NUR 272 EXAM 3 REVIEW QUESTIONS & ANSWERS
A patient with acute shortness of breath is admitted to the hospital. Which action should
the nurse take during the initial assessment of the patient?
a. Ask the patient to lie down to complete a full physical assessment.
b. Briefly ask specific questions about this episode of respiratory distress.
c. Complete the admission database to check for allergies before treatment.
d. Delay the physical assessment to first complete pulmonary function tests. - Answer -
ANS: B
When a patient has severe respiratory distress, only information pertinent to the current
episode is obtained, and a more thorough assessment is deferred until later. Obtaining
a comprehensive health history or full physical examination is unnecessary until the
acute distress has resolved. Brief questioning and a focused physical assessment
should be done rapidly to help determine the cause of the distress and suggest
treatment. Checking for allergies is important, but it is not appropriate to complete the
entire admission database at this time. The initial respiratory assessment must be
completed before any diagnostic tests or interventions can be ordered
A patient is admitted to the emergency department complaining of sudden onset
shortness of breath and is diagnosed with a possible pulmonary embolus. How should
the nurse prepare the patient for diagnostic testing to confirm the diagnosis?
a. Start an IV so contrast media may be given.
b. Ensure that the patient has been NPO for at least 6 hours.
c. Inform radiology that radioactive glucose preparation is needed.
d. Instruct the patient to undress to the waist and remove any metal objects. - Answer -
ANS: A
Spiral computed tomography (CT) scans are the most commonly used test to diagnose
pulmonary emboli, and contrast media may be given IV. A chest x-ray may be ordered
but will not be diagnostic for a pulmonary embolus. Preparation for a chest x-ray
includes undressing and removing any metal. Bronchoscopy is used to detect changes
in the bronchial tree, not to assess for vascular changes, and the patient should be NPO
6 to 12 hours before the procedure. Positron emission tomography (PET) scans are
most useful in determining the presence of malignancy, and a radioactive glucose
preparation is used
The nurse analyzes the results of a patient's arterial blood gases (ABGs). Which finding
would require immediate action?
a. The bicarbonate level (HCO3-) is 31 mEq/L.
b. The arterial oxygen saturation (SaO2) is 92%.
c. The partial pressure of CO2 in arterial blood (PaCO2) is 31 mm Hg.
,d. The partial pressure of oxygen in arterial blood (PaO2) is 59 mm Hg. - Answer -ANS:
D
All the values are abnormal, but the low PaO2 indicates that the patient is at the point
on the oxyhemoglobin dissociation curve where a small change in the PaO2 will cause
a large drop in the O2 saturation and a decrease in tissue oxygenation. The nurse
should intervene immediately to improve the patient's oxygenation
When assessing the respiratory system of an older patient, which finding indicates that
the nurse should take immediate action?
a. Weak cough effort
b. Barrel-shaped chest
c. Dry mucous membranes
d. Bilateral crackles at lung bases - Answer -ANS: D
Crackles in the lower half of the lungs indicate that the patient may have an acute
problem such as heart failure. The nurse should immediately accomplish further
assessments, such as oxygen saturation, and notify the health care provider. A barrel-
shaped chest, hyperresonance to percussion, and a weak cough effort are associated
with aging. Further evaluation may be needed, but immediate action is not indicated. An
older patient has a less forceful cough and fewer and less functional cilia. Mucous
membranes tend to be drier
The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How
should the nurse position the patient?
a. Supine with the head of the bed elevated 30 degrees
b. In a high-Fowler's position with the left arm extended
c. On the right side with the left arm extended above the head
d. Sitting upright with the arms supported on an over bed table - Answer -ANS: D
The upright position with the arms supported increases lung expansion, allows fluid to
collect at the lung bases, and expands the intercostal space so that access to the
pleural space is easier. The other positions would increase the work of breathing for the
patient and make it more difficult for the health care provider performing the
thoracentesis
The nurse teaches a patient about pulmonary function testing (PFT). Which statement,
if made by the patient, indicates teaching was effective?
a. "I will use my inhaler right before the test."
b. "I won't eat or drink anything 8 hours before the test."
c. "I should inhale deeply and blow out as hard as I can during the test."
d. "My blood pressure and pulse will be checked every 15 minutes after the test." -
Answer -ANS: C
For PFT, the patient should inhale deeply and exhale as long, hard, and fast as
possible. The other actions are not needed with PFT. The administration of inhaled
bronchodilators should be avoided 6 hours before the procedure.
