HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success, Exams of Nursing

Download HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success and more Exams Nursing in PDF only on Docsity! HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 1. A patient is hospitalized with symptoms of tuberculosis (TB). The nurse recognizes that at least one of the sputum specimens for acid- fast bacilli (AFB) needs to be obtained at which time of the day? a. 6am i. Culture is the gold standard for diagnosing TB. Three consecutive sputum specimens are needed, each collected at 8- to 24-hour intervals, with at least one early-morning specimen. The initial test involves a microscopic examination of stained sputum smears for AFB. Early morning (6 a.m.) is the ideal time to collect sputum specimens for an AFB smear because secretions collect during the night. The times of 12 noon, 6 p.m., and 9 p.m. are not ideal times to collect the specimen because the amount of secretions for the specimen may not be optimal. 2. Which type of chest surgery is indicated for a patient with chest trauma? a. Exploratory thoracotomy i. An is an incision into the thorax to look for injured or bleeding tissues. It is indicated for a patient with chest trauma. Pneumonectomy is indicated for a patient with lung cancer. Segmental resection is indicated for a patient with bronchiectasis. Lung volume reduction surgery is indicated HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 for a patient with advanced bullous emphysema. 3. A patient presents to the emergency room with severe dyspnea, tachycardia, tracheal deviation, and neck vein distention. Which condition does the nurse suspect? a. Tension pneumothorax i. Tension pneumothorax is the result of increased air in the pleural space; it causes shifting of bodily organs and an increase in intrathoracic pressure. Manifestations of a tension pneumothorax include severe dyspnea, marked tachycardia, tracheal deviation, decreased or absent breath sounds on the affected side, neck vein distention, cyanosis, and profuse diaphoresis. Hemothorax is an accumulation of blood in the pleural space; the patient usually presents with dyspnea, diminished breath sounds, dullness to percussion, and shock, depending on blood loss. Flail chest is a fracture of two or more ribs; the patient presents with paradoxical movement of the chest wall and respiratory distress. Cardiac tamponade occurs when blood collects in the pericardial sac; the patient presents with muffled, distant heart sounds, hypotension, neck vein distension, and increased central venous pressure. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 disease, such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and pneumonia. A tension pneumothorax is a complication associated with the presence of excessive air in the pleural thorax that cannot escape. This condition results in increased intracranial pressure. A traumatic pneumothorax is a type of chest trauma associated with an opening in the pleural space that results in air entering the pleural space. An iatrogenic pneumothorax is a type of chest trauma that occurs as a result of laceration or puncture of the lung. 7. The nurse is caring for a patient admitted to the hospital with pneumonia. Upon assessment, the nurse notes a temperature of 101.4° F, a productive cough with yellow sputum, and a respiratory rate of 20 breaths/minute. Which is an appropriate nursing diagnosis? a. Hyperthermia related to infectious illness i. cause the patient has spiked a temperature and has a diagnosis of pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill, and the patient's breathing pattern is within normal limits at 20 breaths/minute. There is no evidence of ineffective airway clearance from the information given because the patient is expectorating HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 sputum. 8. A patient who is being treated at home for pneumonia reports fatigue to the home health nurse. Which instructions does the nurse provide for the patient? Select all that apply. a. Get adequate rest b. Restrict fluid intake c. Avoid alcohol and smoking d. Resume work to build strength e. Take every dose of the prescribed antibiotic i. oT ensure complete recovery after pneumonia, the patient should be advised to rest, avoid alcohol and smoking, and take every dose of the prescribed antibiotic. The patient should not resume work if feeling fatigued and should be encouraged to drink plenty of fluids during the recovery period. 9. The nurse reviews the medical record of a patient with a pneumothorax and notes that the patient has a minimal amount of fluid accumulated in the intrapleural space and that the patient is stable. Which does the nurse infer? a. No treatment may be needed i. Treatment of a pneumothorax depends on its severity, its HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 underlying cause, and the hemodynamic stability of the patient. If the patient is stable and has minimal air and/or fluid accumulated in the intrapleural space, no treatment may be needed because the condition may resolve spontaneously. Chest tube drainage is helpful to drain the fluid; however, this procedure is performed when the patient has severe complications. Aspiration with a large- bore needle is thoracentesis. This procedure is performed when the patient has fluid accumulation in the complete lung. Needle decompression helps to resolve pneumothorax when the patient has a medical emergency. 