Chapter 19 Management of Patients With Chest and Lower
Respiratory Tract Disorders
1. A perioperative nurse is caring for a postoperative patient. The patient has a shallow
respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address
the patient's increased risk for what complication?
A) Acute respiratory distress syndrome (ARDS)
B) Atelectasis
C) Aspiration
D) Pulmonary embolism
Ans: B
Feedback:
A shallow, monotonous respiratory pattern coupled with immobility places the patient
at an increased risk of developing atelectasis. These specific factors are less likely to result in
pulmonary embolism or aspiration. ARDS involves an exaggerated inflammatory response and
does not normally result from factors such as immobility and shallow breathing.
2. A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical
complication. The nurse's assessment reveals that the patient has an increased work of
breathing due to copious tracheobronchial secretions. What should the nurse encourage the
patient to do?
A) Increase oral fluids unless contraindicated. B) Call the nurse for oral suctioning, as
needed. C) Lie in a low Fowler's or supine position.
D) Increase activity.
Ans: A
Feedback:
, The nurse should encourage hydration because adequate hydration thins and loosens
pulmonary secretions. Oral suctioning is not sufficiently deep to remove tracheobronchial
secretions. The patient should have the head of the bed raised, and rest should be promoted
to avoid exacerbation of symptoms.
3. The public health nurse is administering Mantoux tests to children who are being registered
for kindergarten in the community. How should the nurse administer this test?
A) Administer intradermal injections into the children's inner forearms.
B) Administer intramuscular injections into each child's vastus lateralis. C) Administer a
subcutaneous injection into each child's umbilical area.
D) Administer a subcutaneous injection at a 45-degree angle into each child's deltoid.
Ans: A
Feedback:
The purified protein derivative (PPD) is always injected into the intradermal layer of the inner
aspect of the forearm. The subcutaneous and intramuscular routes are not utilized.
4. The nurse is caring for a patient who has been in a motor vehicle accident and the care
team suspects that the patient has developed pleurisy. Which of the nurse's assessment
findings would best corroborate this diagnosis?
A) The patient is experiencing painless hemoptysis.
B) The patient's arterial blood gases (ABGs) are normal, but he demonstrates
increased work of breathing.
C) The patient's oxygen saturation level is below 88%, but he denies shortness of
breath.
D) The patient's pain intensifies when he coughs or takes a deep breath.
Ans: D
Feedback:
, The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a
deep breath, coughing, or sneezing worsens the pain. The patient's ABGs would most likely be
abnormal and shortness of breath would be expected.
5. The nurse caring for a patient recently diagnosed with lung disease encourages the patient
not to smoke. What is the primary rationale behind this nursing action?
A) Smoking decreases the amount of mucus production.
B) Smoke particles compete for binding sites on hemoglobin. C) Smoking causes atrophy
of the alveoli.
D) Smoking damages the ciliary cleansing mechanism. Ans: D
Feedback:
In addition to irritating the mucous cells of the bronchi and inhibiting the function of
alveolar macrophage (scavenger) cells, smoking damages the ciliary cleansing mechanism of
the respiratory tract. Smoking also increases the amount of mucus production and distends
the alveoli in the lungs. It reduces the oxygen-carrying capacity of hemoglobin, but not by
directly competing for binding sites.
6. A patient has been brought to the ED by the paramedics. The patient is suspected of having
ARDS. What intervention should the nurse first anticipate?
A) Preparing to assist with intubating the patient
B) Setting up oxygen at 5 L/minute by nasal cannula
C) Performing deep suctioning
D) Setting up a nebulizer to administer corticosteroids
Ans: A
Feedback:
, A patient who has ARDS usually requires intubation and mechanical ventilation. Oxygen by
nasal cannula would likely be insufficient. Deep suctioning and nebulizers may be indicated,
but the priority is to secure the airway.
7. The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung
cancer. While assisting with a subclavian vein central line insertion, the nurse notes the
client's oxygen saturation rapidly dropping. The patient complains of shortness of breath and
becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment
findings supporting the presence of a pneumothorax include what?
A) Diminished or absent breath sounds on the affected side
B) Paradoxical chest wall movement with respirations
C) Sudden loss of consciousness
D) Muffled heart sounds
Ans: A
Feedback:
In the case of a simple pneumothorax, auscultating the breath sounds will reveal absent or
diminished breath sounds on the affected side. Paradoxical chest wall movements occur in
flail chest conditions. Sudden loss of consciousness does not typically occur. Muffled or distant
heart sounds occur in pericardial tamponade.
8. The nurse is providing discharge teaching for a patient who developed a pulmonary embolism
after total knee surgery. The patient has been converted from heparin to sodium warfarin
(Coumadin) anticoagulant therapy. What should the nurse teach the client?
A) Coumadin will continue to break up the clot over a period of weeks
B) Coumadin must be taken concurrent with ASA to achieve anticoagulation.
