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Medical-Surgical Nursing (Care for the Client with Upper Respiratory Disorder)

Total questions: 100

Worksheet time: 1hrs 21mins

Name
Class
Date
1.

A client asks the nurse about the purpose of incentive spirometry. Which information should the nurse include in the​ explanation?

a)

increases lung volume

b)

B.

Prevents lung collapse

c)

Decreases oxygen demand

d)

Clears mucus secretions

2.

A client is prescribed an oral steroid drug to improve breathing. Which instruction should the nurse provide to the​ client?

a)

​"You will probably be taking this medication​ long-term."

b)

Be sure to follow the​ step-wise reduction of the​ medication."

c)

​"Stop the medication when your symptoms​ subside."

d)

​"If you feel side​ effects, cut the dosage in​ half."

3.

The nurse preceptor is monitoring the actions of a new graduate nurse caring for a client with a tracheostomy. Which action by the new graduate requires ​follow-up from the​ preceptor?

a)

Suctioning the​ tracheostomy, then the mouth

b)

Assessing oxygen saturation

c)

Suctioning secretions with a clean technique

d)

Assessing for irritation around the stoma

4.

A client has crackles and reports increasing shortness of breath. Which action should the nurse take first​?

a)

Administer a bronchodilator.

b)

Place the client in high Fowler position.

c)

Assess the respiratory rate.

d)

Apply oxygen to the client.

5.

The nurse is caring for a client with a chest tube. Which intervention should the nurse​ implement? (Select all that​ apply.)

a)

Ensure oxygen is available.

b)

Report hyperresonance with percussion.

c)

Prescribe pain medications as needed.

d)

Monitor for air leaks.

e)

assess for pain

6.

The nurse is planning care for a client who is receiving oxygen. Which intervention should the nurse​ include?

a)

Assess the client for anxiety.

b)

Ensure the client is comfortable with the manner of administration.

c)

Suction upper airways each shift.

d)

D.

Increase the oxygen flow if the client requests.

7.

The nurse assessing a client suspects a right pneumothorax. Which finding supports the​ nurse's suspicion?

a)

Right tracheal shift

b)

Decreased expansion on the left side of the chest

c)

O2 saturation of​ 94%

d)

Asymmetry of the chest expansion

8.

Which manifestation should the nurse recognize as a sign of chronic respiratory disease in a​ client?

a)

Inspiration to expiration​ (I:E) ratio of​ 1:2

b)

Crackles noted in bilateral lungs

c)

Clubbing of the nails

d)

Sudden shortness of breath

9.

The nurse assessing a newborn suspects respiratory distress. Which finding supports the​ suspicion?

a)

Intercostal retractions

b)

Respiratory rate of 44

c)

Acrocyanosis at birth

d)

Abdominal breathing

10.

Which method is the most acurate for measuring a​ client's respiratory​ rate?

a)

Measure the respiratory rate for 6 seconds and multiply by 10.

b)

Measure the respiratory rate for 30 seconds and multiply by 2.

c)

Measure the respiratory rate for 1 minute.

d)

Measure the respiratory rate for 15 seconds and multiply by 4.

11.

The nurse is participating in a community health clinic. Which client should the nurse identify as being at risk for compromised​ oxygenation? (Select all that​ apply.)

a)

A​ 64-year-old woman with osteoporosis and limited mobility

b)

A​ 46-year-old woman with a history of anxiety attacks

c)

A​ 70-year-old woman who eats a​ well-balanced diet and exercises daily

d)

A​ 28-year-old man who smokes with a 10 pack per year history

e)

A​ 56-year-old man who has been working at a textile factory

12.

Which term should the nurse know describes the primary purpose of the​ ribs?

a)

deflation

b)

protection

c)

exhalation

d)

inspiration

13.

The nurse taught a class about the role of the pleural membranes. Which statement by a participant indicates that learning​ occurred?

a)

​"The pleural membranes contain the​ heart."

b)

​"The pleural membranes warm and moisten​ air."

c)

"The pleural membranes permit gas​ exchange."

d)

​"The pleural membranes help to keep the lungs​ inflated."

14.

A client diagnosed with bronchitis asks the nurse about the function of the bronchi. Which should the nurse include in the​ response?

a)

Contain the​ heart, trachea,​ esophagus, and the great vessels

b)

Help to keep the lungs inflated

c)

Capture and help sweep the debris toward the mouth for removal when coughing

d)

Warm and moisten air as it moves through the respiratory tract to the alveoli

15.