10. The nurse provides education for a group of nursing students about acute bronchitis and includes which information? a. Treatment is mainly supportive i. Acute bronchitis is usually self-limiting, and the treatment for acute bronchitis is supportive. Chest x-rays will differentiate acute bronchitis from pneumonia. With bronchitis, no consolidation or infiltrates will be seen on an x-ray as there is with pneumonia. If patients with acute bronchitis develop a fever, have difficulty breathing, or have symptoms last longer than four weeks, they should see their HCP. Because there is no consolidation, egophony would not HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 for a ventilation-perfusion scan. Which instruction does the nurse provide to the patient about the procedure? a. The test involves the injection of a radioisotope and the inhalation of a radioactive gas i. A ventilation-perfusion scan has two parts. In the perfusion portion, a radioisotope is injected into the blood, and the pulmonary vasculature is outlined. In the ventilation part, the patient inhales a radioactive gas that outlines the alveoli. Sedation is not required; magnetic imaging is not a component of the examination, so the patient can have the test even if there is metal in the body. Chest pressure may indicate an adverse reaction and is not normal. 14. A pediatric patient presents with a 2-week history of cough, clear sputum, headache, hoarseness, and myalgias. The patient has no significant medical history. The patient's parent asks why there is no plan to administer an antibiotic. How does the nurse respond? a. Explain that antibiotics are not required for the patient i. The symptoms and signs indicate that the patient may have acute bronchitis, which is a viral disorder. Therefore the nurse should explain to the parent that antibiotics will not help in viral infections. If they are prescribed, antibiotics may cause side effects and may also lead to antibiotic HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 resistance. It is incorrect to advise the parent to see another health care provider, who will likely prescribe a similar course of treatment. The symptoms are not indicative of pertussis. Bronchodilators are not used to treat pertussis. Acute bronchitis is a self-limiting disorder, and the cough may last up to 3 weeks. Informing the parent that antibiotics will be prescribed if the cough persists for another week is not correct. 15. A patient experiences a sucking chest wound as a result of a surgical thoracotomy. Which type of pneumothorax does the nurse suspect? a. Traumatic i. A penetrating wound of the chest may be referred to as a sucking chest wound because air enters the pleural space during inspiration through the chest wall. A surgical thoracotomy can cause sucking chest wounds and result in a traumatic pneumothorax. A tension pneumothorax is the condition associated with the accumulation of air in the pleural space, resulting in lung compression. An iatrogenic pneumothorax is the result of trauma to the chest wall that occurs during a medical procedure such as thoracentesis. A spontaneous pneumothorax is chest wall trauma that is HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 associated with the rupture of small blebs. 16. A patient with no significant health history presents to the emergency department reporting a sudden onset of shortness of breath. The nurse auscultates the lungs and notes that there are no breath sounds in the right upper lobe. The nurse suspects which type of pneumothorax? a. Spontaneous i. A lack of breath sounds over a portion of the lung fields indicates the presence of a pneumothorax. A spontaneous pneumothorax typically occurs as a result of the rupture of small blebs (air-filled sacs) on the surface of the lung. These blebs can occur in healthy young people or from lung disease, such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and pneumonia. A tension pneumothorax occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. An iatrogenic pneumothorax can occur because of laceration or puncture of the lung during medical procedures. A traumatic pneumothorax can occur from either penetrating (open) or nonpenetrating (closed) chest trauma. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 for a patient with pneumonia when the patient makes which statement? a. I should take antibiotics for all upper respiratory infections i. Antibiotics are not indicated for all upper respiratory tract infections, such as viral infections, because they have side effects and promote antibiotic resistance. It is important for the patient to continue with coughing and deep breathing exercises for at least six weeks, until all of the infection has cleared from the lungs. The patient should take all medications as prescribed and seek medical attention for signs or symptoms of a new infection. 21. Which is the reason that the nurse, while assisting with insertion of a chest tube, positions the patient with the arm raised above the head on the affected side? a. To expose the midaxillary area i. The midaxillary area is the standard site for the insertion of a chest tube. Therefore the nurse will position the patient with the arm raised above the head on the affected side to expose the midaxillary area. Analgesics will be given to the patient to minimize pain. The patient’s head will be elevated to reduce the risk of injury. The chest tube will be advanced up over the top of the rib to avoid the intercostal nerves. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 22. When caring for a patient with pertussis, which intervention does the nurse prioritize? a. Administering antibiotic therapy i. The treatment is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. For the patient who cannot take macrolides, trimethoprim/sulfamethoxazole is used. Cough suppressants and antihistamines should not be used because they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are not useful in reducing symptoms. 