C) Anticoagulant therapy usually lasts between 3 and 6 months. D) He should take a
vitamin supplement containing vitamin K Ans: C
Feedback:
Respiratory Tract Disorders
1. A perioperative nurse is caring for a postoperative patient. The patient has a shallow
respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address
the patient's increased risk for what complication?
A) Acute respiratory distress syndrome (ARDS)
B) Atelectasis
C) Aspiration
D) Pulmonary embolism
Ans: B
Feedback:
A shallow, monotonous respiratory pattern coupled with immobility places the patient
at an increased risk of developing atelectasis. These specific factors are less likely to result in
pulmonary embolism or aspiration. ARDS involves an exaggerated inflammatory response and
does not normally result from factors such as immobility and shallow breathing.
2. A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical
complication. The nurse's assessment reveals that the patient has an increased work of
breathing due to copious tracheobronchial secretions. What should the nurse encourage the
patient to do?
A) Increase oral fluids unless contraindicated. B) Call the nurse for oral suctioning, as
needed. C) Lie in a low Fowler's or supine position.
D) Increase activity.
Ans: A
Feedback:
, The nurse should encourage hydration because adequate hydration thins and loosens
pulmonary secretions. Oral suctioning is not sufficiently deep to remove tracheobronchial
secretions. The patient should have the head of the bed raised, and rest should be promoted
to avoid exacerbation of symptoms.
3. The public health nurse is administering Mantoux tests to children who are being registered
for kindergarten in the community. How should the nurse administer this test?
A) Administer intradermal injections into the children's inner forearms.
B) Administer intramuscular injections into each child's vastus lateralis. C) Administer a
subcutaneous injection into each child's umbilical area.
D) Administer a subcutaneous injection at a 45-degree angle into each child's deltoid.
Ans: A
Feedback:
The purified protein derivative (PPD) is always injected into the intradermal layer of the inner
aspect of the forearm. The subcutaneous and intramuscular routes are not utilized.
4. The nurse is caring for a patient who has been in a motor vehicle accident and the care
team suspects that the patient has developed pleurisy. Which of the nurse's assessment
findings would best corroborate this diagnosis?
A) The patient is experiencing painless hemoptysis.
B) The patient's arterial blood gases (ABGs) are normal, but he demonstrates
increased work of breathing.
C) The patient's oxygen saturation level is below 88%, but he denies shortness of
breath.
D) The patient's pain intensifies when he coughs or takes a deep breath.
Ans: D
Feedback:
, The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a
deep breath, coughing, or sneezing worsens the pain. The patient's ABGs would most likely be
abnormal and shortness of breath would be expected.
5. The nurse caring for a patient recently diagnosed with lung disease encourages the patient
not to smoke. What is the primary rationale behind this nursing action?
A) Smoking decreases the amount of mucus production.
B) Smoke particles compete for binding sites on hemoglobin. C) Smoking causes atrophy
of the alveoli.
D) Smoking damages the ciliary cleansing mechanism. Ans: D
Feedback:
In addition to irritating the mucous cells of the bronchi and inhibiting the function of
alveolar macrophage (scavenger) cells, smoking damages the ciliary cleansing mechanism of
the respiratory tract. Smoking also increases the amount of mucus production and distends
the alveoli in the lungs. It reduces the oxygen-carrying capacity of hemoglobin, but not by
directly competing for binding sites.
6. A patient has been brought to the ED by the paramedics. The patient is suspected of having
ARDS. What intervention should the nurse first anticipate?
A) Preparing to assist with intubating the patient
B) Setting up oxygen at 5 L/minute by nasal cannula
C) Performing deep suctioning
D) Setting up a nebulizer to administer corticosteroids
Ans: A
Feedback:
, A patient who has ARDS usually requires intubation and mechanical ventilation. Oxygen by
nasal cannula would likely be insufficient. Deep suctioning and nebulizers may be indicated,
but the priority is to secure the airway.
7. The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung
cancer. While assisting with a subclavian vein central line insertion, the nurse notes the
client's oxygen saturation rapidly dropping. The patient complains of shortness of breath and
becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment
findings supporting the presence of a pneumothorax include what?
A) Diminished or absent breath sounds on the affected side
B) Paradoxical chest wall movement with respirations
C) Sudden loss of consciousness
D) Muffled heart sounds
Ans: A
Feedback:
In the case of a simple pneumothorax, auscultating the breath sounds will reveal absent or
diminished breath sounds on the affected side. Paradoxical chest wall movements occur in
flail chest conditions. Sudden loss of consciousness does not typically occur. Muffled or distant
heart sounds occur in pericardial tamponade.
8. The nurse is providing discharge teaching for a patient who developed a pulmonary embolism
after total knee surgery. The patient has been converted from heparin to sodium warfarin
(Coumadin) anticoagulant therapy. What should the nurse teach the client?
A) Coumadin will continue to break up the clot over a period of weeks
B) Coumadin must be taken concurrent with ASA to achieve anticoagulation.
C) Anticoagulant therapy usually lasts between 3 and 6 months. D) He should take a
vitamin supplement containing vitamin K Ans: C
Feedback:
