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 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. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 2. 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. . 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 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 on the affected side, and hyperresonance on percussion. Because no air movement occurs with a pneumothorax, no breath sounds, including crackles, will be heard. Assessment findings will include hyperresonance on percussion. 6. The nurse reviews a patient’s medical record and notes the presence of ruptured small blebs on the surface of the lung. The nurse identifies that the finding is consistent with which type of pneumothorax? a. Spontaneous i. 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 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 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 be auscultated. Egophony is an increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis. It is caused by the enhanced transmission of high- frequency sound across fluid, such as in abnormal lung tissue, with lower frequencies filtered out. 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 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 17. A patient is hospitalized with a diagnosis of pneumonia. When reviewing the patient’s history, the nurse finds that the patient experienced a seizure with profuse vomiting four days prior to the hospital admission. Which type of pneumonia does the nurse suspect? a. Aspiration pneumonia i. Aspiration pneumonia results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. Conditions that increase the risk for aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric (NG) tubes with or without enteral feeding. The aspirated material (food, water, vomitus, oropharyngeal secretions) triggers an inflammatory response. The history of the patient does not suggest any exposure to pneumonia in the community. The patient has never been in the hospital; therefore hospital-associated pneumonia is highly unlikely. The patient does not have a history of HIV, intake of immunosuppressive drugs, corticosteroids, or any disorders leading to immunosuppression; therefore opportunistic pneumonia did not occur in this patient. 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 18. How does splinting the incision with a pillow benefit a patient who underwent surgery to repair chest trauma? a. It facilitates deep breathing i. The patient will have difficulty breathing after surgery as a result of the incision on the chest. Splinting the incision facilitates deep breathing. The nurse administers analgesics to reduce pain. An occlusive dressing is applied over the site of surgery to reduce air leakage. The nurse instructs the patient to perform range-of-motion exercise to increase perfusion or oxygen supply to the injured site. 19. Which surgical lung procedure involves the removal of a small, localized lesion that occupies only part of a segment? a. Wedge resection i. A wedge resection is the removal of a small, localized lesion that occupies only part of a segment. Pleurodesis is the surgical procedure that helps in the adhesion of the visceral and parietal pleura in the patient who has a pneumothorax. Pleural biopsy is a procedure in which a sample of pleural cells is examined for tumors. Thoracentesis is a procedure that is performed to drain the fluid from the pleural space. 20. The nurse determines that additional discharge teaching is needed 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 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 enough, or (3) the pleural air leak is so large that the suction is not high enough to evacuate it. The wall suction regulator should be set until there is continuous gentle bubbling in the suction control chamber (generally 80 to 120 mm Hg). The water-seal chamber should not contain blood; this finding indicates that the chest tube drainage system may have overturned and should be replaced. 28. The nurse is providing postoperative care for a patient three days after a total knee arthroplasty. The patient reports a sudden onset of shortness of breath, slight chest pain, and that "something is wrong." The assessment findings include a temperature of 98.4°F (36.9°C), BP 130/88 mm Hg, respirations 36 breaths/min, and an oxygen saturation reading of 91% on room air. Which immediate action does the nurse take? 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 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 vehicle accident. The patient’s assessment findings include asymmetric chest excursion and an absence of breath sounds on the left side. Which condition does the nurse suspect? a. Left-sided pneumothorax i. A pneumothorax should be suspected after any trauma to the chest wall. A pneumothorax is caused by air entering the pleural cavity. The pleural space has a few milliliters of lubricating fluid to reduce friction when the tissues move. When air enters this space, the change in positive pressure causes a partial or complete lung collapse. As the volume of air in the pleural space increases, lung volume decreases. The patient described experienced a closed (no external wound) pneumothorax. When the left part of a chest is crushed, breathing will be compromised, resulting in asymmetric excursion. On auscultation, breath sounds are absent over the affected area. PE is an abnormal collection of fluid in the pleural space. Clinical manifestations associated with PE include dyspnea, hypoxemia, tachypnea, cough, chest pain, hemoptysis, crackles, 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. Pneu m 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 38. A patient’s initial purified protein derivative (PPD) skin test result is positive. A repeat skin test is also positive. No signs or symptoms of tuberculosis or allergies are evident. Which medication therapy does the nurse anticipate will be prescribed? a. Isoniazid (INH) i. The standard treatment regimen for latent tuberculosis infection (LTBI) is nine months of daily isoniazid. It is an effective and inexpensive drug that the patient can take orally. Penicillin and theophylline would not be prescribed for the treatment of TB exposure. INH plus an antibiotic would not likely be prescribed for this scenario. 