23. The nurse provides which information about the water-seal chamber on a chest drainage unit (CDU) when educating a group of nursing students? a. It contains 2 cm of water i. The water-seal chamber is the second chamber of the chest drainage system. It contains 2 cm of water, which acts as a one-way valve. The first chamber of the drainage system receives fluid and air from the pleural space. The third chamber applies suction to the chest drainage system. 24. The nurse provides teaching for a patient who is scheduled for a HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 bedside thoracentesis. Which does the nurse explain as the primary purpose of the procedure? a. Relieving an abnormal accumulation of fluid in the pleural space i. Thoracentesis involves the insertion of a large-bore needle into the pleural space to relieve an abnormal accumulation of fluid in the pleural space. The procedure can significantly relieve symptoms related to this fluid accumulation, such as shortness of breath and discomfort. Thoracentesis cannot reveal the stage of lung cancer or permit direct inspection and examination of the pleural space. It may provide a pleural fluid specimen but not a pleural tissue specimen. 25. The nurse determines effective discharge teaching for a patient with pneumonia when the patient makes which statement? a. I will need to have a follow-up chest x-ray in six to eight weeks to evaluate the pneumonia's resolution i. The follow-up chest x-ray will be done in six to eight weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than seven days. It may be important for the patient to continue with deep-breathing exercises for six to eight weeks, not 12 weeks, until all of the infection has cleared from the lungs. Increased fluid intake, not caloric HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 a. Sit the patient up in bed as tolerated and apply oxygen i. The patient's clinical picture is most likely pulmonary embolism (PE), and the first action the nurse should take is to assist with the patient's respirations. The prognosis of a patient with PE is good if therapy is started immediately. The nurse should keep the patient on bed rest in a semi- Fowler’s position to facilitate breathing. The nurse should assess the patient’s cardiopulmonary status with careful monitoring of vital signs, cardiac rhythm, pulse oximetry, arterial blood gases (ABGs), and lung sounds. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before eliciting additional help. A Code Blue would not be called unless the patient experiences a loss of pulse and/or respirations. The nitroglycerin tablet would not be helpful, and the oxygenation status is a bigger problem than the slight chest pain at this time. 29. A patient with chest trauma has a chest tube in place. Upon entering the patient’s room, the nurse notes that the chest tube is completely broken at the midpoint and is no longer attached to the drainage unit. Which action does the nurse take? a. Places the tubing in a sterile water container i. The drainage system should be properly checked to lessen HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 the risk of complications. If the drainage system is found to be broken, then the distal end of the chest tubing connection should be placed in a sterile water container at a 2-cm level as an emergency water seal. Milking and stripping the drainage tubes are done only when there is an order from the physician. The collection chamber should never be emptied but should be replaced. 30. Forty-eight hours after a patient received an intradermal tuberculin skin test (Mantoux), the nurse assesses the injection site and notes a 12-mm area of palpable induration. How does the nurse interpret this result? a. A significant indication that the patient has been exposed to tuberculosis i. The test is read by inspection and palpation 48 to 72 hours late r for the presence or absence of induration. Induration, a palpable, raised, hardened area or swelling (not redness) at the injection site, means the person has been exposed to tuberculosis and has developed antibodies. The other answer options are incorrect conclusions related to the findings.3 31. The registered nurse is evaluating the actions of a nursing student HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 who is maintaining a chest drainage unit (CDU) for a patient with chest trauma. The nurse intervenes when the student performs which actions? Select all that apply. a. Coils the tubing above the chest level b. Expects air fluctuations in the water-seal chamber c. Verifies the presence of an air-occlusive dressing over the insertion site d. Connects the chest tube to wall suction to check for tidaling e. Positions the tubing so that the drainage flows freely from the insertion site to the collection chamber i. Coiling of the tubing above the chest level may cause fluid to drain back into the pleural cavity. Therefore the tubing of the drainage system should be coiled below the chest level. The chest tube should be disconnected from wall suction to check the tidaling because the suction will be increased. An absence of air fluctuations in the water-seal chamber indicates blockage of the tubing. The dressing of the drainage system should be air-occlusive to prevent leakage. The tubing should be dropped straight from the bed or chair to the drainage unit for easy flow. 32. A patient experiences a chest injury as a result of a motor HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 c. Maintain a 30-degree head elevation when in bed d. Avoid throat lozenges because they may induce coughing e. Eat a spoonful of honey to help relieve cough i. The goal of treatment is to relieve symptoms and prevent pneumonia. Treatment is supportive. It includes encouraging oral fluid intake. Honey may help relieve cough. The nurse should encourage patients not to smoke, to avoid secondhand smoke, and to wash their hands often. The patient should be positioned in an upright sitting position (high Fowler's) with the head slightly flexed. Throat lozenges may help relieve cough. 