ATI Med-Surge Respiratory Exam Questions and Answers with Rationales

A nurse in a provider's office is assessing a client who states he was recently exposed to tuberculosis. Which of the following findings is a clinical manifestation of pulmonary tuberculosis (TB)? Pericardial friction rub Weight gain Night sweats Cyanosis of the finger Night Sweats Rationale: Night sweats and fevers are clinical manifestations of TB. A charge nurse receives notification of the admission of a client who is coughing frequently and whose sputum is pink, frothy, and copious. The client has a history of night sweats, anorexia, and weight loss. Which of the following actions should the nurse take? (SATA) Assign the client to a private room with negative-pressure airflow. Add contact precautions to the client's plan of care Wear an N95 respirator when entering the client's room Ensure the client's environment provides 4 exchanges of fresh air per minute Institute protective environment precautions as soon as the client arrives on the unit Assign the client to a private room with negative-pressure airflow Wear an N95 respirator when entering the client's room Rationale: This client's history and present status suggest tuberculosis (TB), a communicable infection that mandates a private room with negative-pressure airflow. Airborne precautions will be required, including wearing an N95 respirator when entering the client's room. A nurse on a medical-surgical unit is assessing a client who recently transferred from the ICU following endotracheal extubation. Which of the following findings should the nurse identify as a possible manifestation of tracheal stenosis and report to the provider? Increased coughing Diaphragmatic breathing Hemoptysis Kussmaul respirations Increased coughing Rationale: The nurse should identify increased coughing as a manifestation of tracheal stenosis. Other manifestations include an inability to cough up secretions and difficulty talking or breathing. A nurse is providing discharge teaching to a client who has emphysema. Which of the following instructions should the nurse include? "Be sure to take cough medicine to avoid coughing." "Try to drink at least 2 to 3 liters of fluid per day." "Try to reduce your smoking to 2 cigarettes per day." "Be sure to eat 3 full meals each day." "Try to drink at least 2 to 3 liters of fluid per day." Rationale: Although adequate hydration is essential for all clients, clients who have emphysema should drink 2 to 3 L per day to help liquefy secretions. A nurse is caring for a client who smokes cigarettes and has a new diagnosis of emphysema. How should the nurse assist the client with smoking cessation? Discuss ways the client can reduce the number of cigarettes smoked per day Suggest the client switch from smoking cigarettes to smoking a pipe Inform the client that treatment will be ineffective if smoking continues Discourage the use of nicotine gum Discuss ways the client can reduce the number of cigarettes smoked per day Rationale: The nurse should discuss ways the client can reduce the number of cigarettes smoked per day to assist the client in creating a realistic goal to decrease smoking gradually. A nurse is providing teaching to a client about pulmonary function testing. Which of the following tests measures the volume of air the lungs can hold at the end of maximum inhalation? Total lung capacity Vital lung capacity Functional residual capacity Residual volume Total lung capacity Rationale: Pulmonary function tests are used to examine the effectiveness of the lungs and to identify lung problems. Total lung capacity measures the amount of air the lungs can hold after maximum inhalation. A nurse is preparing a client for a bronchoscopy. Which of the following actions should the nurse take? (SATA) Explain that the client will receive sedation and will not remember the procedure Verify that the client understands the purpose and nature of the procedure Offer the client sips of clear liquids until 1 hr before the test Obtain a pre-procedural sputum specimen Instruct the client to keep his neck in a neutral position Explain that the client will receive sedation and will not remember the procedure Verify that the client understands the purpose and nature of the procedure Rationale: For bronchoscopy, clients typically receive premedication with a benzodiazepine or an opioid to ensure sedation and amnesia. The client will have signed a consent form, so the nurse should verify that the provider explained the procedure and that the client understands it. A nurse is caring for a client following a right pleural thoracentesis. The nurse measures a total of 35 mL of purulent drainage. Which of the following findings should the nurse recognize as an indication of a tension pneumothorax? (SATA) Tracheal deviation to the left Temp of 102 Absent breath sounds on the right side Neck vein distention Bradypnea Tracheal deviation to the left Absent breath sounds on the right side Neck vein distention Rationale: A tension pneumothorax can occur following a thoracentesis. A trachea that is deviated to the unaffected side instead of being in the center of the neck is a