Ch. 20- Respiratory Function

A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does serous fluid indicate?

a) Cancer

b) Emphysema

c) Trauma

d) Infection

Cancer Explanation: A thoracentesis may be performed to obtain a sample of pleural fluid or to biopsy a specimen from the pleural wall for diagnostic purposes. Serous fluid may be associated with cancer, inflammatory conditions, or heart failure. Blood fluid typically suggests trauma. Purulent fluid is diagnostic for infection. Complications that may follow a thoracentesis include pneumothorax and subcutaneous emphysema.

A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient?

a) 95%

b) 80%

c) 40%

d) 75%

95% Explanation: With a normal value for the partial pressure of oxygen (PaO2) (80 to 100 mm Hg) and oxygen saturation (SaO2) (95% to 98%), there is a 15% margin of excess oxygen available to the tissues. With a normal hemoglobin level of 15 mg/dL and a PaO2 level of 40 mm Hg (SaO2 75%), there is adequate oxygen available for the tissues but no reserve for physiologic stresses that increase tissue oxygen demand.

You are caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from?

a) A catheter in the arm vein

b) A puncture at the radial artery

c) The trachea and bronchi

d) The pleural surfaces

A puncture at the radial artery Explanation: ABGs determine the blood’s pH, oxygen-carrying capacity, levels of oxygen, CO2, and bicarbonate ion. Blood gas samples are obtained through an arterial puncture at the radial, brachial, or femoral artery. A client also may have an indwelling arterial catheter from which arterial samples are obtained. Blood gas samples are not obtained from the pleural surfaces or trachea and bronchi.

In which position should the patient be placed for a thoracentesis?

a) Prone

b) Supine

c) Lateral recumbent

d) Sitting on the edge of the bed

Sitting on the edge of the bed Explanation: If possible place the patient upright or sitting on the edge of the bed with the feet supported and arms and head on a padded over-the-bed table. Other positions in which the patient could be placed include straddling a chair with arms and head resting on the back of the chair, or lying on the unaffected side with the head of the bed elevated 30 to 45 degrees if unable to assume a sitting position.

A nurse is preparing a client with a pleural effusion for a thoracentesis. The nurse should:

a) raise the arm on the side of the client’s body on which the physician will perform the thoracentesis.

b) assist the client to a sitting position on the edge of the bed, leaning over the bedside table.

c) raise the head of the bed to a high Fowler’s position.

d) place the client supine in the bed, which is flat.

assist the client to a sitting position on the edge of the bed, leaning over the bedside table. Explanation: A physician usually performs a thoracentesis when the client is sitting in a chair or on the edge of the bed, with the legs supported and the arms folded and resting on a pillow or on the bedside table. Raising an arm, lying supine, or raising the head of the bed won’t allow the physician to easily access the thoracic cavity

In relation to the structure of the larynx, the cricoid cartilage is

a) used in vocal cord movement with the thyroid cartilage.

b) the valve flap of cartilage that covers the opening to the larynx during swallowing.

c) the only complete cartilaginous ring in the larynx.

d) the largest of the cartilage structures.

the only complete cartilaginous ring in the larynx. Explanation: The cricoid cartilage is located below the thyroid cartilage. The arytenoid cartilages are used in vocal cord movement with the thyroid cartilage. The thyroid cartilage is the largest of the cartilage structures and part of it forms the Adam’s apple. The epiglottis is the valve flap of cartilage that covers the opening to the larynx during swallowing.

When assessing a client, which adaptation indicates the presence of respiratory distress?

a) Orthopnea

b) Productive cough

c) Respiratory rate of 14 breaths per minute

d) Sore throat

Orthopnea Explanation: Orthopnea is the inability to breathe easily except when upright. This positioning can mean while in bed and propped with a pillow or sitting in a chair. If a client cannot breathe easily while lying down, there is an element of respiratory distress.

The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about?

a) Absent distal pulses

b) Flushed feeling in the client

c) Excessive capillary refill

d) Raised temperature in the affected limb

Absent distal pulses Explanation: When monitoring clients after a pulmonary angiography, nurses must notify the physician about diminished or absent distal pulses, cool skin temperature in the affected limb, and poor capillary refill. When the contrast medium is infused, the client will sense a warm, flushed feeling.

The nurse inspects the thorax of a patient with advanced emphysema. What does the nurse expect the chest configuration to be for this patient?

a) Kyphoscoliosis

b) Pigeon chest

c) Barrel chest

d) Funnel chest

Barrel chest Explanation: Barrel chest occurs as a result of overinflation of the lungs, which increases the anteroposterior diameter of the thorax. It occurs with aging and is a hallmark sign of emphysema and COPD. In a patient with emphysema, the ribs are more widely spaced and the intercostal spaces tend to bulge on expiration. Funnel chest occurs when there is a depression in the lower portion of the sternum. This may compress the heart and great vessels, resulting in murmurs. Funnel chest may occur with rickets or Marfan’s syndrome. A pigeon chest occurs as a result of the anterior displacement of the sternum, which also increases the anteroposterior diameter. This may occur with rickets, Marfan syndrome, or severe kyphoscoliosis. Kyphoscoliosis is characterized by elevation of the scapula and a corresponding S-shaped spine. This deformity limits lung expansion within the thorax. It may occur with osteoporosis and other skeletal disorders that affect the thorax.

The term for the volume of air inhaled and exhaled with each breath is

a) tidal volume.

b) residual volume.

c) vital capacity.

d) expiratory reserve volume.

tidal volume. Explanation: Tidal volume is the volume of air inhaled and exhaled with each breath. Residual volume is the volume of air remaining in the lungs after a maximum expiration. Vital capacity is the maximum volume of air exhaled from the point of maximum inspiration. Expiratory reserve volume is the maximum volume of air that can be exhaled after a normal inhalation.

A client with chronic bronchitis is admitted with an exacerbation of symptoms. During the nursing assessment, the nurse will expect which of the following findings? Select all that apply.

a) Tympany percussed bilaterally over the lung bases

b) Hypoventilatory breathing pattern

c) Purulent sputum with frequent coughing

d) Use of accessory muscles to breathe

e) Respiratory rate of 10 breaths per minute

• Use of accessory muscles to breathe • Purulent sputum with frequent coughing Explanation: Chronic bronchitis increases airway resistance and can thicken bronchial mucosa during an exacerbation. The client will have dyspnea requiring the use of accessory muscles to breathe, along with tachypnea and sputum production. Bronchial irritation and the need to expectorate mucus will lead to coughing. Percussion in this client would lead to resonant or hyperresonant sounds.

A client appears to be breathing faster than during the last assessment. Which of the following interventions should the nurse perform?

a) Assist the client to lie down.

b) Assess the radial pulse.

c) Count the rate of respirations.

d) Inquire if there have been any stressful visitors.

Count the rate of respirations. Explanation: Observing the rate and depth of respiration is an important aspect of a nursing assessment. The normal adult resting respiratory rate is 12 to 18 breaths per minute. Tachypnea is rapid breathing with a rate greater than 24 breaths per minute. An increase in the rate of respirations needs further investigation and must be reported.

A client experiences a head injury in a motor vehicle accident. The client’s level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client’s respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth?

a) Wernicke’s area

b) The frontal lobe

c) The pons

d) Central sulcus

The pons Explanation: The pons in the brainstem controls rate and depth of respirations. When injury occurs or increased intracranial pressure results, respirations are slowed. The frontal lobe completes executive functions and cognition. The central sulcus is a fold in the cerebral cortex called the central fissure. The Wernicke’s area is the area linked to speech.

Knowing respiratory physiology is important to understand how the disease process can work within that system. Which hollow tube transports air from the laryngeal pharynx to the bronchi?

a) Larynx

b) Bronchioles

c) Trachea

d) Pharynx

Trachea Explanation: The trachea is a hollow tube composed of smooth muscle and supported by C-shaped cartilage. The trachea transports air from the laryngeal pharynx to the bronchi and lungs. This is a cartilaginous framework between the pharynx and trachea that produces sound. The bronchioles are smaller subdivisions of bronchi within the lungs. The pharynx, or throat, carries air from the nose to the larynx and food from the mouth to the esophagus.

A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3−of 28 mEq/L. The nurse reports to the physician which finding?

a) Respiratory alkalosis

b) Metabolic acidosis

c) Respiratory acidosis

d) Metabolic alkalosis

Respiratory acidosis Explanation: Respiratory acidosis would be reported to the physician citing the lab values. Analysis of the blood gases reveals that the client is acidotic with a pH under 7.35. Also noted is the PCO2above the normal range of 30 to 40 mm Hg. The HCO3− is slightly elevated because the normal level is 22 to 26 mEq/L.

A nonverbal client has just finished undergoing a bronchoscopy procedure and writes that he want to eat lunch now. Which intervention is necessary for the nurse to complete at this time?

a) Call dietary services to send the client’s tray now.

b) Assess for a cough reflex.

c) Assess for bowel sounds.

d) Perform mouth care.

Assess for a cough reflex. Explanation: Before a bronchoscopy procedure, the nurse will administer preoperative medications, usually atropine and a sedative. These are prescribed to inhibit vagal stimulation, suppress the cough reflex, sedate the client, and relieve anxiety. After the procedure, it is important that the client take nothing by moth until the cough reflex returns. This is because the preoperative medication impairs the protective laryngeal reflex and swallowing for several hours. Once the client demonstrates a cough reflex or the nurse positively assesses one, then the nurse may offer ice chips and fluids.

Which of the following terms is used to describe the inability to breathe easily except in an upright position?

a) Orthopnea

b) Dyspnea

c) Hemoptysis

d) Hypoxemia

Orthopnea Explanation: Patients with orthopnea are placed in a high Fowler’s position to facilitate breathing. Dyspnea refers to labored breathing or shortness of breath. Hemoptysis refers to expectoration of blood from the respiratory tract. Hypoxemia refers to low oxygen levels in the blood

Your client is scheduled for a bronchoscopy to visualize the larynx, trachea, and bronchi. What precautions would you recommend to the client before the procedure?

a) Practice holding the breath for short periods.

b) Avoid atropines as they dry the secretions.

c) Abstain from food for at least 6 hours before the procedure.

d) Avoid sedatives or narcotics as they depress the vagus nerve.