35. Following a thoracotomy, a patient uses patient-controlled analgesia (PCA). Which related outcomes does the nurse expect? Select all that apply. a. The patient will have an effective cough b. The patient will be able to take deep breaths. c. The patient will have reexpansion of the lungs d. The patient will have reduced pulmonary edema e. The patient will be able to move the arm on the operative side i. Thoracotomy is a painful procedure and involves cutting HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 respiratory muscles during the surgery. Postoperative use of PCA, epidural infusions, and intercostal nerve blocks allows patients to breathe deeply, cough, and move the arm and shoulder on the operative side. The chest tube placed on the chest after thoracotomy helps lung expansion. The nurse administers diuretics to relieve pulmonary edema. 36. When admitting a female patient with a diagnosis of pulmonary embolism (PE), the nurse assesses for which risk factors? Select all that apply. a. Pregnancy b. Pneum onia c. Cancer d. Oral contraceptive use e. Hormone therapy i. Risk factors for PE include immobility or reduced mobility, surgery within the last three months (especially pelvic and lower extremity surgery), history of venous thromboembolism (VTE), cancer, obesity, oral HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 contraceptives, hormone therapy, cigarette smoking, prolonged air travel, heart failure, pregnancy, and clotting disorders. Pneumonia is not a risk factor. 37. The treatment plan for a patient with tuberculosis includes isoniazid and rifampin. Which data found in the patient's health history cause the nurse to question the medication prescriptions? a. Hepatitis i. Isoniazid (INH) and rifampin are tuberculosis medications that are metabolized in the liver and are extremely toxic. Hepatotoxicity is a common side effect. A history of asthma, rheumatic fever, or allergy to penicillin is not a contraindication to the administration of INH and rifampin. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 41. A patient presents to the emergency department with a temperature of 101.4°F (38.6°C) and a productive cough with rust- colored sputum. The nurse suspects which diagnosis? a. Pneumonia i. Sputum associated with pneumonia may be green, yellow, or even rust colored (bloody). Tuberculosis frequently presents with a dry cough. With acute bronchitis, clear sputum is often present, although some patients have purulent sputum. Pink, frothy sputum would be present in CHF and pulmonary edema. 42. A patient presents with a pneumonia score of 5 on the Expanded CURB-65 scale. Which action does the nurse take? a. Consider admission to an intensive care unit i. The Expanded CURB-65 scale may be used as a supplement to clinical judgment to determine the severity of pneumonia and if patients need to be hospitalized. A patient score of 5 on the scale means the perceived risk is high and that placement in the intensive care unit is warranted. If the patient has symptoms of pneumonia, advising no treatment is not appropriate. Treatment in an outpatient setting is advised when the scores are 0 to 2 on the scale. Hospital HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 admission is advised when the scores are 3 to 4 on the scale. 43. Which chest injury is depicted in the accompanying image, as it occurs during patient inspiration? HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 a. Flail chest i. The image depicts a lung during inspiration and indicates paradoxical breathing as the chest is sucked in during inspiration. This indicates flail chest. Cardiac tamponade is a complication associated with the presence of excess fluid in the heart, which increases pressure on the heart. Iatrogenic pneumothorax is a type of chest trauma associated with a laceration on the lung that occurs during medical procedures. Traumatic pneumothorax is chest trauma associated with excess air in the chest cavity as a result of an opening in the chest wall. 44. The nurse is caring for a patient with acute pulmonary embolism (PE) and expects that which subcutaneous medication will be included in the patient’s treatment plan? HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 breathing, incentive spirometer use, and range-of-motion exercises. The nurse instructs the patient to change position slowly if he or she has hypotension. Protein is essential and does not reduce the risk of atelectasis. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 47. The nurse cares for a patient who is immunocompetent and presents with pulmonary tuberculosis (TB). Which clinical manifestation does the nurse expect? a. Mucopurulent sputum i. A cough that progresses in frequency and produces mucoid or mucopurulent sputum is the most common symptom of pulmonary TB. Diarrhea, lymph node enlargement, and dehydration are manifestations not directly associated with pulmonary TB in a patient who is immunocompetent. 