39. A patient with a pneumothorax has a chest tube in place. The nurse verifies that there are no leaks in the tubing or at the insertion site. The nurse notes that there is no bubbling in the suction control chamber of the chest drainage unit (CDU). Which are the most probable reasons for the absence of bubbling? Select all that apply. a. There is no suctioning being applied b. The CDU is not working properly. c. The suction pressure is very low d. The pleural air leak is so large that the suction is not high enough 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 to evacuate it e. There is a collection of blood in the pleural space i. If there is no bubbling in the suction control chamber , (1) there is no suction, (2) the suction is not high enough, or (3) the pleural air leak is so large that the suction is not high enough to evacuate it. A malfunctioning CDU is probably not the cause of the absence of bubbling. A collection of blood in the pleural space would be evident by the type of drainage. 40. Which immediate action does the nurse take when discovering that a patient’s chest tube is disconnected from the chest drainage unit (CDU)? a. Immerse the distal end of the chest tube in sterile water i. If the drainage system breaks, the nurse should place the distal end of the chest tubing connection in a sterile water container at a 2-cm level as an emergency water seal. This will reduce the risk of air entering the pleural space. Applying a clamp to the tube will accumulate fluid or air in the pleural space. There is no information given related to respiratory status to determine correct patient positioning. Wrapping a petroleum (airtight) gauze over the end of the chest tube will accumulate fluid or air in the pleural space. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 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. 42. 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. 43. 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 a. Enoxaparin i. Subcutaneous administration of low-molecular-weight heparin (LMWH) (e.g., enoxaparin [Lovenox], fragmin [Dalteparin], or fondaparinux) is the recommended treatment for patients with acute PE. LMWH is safer and more effective than unfractionated heparin. Warfarin (Coumadin) is an oral anticoagulant; it is started at the time of diagnosis. Warfarin should be given for at least three months and then reevaluated. Direct thrombin inhibitors are given IV; some health care providers use them in the treatment of PE. The fibrinolytic agents, such as tissue plasminogen activator (tPA) or alteplase (Activase), may help dissolve the PE and the source of the thrombus in the pelvis or deep leg veins, thereby decreasing the risk for recurrent emboli. 44. A patient reports shortness of breath one day after a cholecystectomy. The nurse assesses the right lung sounds and notes dullness to percussion and decreased breath sounds. Which is the most probable reason for the assessment findings? a. Atelectasis i. Atelectasis is a lung condition characterized by collapsed, airless alveoli. There may be decreased or absent breath 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 46. 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. 47. 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 therapy 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 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 49. The bubbling in a patient’s chest drainage unit (CDU) has increased, and the nurse suspects an air leak. The patient’s chest tube is numbered from 1 to 5 in regular increments on the tube. To determine the location of the air leak, the nurse briefly and methodically clamps down the tubing away from the patient. The leak stops when the tube is clamped between the numbers 3 and 4. How does the nurse interpret the finding? a. The air leak is in the tube between points 3 and 4. i. Whenever the bubbling increases, the nurse should suspect an air leak. If a leak persists, the nurse should briefly clamp the chest tube starting at the patient’s chest. The nurse should briefly and methodically move the clamps down the tubing, away from the patient, until the air leak stops. The leak will then be present between the last two clamp points. If the leak persists, the nurse should briefly clamp the chest tube at the patient’s chest. If the leak stops when the tube is clamped at the patient’s chest, the air is coming from the patient. For this patient, the leak is present between the last two clamp points, which are numbers 3 and 4. If the air leak persists all the way to the drainage unit, the unit should be replaced. 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 50. A patient is admitted to an intensive care unit in stable condition with suspected acute pulmonary embolism (PE). The nurse prepares for the administration of which medication? a. Subcutaneous enoxaparin i. Immediate anticoagulation is required for patients with PE. Subcutaneous administration of low- molecular- weight heparin (LMWH) (e.g., enoxaparin [Lovenox]) or fragmin [Dalteparin] or fondaparinux) is the recommended treatment for patients with acute PE. Subcutaneous administration of LMWH has been found to be safer and more effective than the use of unfractionated heparin. Oral warfarin (vs. apixaban) is the most widely used oral anticoagulant. Warfarin should be given for at least three months and then reevaluated. Thrombolytic therapy 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. 53. 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. 54. 