Which condition will cause a patient to secrete erythropoietin?

a)

Low blood pressure

b)

Hypercarbia

c)

Inflammation

d)

Hypoxia

16.

A staff member wants to know where the greatest proportion of iron is located. How should the nurse respond? The greatest proportion of total body iron is located in the:

a)

Erythrocytes

b)

Spleen pulp

c)

Bone marrow

d)

Liver tissue

17.

A 60-year-old female with emphysema is having difficulty expiring a given volume of air. When giving report, the nurse will relay that the patient is most likely experiencing _____ pulmonary disease.

a)

Restrictive

b)

Obstructive

c)

Atelectatic

d)

Pleuritic

18.

A 30-year-old male is involved in a motor vehicle accident and sustains trauma to the lungs and chest wall. He experiences respiratory failure. Which of the following lab values would the nurse expect?

a)

Electrolyte imbalances

b)

Elevated PaCO2

c)

Low hematocrit

d)

Elevated pH

19.

A nurse is reviewing the results of an ABG and finds reduced oxygenation of arterial blood. What term should the nurse use to describe this condition?

a)

Ischemia

b)

Hypoxia

c)

Hypoxemia

d)

Hypocapnia

20.

A 20-year-old male is in acute pain. An arterial blood gas reveals decreased carbon dioxide (CO2) levels. Which of the following does the nurse suspect is the most likely cause?

a)

Hyperventilation

b)

Hypoventilation

c)

Apnea

d)

Cyanosis

21.

A patient wants to know how carbon dioxide is transported in the body. How should the nurse respond? Carbon dioxide (CO2) is mainly transported in the blood:

a)

Attached to oxygen (O2)

b)

Dissolved in red blood cells

c)

Combined with albumin

d)

In the form of bicarbonate

22.

A patient asks how oxygen is transported in the body. What is the nurse’s best response? Most of the oxygen (O2) is transported:

a)

Dissolved in the plasma

b)

Bound to hemoglobin

c)

In the form of carbon dioxide (CO2)

d)

As a free-floating molecule

23.

An aide asks a nurse how surfactant works. How should the nurse respond? Surfactant facilitates alveolar distention and ventilation by:

a)

Decreasing thoracic compliance

b)

Attracting water to the alveolar surface

c)

Decreasing surface tension in alveoli

d)

Increasing diffusion in alveoli

24.

During inspiration, muscular contraction of the diaphragm causes air to move into the lung. The mechanisms that drive air movement during inspiration are a(n):

a)

Decrease in intra-alveolar pressure and shortening of the rib cage

b)

Decrease in the size of the thorax and alveolar expansion

c)

Increase in the size of the thorax and a decrease in intrapleural pressure

d)

Increase in atmospheric pressure and intrapleural pressure

25.

If an individual with respiratory difficulty were retaining too much carbon dioxide, which of the following compensatory responses would the nurse expect to be initiated?

a)

Decrease in ventilation rate

b)

Increase in respiratory rate

c)

Increase in tidal volume

d)

Vasodilation of the pulmonary arterioles

26.

While reviewing the results of the pulmonary functions test, the nurse is aware that the maximum amount of gas that can be displaced (expired) from the lung is called:

a)

Vital capacity (VC)

b)

Total lung capacity

c)

Functional capacity

d)

Residual volume

27.

The nurse is describing the movement of blood into and out of the capillary beds of the lungs to the body organs and tissues. What term should the nurse use to describe this process?

a)

perfusion

b)

ventilation

c)

diffusion

d)

circulation

28.

Prolonged immobility is implicated in the development of which of the following disorders?

a)

Bronchitis and bronchiectasis

b)

Sarcoidosis and idiopathic pulmonary fibrosis

c)

Atelectasis and pulmonary embolism

d)

Pulmonary hypertension and cor pulmonale

29.

Which of the following individuals is experiencing a disorder of ventilation that has a restrictive rather than obstructive etiology?

a)

A 30-year-old African American man who has been diagnosed with sarcoidosis

b)

An infant whose routine screening is suggestive of cystic fibrosis

c)

An elderly, lifelong smoker who has been admitted to hospital with emphysema

d)

A 16-year-old girl who must limit her activity to prevent asthmatic attacks

30.

Which of the following manifestations typically accompanies an asthmatic attack?

a)

Decreased residual volume

b)

Decreased pulmonary arterial pressure

c)

Prolonged inspiration

d)

Hyperinflation of the lungs

31.

Most respiratory disorders in infants produce a decrease in:

a)

lung compliance.

b)

airway resistance.

c)

oxygen demand.

d)

respiratory rate.

32.