48. A patient who has tuberculosis (TB) is being treated with combination drug therapy. The nurse explains that combination drug therapy is essential for which reason? a. It discourages the development of resistant strains of the TB organism i. Because of the growing prevalence of multidrug-resistant tuberculosis (MDR-TB), it is important to manage the patient with active TB aggressively. Drug therap y is divided into two phases: initial and continuation. In most circumstances, the treatment regimen for patients with previously untreated TB consists of a three-month initial phase with four drugs (isoniazid, rifampin, pyrazinamide, and ethambutol). The dosage, side effects, and duration of the regimen are not HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 reasons for combination drug therapy in a patient with TB. 49. An unconscious patient who was brought to the emergency department responded well to cardiopulmonary resuscitation (CPR). After several hours in stable condition, the patient experiences dyspnea, tachycardia, cyanosis, and neck vein distention. The nurse prepares for which immediate intervention? a. Needle decompression i. The symptoms and signs indicate that the patient has a tension pneumothorax. Tension pneumothorax occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. This results in compression of the lung on the affected side and pressure on the heart and great vessels, pushing them away from the affected side. If the tension in the pleural space is not relieved, the patient is likely to die from inadequate cardiac output or severe hypoxemia. Therefore the patient requires immediate needle decompression followed by chest tube insertion with a chest drainage system. Pericardiocentesis is the treatment for cardiac tamponade. Insertion of a CVAD is not the priority. The patient will likely be placed in the semi- Fowler’s position to facilitate breathing. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 (e.g., alteplase) to treat PE is prescribed in cases of hemodynamic instability and right ventricular dysfunction. 52. A 70-year-old patient presents to the emergency department with symptoms that indicate pneumonia. Assessment findings include a new onset of confusion, a respiratory rate of 42 breaths/minute, a blood urea nitrogen (BUN) of 24 mg/dL, and a BP of 80/50 mm Hg. The nurse expects which treatment plan? a. Admit the patient to the intensive care unit i. According to the Expanded CURB-65 scale, which is used as a supplement to clinical judgment to determine the severity of pneumonia, the patient’s score is a 5; placement in the intensive care unit is recommended. The patient receives 1 point for each criterion: confusion (compared to baseline); BUN greater than 20 mg/dL; respiratory rate greater than or equal to 30 breaths/min; systolic BP of less than 90 mm Hg; and age greater than or equal to 65 yrs. With severe pneumonia, the patient needs a higher level of care than general medical-surgical. Discharging the patient is unsafe. Pulmonary embolism does not manifest in this way, and assessing for it is not required in this case. 53. The nurse cares for a patient with a diagnosis of tuberculosis. Which HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 assessment finding best indicates that the patient has been following the prescribed treatment plan? a. Negative sputum cultures i. A patient's sputum is expected to convert to negative within three months of the beginning of treatment. If it does not, the patient is either not taking the medication or has drug-resistant organisms. Bilaterally clear breath sounds, a decrease in coughing, and less fatigue are good indications that the patient is following the prescribed plan, but they are not as confirmatory as negative sputum cultures. 54. A patient with a spontaneous pneumothorax has a chest tube in place that is attached to a chest drainage unit (CDU) with no suction being applied. The water level in the water-seal chamber is fluctuating. Which action does the nurse take? a. Continue to monitor and document the respiratory status i. In a CDU that is not attached to suction, the fluid in the water-seal chamber rises when the patient inhales and falls when the patient exhales. This is a normal finding. The absence of fluctuations may indicate an obstruction in the system. The nurse must continually check the function of the CDU and assess respiratory status at least every four HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 hours. There is no need to notify the health care provider or decrease the amount of water in the water-seal chamber because the chest tube system is functioning normally. The chest tube should not be clamped; doing so could cause a tension pneumothorax. 55. A patient has a chest tube with a chest drainage unit (CDU) in place. The nurse notes that the tidaling in the water-seal chamber has stopped. Which action does the nurse take? a. Assess the drainage system for occlusion i. Normal fluctuation of the water within the water-seal chamber is called tidaling. This up-and- down movement of water in concert with respiration reflects the intrapleural pressure changes during inspiration and expiration. If tidaling (rising with inspiration and falling with expiration in the spontaneously breathing patient) is not seen, the drainage system is blocked, the lungs are reexpanded, or the system is attached to suction. If tidaling is not seen, the nurse needs to determine the cause rather than simply continuing to monitor the patient. The nurse could check all connections for a leak, but the most common cause is HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 58. The nurse is assessing patients who are undergoing the process of chest drainage using a chest drainage unit (CDU). Which patient requires -10 cm H2O? a. Patient C i. High pressure may cause tissue damage in Patient A, who is very frail. Lower pressure (-10 cm H2O) may be used for frail and older patients at risk for tissue damage with higher pressures. The suction pressure is usually ordered to be -20 cm H2O, which is appropriate for Patient B. Patient C HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 requires evacuation of the pleural thorax; therefore the patient requires high-pressure drainage, such as -30 to -40 cm H2O. Patient D has a pneumothorax, so the patient will require high pressure, such as -30 to -40 cm H2O, to evacuate the pleural space. 