manifestation of a pneumothorax. Absent breath sounds on the affected side and neck vein distention are also manifestations of a pneumothorax. As the client's difficulty increases, the blood flow return compresses, causing the neck veins to distend. A nurse is caring for a client who is postoperative following a thoracic lobectomy. The client has 2 chest tubes in place: 1 in the lower portion of the thorax and the other higher on the chest wall. When a family member asks why the client has 2 chest tubes, which of the following responses should the nurse make? "Two tubes were necessary due to excessive bleeding from the area of the surgery." "The tubes drain blood from 2 different lung areas." "The lower tube will drain blood, and the higher tube will remove air." "The second tube will take over if blood clots block the first tube." "The lower tube will drain blood, and the higher tube will remove air." Rationale: The tube that is lower on the thorax will drain blood, and the tube that is higher on the thorax will allow for removal of air. A nurse is providing discharge instructions to a client who has a new laryngectomy. The nurse should tell the client to be careful while bathing to prevent which of the following complications? Aspiration of water Infection of the stoma Bleeding around the stoma Skin breakdown around the stoma Aspiration of water Rationale: The client should be careful during bathing and showering and should avoid swimming due to the risk of aspiration of water. The client should use a shower shield over the stoma when bathing or showering to keep water out of the airway. A nurse is auscultating the lungs of a client who is having an acute asthma attack. Which of the following sounds should the nurse expect to hear? Soft blowing Loud bubbling Dry grating Noisy wheezing Noisy wheezing Rationale: Asthma causes the bronchioles of the lungs to constrict, creating a wheezing sound. A nurse is preparing to assist a provider with an arterial blood withdrawal from a client's radial artery for ABG measurement. Which of the following actions should the nurse plan to take? Hyperventilate the client with 100% oxygen prior to obtaining the specimen Apply ice to the site after obtaining the specimen Perform an Allen's test prior to obtaining the specimen Release the pressure applied to the puncture site 1 min after the needle is withdrawn Perform an Allen's test prior to obtaining the specimen Rationale: The nurse should ensure that circulation to the hand is adequate from the ulnar artery in case the radial artery is injured from the blood draw. The most common site for withdrawal of arterial blood gases is the radial artery. A nurse in an urgent care clinic is collecting data from a client who reports exposure to anthrax. Which of the following findings is an indication of the prodromal stage of inhalation anthrax? Dry cough Rhinitis Sore throat Swollen lymph nodes Dry cough Rationale: A dry cough is a clinical manifestation of the prodromal stage of inhalation anthrax. During this stage, it is difficult to distinguish the condition from influenza or pneumonia because there is no sore throat or rhinitis. A nurse is caring for a client who has a tracheostomy with an inflated cuff in place. Which of the following findings indicates that the nurse should suction the client's airway secretions? The client is unable to speak The client's airway secretions were last suctioned 2 hr ago The client coughs and exporates a large mucous plug The nurse auscultates coarse in the lung fields The nurse auscultates coarse in the lung fields Rationale: The nurse should auscultate coarse crackles or rhonchi, identify a moist cough, hear or see secretions in the tracheostomy tube, and then suction the client's airway secretions. A nurse is caring for a client who is postoperative following a rhinoplasty. Which of the following findings should the nurse report to the surgeon? Nasal edema Mouth breathing Periorbital ecchymosis Frequent swallowing Frequent swallowing Rationale: Frequent swallowing indicates posterior nasal bleeding and possibly hemorrhage. The nurse should notify the surgeon promptly about this finding. A client is admitted to the emergency department following a motorcycle crash. The nurse notes a crackling sensation upon palpation of the right side of the client's chest. After notifying the provider, the nurse should document this finding as which of the following? Friction rub Crackles Crepitus Tactile fremitus Crepitus Rationale: Crepitus, also called subcutaneous emphysema, is a coarse crackling sensation that the nurse can feel when palpating the skin surface over the client's chest. Crepitus indicates an air leak into the subcutaneous tissue which is often a clinical manifestation of pneumothorax. A nurse is caring for a client who has a chest tube. The nurse notes that the chest tube has become disconnected from the chest drainage system. Which of the following actions should the nurse take? Place the drainage system at the head of the client's bed Increase the suction to the chest drainage system Place the client on low-flow oxygen via nasal cannula Immerse the end of the chest tube in