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 occlusion. The collection unit is likely already in a low HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 i. The patient's parent would be most susceptible to TB as a consequence of advanced age and immunosuppression by the corticosteroid. A history of asthma, obesity, and pregnancy do not increase the risk of contracting TB. 56. A patient sustains injuries to the chest as a result of an altercation. The nurse assesses the right lung and notes decreased breath sounds and dullness on percussion. The patient reports difficulty breathing. The nurse makes preparations to assist the health care provider with the insertion of which size chest tube? a. 38F i. The symptoms indicate that the patient has a hemothorax, which means blood in the pleural space. Manifestations of a hemothorax include dyspnea, decreased or absent breath sounds, dullness to percussion, decreased hemoglobin, and shock (depending on blood volume lost). The priority intervention is chest tube insertion with a chest drainage system to drain the blood. The size of the tube to be used is determined by the patient's condition. Large tubes (36F to 40F) are used to drain blood; therefore the 38F tube should be used for this patient. Medium (24F to 36F) tubes are used to drain fluid, and small (12F to 24F) tubes are used to drain air. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 H2O) may be used for frail HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 57. 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 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 the pleural space is not relieved, the patient is likely to die from inadequate cardiac output or severe hypoxemia. Pain may be caused by the other problems; this assessment is a lower priority than ensuring a patent airway. Circulatory compromise is identified with a rapid, thready pulse, and possible abdominal bleeding is indicated by bruising to the left flank; checking for these can follow checking for tracheal deviation. 60. The nurse reviews the medical records of patients diagnosed with community-acquired pneumonia (CAP) and identifies that the patients meet which criterion? a. The patients have not been hospitalized or have not lived in a long-term care facility within 14 days of the onset of symptoms i. CAP is an acute infection of the lung occurring in patients who have not been hospitalized or lived in a long-term care facility within 14 days of the onset of symptoms. 61. A patient received antibiotic treatment for bacterial pneumonia. The nurse determines that the levofloxacin therapy has not been effective after noting which indicator? a. White blood cell count 16,000/μL i. The normal white blood cell (WBC) count is 5000 to 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 10,000/mm3. The presence of leukocytosis (WBC count >15,000/μL) indicates that the infection persists despite treatment with an antibiotic. Lung sounds and respiratory rate are not indicators of the efficacy of antibiotic treatment. A low-grade fever also may signify that the infection is persisting; however, the WBC count is the most reliable indicator of active infection. 62. The nurse is preparing a community education session related to the increased incidence of tuberculosis (TB) among the city’s residents. The nurse identifies that which populations are most at risk for the disease? Select all that apply. a. Workers at a nearby prison b. Elderly adults who attend activities at a local senior center c. Adults who are homeless d. Children who attend a preschool three days a week e. Middle-aged adults who live in the inner-city neighborhood f. Immigrants from an underdeveloped country who live in temporary housing in the city i. TB occurs disproportionately in the poor, underserved, and minorities. People most at risk include the homeless, residents of inner-city neighborhoods, foreign-born people, HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 63. 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 64. 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. 65. 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. 68. 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. 69. 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 generally at -20 cm H2O pressure. The HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 i. The nurse should keep the cover over the suction control chamber in place to prevent rapid evaporation of water and to decrease the noise of the bubbling. The ordered suction amount is nurse should dial the wall suction regulator until there is continuous gentle bubbling in the suction control chamber (generally 80 to 120 mm Hg). 72. The nurse is caring for a patient who is at risk for a flail chest and recalls which information about the condition? Select all that apply. a. Palpation must be performed to assess for crepitus. b. At times, intubation and ventilation may be needed. 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. Paradoxical chest movements only occur if the sternum also is fractured d. In cases of extreme chest trauma, surgical fixation of the flail segment may be done e. Flail chest results from the fracture of two or more consecutive ribs on the same side f. Paradoxical chest movements involve the affected portion being sucked in during expiration and bulging out during inspiration i. Flail chest results from the fracture of three or more consecutive ribs in two or more separate places, causing an unstable segment. It also can be caused by a fracture of the sternum and several consecutive ribs. Observation of abnormal chest cavity movement, palpation for crepitus near the rib fractures, and chest x-ray all assist in the diagnosis. The paradoxical chest movement prevents adequate ventilation; intubation may be needed, and the nurse may need to provide ventilation. In cases of extreme chest trauma, surgical fixation of the flail segment may be done. With flail chest, the resulting instability of the chest wall (regardless of whether the sternum is fractured) causes paradoxical movement during breathing. The affected (flail) area moves in the opposite direction with respect to the intact part of the chest. During inspiration, the affected part 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. 74. 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. 75. 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 transplant 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