59. The nurse identifies a nursing diagnosis of impaired gas exchange for a patient with pneumonia based on which physical assessment findings? Select all that apply. a. SpO2 of 85% b. PaCO2 of 65 mm Hg HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 c. Thick yellow mucus expectorant d. Respiratory rate of 24 breaths/minute e. Dullness to percussion over the affected area i. Indications of impaired gas exchang e for this patient include a decreased oxygen saturation level (SpO2 less than 90%) and an increased partial pressure of carbon dioxide level (PaCO2 greater than 45 mm Hg). PaCO2 is the partial pressure of carbon dioxide in arterial blood. Dullness to percussion over the affected area indicates a pleural effusion, which is associated with pneumonia. Yellow mucus would indicate clearance of secretions. An increased respiratory rate does not imply impaired gas exchange. 60. The nurse provides care for a patient who sustained multiple injuries as a result of a motor vehicle accident. Which assessment finding requires immediate intervention? a. Tracheal deviation i. The nurse must check the patient’s airway, breathing, and circulation. The clinical manifestation of tracheal deviation indicates that the patient is experiencing a tension pneumothorax, which is a medical emergency. It affects both the respiratory and cardiovascular systems. If the tension in HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 those living or working in institutions (long-term care facilities, prisons, shelters, hospitals), IV-injecting drug users, those with overcrowded living conditions and less- than-optimal sanitation, and those with poor access to health care. Immunosuppression from any cause (e.g., HIV infection, cancer, long-term corticosteroid use) increases the risk for active TB infection. Elderly adults who attend activities at a local senior center and children who attend a preschool three days a week do not have an increased risk of the disease. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 64. A patient started treatment for sputum smear–positive tuberculosis (TB) 1 week prior to the home health nurse’s visit. Which instructions does the nurse provide to the patient to minimize exposure to close contacts and household members? Select all that apply. a. Increase the intake of foods that are high in vitamin C b. Ensure that the home is well ventilated c. Sleep alone d. Spend as much time as possible outdoors e. Minimize time in congregate settings f. Minimize time on public transportation i. Patients with sputum smear–positive TB are considered infectious for the first 2 weeks after starting treatment. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. While still infectious, the patient should sleep alone, spend as much time as possible outdoors, and minimize time spent in congregate settings or on public transportation. Increasing the intake of foods that are high in vitamin C does not decrease exposure to others. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 65. The nurse notes that a patient’s treatment plan for chylothorax includes chemical pleurodesis. The nurse expects that which medication will be prescribed? a. Chylothorax is the presence of lymphatic fluid in the pleural space. The thoracic duct is disrupted either traumatically or from cancer, allowing lymphatic fluid to fill the pleural space. Chemical pleurodesis is done to obliterate the pleural space and prevent reaccumulation of effusion fluid. This procedure first requires chest tube drainage of the effusion. Once the fluid is drained, a chemical slurry is instilled into the pleural space. Talc is the most effective agent for pleurodesis. Other agents that can be used include doxycycline and bleomycin. Octreotide is a hormone-like drug that acts as a vasoconstrictor and reduces lymphatic flow; however, this medication is not used after pleurodesis. Prednisone is a corticosteroid used to reduce the progression of chronic pulmonary fibrosis. Cyclosporine is an immunosuppressive drug that treats pulmonary fibrosis. 66. The nurse assesses a patient following a transthoracic needle aspiration and notes excess air in the pleural space. How does the nurse interpret the finding? a. The patient has an iatrogenic pneumothorax i. An iatrogenic pneumothorax can occur as a result of a HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 prolonged air travel. Pneumonia would be evident if the patient had a fever; elevated white blood cell count; and a productive cough with yellow, green, or rust-colored sputum. Unstable angina would present with chest pain occurring at rest; COPD exacerbation would present with wheezing, cough, and shortness of breath. 69. On the third postoperative day following hip surgery, a patient states, "This morning I started to have shortness of breath, slight chest pain, and a feeling as if something isn’t right." The patient’s assessment findings include respirations 32 breaths/min, pulse 110 beats/min, and an oxygen saturation of 87% on room air. Which is the priority nursing action? a. Apply oxygen i. The patient's clinical picture is consistent with pulmonary embolism (PE) . The priority is airway, breathing, and circulation. Manifestations of PE depend on the type, size, and extent of emboli. Small emboli may go undetected or cause vague, transient symptoms. Symptoms may begin slowly or appear suddenly. Dyspnea is the most common presenting symptom, occurring in 85% of patients with PE. Mild to moderate hypoxemia may occur. Other manifestations include tachypnea, cough, chest pain, HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 hemoptysis, crackles, wheezing, fever, accentuation of pulmonic heart sound, tachycardia, and syncope. Immediate assessment should focus on the patient’s cardiopulmonary status. O2 should be given by mask or cannula when hypoxemia is present. Notifying the HCP, obtaining an ECG, and calling the rapid response team can occur after the patient’s respiratory status is addressed. 