Abstain from food for at least 6 hours before the procedure. Explanation: For at least 6 hours before bronchoscopy, the client must abstain from food or drink to decrease the risk of aspiration. Risk is increased because the client receives local anesthesia, which suppresses the reflexes to swallow, cough, and gag. The client receives medications before the procedure. Typically, atropine is given to dry secretions and a sedative or narcotic is given to depress the vagus nerve. The client may need to hold his or her breath for short periods during lung scans and for bronchoscopy.

The term for the volume of air inhaled and exhaled with each breath is

a) residual volume.

b) vital capacity.

c) expiratory reserve volume.

d) tidal volume.

tidal volume. Explanation: Tidal volume is the volume of air inhaled and exhaled with each breath. Residual volume is the volume of air remaining in the lungs after a maximum expiration. Vital capacity is the maximum volume of air exhaled from the point of maximum inspiration. Expiratory reserve volume is the maximum volume of air that can be exhaled after a normal inhalation.

A patient diagnosed with diabetic ketoacidosis would be expected to have which type of respiratory pattern?

a) Cheyne-Stokes

b) Kussmaul respirations

c) Apnea

d) Biot’s respirations

Kussmaul respirations Explanation: Kussmaul respirations are seen in patients with diabetic ketoacidosis. In Cheyne-Stokes respiration, rate and depth increase, then decrease until apnea occurs. Biot’s respiration is characterized by periods of normal breathing (3 to 4 breaths) followed by a varying period of apnea (usually 10 to 60 seconds).

You are caring for a client admitted with chronic bronchitis. The client is having difficulty breathing, and the family asks you what causes this difficulty. What would be your best response?

a) "Anytime there is a chronic disease process it is hard for the person to breathe."

b) "Having a chronic respiratory disease scars the lung and affects the effort it takes to breathe."

c) "In this particular case your family member is just overly tired and having problems breathing."

d) "Conditions such as chronic bronchitis cause thickening of the bronchial mucosa so it makes it harder to breathe."

"Conditions such as chronic bronchitis cause thickening of the bronchial mucosa so it makes it harder to breathe." Explanation: Conditions that may alter bronchial diameter and affect airway resistance include contraction of bronchial smooth muscle (e.g., asthma); thickening of bronchial mucosa (e.g., chronic bronchitis); airway obstruction by mucus, a tumor, or a foreign body; and loss of lung elasticity (e.g., emphysema). Option A is incorrect, not all chronic diseases make it hard to breathe. Option B is incorrect; not all chronic respiratory diseases caused scarring in the lung. Option C is incorrect; this response negates the families question and belittles their concern.

Your client has just had an invasive procedure to assess the respiratory system. What do you know should be assessed on this client?

a) Loss of consciousness

b) Masses in pleural space

c) Watery sputum

d) Respiratory distress

Respiratory distress Explanation: After invasive procedures, the nurse must carefully check for signs of respiratory distress and blood-streaked sputum. Masses in the pleural space are a condition that affects fremitus. General examination of overall health and condition includes assessing the consciousness of a client.

A patient comes to the emergency department complaining of a knifelike pain when taking a deep breath. What does this type of pain likely indicate to the nurse?

a) Lung infarction

b) Pleurisy

c) Bacterial pneumonia

d) Bronchogenic carcinoma

Pleurisy Explanation: Pleuritic pain from irritation of the parietal pleura is sharp and seems to "catch" on inspiration; patients often describe it as being "like the stabbing of a knife." In carcinoma, the pain may be dull and persistent because the cancer has invaded the chest wall, mediastinum, or spine.

While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following?

a) Wheezes

b) Rhonchi

c) Pleural friction rub

d) Crackles

Wheezes Explanation: Wheezes, usually heard on expiration, are continuous, musical, high pitched, and whistle-like sounds caused by air passing through narrowed airways. Often, wheezes are associated with asthma.

A nurse practitioner diagnosed a patient with an infection in the maxillary sinuses. Select the area that the nurse palpated to make that diagnosis.

a) Above the eyebrows

b) On the cheeks below the eyes

c) Between the eyes and behind the nose

d) Behind the ethmoid sinuses

On the cheeks below the eyes Explanation: To palpate the maxillary sinuses, the nurse should apply gentle pressure in the cheek area below the eyes, adjacent to the nose.

The nursing instructor is talking with senior nursing students about diagnostic procedures used in respiratory diseases. The instructor discusses thoracentesis, defining it as a procedure performed for diagnostic purposes or to aspirate accumulated excess fluid or air from the pleural space. What would the instructor tell the students purulent fluid indicates?

a) Inflammation

b) Cancer

c) Heart failure

d) Infection

Infection Explanation: A small amount of fluid lies between the visceral and parietal pleurae. When excess fluid or air accumulates, the physician aspirates it from the pleural space by inserting a needle into the chest wall. This procedure, called thoracentesis, is performed with local anesthesia. Thoracentesis also may be used to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes such as a culture, sensitivity, or microscopic examination. Purulent fluid is the recommended diagnosis for infection. Serous fluid may be associated with cancer, inflammatory conditions, or heart failure.

The nurse is calculating the patient’s smoking history in pack-years. The patient has recently been diagnosed with malignant lung cancer. The patient states he has been smoking two packs of cigarettes a day for the past 11 years. The nurse correctly documents the patient’s pack-years as which of the following?

a) 11

b) 22

c) 5

d) 10

22 Explanation: Smoking history is usually expressed in pack-years, which is the number of packs of cigarettes smoked per day times the number of years the patient smoked. It is important to find out if the patient is still smoking or when the patient quit smoking. In this situation, the patient’s pack years is 22 (2 × 11).

