ATI Respiratory System Evolve Exam Questions

The nurse assesses a patient with emphysema and notes a barrel chest. What is the reason for this patient's chest anomaly? - Hyperinflation of the lungs Rationale: A patient with emphysema develops a barrel chest as a result of the trapping of air in the lungs, which causes them to hyperinflate. Collapsed alveoli, use of accessory muscles, and long-term, chronic hypoxia do not cause a barrel chest. The nurse notes that the respiratory symptoms of the patient with chronic obstructive pulmonary disease (COPD) have affected his nutrition. Which would most help improve the patient's nutrition? - Extra protein is required to repair damaged tissues Rationale: Nutrition is very important for the patient with COPD because the extra work to breathe properly uses more calories and anorexia may be present. Extra protein is required to repair damaged tissues. It is helpful to drink six to eight glasses of noncaffeinated fluids per day to keep mucus thin and easier to cough up, unless the physician has the patient on a fluid restriction. The patient should rest before eating, not exercise before meals. The patient should avoid overeating and should eat four to six small meals a day rather than three regular meals to decrease stomach fullness and reduce fatigue. A patient with COPD asks the nurse to turn his oxygen up from 3 L/min via nasal cannula to 5 L/min. The nurse asseses the patient and finds that the oxygen saturation level is at 91%. The nurse explains to the patient that she cannot turn his oxygen up this high for what reason? - Oxygen is titrated to maintain saturation levels. Rationale: O2 should be titrated to maintain an oxygen saturation of 88% to 92%. COPD patients have adjusted to chronic hypoxia and to high CO2 levels. Closely monitor the pulse oximetry readings and titrate the oxygen as needed. Hypercapnia is the result of hypoventilation, during which the usual amount of carbon dioxide is not eliminated by exhalation. Carbon dioxide is a respiratory stimulant, and the normal response to excessive levels of carbon dioxide is an increase in respiratory rate. Increasing the oxygen flow unnecessarily will not relieve increased respirations. Low oxygen levels, not high carbon dioxide levels, are the stimulus for breathing for a patient with COPD. Higher concentrations of oxygen will not be required for ABGs or result in a headache. A patient taking aminophylline tells the nurse that he is going to begin a smoking cessation program when he is discharged from the hospital. Why should the nurse tell this patient to notify his physician if his smoking pattern changes? - The patient will need his aminophylline dosage adjusted. Rationale: The length of the action of aminophylline is decreased by smoking. Therefore, changes in smoking patterns should be discussed with the physician or other health care provider because this may affect the dosage of aminophylline needed. Patients COPD are managed with expectorants, not antitussives. Annual influenza vaccine is recommended for all patients with lung disease. The patient should experience increased benefits from inhaler use following smoking cessation. A patient with emphysema may lose weight despite having an adequate caloric intake. What advice should the nurse give the patient regarding ways to maintain an optimal weight? - Increase calories, protein, vitamins, and minerals. Rationale: Due to the amount of energy expended for breathing, patients with emphysema often need additional calories, protein, vitamins, and minerals. Patients require more calories but not more fats. Increasing activity will increase oxygen demand and result in further weight loss. The student nurse is caring for a patient with a restrictive respiratory disease. Which description demonstrates the student's knowledge of the disease? - The disease is characterized by decreased lung expansion. Rationale :Restrictive respiratory disorders may be caused by decreased elasticity or compliance of the lungs, decreased ability of the chest wall to expand, or disorders of the central nervous system. Increased lung volumes, lung obstruction, or narrowed tracheobronchial tree openings are not characteristics of restrictive respiratory disease. A patient who experienced high fever and chills, a productive cough, chest pain, general malaise, and aching muscles during the past week is admitted to the hospital. The nurse realizes these symptoms correspond most closely with which disease? - Pneumonia Rationale: Typical signs and symptoms of pneumonia include high fever, chills, a cough that produces rusty or blood-flecked sputum, sweating, chest pain, a general feeling of malaise, and aching muscles. These symptoms do not describe type A influenza, pleurisy with effusion, or S. empyema infection. A patient with asthma is suddenly experiencing difficulty breathing, tachypnea, and wheezing. Which medication listed on the medication administration record, administered through an inhaler, should the nurse administer to this patient? - Albuterol Rationale: Albuterol