70. A patient receives a prescription for amphotericin B. The nurse identifies that the medication is being given to treat which respiratory condition? a. Pulmonary fungal infection i. Amphotericin B is the standard therapy for treating serious systemic fungal infections. It must be given IV to achieve adequate blood and tissue levels because the gastrointestinal tract does not absorb it well. For a lung abscess, clindamycin is the first-line therapy because of its effectiveness against Staphylococcus and anaerobic organisms. The treatment for necrotizing pneumonia includes long-term antibiotic therapy. The treatment for pertussis is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 71. The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, neck vein distention, and an increase in intrathoracic pressure. The nurse prepares for which procedure? a. Needle decompression i. Cyanosis, air hunger, extreme agitation, subcutaneous emphysema, neck vein distention, hyperresonance to percussion, and tracheal deviation away from affected side (late sign) are manifestations of a tension pneumothorax in a patient with chest trauma. A tension pneumothorax is a complication associated with the presence of excess air in the pleural thorax that cannot escape and is treated with needle decompression. Pericardiocentesis is helpful in aspirating fluid from the pleural space, which is more useful in cases of cardiac tamponade. Insertion of a chest tube with a flutter valve or a chest tube with drainage are techniques that help to drain air from the lung. However, these techniques are performed after needle decompression. 72. The nurse reviews the process for setting up a wet suction system that is attached to a chest tube and questions which step that is listed in the procedure? a. Keep the suction control chamber uncovered HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 is sucked in, and during expiration, it bulges out. This paradoxical chest movement prevents adequate ventilation and increases the work of breathing. 74. A patient presents for a follow-up office visit one week after sustaining rib fractures that resulted in flail chest. Which instructions does the nurse provide to the patient? Select all that apply. a. You should take a shower instead of a bath for one more week b. You may want to sleep in the semi-Fowler’s position to make your breathing easier c. You should apply a binder over your chest during the day while performing activities d. You should wear compression hose throughout the day e. You may experience intercostal pain for several more weeks, so pain medication may still be needed i. The semi-Fowler’s position facilitates lung expansion, so the patient will be able to breathe easily. The lung parenchyma and fractured ribs heal with time. Some patients continue to have intercostal pain several weeks after the flail chest has resolved. Bathing will not complicate the patient’s condition. Applying a binder will reduce chest expansion, so the nurse does not instruct the patient to apply a binder over his or her chest. There is no indication that compression hose are HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 needed or that the patient is at risk for a thrombosis. 75. The nurse is providing postoperative care for a patient following a left pneumonectomy. Which is an appropriate nursing intervention? a. Encouraging range-of-motion exercises on the left upper extremity i. A pneumonectomy is the removal of an entire lung. Range-of- motion exercises performed on the affected upper extremity will prevent edema and encourage circulation to the lung space to promote healing. A patient who has had a pneumonectomy may have a clamped chest tube postoperatively, so there will not be any drainage. Fluid will gradually fill the space where the lung has been removed. The patient should be positioned on the operative side to facilitate the expansion of the remaining lung. There will not be lung sounds on the operative side because the entire lung has been removed. 76. The nurse prepares staff education related to lung transplantation and includes which information? Select all that apply. a. Acute rejection typically occurs in the first two to three weeks after surgery. b. Accurate diagnosis of rejection is by transtracheal biopsy HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 c. Immunosuppressive therapy usually includes a two-drug regimen. d. Cytomegalovirus (CMV) is a common causative agent of infection after lung transplant e. During the first year after transplantation, viral pneumonia is the most common type of infection f. Lung transplant recipients usually receive higher levels of immunosuppressive therapy than other organ recipients i. Lung transplan t recipients are at high risk for multiple complications. Accurate diagnosis of rejection is by transtracheal biopsy. Infections are the leading cause of death at all time points after lung transplant. Bacterial bronchitis and pneumonia are the most common infections. CMV, fungi, viruses, and mycobacteria are also causative agents. Lung transplant recipients usually receive higher levels of immunosuppressive therapy than other organ recipients. Acute rejection is fairly common in lung transplantation; it typically occurs in the first 5 to 10 days after surgery. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 effect. 