TEST BANK For Mosby’s Respiratory Care Equipment,
11th Edition, by J. M. Cairo
After lobectomy for lung cancer, a client receives a chest tube connected to a
disposable chest drainage system. The nurse observes that the drainage system is
functioning correctly when she notes tidal movements or fluctuations in which
compartment of the system as the client breathes? - ANSWER:Water-seal chamber
A client suffers acute respiratory distress syndrome as a consequence of shock. The
client's condition deteriorates rapidly, and endotracheal (ET) intubation and
mechanical ventilation are initiated. When the high-pressure alarm on the
mechanical ventilator sounds, the nurse starts to check for the cause. Which
condition triggers the high-pressure alarm? - ANSWER:Kinking of the ventilator
tubing
A client with chronic obstructive pulmonary disease (COPD) is intubated and placed
on continuous mechanical ventilation. Which equipment is most important for the
nurse to keep at this client's bedside? - ANSWER:Manual resuscitation bag
For a client with an endotracheal (ET) tube, which nursing action is the most
important? - ANSWER:Auscultating the lungs for bilateral breath sounds
For a client who has a chest tube connected to a closed water-seal drainage system,
the nurse should include which action in the care plan? - ANSWER:Measuring and
documenting the drainage in the collection chamber
A nurse is caring for a client who recently underwent a tracheostomy. The first
priority when caring for a client with a tracheostomy is: - ANSWER:keeping his
airway patent.
A nurse prepares to perform postural drainage. How should the nurse ascertain the
best position to facilitate clearing the lungs? - ANSWER:Auscultation
The nurse is assisting a physician with an endotracheal intubation for a client in
respiratory failure. It is most important for the nurse to assess for: -
ANSWER:Symmetry of the client's chest expansion
A client is on a positive-pressure ventilator with a synchronized intermittent
mandatory ventilation (SIMV) setting. The ventilator is set for 8 breaths per minute.
The client is taking 6 breaths per minute independently. The nurse -
ANSWER:Continues assessing the client's respiratory status frequently
A client is on a ventilator. Alarms are sounding, indicating an increase in peak airway
pressure. The nurse assesses first for - ANSWER:A kink in the ventilator tubing
,A client with a respiratory condition is receiving oxygen therapy. While assessing the
client's PaO2, the nurse knows that the therapy has been effective based on which of
the following readings? - ANSWER:84 mm Hg
The nurse is assisting a client with postural drainage. Which of the following
demonstrates correct implementation of this technique? - ANSWER:Instruct the
client to remain in each position of the postural drainage sequence for 10 to 15
minutes.
The nurse is preparing to perform chest physiotherapy (CPT) on a client. Which
statement by the client tells the nurse that the procedure is contraindicated. -
ANSWER:"I just finished eating my lunch, I'm ready for my CPT now."
A patient is being educated in the use of incentive spirometry prior to having a
surgical procedure. What should the nurse be sure to include in the education? -
ANSWER:Encourage the patient to take approximately 10 breaths per hour, while
awake.
The nurse suctions a patient through the endotracheal tube for 20 seconds and
observes dysrhythmias on the monitor. What does the nurse determine is occurring
with the patient? - ANSWER:The patient is hypoxic from suctioning.
The nurse assesses a patient with a heart rate of 42 and a blood pressure of 70/46.
What type of hypoxia does the nurse determine this patient is displaying? -
ANSWER:Circulatory hypoxia
The nurse is caring for a client with an endotracheal tube (ET). Which nursing
intervention is contraindicated? - ANSWER:Routinely deflating the cuff
A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing.
Place the steps in order in which the nurse will instruct the client. - ANSWER:Inhale
through your nose."
"Slowly count to 3."
"Exhale slowly through pursed lips."
"Slowly count to 7."
A client with myasthenia gravis is receiving continuous mechanical ventilation. When
the high-pressure alarm on the ventilator sounds, what should the nurse do? -
ANSWER:Suction the client's artificial airway.
After undergoing a left thoracotomy, a client has a chest tube in place. When caring
for this client, the nurse must: - ANSWER:encourage coughing and deep breathing.