Which of the following terms will the nurse use to document the inability of a patient to breathe easily unless positioned upright?

a) Orthopnea

b) Hemoptysis

c) Dyspnea

d) Hypoxemia

Orthopnea Explanation: Orthopnea is the term used to describe a patient’s inability to breathe easily except in an upright position. Orthopnea may be found in patients with heart disease and, occasionally, in patients with COPD. Patients with orthopnea are placed in a high Fowler’s position to facilitate breathing. Dyspnea refers to labored breathing or shortness of breath. Hemoptysis refers to expectoration of blood from the respiratory tract. Hypoxemia refers to low oxygen levels in the blood

The nurse is caring for a client diagnosed with asthma. While performing the shift assessment, the nurse auscultates breath sounds including sibilant wheezes, which are continuous musical sounds. What characteristics describe sibilant wheezes?

a) They occur when the pleural surfaces are inflamed.

b) They are heard in clients with decreased secretions.

c) They result from air passing through widened air passages.

d) They can be heard during inspiration and expiration.

They can be heard during inspiration and expiration. Explanation: Sibilant or hissing or whistling wheezes are continuous musical sounds that can be heard during inspiration and expiration. They result from air passing through narrowed or partially obstructed air passages and are heard in clients with increased secretions. The crackling or grating sounds heard during inspiration or expiration are friction rubs. They occur when the pleural surfaces are inflamed.

A physician has ordered that a client with suspected lung cancer undergo magnetic resonance imaging (MRI). The nurse explains the benefits of this study to the client. Included in teaching would be which of the following regarding the MRI?

a) Tumor densities can be seen with radiolucent images.

b) Narrow-beam x-ray can scan successive lung layers.

c) MRI can view soft tissues and can help stage cancers.

d) Lung blood flow can be viewed after a radiopaque agent is injected.

MRI can view soft tissues and can help stage cancers. Explanation: MRI uses magnetic fields and radiofrequency signals to produce a detailed diagnostic image. MRI can visualize soft tissues, characterize nodules, and help stage carcinomas. The other options describe different studies

The nurse answers the call light of a male patient. The patient is complaining of an irritating tickling sensation in the throat, a salty taste, and a burning sensation in the chest. Upon further assessment, the nurse notes a tissue with bright red, frothy blood at the bedside. The nurse can assume the source of the blood is likely from which of the following?

a) The nose

b) The rectum

c) The stomach

d) The lungs

The lungs Explanation: Blood from the lung is usually bright red, frothy, and mixed with sputum. Initial symptoms include a tickling sensation in the throat, a salty taste, a burning or bubbling sensation in the chest, and perhaps chest pain, in which case the patient tends to splint the bleeding side. This blood has an alkaline pH (>7.0). Blood from the stomach is vomited rather than expectorated, may be mixed with food, and is usually much darker; often referred to as "coffee ground emesis." This blood has an acid pH (<<7.0). Bloody sputum from the nose or the nasopharynx is usually preceded by considerable sniffing, with blood possibly appearing in the nose

A nurse assesses a client’s respiratory status. Which observation indicates that the client is having difficulty breathing?

a) Controlled breathing

b) Diaphragmatic breathing

c) Use of accessory muscles

d) Pursed-lip breathing

Use of accessory muscles Explanation: The use of accessory muscles for respiration indicates the client is having difficulty breathing. Diaphragmatic and pursed-lip breathing are two controlled breathing techniques that help the client conserve energy.

A client with a suspected pulmonary disorder undergoes pulmonary function tests. To interpret test results accurately, the nurse must be familiar with the terminology used to describe pulmonary functions. Which term refers to the volume of air inhaled or exhaled during each respiratory cycle?

a) Maximal voluntary ventilation

b) Tidal volume

c) Functional residual capacity

d) Vital capacity

Tidal volume Explanation: Tidal volume refers to the volume of air inhaled or exhaled during each respiratory cycle when breathing normally. Normal tidal volume ranges from 400 to 700 ml. Vital capacity refers to the total volume of air that can be exhaled during a slow, maximal expiration after maximal inspiration. Functional residual capacity refers to the volume of air remaining in the lungs after a normal expiration. Maximal voluntary ventilation is the greatest volume of air expired in 1 minute with maximal voluntary effort.

The nurse is caring for a patient with a pulmonary disorder. What observation by the nurse is indicative of a very late symptom of hypoxia?

a) Confusion

b) Dyspnea

c) Cyanosis

d) Restlessness

Cyanosis Explanation: Cyanosis, a bluish coloring of the skin, is a very late indicator of hypoxia. The presence or absence of cyanosis is determined by the amount of unoxygenated hemoglobin in the blood. Cyanosis appears when there is at least 5 g/dL of unoxygenated hemoglobin.

The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months’ duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely?

a) Adult respiratory distress syndrome

b) Acute respiratory obstruction

c) Asthma

d) Pneumothorax

Asthma Explanation: The presence of both inspiratory and expiratory wheezing usually signifies asthma if the individual does not have heart failure. Sudden dyspnea is an indicator of the other choices.