is a fast-acting bronchodilator and can be given during an acute episode of asthma symptoms. Its onset of action is 5 to 10 minutes and its duration is 3 to 4 h. Cromolyn is an inhaled antiinflammatory agent that may take up to 2 weeks to produce a therapeutic effect. Salmeterol and formoterol are longacting bronchodilators that should not be used to treat acute episodes of asthma. The nurse is caring for a patient with viral pneumonia. Which intervention(s) should the nurse expect to be included in the care plan? Select all apply - -Providing adequate rest periods -Maintaining adequate fluid intake -Monitoring vital signs and respiratory status -providing oral hygiene before and after meals rationale: Antibiotics are effective only for bacterial, not viral, infections. Antibiotics would be given only for secondary bacterial infections. The care plan should include provision of adequate rest periods, maintaining adequate fluid intake, monitoring vital signs and respiratory status, and providing oral hygiene before and after meals. The student nurse is preparing a report about COPD. The student would be correct in including which disease(s) in the report? (Select all that apply.) - -emphysema -chronic bronchitis rationale: Chronic bronchitis and emphysema are categorized as COPD. They are obstructive pulmonary disorders characterized by problems with moving air into and out of the lungs and progressive dyspnea. Asthma is considered a chronic airflow limitation disorder. Pleurisy is inflammation of the pleura. Pulmonary tuberculosis is an infection of the lungs. The nurse is suctioning a patient who is unable to expectorate respiratory secretions from his tracheotomy. How can the nurse avoid the serious consequences of removing oxygen when suctioning this patient? - Do not suction the patient for more than 10 to 15 seconds. Rationale: Limiting suctioning to 10 to 15 seconds per suction attempt will help prevent the removal of too much oxygen from the patient. The patient should be preoxygenated before suctioning, and the pressure should be between 80 and 100 mm Hg. Suction should be applied only while the catheter is being removed. Which finding in a female patient should indicate to the LPN/LVN that the patient is likely to have a respiratory problem? - Clubbing of the fingers Rationale: Clubbing of the fingers may be seen in patients with chronic respiratory or heart disease. Clubbing is characterized by the fingers being wider than normal at the distal end, similar in shape of a club. Also, there is marked rounded curvature of the fingernails. Inverted breast nipples, the inability to rotate the shoulder joint, and a fine maculopapular rash over the anterior of the chest do not indicate respiratory problems. A patient is to have a bronchoscopy. The LPN/LVN should expect which finding in the postprocedure period? - Blood tinged sputum Rationale: It is normal to find a small amount of blood-tinged sputum due to the irritation of the respiratory mucosa during the procedure. Elevated blood pressure, elevated temperature, and dyspnea are indications that complications may be occurring postprocedure. The patient tells the LPN/LVN that she has been hoarse for the past 2½ weeks. Which response by the nurse is most appropriate? - You should see your primary health care provider." Rationale: Hoarseness or a sore throat that lasts longer than 2 weeks should be investigated by the primary health care provider and can assist in the early detection of throat malignancy. Running a humidifier, talking as little as possible, and gargling with warm salted water are good interventions if the hoarseness is found to be viral or a bacterial infection, but the hoarseness could be due to a more serious cause. It is appropriate to teach patients to obtain sufficient rest to help decrease the frequency with which they contract upper respiratory infections. How does rest help prevent respiratory infections? - Rest assists in keeping the immune system healthy Rationale: Proper rest and good nutrition help keep the immune system functioning properly, which will decrease the likelihood of contracting respiratory infections. White blood cells, rather than red blood cells, fight infection; rest does not influence the amount of vitamin C excreted, and rest does not have an effect on the cough reflex. To defend against exposure to foreign particles, the mucous membrane of the respiratory tract contains tiny, hairlike projections. What are these called? - cilia rationale: Cilia are the hairlike projections that catch foreign particles before these particles advance farther into the respiratory tract and cause infection. Alveoli are tiny air sacs where gas exchange occurs. Surfactant is a substance that decreases surface tension. Chemoreceptors detect changes in the blood that reflect gas exchange. The nurse is caring for a patient who is going to have a thoracentesis performed. How should the nurse position the patient for this procedure? - Sitting, facing the side of the bed. rationale: To prepare a patient for a thoracentesis, the nurse