,what does extrinsic PEEP do - Answer -used to increase oxygenation
when is extrinsic PEEP used - Answer -when a person is experiencing ARDS
A patient who has a history of chronic obstructive pulmonary disease (COPD) was
hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of
89% to 90%). In planning for discharge, which action by the nurse will be most effective
in improving compliance with discharge teaching?
a. Start giving the patient discharge teaching on the day of admission.
b. Have the patient repeat the instructions immediately after teaching.
c. Accomplish the patient teaching just before the scheduled discharge.
d. Arrange for the patient's caregiver to be present during the teaching. - Answer -ANS:
D
Hypoxemia interferes with the patient's ability to learn and retain information, so having
the patient's caregiver present will increase the likelihood that discharge instructions will
be followed. Having the patient repeat the instructions will indicate that the information
is understood at the time, but it does not guarantee retention of the information.
Because the patient is likely to be distracted just before discharge, giving discharge
instructions just before discharge is not ideal. The patient is likely to be anxious and
even more hypoxemic than usual on the day of admission, so teaching about discharge
should be postponed.
A patient in metabolic alkalosis is admitted to the emergency department, and pulse
oximetry (SpO2) indicates that the O2 saturation is 94%. Which action should the nurse
take next?
a. Administer bicarbonate.
b. Complete a head-to-toe assessment.
c. Place the patient on high-flow oxygen.
d. Obtain repeat arterial blood gases (ABGs). - Answer -ANS: C
Although the O2 saturation is adequate, the left shift in the oxyhemoglobin dissociation
curve will decrease the amount of oxygen delivered to tissues, so high oxygen
concentrations should be given. Bicarbonate would worsen the patient's condition. A
head-to-toe assessment and repeat ABGs may be implemented. However, the priority
intervention is to give high-flow oxygen
The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who
has been admitted with increasing dyspnea over the last 3 days. Which finding is most
important for the nurse to report to the health care provider?
a. Respirations are 36 breaths/minute.
b. Anterior-posterior chest ratio is 1:1.
c. Lung expansion is decreased bilaterally.
d. Hyperresonance to percussion is present. - Answer -ANS: A
, The increase in respiratory rate indicates respiratory distress and a need for rapid
interventions such as administration of oxygen or medications. The other findings are
common chronic changes occurring in patients with COPD
An occupational health nurse works at a manufacturing plant where there is potential
exposure to inhaled dust. Which action, if recommended by the nurse, will be most
helpful in reducing the incidence of lung disease?
a. Treat workers with pulmonary fibrosis.
b. Teach about symptoms of lung disease.
c. Require the use of protective equipment.
d. Monitor workers for coughing and wheezing. - Answer -ANS: C
Prevention of lung disease requires the use of appropriate protective equipment such as
masks. The other actions will help in recognition or early treatment of lung disease but
will not be effective in prevention of lung damage. Repeated exposure eventually results
in diffuse pulmonary fibrosis. Fibrosis is the result of tissue repair after inflammation
The nurse monitors a patient after chest tube placement for a hemopneumothorax. The
nurse is most concerned if which assessment finding is observed?
a. A large air leak in the water-seal chamber
b. 400 mL of blood in the collection chamber
c. Complaint of pain with each deep inspiration
d. Subcutaneous emphysema at the insertion site - Answer -ANS: B
The large amount of blood may indicate that the patient is in danger of developing
hypovolemic shock. An air leak would be expected immediately after chest tube
placement for a pneumothorax. Initially, brisk bubbling of air occurs in this chamber
when a pneumothorax is evacuated. The pain should be treated but is not as urgent a
concern as the possibility of continued hemorrhage. Subcutaneous emphysema should
be monitored but is not unusual in a patient with pneumothorax. A small amount of
subcutaneous air is harmless and will be reabsorbed
A patient experiences a chest wall contusion as a result of being struck in the chest with
a baseball bat. The emergency department nurse would be most concerned if which
finding is observed during the initial assessment?
a. Paradoxic chest movement
b. Complaint of chest wall pain
c. Heart rate of 110 beats/minute
d. Large bruised area on the chest - Answer -ANS: A
Paradoxic chest movement indicates that the patient may have flail chest, which can
severely compromise gas exchange and can rapidly lead to hypoxemia. Chest wall
pain, a slightly elevated pulse rate, and chest bruising all require further assessment or
intervention, but the priority concern is poor gas exchange
A patient with acute shortness of breath is admitted to the hospital. Which action should
the nurse take during the initial assessment of the patient?
a. Ask the patient to lie down to complete a full physical assessment.
b. Briefly ask specific questions about this episode of respiratory distress.