A client is receiving supplemental oxygen. When determining the effectiveness of
oxygen therapy, which arterial blood gas value is most important? - ANSWER:Partial
pressure of arterial oxygen (PaO2)
, A nurse observes constant bubbling in the water-seal chamber of a closed chest
drainage system. What should the nurse conclude? - ANSWER:The system has an air
leak
A nurse is caring for a client who has a tracheostomy and temperature of 103° F
(39.4° C). Which intervention will most likely lower the client's arterial blood oxygen
saturation? - ANSWER:Endotracheal suctioning
Which is the most reliable and accurate method for delivering precise concentrations
of oxygen through noninvasive means? - ANSWER:Venturi mask
Which is a potential complication of a low pressure in the endotracheal tube cuff? -
ANSWER:Aspiration pneumonia
The nurse is teaching a postoperative client who had a coronary artery bypass graft
about using the incentive spirometer. The nurse instructs the client to perform the
exercise in the following order: - ANSWER:Sit in an upright position.
Place the mouthpiece of the spirometer in the mouth.
Breathe air in through the mouth.
Hold breath for about 3 seconds.
Exhale air slowly through the mouth.
Which oxygen administration device has the advantage of providing a high oxygen
concentration? - ANSWER:Nonrebreathing mask
The nurse is caring for a client following a thoracotomy. Which finding requires
immediate intervention by the nurse? - ANSWER:Chest tube drainage, 190 mL/hr
A client is being mechanically ventilated in the ICU. The ventilator alarms begin to
sound. The nurse should complete which action first? - ANSWER:Troubleshoot to
identify the malfunction.
The nurse has instructed a client on how to perform pursed-lip breathing. The nurse
recognizes the purpose of this type of breathing is to accomplish which result? -
ANSWER:Improve oxygen transport; induce a slow, deep breathing pattern; and
assist the client to control breathing
The nurse is preparing to assist the health care provider to remove a client's chest
tube. Which instruction will the nurse correctly give to the client? - ANSWER:"When
the tube is being removed, take a deep breath, exhale, and bear down."
11th Edition, by J. M. Cairo
After lobectomy for lung cancer, a client receives a chest tube connected to a
disposable chest drainage system. The nurse observes that the drainage system is
functioning correctly when she notes tidal movements or fluctuations in which
compartment of the system as the client breathes? - ANSWER:Water-seal chamber
A client suffers acute respiratory distress syndrome as a consequence of shock. The
client's condition deteriorates rapidly, and endotracheal (ET) intubation and
mechanical ventilation are initiated. When the high-pressure alarm on the
mechanical ventilator sounds, the nurse starts to check for the cause. Which
condition triggers the high-pressure alarm? - ANSWER:Kinking of the ventilator
tubing
A client with chronic obstructive pulmonary disease (COPD) is intubated and placed
on continuous mechanical ventilation. Which equipment is most important for the
nurse to keep at this client's bedside? - ANSWER:Manual resuscitation bag
For a client with an endotracheal (ET) tube, which nursing action is the most
important? - ANSWER:Auscultating the lungs for bilateral breath sounds
For a client who has a chest tube connected to a closed water-seal drainage system,
the nurse should include which action in the care plan? - ANSWER:Measuring and
documenting the drainage in the collection chamber
A nurse is caring for a client who recently underwent a tracheostomy. The first
priority when caring for a client with a tracheostomy is: - ANSWER:keeping his
airway patent.
A nurse prepares to perform postural drainage. How should the nurse ascertain the
best position to facilitate clearing the lungs? - ANSWER:Auscultation
The nurse is assisting a physician with an endotracheal intubation for a client in
respiratory failure. It is most important for the nurse to assess for: -
ANSWER:Symmetry of the client's chest expansion
A client is on a positive-pressure ventilator with a synchronized intermittent
mandatory ventilation (SIMV) setting. The ventilator is set for 8 breaths per minute.