a bottle of sterile water Immerse the end of the chest tube in a bottle of sterile water Rationale: If the chest tube and drainage system have become disconnected, air can enter the pleural space, producing a pneumothorax that can result in severe respiratory distress. To prevent a pneumothorax from developing, a temporary water seal can be established by immersing the end of the chest tube in an open bottle of sterile water. This allows air to escape and not enter the pleural space. A bottle of sterile water should always be ready available at the bedside for a client who has a chest tube. A nurse is teaching breathing techniques to a client who has emphysema. Which of the following statements indicates that the client understands the mechanics of pursed-lip breathing? "I'll inhale slowly through pursed lips to help me breathe better." "When I do my pursed-lip breathing, I'll lie down first." "When I breathe out through pursed lips, my airways don't collapse between breaths." "I'll relax my stomach muscles when I am doing my pursed-lip breathing exercises." "When I breathe out through pursed lips, my airways don't collapse between breaths." Rationale: Breathing through pursed lips slows exhalation and maintains inflation of the distal airways, which enhances respiration for client who have emphysema. The client should use this technique during physical activity and episodes of dyspnea. A nurse is caring for a client who has a left lower lobectomy to treat lung cancer. Which of the following factors will have a significant impact on the plan of care for this client? The client will need intensive smoking-cessation education After surgery, the prognosis for clients with lung cancer is usually good Lung cancer usually has metastasized before the client presents with symptoms Oxygen therapy is ineffective following a lobectomy Lung cancer usually has metastasized before the client presents with symptoms Rationale: The nurse should be aware that lung cancer is usually at an advanced stage before the client has any manifestations. This has implications for both shortterm and long-term care options for the client. A nurse is caring for a client who has a tracheostomy and is receiving mechanical ventilation. When the low-pressure alarm on the ventilator sounds, it indicates which of the following to the nurse? Excessive airway secretions A leak within the ventilator's circulatory Decreased lung compliance The client coughing or attempting to talk A leak within the ventilator's circulatory Rationale: The low-pressure alarm means that either the ventilator tubing has come apart or the tubing detached from the client. Low-pressure alarms are often the result of a malfunction or displacement of connections somewhere between the endotracheal or tracheostomy tube and the ventilator. A nurse is providing postoperative care for a client who has 2 chest tubes in place following a lobectomy. The client asks the nurse the reason for having 2 chest tubes. The nurse should inform the client that the lower chest tube is placed for which of the following reasons? Removing air from the pleural space Creating access for irrigating the chest cavity Evacuating secretions from the bronchioles and alveoli Draining blood and fluid from the pleural space Draining blood and fluid from the pleural space Rationale: The nurse should inform the client that blood and fluids tend to accumulate in the bases and posterior areas of the pleural cavity following a lobectomy. For this reason, the lower chest tube primarily drains blood and fluid from the pleural space. A nurse is providing preoperative teaching to a client who has lung cancer and will undergo a pneumonectomy. Which of the following statements should the nurse include? (SATA) "You will have a chest tube in place after surgery." "We'll frequently help you turn, cough, and breathe deeply after surgery." "You will have to remain in bed for about 2 days after the surgery." "We'll give you oxygen to support your breathing if you need it." "You should expect pain for the first few days after surgery." "You will have a chest tube in place after surgery." "We'll frequently help you turn, cough, and breathe deeply after surgery." "We'll give you oxygen to support your breathing if you need it." Rationale: After a pneumonectomy, some client have a clamped chest tube briefly to help reduce mediastinal shift. They do not usually have closed-chest drainage. Helping the client turn, cough, and breathe deeply is standard preventive postoperative care after thoracic surgery. After thoracic surgery, clients typically receive oxygen by nasal cannula or mask for the first 2 days and then as needed. A nurse is providing discharge teaching about improving gas exchange for a client who has emphysema. Which of the following instructions should the nurse include in the teaching? Use pursed-lip breathing during periods of dyspnea Limit fluid intake to 1,500 mL per day Practice chest breathing each day Wear home O2 to maintain SaO2 of at least 94% Use pursed-lip breathing during periods of dyspnea Rationale: The nurse should instruct the client about using pursed-lip breathing during periods of dyspnea to slow expiration, increase airway pressure, and facilitate effective gas exchange. A nurse is assessing a client who has pharyngitis. Which of the following finding is the nurse's priority to report to the provider? Elevated temperature Swollen cervical lymph nodes Inspiratory stridor Purulent nasal discharge Inspiratory stridor Rationale: The nurse should determine that the priority finding is inspiratory stridor, which is a manifestation of airway obstruction. The nurse should notify the rapid response team and administer humidified oxygen. A nurse is providing discharge teaching to a client who had a pulmonary embolism. Which of the following statements indicates that the client understands the information? "I'll expect a little leg swelling since I won't be that active for a while. " "I'll see the doctor every week to change my vena cava filter." "I'll call the doctor if I see any blood in my urine or stool." "I'll have to take the blood thinner for a few more days." "I'll call the doctor if I see any blood in my urine or stool." Rationale: Bleeding precautions are essential for clients who had a pulmonary embolism because they take an anticoagulant. They should report any signs of bleeding immediately. A nurse is caring for a client with pneumonia who is experiencing thick oral secretions. Which of the following actions should the nurse take first? Provide chest physiotherapy Perform oropharyngeal suction Encourage deep-breathing and coughing Assist the client with ambulation Encourage deep-breathing and coughing Rationale: The first action the nurse should take when using the (ABC) approach is to encourage the client to breathe deeply and cough to clear secretions from the airway. A nurse in the PACU is assessing a newly admitted client and observes intercostal retractions and a high-pitched inspiratory sound. The nurse should identify these findings as manifestations of which of the following complications? Pulmonary edema Tension pneumothorax Flail chest Respiratory obstruction Respiratory obstruction Rationale: Intercostal retractions and a high-pitched inspiratory noise are manifestations of an airway obstruction caused by laryngospasm and edema. The nurse should notify the rapid response team and plan to administer racemic epinephrine. A nurse is preparing a client for discharge following a bronchoscopy. Which of the following assessments is the nurse's monitoring priority? Measuring heart rate Palpating peripheral pulses Observing sputum for blood Confirming the gag reflex Confirming the gag reflex Rationale: The greatest risk to the client's safety is aspiration resulting from a depressed gag reflex. The nurse's priority is to make sure the client's gag reflex has returned before discharge so that the client can maintain hydration and nutrition without risk. A nurse in the ED is assessing a client for closed pneumothorax and significant bruising to the left chest following a motor-vehicle crash. The client reports severe left chest pain on inspiration. The nurse should assess the client for which of the following manifestations of pneumothorax? Absence of breath sounds Expiratory wheezing Inspiratory stridor Rhonchi Absence of breath sounds Rationale: A client who has pneumothorax experiences severely diminished or absent breath sounds on the affected side. A nurse is caring for a client who is extremely anxious and is hyperventilating. The client's ABG results are pH 7.50, PaCO2 27, and HCO3 25. The nurse should identify that the client has which of the following acid-base imbalances? Respiratory acidosis Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Respiratory alkalosis Rationale: Because of rapid breathing, the client is exhaling excessive amount of carbon dioxide. This loss of carbon dioxide decreases the hydrogen ion level of the blood, which causes the pH to increase and results in respiratory alkalosis. A nurse is assisting a provider with a comprehensive physical examination of a client. When the provider uses transillumination, the nurse should explain to the client that this technique helps evaluate which of the following structures? Lymph nodes Maxillary sinuses Intercostal spaces Salivary glands Maxillary sinuses Rationale: Transillumination is a procedure that allows the passage of light, often bright halogen light, through body tissues. Occluded sinuses prevent the passage of light rays through the sinus air sacs. Clear sinus air spaces allow transillumination. A nurse is developing a teaching plan for a client about preventing acute asthma attacks. Which of the following points should the nurse plan to discuss first? Eliminating environmental triggers that precipitate attacks Addressing the client's perception of the disease process and what might have triggered past attacks Overviewing the client's medication regimen Explaining manifestations of respiratory infections Addressing the client's perception of the disease process and what might have triggered past attacks Rationale: Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing the client will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first assess the client's current knowledge.