A patient has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the patient’s immediate recovery?

a)

Bedrest and supplementary oxygen by nasal cannula

b)

Administration of bronchodilators by nebulizer

c)

Deep-breathing exercises and early mobilization

d)

Adequate hydration and a high-humidity environment

33.

Cystic fibrosis (CF), the major cause of severe chronic respiratory disease in children, is characterized by:

a)

constipation.

b)

salt depletion.

c)

watery mucus.

d)

high cholesterol.

34.

Acute onset bronchial asthma causes wheezing and breathlessness as a result of

a)

airway inflammation.

b)

alveolar collapse.

c)

compression atelectasis.

d)

pulmonary hypertension.

35.

A patient with a diagnosis of community-acquired pneumonia is producing copious secretions that are physically obstructing her airway. Which of the following pathophysiologic processes will result from this condition?

a)

Compensatory vasoconstriction

b)

Ventilation without perfusion

c)

Dead air space

d)

Perfusion without ventilation

36.

A Total laryngectomy results in?

a)

Permanent loss of the voice and a change in the airway.

b)

Retains some voice

c)

Client is able to eat post operatively

37.

With a hemilaryngectomy.......

a)

No change may occur in voice quality occurs

b)

Airway and swallowing remain intact

c)

Airway and swallowing do not remain intact

38.

Is a Supraglottic laryngectomy a voice-sparing operation?

a)

Yes

b)

No

c)

I don't know

39.

What are some nursing interventions that an RN would implement to Monitoring for or Prevent Aspiration?

a)

Administer antiemetic medications

b)

Have functioning suction set-up

c)

Confirm placement of feeding tube and check residuals per protocol

d)

Keep the HOB at 30-45 degrees

40.

Bleeding is a postoperative complication. What are signs and symptoms of bleeding would the RN assess and monitor for?

a)

Active bleeding from the surgical site, drains, and trachea.

b)

Increased heart rate, decreased blood pressure

c)

Cold, clammy, pale skin

d)

Tachypnea

41.

What would the RN include when Monitoring for Respiratory Distress/Hypoxia?

a)

Restlessness

b)

Confusion

c)

Tachypnea

d)

Use of accessory muscles

e)

Pulse oximetry

42.

In preparing the client to go home, the nurse assesses the patient’s level of knowledge about self-care management. What are some nursing interventions you would utilize to ensure the client is ready to go home?

a)

Explain tubes, dressings, and drains, monitor drainage

b)

Verbalize avoidance of strenuous exercise

c)

Educate client on proper nutrition and fluid intake to prevent malnutrition and dehydration

d)

Ensure client and family recognize s/s of infection

e)

Educate on the importance of wearing or carrying medical identification—such as a bracelet or card

43.

When caring for a postoperative laryngectomy patient what are some nursing interventions that Promote Adequate Nutrition & Hydration especially if client is NPO.

a)

Provide IV fluids

b)

Provide thick liquids, closely monitor and have suction readily available

c)

Monitor weight & Vital signs

d)

Monitor electrolytes

e)

Administer enteral feedings through a nasogastric or gastrostomy tube, and parenteral nutrition.

44.

After a total laryngectomy what nursing interventions would you implement when caring for this client?

a)

Maintain HOB in Semi or High Fowlers position

b)

Provide adequate Humidification

c)

Cautious use of analgesic medications

d)

Use pulse oximeter to monitor 02 status

e)

Encourage coughing and deep breathing

45.

You are explaining to a nursing student what a Total Laryngectomy is. What would you include in your explanation?

a)

A complete removal of the larynx

b)

This procedure is performed for advanced laryngeal cancer

c)

Results in permanent loss of the voice

d)

Need to breathe through a stoma created in the lower neck

46.

10. A student is nervous for a big exam and is breathing rapidly, what do you expect out

of the followings

a)

a) Metabolic Acidosis

b)

b) Metabolic Alkalosis

c)

c) Respiratory Acidosis

d)

d) Respiratory Alkalosis

47.

9- Which of the following laboratory results below indicates compensated metabolic alkalosis?

a)

a) Low p CO2, normal bicarbonate and, high pH

b)

b) Low p CO2, low bicarbonate, low pH

c)

c) High p CO2, normal bicarbonate and, low p H

d)

d) High pCO2, high bicarbonate and High pH

48.

8.- Which of the following is most appropriate for a female suffering from Insulin

dependent diabetes mellitus with a pH of 7.2, HCO3-17 mmol/L and pCO2-20 mm HG

a)

a) Metabolic Acidosis

b)

b) Metabolic Alkalosis

c)

c) Respiratory Acidosis

d)

d) Respiratory Alkalosis

49.