The client is taking 6 breaths per minute independently. The nurse -
ANSWER:Continues assessing the client's respiratory status frequently
A client is on a ventilator. Alarms are sounding, indicating an increase in peak airway
pressure. The nurse assesses first for - ANSWER:A kink in the ventilator tubing
,A client with a respiratory condition is receiving oxygen therapy. While assessing the
client's PaO2, the nurse knows that the therapy has been effective based on which of
the following readings? - ANSWER:84 mm Hg
The nurse is assisting a client with postural drainage. Which of the following
demonstrates correct implementation of this technique? - ANSWER:Instruct the
client to remain in each position of the postural drainage sequence for 10 to 15
minutes.
The nurse is preparing to perform chest physiotherapy (CPT) on a client. Which
statement by the client tells the nurse that the procedure is contraindicated. -
ANSWER:"I just finished eating my lunch, I'm ready for my CPT now."
A patient is being educated in the use of incentive spirometry prior to having a
surgical procedure. What should the nurse be sure to include in the education? -
ANSWER:Encourage the patient to take approximately 10 breaths per hour, while
awake.
The nurse suctions a patient through the endotracheal tube for 20 seconds and
observes dysrhythmias on the monitor. What does the nurse determine is occurring
with the patient? - ANSWER:The patient is hypoxic from suctioning.
The nurse assesses a patient with a heart rate of 42 and a blood pressure of 70/46.
What type of hypoxia does the nurse determine this patient is displaying? -
ANSWER:Circulatory hypoxia
The nurse is caring for a client with an endotracheal tube (ET). Which nursing
intervention is contraindicated? - ANSWER:Routinely deflating the cuff
A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing.
Place the steps in order in which the nurse will instruct the client. - ANSWER:Inhale
through your nose."
"Slowly count to 3."
"Exhale slowly through pursed lips."
"Slowly count to 7."
A client with myasthenia gravis is receiving continuous mechanical ventilation. When
the high-pressure alarm on the ventilator sounds, what should the nurse do? -
ANSWER:Suction the client's artificial airway.
After undergoing a left thoracotomy, a client has a chest tube in place. When caring
for this client, the nurse must: - ANSWER:encourage coughing and deep breathing.
A client is receiving supplemental oxygen. When determining the effectiveness of
oxygen therapy, which arterial blood gas value is most important? - ANSWER:Partial
pressure of arterial oxygen (PaO2)
, A nurse observes constant bubbling in the water-seal chamber of a closed chest
drainage system. What should the nurse conclude? - ANSWER:The system has an air
leak
A nurse is caring for a client who has a tracheostomy and temperature of 103° F
(39.4° C). Which intervention will most likely lower the client's arterial blood oxygen
saturation? - ANSWER:Endotracheal suctioning
Which is the most reliable and accurate method for delivering precise concentrations
of oxygen through noninvasive means? - ANSWER:Venturi mask
Which is a potential complication of a low pressure in the endotracheal tube cuff? -
ANSWER:Aspiration pneumonia
The nurse is teaching a postoperative client who had a coronary artery bypass graft
about using the incentive spirometer. The nurse instructs the client to perform the
exercise in the following order: - ANSWER:Sit in an upright position.
Place the mouthpiece of the spirometer in the mouth.
Breathe air in through the mouth.
Hold breath for about 3 seconds.
Exhale air slowly through the mouth.
Which oxygen administration device has the advantage of providing a high oxygen
concentration? - ANSWER:Nonrebreathing mask
The nurse is caring for a client following a thoracotomy. Which finding requires
immediate intervention by the nurse? - ANSWER:Chest tube drainage, 190 mL/hr
A client is being mechanically ventilated in the ICU. The ventilator alarms begin to
sound. The nurse should complete which action first? - ANSWER:Troubleshoot to
identify the malfunction.
The nurse has instructed a client on how to perform pursed-lip breathing. The nurse
recognizes the purpose of this type of breathing is to accomplish which result? -
ANSWER:Improve oxygen transport; induce a slow, deep breathing pattern; and
assist the client to control breathing
The nurse is preparing to assist the health care provider to remove a client's chest
tube. Which instruction will the nurse correctly give to the client? - ANSWER:"When
the tube is being removed, take a deep breath, exhale, and bear down."