The instructor of the pre-nursing physiology class is explaining respiration to the class. What does the instructor explain is the main function of respiration?

a) To exchange oxygen and CO2 between the atmospheric air and the blood and between the blood and the cells

b) To move CO2 out of the atmospheric air and into the expired air

c) To exchange atmospheric air between the blood and the cells

d) To move O2 out of the atmospheric air and into the retained air

To exchange oxygen and CO2 between the atmospheric air and the blood and between the blood and the cells Explanation: The main function of the respiratory system is to exchange oxygen and CO2 between the atmospheric air and the blood and between the blood and the cells. This process is called respiration. The purpose of respiration is not to move any gas into the expired air; retained air is simply a distractor for this question; and atmospheric air is not exchanged between the blood and the cells.

A nurse is caring for a client after a lung biopsy. Which assessment finding requires immediate intervention?

a) Client stating pain level of 7 out of 10 that decreases with pain medication

b) Oxygen saturation level of 96% on 3 L of oxygen

c) Respiratory rate of 44 breaths/minute

d) Client dozing when left alone but awakening easily

Respiratory rate of 44 breaths/minute Explanation: A respiratory rate of 44 breaths/minute is significant and requires immediate intervention. The client may be experiencing postoperative complications, such as pneumothorax or bleeding. An oxygen saturation level of 96% on 3 L of oxygen, a pain level of 7 out of 10 that decreases with pain medication, and dozing when left alone are normal and don’t require further intervention.

A son brings his father into the clinic, stating that his father’s color has changed to bluish around the mouth. The father is confused, with a respiratory rate of 28 breaths per minute and scattered crackles throughout. The son states this condition just occurred within the last hour. Which of the following factors indicates that the client’s condition has lasted for more than 1 hour?

a) Crackles

b) Cyanosis

c) Son’s statement

d) Respiratory rate

Cyanosis Explanation: The client’s appearance may give clues to respiratory status. Cyanosis, a bluish coloring of the skin, is a very late indicator of hypoxia. The presence of cyanosis is from decreased unoxygenated hemoglobin. In the presence of a pulmonary condition, cyanosis is assessed by observing the color of the tongue and lips.

The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard?

a) Wheezes

b) Rales

c) Crackles

d) Rhonchi

Wheezes Explanation: Sibilant wheezes are continuous, musical, high-pitched, whistle-like sounds heard during inspiration and expiration caused by air passing through narrowed or partially obstructed airways; they may clear with coughing. Crackles, formerly called rales, are soft, high-pitched, discontinuous popping sounds that occur during inspiration (while usually heard on inspiration, they may also be heard on expiration); they may or may not be cleared by coughing. Rhonchi, or sonorous wheezes, are deep, low-pitched rumbling sounds heard primarily during expiration; they are caused by air moving through narrowed tracheobronchial passages.

A client appears to be breathing faster than during the last assessment. Which of the following interventions should the nurse perform?

a) Inquire if there have been any stressful visitors.

b) Assist the client to lie down.

c) Count the rate of respirations.

d) Assess the radial pulse.

Count the rate of respirations. Explanation: Observing the rate and depth of respiration is an important aspect of a nursing assessment. The normal adult resting respiratory rate is 12 to 18 breaths per minute. Tachypnea is rapid breathing with a rate greater than 24 breaths per minute. An increase in the rate of respirations needs further investigation and must be reported.

A client experiences a head injury in a motor vehicle accident. The client’s level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client’s respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth?

a) Wernicke’s area

b) The pons

c) Central sulcus

d) The frontal lobe

The pons Explanation: The pons in the brainstem controls rate and depth of respirations. When injury occurs or increased intracranial pressure results, respirations are slowed. The frontal lobe completes executive functions and cognition. The central sulcus is a fold in the cerebral cortex called the central fissure. The Wernicke’s area is the area linked to speech.

Knowing respiratory physiology is important to understand how the disease process can work within that system. Which hollow tube transports air from the laryngeal pharynx to the bronchi?

a) Trachea

b) Bronchioles

c) Larynx

d) Pharynx

Trachea Explanation: The trachea is a hollow tube composed of smooth muscle and supported by C-shaped cartilage. The trachea transports air from the laryngeal pharynx to the bronchi and lungs. This is a cartilaginous framework between the pharynx and trachea that produces sound. The bronchioles are smaller subdivisions of bronchi within the lungs. The pharynx, or throat, carries air from the nose to the larynx and food from the mouth to the esophagus.

A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3−of 28 mEq/L. The nurse reports to the physician which finding?

a) Respiratory alkalosis

b) Metabolic alkalosis

c) Metabolic acidosis

d) Respiratory acidosis

Respiratory acidosis Explanation: Respiratory acidosis would be reported to the physician citing the lab values. Analysis of the blood gases reveals that the client is acidotic with a pH under 7.35. Also noted is the PCO2above the normal range of 30 to 40 mm Hg. The HCO3− is slightly elevated because the normal level is 22 to 26 mEq/L.

A nonverbal client has just finished undergoing a bronchoscopy procedure and writes that he want to eat lunch now. Which intervention is necessary for the nurse to complete at this time?

a) Perform mouth care.

b) Call dietary services to send the client’s tray now.

c) Assess for a cough reflex.

d) Assess for bowel sounds.

Assess for a cough reflex. Explanation: Before a bronchoscopy procedure, the nurse will administer preoperative medications, usually atropine and a sedative. These are prescribed to inhibit vagal stimulation, suppress the cough reflex, sedate the client, and relieve anxiety. After the procedure, it is important that the client take nothing by moth until the cough reflex returns. This is because the preoperative medication impairs the protective laryngeal reflex and swallowing for several hours. Once the client demonstrates a cough reflex or the nurse positively assesses one, then the nurse may offer ice chips and fluids.

Your client is scheduled for a bronchoscopy to visualize the larynx, trachea, and bronchi. What precautions would you recommend to the client before the procedure?

a) Abstain from food for at least 6 hours before the procedure.

b) Avoid sedatives or narcotics as they depress the vagus nerve.

c) Practice holding the breath for short periods.

d) Avoid atropines as they dry the secretions.

Abstain from food for at least 6 hours before the procedure. Explanation: For at least 6 hours before bronchoscopy, the client must abstain from food or drink to decrease the risk of aspiration. Risk is increased because the client receives local anesthesia, which suppresses the reflexes to swallow, cough, and gag. The client receives medications before the procedure. Typically, atropine is given to dry secretions and a sedative or narcotic is given to depress the vagus nerve. The client may need to hold his or her breath for short periods during lung scans and for bronchoscopy.

You are caring for a client admitted with chronic bronchitis. The client is having difficulty breathing, and the family asks you what causes this difficulty. What would be your best response?

a) "Anytime there is a chronic disease process it is hard for the person to breathe."

b) "Having a chronic respiratory disease scars the lung and affects the effort it takes to breathe."

c) "In this particular case your family member is just overly tired and having problems breathing."

d) "Conditions such as chronic bronchitis cause thickening of the bronchial mucosa so it makes it harder to breathe."

"Conditions such as chronic bronchitis cause thickening of the bronchial mucosa so it makes it harder to breathe." Explanation: Conditions that may alter bronchial diameter and affect airway resistance include contraction of bronchial smooth muscle (e.g., asthma); thickening of bronchial mucosa (e.g., chronic bronchitis); airway obstruction by mucus, a tumor, or a foreign body; and loss of lung elasticity (e.g., emphysema). Option A is incorrect, not all chronic diseases make it hard to breathe. Option B is incorrect; not all chronic respiratory diseases caused scarring in the lung. Option C is incorrect; this response negates the families question and belittles their concern.

If concern exists about fluid accumulation in a client’s lungs, what area of the lungs will the nurse focus on during assessment?

a) Anterior bronchioles

b) Posterior bronchioles

c) Left lower lobe

d) Bilateral lower lobes

Bilateral lower lobes Explanation: Crackles are secondary to fluid in the alveoli and create a soft, discontinuous popping sound. Because fluid creates these adventitious sounds, the principle of gravity will remind the nurse to focus the assessment on the lower portion of the thorax or the lower lobes of the lungs.

The nurse is caring for a client diagnosed with asthma. While performing the shift assessment, the nurse auscultates breath sounds including sibilant wheezes, which are continuous musical sounds. What characteristics describe sibilant wheezes?

a) They result from air passing through widened air passages.

b) They occur when the pleural surfaces are inflamed.

c) They are heard in clients with decreased secretions.

d) They can be heard during inspiration and expiration.

They can be heard during inspiration and expiration. Explanation: Sibilant or hissing or whistling wheezes are continuous musical sounds that can be heard during inspiration and expiration. They result from air passing through narrowed or partially obstructed air passages and are heard in clients with increased secretions. The crackling or grating sounds heard during inspiration or expiration are friction rubs. They occur when the pleural surfaces are inflamed.

A nurse is obtaining a health history from a client who reports hemoptysis for the past 2 months. The client reports occasional dyspnea. Which imaging study, ordered by the physician, will view the thoracic cavity while in motion?

a) Chest x-ray

b) Fluoroscopy

c) Computed tomography (CT) scan

d) Magnetic resonance imaging (MRI)

Fluoroscopy Explanation: Fluoroscopy enables the physician to view the thoracic cavity with all of its contents in motion. A fluoroscopy more precisely diagnoses the location of a tumor or lesion. An x-ray shows the size, shape, and position of the lungs. An MRI and CT produce axial views of the lungs.

The nurse is instructing the client on the normal sensations, which can occur when contrast medium is infused during pulmonary angiography. Which statement, made by the client, demonstrates an understanding?

a) "I will feel waves of nausea throughout the procedure."

b) "I will feel a dull pain when the catheter is introduced."

c) "I will feel warm and an urge to cough."

d) "I will feel light-headed when the contrast medium is introduced."

"I will feel warm and an urge to cough." Explanation: During a pulmonary angiography a contrast medium is injected into the femoral artery. When the medium is infused, the client will feel a sense of warm and flushed with an urge to cough. The client will feel a pressure when the catheter is inserted. The client does not typically feel light-headed or nauseated during the procedure.

A 53-year-old male is a regular client in the respiratory group where you practice nursing. As with all adults, millions of alveoli form most of the pulmonary mass. The squamous epithelial cells lining each alveolus consist of different types of cells. Which type of the alveoli cells produce surfactant?

a) Type II cells

b) Type III cells.

c) Type IV cells.

d) Type I cells

Type II cells Explanation: Type II cells—produce surfactant, a phospholipid that alters the surface tension of alveoli, preventing their collapse during expiration and limiting their expansion during inspiration. Type I cells line most alveolar surfaces. The epithelium of the alveoli does not contain Type IV cells. Type III cells destroy foreign material, such as bacteria.

A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs?

a) Decreased cardiac output

b) Ineffective airway clearance

c) Impaired spontaneous ventilation

d) Impaired gas exchange

Impaired gas exchange Explanation: Airflow is decreased with atelectasis, which is a bronchial obstruction from collapsed lung tissue. If there is an obstruction, there is limited or no gas exchange in this area. Impaired gas exchange is thus the most likely nursing diagnosis with atelectasis.

What is the difference between respiration and ventilation?

a) Ventilation is the process of getting oxygen to the cells.

b) Ventilation is the process of gas exchange.

c) Ventilation is the exchange of gases in the lung.

d) Ventilation is the movement of air in and out of the respiratory tract.

Ventilation is the movement of air in and out of the respiratory tract. Explanation: Ventilation is the actual movement of air in and out of the respiratory tract. Respiration is the exchange of oxygen and CO2 between atmospheric air and the blood and between the blood and the cells. Therefore, options A, C, and D are incorrect.

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation?

a) Bronchial breath sounds

b) Egophony

c) Absent breath sounds

d) Crackles at lung bases

Crackles at lung bases Explanation: A patient with pulmonary edema would be expected to have crackles in the lung bases, and possible wheezes. Egophony may occur in patients diagnosed with pleural effusion. Absent breath sounds occurs in pneumothorax. Bronchial breath sounds occur in consolidation, such as pneumonia.

The nursing instructor is talking with senior nursing students about diagnostic procedures used in respiratory diseases. The instructor discusses thoracentesis, defining it as a procedure performed for diagnostic purposes or to aspirate accumulated excess fluid or air from the pleural space. What would the instructor tell the students purulent fluid indicates?

a) Heart failure

b) Infection

c) Cancer

d) Inflammation

Infection Explanation: A small amount of fluid lies between the visceral and parietal pleurae. When excess fluid or air accumulates, the physician aspirates it from the pleural space by inserting a needle into the chest wall. This procedure, called thoracentesis, is performed with local anesthesia. Thoracentesis also may be used to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes such as a culture, sensitivity, or microscopic examination. Purulent fluid is the recommended diagnosis for infection. Serous fluid may be associated with cancer, inflammatory conditions, or heart failure.

The nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first?

a) Chest x-ray

b) Pulse oximetry

c) Pulmonary function test

d) Arterial blood gases

Pulse oximetry Explanation: Pulse oximetry is a noninvasive method to determine arterial oxygen saturation. Normal values are 95% and above. Using this diagnostic test first provides rapid information of the client’s respiratory system. All other options vary in amount of time and patient participation in determining further information regarding the respiratory system.

The nurse is caring for a patient diagnosed with pneumonia. The nurse will assess the patient for tactile fremitus by completing which of the following?

a) Placing the thumbs along the costal margin of the chest wall and instructing the patient to inhale deeply

b) Asking the patient to repeat "ninety-nine" as the nurse’s hands move down the patient’s thorax

c) Asking the patient to say "one, two, three" while auscultating the lungs

d) Instructing the patient to take a deep breath and hold it while the diaphragm is percussed

Asking the patient to repeat "ninety-nine" as the nurse’s hands move down the patient’s thorax Explanation: While the nurse is assessing for tactile fremitus, the patient is asked to repeat "ninety-nine" or "one, two, three," or "eee, eee, eee" as the nurse’s hands move down the patient’s thorax. The vibrations are detected with the palmar surfaces of the fingers and hands, or the ulnar aspect of the extended hands, on the thorax. The hand or hands are moved in sequence down the thorax. Corresponding areas of the thorax are compared. Asking the patient to say "one, two, three" while auscultating the lungs is not the proper technique for assessing for tactile fremitus. The nurse assesses for anterior respiratory excursion by placing the thumbs along the costal margin of the chest wall and instructing the patient to inhale deeply. The nurse assesses for diaphragmatic excursion by instructing the patient to take a deep breath and hold it while the diaphragm is percussed.

Upon palpation of the sinus area, what would the nurse identify as a normal finding?

a) No sensation during palpation

b) Pain sensation behind the eyes

c) Tenderness during palpation

d) Light not going through the sinus cavity

No sensation during palpation Explanation: Sinus assessment involves using the thumbs to apply gentle pressure in an upward fashion at the sinuses. Tenderness suggests inflammation. The sinuses can be inspected by transillumination, where a light is passed through the sinuses. If the light fails to penetrate, the cavity contains fluid.

The nurse enters the room of a client who is being monitored with pulse oximetry. Which of the following factors may alter the oximetry results?

a) Diagnosis of peripheral vascular disease

b) Placement of the probe on an earlobe

c) Reduced lighting in the room

d) Increased temperature of the room

Diagnosis of peripheral vascular disease Explanation: Pulse oximetry is a noninvasive method of monitoring oxygen saturation of hemoglobin. A probe is placed on the fingertip, forehead, earlobe, or bridge of nose. Inaccuracy of results may be from anemia, bright lights, shivering, nail polish, or peripheral vascular disease.