7.Which of the following laboratory results below indicates uncompensated metabolic

alkalosis?

a)

a) Low p CO2, normal bicarbonate and, high pH

b)

b) Low p CO2, low bicarbonate, low pH

c)

c) High p CO2, normal bicarbonate and, low p H

d)

d) Normal pCO2, high bicarbonate and High Ph

50.

6.The main compensatory mechanism in respiratory alkalosis is

a)

a) Retention of bicarbonate

b)

b) Decrease in renal acid excretion

c)

c) Increase in Red Blood Cells.

d)

d) Buffer system.

51.

5.The primary change in respiratory acidosis is

a)

a) Increase in bicarbonate concentration.

b)

b) Increase in pCO2.

c)

c) Decrease in respiratory rate.

d)

d) Hypoxia.

52.

4.Hemoglobin has more powerful buffering action compared to plasma proteins because of:

a)

a) Carboxylic groups.

b)

b) Amino groups.

c)

c) Imidazole groups of histidine residues.

d)

d) Formation of carbaminohemoglobin.

53.

3.The greatest buffering capacity at physiological pH would be provided by a protein rich in which of the following amino acids?

a)

a) Lysine

b)

b) Histidine

c)

c) Aspartic acid

d)

d) Leucine

54.

2.In correcting alkalosis, bicarbonate buffering action is not efficient because:

a)

a) pH value is low.

b)

b) It is a weak buffer.

c)

c) Base/Acid ratio is 20/1

d)

d) Bicarbonate quantity is not enough.

55.

1.- The pH of the body fluids is stabilized by buffer systems. Which of the following compounds is the most effective buffer system at physiological pH?

a)

a) Bicarbonate buffer

b)

b) Phosphate buffer

c)

c) Protein buffer

d)

d) Haemoglobin buffer

56.
The role of the mucus and and cilia in the respiratory system is to....
a)
warm the air. 
b)
clean the air.
c)
humidify the air. 
d)
All of the choices are true. 
57.
The larynx is also known as the...
a)
Voice box
b)
Passage to the lungs
c)
Long vein
d)
Airway
58.
What type of cells carries oxygen?
a)
red blood cells
b)
white blood cells
c)
neurons
59.
Sensitivity caused by an allergen
a)
bronchitis
b)
asthma
c)
emphysema
60.
Wheezing,coughing,tightness of the chest are symptoms of
a)
asthma
b)
epistaxis
c)
rhinitis
61.
The wall of the alveoli deteriorate and lose their elasticity
a)
emphysema
b)
tuberculosis
c)
asthma
62.
A wheezing sound caused by bronchospasms
a)
emphysema
b)
bronchitis
c)
asthma
63.
Which of the following statements is not true about lung cancer?
a)
It is the leading cause of cancer death in both men and women. 
b)
It cannot be prevented
c)
There are no symptoms in the early stages
d)
Prognosis is poor
64.
A noninfectious, chronic respiratory condition that occurs when the walls of their elasticity is _____. 
a)
asthma
b)
chronic obstructive pulmonary disease
c)
emphysema
d)
pleurisy
65.
A respiratory disorder caused by a sensitivity to an allergen is ____. 
a)
asthma
b)
chronic obstructive pulmonary disease
c)
bronchitis
d)
emphysema
66.

Emphysema

a)

specific area that is drained by a stream

b)

negatively charged electrons

c)

Lung disease in which the avioli lose elasticity

d)

chemical reaction in which heat energy is absorbed

67.
Within the lungs, the exchange of oxygen and carbon dioxide occurs between the ___ and the capillaries. 
a)
trachea 
b)
bronchi 
c)
alveoli
d)
diaphragm
68.
The air sacs that are covered with capillaries where gas exchange takes place
a)
bronchi
b)
lungs
c)
oxygen
d)
alveoli
69.
A disorder of the lungs called ____ causes the bronchi to become restricted (get smaller) so air can't get to the lungs.
a)
asthma 
b)
cold
c)
influenza 
d)
bronchitis 
70.
When you breathe, your lungs take in ___ and remove ___. 
a)
air/oxygen
b)
oxygen/carbon dioxide 
c)
carbon dioxide/waste 
d)
waste/air 
71.

How do you position patient with epistaxis?

a)

Lithotomy position

b)

Sit upright with head tilted forward

c)

Sit upright with head tilted backward

d)

Side lying position with neck support

72.

9X8

a)

72

b)

81

c)

76

d)

84

73.

