory distress, including rapid shallow respirations, air hunger, dyspnea, and oxygen desaturation.
If wrong: Findings on auscultation are bilaterally unequal breath sounds, with no breath sounds over the affected area. A larger pneumothorax causes respiratory distress, including rapid shallow respirations, air hunger, dyspnea, and oxygen desaturation.

Q: A patient is on postoperative day 4 after undergoing a total hip replacement. He is diagnosed as having a pulmonary embolism. Pulmonary embolism may occur as a postoperative complication of
- arterial thrombosis.
- venous thrombosis.
- shallow, ineffective respirations.
- rapid infusion of intravenous fluids.
A: venous thrombosis.
If right: Venous status, venous wall injury, and increased coagulability of blood cause the formation of a venous thrombosis. The thrombus (usually in the deep veins of the lower extremities) dislodges and travels through the venous circulation; it passes through the right side of the heart and enters the pulmonary artery, where it becomes lodged.
If wrong: Venous status, venous wall injury, and increased coagulability of blood cause the formation of a venous thrombosis. The thrombus (usually in the deep veins of the lower extremities) dislodges and travels through the venous circulation; it passes through the right side of the heart and enters the pulmonary artery, where it becomes lodged.