should position the patient sitting, facing the side of the bed, and leaning over the overbed table with arms crossed on it; pillows or the back of a chair can also be used. The nurse should assist the patient to remain still during the procedure. A flat position, while either prone or supine, does not allow for full chest expansion What structure allows for gas exchange with the pulmonary capillaries during respiration? - alveoli rationale: Alveoli are tiny air sacs covered with a permeable membrane that come into contact with the pulmonary arterioles and venules; oxygen passes into the blood and carbon dioxide passes from the blood into the alveoli. The trachea and bronchi are air passageways, but no gas exchange occurs in these structures. The entire process occurs in the lungs. The school nurse is teaching a group of older adults about maintaining a healthy respiratory system. Which risk factor(s) for respiratory disease should the nurse include? (Select all that apply.) - -tobacco use -chronic renal disease -group living conditions -compromised immune response The nurse is teaching the patient about ways to prevent inflammation in the respiratory tract. Which patient statement(s) demonstrate(s) knowledge of this subject? (Select all that apply.) - - " I need to stop smoking" - " I should be sure to practice good handwashing" -I need to get enough rest and eat a balanced diet" -"It's a good idea to stay away from crowds during cold and flu season" Rationale: The patient demonstrates an understanding of how to decrease inflammation in the respiratory tract by discussing the need to quit smoking, receive adequate rest, eat a balanced diet, practice hand hygiene, and avoid crowds during cold and flu season. An additional way is to avoid known allergens. An aspirin every day helps maintain good circulation and prevents clots; it does not decrease respiratory inflammation. For which of these reasons is it particularly important for older adults to receive influenza immunizations? - They are more susceptible to upper respiratory infections. Rationale: The elderly tend to have a weaker immune system so it is important for them to receive an influenza immunization to help protect them from developing this infection, which can lead to secondary infections. The nurse is caring for a patient who has had a partial laryngectomy and is experiencing difficulty swallowing. For which complication is this patient most at risk? - Aspiration Rationale: The patient with a difficulty swallowing is most at risk for aspiration of food or fluids, which often leads to aspiration pneumonia. The patient is not at risk for epiglottitis, esophageal varicosities, or paralysis of the vocal cords. A patient's nose begins to bleed. Which action should the LPN/LVN take? - Have the patient apply direct pressure by pinching his nose for 10 to 15 minutes. Rationale: The patient should lean forward and apply pressure by pinching the soft portion of his nose for 10 to 15 minutes. Blowing the nose will increase bleeding, as will applying heat. Swallowing may lead to nausea and vomiting from blood entering the stomach. A patient with a sore throat is to have a throat culture to establish whether the infection is being caused by Streptococcus. If it is a streptococcal infection and the patient is not treated, what may the patient be at risk for? - Glomerulonephritis rationale: Streptococcus can invade the kidney or heart if the infection is left untreated, causing glomerulonephritis or rheumatic fever. The patient is not at risk for cystitis, hepatitis, or glaucoma. The nurse is caring for a patient going to surgery for a tracheostomy. What is the purpose of a tracheostomy? - insert a tube for breathing rationale: A tracheostomy is a surgical incision into the trachea for the purpose of inserting a tube for breathing. A feeding tube is inserted for feeding a patient. A nasogastric tube is inserted for gastric drainage and a T-tube is inserted for bile drainage. What are some commonly prescribed drugs used for allergic rhinitis and sinusitis? - Antihistamines, corticosteroids, and decongestants Rationale: Commonly prescribed drugs used for allergic rhinitis and sinusitis include antihistamines, corticosteroids, decongestants, and mast cell stabilizers. Beta blockers, aspirin, anginals, anticoagulants, and alpha antagonists are not prescribed drugs for allergic rhinitis and sinusitis. A patient presents at the emergency room complaining of severe throat pain "that's so bad I can hardly swallow. It feels like there's a huge lump in my throat." The patient is diagnosed with severe pharyngitis. What would the nurse include in patient teaching regarding this condition? - Increase fluid intake Rationale: Increasing fluid intake will thin any secretions that develop and keep the patient from becoming dehydrated. Decreased humidity will thicken secretions and create more difficulty swallowing. Because of the vitamin C content, fruit juices will help the immune system and the ability to fight infection. Hot baths or showers pose no problem for this patient.