This remains the most common treatment for rhinitis and are administered for sneezing, pruritus and rhinorrhea.

a)

Antibiotics

b)

Antivirals

c)

Antihistamines

d)

Antimetabolites

74.

The most common cause of laryngitis is:

a)

Bacterial

b)

Viral

c)

Superficial

d)

Fungal

75.

The nurse is caring for a patient who had total laryngectomy and has drains in place. When does the nurse understand that the drains will most likely be removed?

a)

When a patient has less than 30 ml for 2 consecutive days

b)

When the patient states that there is discomfort and requests removal

c)

When the drainage tube comes out

d)

In 1 week when the patient no longer has serous drainage.

76.

A patient has herpes simplex infection that developed adter having the common cold. What medication does the nurse anticipate will be administered for this infection?

a)

Antibiotic

b)

Antiviral

c)

Antihistamine

d)

Antibacterial ointment

77.

The most common major suppurative complication of sore throat.

a)

Peritonsillar abscess

b)

Infection

c)

Bleeding

d)

Loss of voice

78.

The most serious complication of tonsillectomy is _______

a)

loss of voice

b)

hemorrhage

c)

pain scale of 9 out of 10

d)

infection

79.

The oxygen flow rate for nasal cannula should not exceed _____ L/min

a)

4

b)

6

c)

8

d)

10

80.

A patient will require a ______ mask, which is the most reliable and accurate method of delivery, when precise concentration of oxygen is required.

a)

T-Piece

b)

Re-breather mask

c)

Venturi Mask

d)

Nasal Cannula

81.

A ________ is used when a patient requires low medium concentration of oxygen for which precise accuracy is not essential.

a)

Venturi Mask

b)

Rebreather mask

c)

Nasal Cannula

d)

T-piece

82.

It is important when a patient is on oxygen to post a " ______" to prevent an untoward incident.

a)

No playing

b)

No smoking

c)

No talking

d)

No eating

83.

Decrease in the oxygen supply in the tissues is called?

a)

Hypoxia

b)

Hypoxemia

c)

Anemic hypoxia

d)

Circulatory hypoxia

84.

Decreased oxygen level in the blood is called?

a)

Hypoxia

b)

Hypoxemia

c)

Hypoxemic Hypoxia

d)

Anemic hypoxia

85.

The two centers of the brain that are responsible for the neurologic control of ventilation are the Pneumotaxic center and _______?

a)

Apneustic center

b)

Ballistic Center

c)

Opportunistic

d)

Dyspneic center

86.

What is the Purpose of Cilia?

a)

Traps the mucus in the respiratory tract

b)

Moves the mucus back up to the Larynx

c)

Catches the bacteria in the respiratory tract

d)

I don't care

87.

A patient with sinus congestion reports discomfort when the nurse is palpating the SUPRA-ORBITAL ridges. The nurse is aware that the patient is referring to which SINUS?

a)

Frontal

b)

Ethmoidal

c)

Maxillary

d)

Sphenoidal

88.

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)

Barrel Chest

b)

Funnel Chest

c)

Kyphoscoliosis

d)

Pigeon Chest

89.

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)

40 mm Hg

b)

75 mm Hg

c)

90 mm Hg

d)

95 mm Hg

90.

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

a)

Rales

b)

Crackles

c)

Wheezes

d)

Rhonchi

91.

Younger children are usually affected with Epiglottitis and older children are affected with Croup

a)

True

b)

False

92.

Croup can be managed at home

a)

True

b)

False

93.

Croup is mostly caused by viral infection

a)

True

b)

False

94.

Select all that apply. Epiglottitis is managed by the following:

a)

Intubation

b)

Tracheostomy

c)

Antibiotics

d)

Oral Suctioning

95.

Treatment of epiglottitis requires immediate and prophylactic intubation

a)

True

b)

False

96.

Management of epiglottitis requires careful assessment of the inflammation using careful oral inspection

a)

True

b)

False

97.

Epiglottitis is always considered as a medical emergency

a)

True

b)

False

98.

Which is not a common manifestation of Croup?

a)

Stridor

b)

Barking cough

c)

Retractions

d)

High grade fever

99.

Which of the following is/are true about Croup? Select all that apply.

a)

Primarily caused by viral infection

b)

Always considered as a medical emergency

c)

Can be managed at home

d)

Managed with bronchodilators

100.

Select all that apply. Manifestations of Tracheomalacia include:

a)

Intercostal retraction

b)

Feeding problem

c)

Clubbing of fingers

d)

Stridor