80. The nurse expects that which interventions will be listed on a treatment plan for a patient with bronchitis? Select all that apply. a. Humidify the oxygen b. Teach pursed lip breathing c. Administer an antibiotic d. Encourage the consumption of hot tea e. Increase fluid intake to 3 L per day if tolerated i. The goal of treatment for bronchitis is to relieve symptoms and prevent pneumonia. Treatment is supportive. It includes humidifying the oxygen to help loosen secretions. Throat lozenges, hot tea, and honey may help relieve cough. Increasing fluid intake will liquefy the secretions so that the patient can expectorate them more easily, Pursed lip breathing will not promote mucus production and expectoration. Antibiotics are not prescribed for viral infections because they have side effects and promote antibiotic resistance. Several interventions may help the patient expectorate mucus, including elevating the head of the bed to increase the movement of mucus. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 81. While obtaining a health history for a patient with suspected tuberculosis (TB), the nurse expects which early signs or symptoms of the disease? Select all that apply. a. Anor exia b. Fatigue c. Dizziness d. Night sweats e. Chest tightness i. Symptoms of pulmonary TB usually do not develop until 2 to 3 weeks after infection or reactivation. The primary manifestation is an initial dry cough that often becomes productive with mucoid or mucopurulent sputum. Active TB disease may initially present with constitutional HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 symptoms (e.g., fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, night sweats). Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late sign. Dizziness and chest tightness are not symptoms associated with TB. 82. The nurse presents education to a group of nursing students about lung abscess and includes which information? a. The purulent sputum that is produced is often dark brown. i. Purulent sputum is dark brown, foul smelling, and foul tasting. With a lung abscess, hemoptysis is common, especially when an abscess ruptures into a bronchus. Other manifestations include fever, chills, prostration, night sweats, pleuritic pain, dyspnea, anorexia, and weight loss. Nausea and vague abdominal pain are not symptoms associated with a lung abscess. Physical examination shows dullness and decreased breath sounds. Clindamycin is the first-line therapy for its effectiveness against Staphylococcus and anaerobic organisms. 83. The nurse provides care for a patient with a suspected lung HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 hepatotoxicity because of his or her history of alcoholism. The children definitely require preventive treatment with INH. 86. Which intervention does the nurse perform 30 minutes before removing a chest tube from a patient? a. Administer a pain medication to the patient. i. While removing the chest tube, the patient may have pain; therefore the nurse administers pain medication 30 to 60 minutes before the procedure. A sterile field should be prepared immediately before a sterile procedure. There is insufficient information to determine the status of the chest tube. It is highly unlikely that the chest tube is to be clamped because this increases pressure within the pleural space. The patient does not need to be NPO before the procedure. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 87. The nurse observes another staff member providing care for a patient who has a chest tube in place. Which action by the staff member may result in increased air in the pleural space and requires the nurse to intervene? a. lamps the chest tube while ambulating the patient in the hallway i. Clamping of chest tubes during transport or when the tube is accidentally disconnected is no longer advocated. The danger of rapid accumulation of air in the pleural space, causing tension pneumothorax, is far greater than that of a small amount of atmospheric air that enters the pleural space. Most health care providers prefer to seal the wound around the chest tube with petroleum (airtight) gauze. Moving the clamp down the tubing to assess for an air leak is brief and will not cause an accumulation of air in the pleural space. Bearing down (Valsalva maneuver) during tube removal prevents air from entering the pleural space. 88. The nurse is caring for a patient with a diagnosis of active tuberculosis (TB) and anticipates that which item will be included in the patient’s treatment plan? a. Avoid alcohol because it increases the hepatotoxicity associated with isoniazid (INH) i. Alcohol must be avoided because it increases the HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 hepatotoxicity of INH. Directly observed therapy must be continued through both phases in patients who are at risk for noncompliance with drug therapy. Drug therapy includes a two-phase process, with an initial and continuation phase. Baseline LFTs are done before treatment is begun and then monitored monthly. 89. The nurse provides education for a patient with human immunodeficiency virus (HIV) who is diagnosed with an infection of the lungs caused by Candida albicans. Which statement made by the patient indicates the need for further teaching? a. I need to be isolated from my family and friends so that they won't get the infection i. C. albicans is an organism that causes a fungal infection. Pulmonary fungal infections are acquired by inhaling spores. They are not transmitted from person to person. The patient does not have to be placed in isolation. Because the patient is immunocompromised (because of HIV), the patient is likely to have a serious infection, so the treatment will likely include IV amphotericin B. The effectiveness of the therapy can be monitored with fungal serology titers. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023