The client is returning from the operating room following a bronchoscopy. Which action, performed by the nursing assistant, would the nurse stop if began prior to nursing assessment?

a) The nursing assistant is assisting the client to the side of the bed to use a urinal.

b) The nursing assistant is assisting the client to a semi-Fowler’s position.

c) The nursing assistant is pouring a glass of water to wet the client’s mouth.

d) The nursing assistant is asking a question requiring a verbal response.

The nursing assistant is pouring a glass of water to wet the client’s mouth. Explanation: When completing a procedure which sends a scope down the throat, the gag reflex is anesthetized to reduce discomfort. Upon returning to the nursing unit, the gag reflex must be assessed before providing any food or fluids to the client. The client may need assistance following the procedure for activity and ambulation but this is not restricted in the post procedure period.

The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse’s priority?

a) Swallow reflex

b) Medication allergies

c) Ability to deep breathe

d) Presence of carotid pulse

Swallow reflex Explanation: The physician sprays a local anesthetic into the client’s throat before performing a bronchoscopy. The nurse must assess the swallow reflex when the client returns to the unit and before giving him anything by mouth. The nurse should also assess for medication allergies, carotid pulse, and deep breathing, but they aren’t the priority at this time.

The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about?

a) Absent distal pulses

b) Flushed feeling in the client

c) Excessive capillary refill

d) Raised temperature in the affected limb

Absent distal pulses Explanation: When monitoring clients after a pulmonary angiography, nurses must notify the physician about diminished or absent distal pulses, cool skin temperature in the affected limb, and poor capillary refill. When the contrast medium is infused, the client will sense a warm, flushed feeling.

The nurse inspects the thorax of a patient with advanced emphysema. What does the nurse expect the chest configuration to be for this patient?

a) Barrel chest

b) Pigeon chest

c) Funnel chest

d) Kyphoscoliosis

Barrel chest Explanation: Barrel chest occurs as a result of overinflation of the lungs, which increases the anteroposterior diameter of the thorax. It occurs with aging and is a hallmark sign of emphysema and COPD. In a patient with emphysema, the ribs are more widely spaced and the intercostal spaces tend to bulge on expiration. Funnel chest occurs when there is a depression in the lower portion of the sternum. This may compress the heart and great vessels, resulting in murmurs. Funnel chest may occur with rickets or Marfan’s syndrome. A pigeon chest occurs as a result of the anterior displacement of the sternum, which also increases the anteroposterior diameter. This may occur with rickets, Marfan syndrome, or severe kyphoscoliosis. Kyphoscoliosis is characterized by elevation of the scapula and a corresponding S-shaped spine. This deformity limits lung expansion within the thorax. It may occur with osteoporosis and other skeletal disorders that affect the thorax.

The term for the volume of air inhaled and exhaled with each breath is

a) residual volume.

b) tidal volume.

c) expiratory reserve volume.

d) vital capacity.

tidal volume. Explanation: Tidal volume is the volume of air inhaled and exhaled with each breath. Residual volume is the volume of air remaining in the lungs after a maximum expiration. Vital capacity is the maximum volume of air exhaled from the point of maximum inspiration. Expiratory reserve volume is the maximum volume of air that can be exhaled after a normal inhalation.

The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation?

a) PaO2

b) pH

c) SaO2

d) PaCO2

PaCO2 Explanation: When the minute ventilation falls, alveolar ventilation in the lungs also decreases, and the PaCO2 increases.

A physician has ordered that a client with suspected lung cancer undergo magnetic resonance imaging (MRI). The nurse explains the benefits of this study to the client. Included in teaching would be which of the following regarding the MRI?

a) Lung blood flow can be viewed after a radiopaque agent is injected.

b) MRI can view soft tissues and can help stage cancers.

c) Narrow-beam x-ray can scan successive lung layers.

d) Tumor densities can be seen with radiolucent images.

MRI can view soft tissues and can help stage cancers. Explanation: MRI uses magnetic fields and radiofrequency signals to produce a detailed diagnostic image. MRI can visualize soft tissues, characterize nodules, and help stage carcinomas. The other options describe different studies.

A 6-month-old male client and his elder brother, a 3-year-old male, are being seen in the pediatric clinic for their third middle ear infection of the winter. The mother reports they develop an upper respiratory infection and an ear infection seems quick to follow. What contributes to this event?

a) Genetics

b) Eustachian tubes

c) Epiglottis

d) Oropharynx

Eustachian tubes Explanation: The nasopharynx contains the adenoids and openings of the eustachian tubes. The eustachian tubes connect the pharynx to the middle ear and are the means by which upper respiratory infections spread to the middle ear. The client’s infection is not caused by genetics. The oropharynx contains the tongue. The epiglottis closes during swallowing and relaxes during respiration.

The nurse is caring for a client with chronic obstructive pulmonary disease. The client calls the doctor and states having difficulty breathing and overall feeling fatigued. The nurse realizes that this client is at high risk for which condition?

a) Metabolic alkalosis

b) Metabolic acidosis

c) Respiratory alkalosis

d) Respiratory acidosis

Respiratory acidosis Explanation: Respiratory acidosis occurs when the body is unable to blow off CO2 due to the hypoventilation of disease processes such as COPD. An increase in blood carbon dioxide concentration occurs and a decreased pH causing acidosis. Respiratory alkalosis is a decrease in acidity of the blood and often caused by hyperventilation. Metabolic acidosis/alkalosis are disorders that affect the bicarbonate.