c. Complete the admission database to check for allergies before treatment.
d. Delay the physical assessment to first complete pulmonary function tests. - Answer -
ANS: B
When a patient has severe respiratory distress, only information pertinent to the current
episode is obtained, and a more thorough assessment is deferred until later. Obtaining
a comprehensive health history or full physical examination is unnecessary until the
acute distress has resolved. Brief questioning and a focused physical assessment
should be done rapidly to help determine the cause of the distress and suggest
treatment. Checking for allergies is important, but it is not appropriate to complete the
entire admission database at this time. The initial respiratory assessment must be
completed before any diagnostic tests or interventions can be ordered
A patient is admitted to the emergency department complaining of sudden onset
shortness of breath and is diagnosed with a possible pulmonary embolus. How should
the nurse prepare the patient for diagnostic testing to confirm the diagnosis?
a. Start an IV so contrast media may be given.
b. Ensure that the patient has been NPO for at least 6 hours.
c. Inform radiology that radioactive glucose preparation is needed.
d. Instruct the patient to undress to the waist and remove any metal objects. - Answer -
ANS: A
Spiral computed tomography (CT) scans are the most commonly used test to diagnose
pulmonary emboli, and contrast media may be given IV. A chest x-ray may be ordered
but will not be diagnostic for a pulmonary embolus. Preparation for a chest x-ray
includes undressing and removing any metal. Bronchoscopy is used to detect changes
in the bronchial tree, not to assess for vascular changes, and the patient should be NPO
6 to 12 hours before the procedure. Positron emission tomography (PET) scans are
most useful in determining the presence of malignancy, and a radioactive glucose
preparation is used
The nurse analyzes the results of a patient's arterial blood gases (ABGs). Which finding
would require immediate action?
a. The bicarbonate level (HCO3-) is 31 mEq/L.
b. The arterial oxygen saturation (SaO2) is 92%.
c. The partial pressure of CO2 in arterial blood (PaCO2) is 31 mm Hg.
,d. The partial pressure of oxygen in arterial blood (PaO2) is 59 mm Hg. - Answer -ANS:
D
All the values are abnormal, but the low PaO2 indicates that the patient is at the point
on the oxyhemoglobin dissociation curve where a small change in the PaO2 will cause
a large drop in the O2 saturation and a decrease in tissue oxygenation. The nurse
should intervene immediately to improve the patient's oxygenation
When assessing the respiratory system of an older patient, which finding indicates that
the nurse should take immediate action?
a. Weak cough effort
b. Barrel-shaped chest
c. Dry mucous membranes
d. Bilateral crackles at lung bases - Answer -ANS: D
Crackles in the lower half of the lungs indicate that the patient may have an acute
problem such as heart failure. The nurse should immediately accomplish further
assessments, such as oxygen saturation, and notify the health care provider. A barrel-
shaped chest, hyperresonance to percussion, and a weak cough effort are associated
with aging. Further evaluation may be needed, but immediate action is not indicated. An
older patient has a less forceful cough and fewer and less functional cilia. Mucous
membranes tend to be drier
The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How
should the nurse position the patient?
a. Supine with the head of the bed elevated 30 degrees
b. In a high-Fowler's position with the left arm extended
c. On the right side with the left arm extended above the head
d. Sitting upright with the arms supported on an over bed table - Answer -ANS: D
The upright position with the arms supported increases lung expansion, allows fluid to
collect at the lung bases, and expands the intercostal space so that access to the
pleural space is easier. The other positions would increase the work of breathing for the
patient and make it more difficult for the health care provider performing the
thoracentesis
The nurse teaches a patient about pulmonary function testing (PFT). Which statement,
if made by the patient, indicates teaching was effective?
a. "I will use my inhaler right before the test."
b. "I won't eat or drink anything 8 hours before the test."
c. "I should inhale deeply and blow out as hard as I can during the test."
d. "My blood pressure and pulse will be checked every 15 minutes after the test." -
Answer -ANS: C
For PFT, the patient should inhale deeply and exhale as long, hard, and fast as
possible. The other actions are not needed with PFT. The administration of inhaled
bronchodilators should be avoided 6 hours before the procedure.
,what does extrinsic PEEP do - Answer -used to increase oxygenation
when is extrinsic PEEP used - Answer -when a person is experiencing ARDS
A patient who has a history of chronic obstructive pulmonary disease (COPD) was
hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of
89% to 90%). In planning for discharge, which action by the nurse will be most effective
in improving compliance with discharge teaching?
a. Start giving the patient discharge teaching on the day of admission.
b. Have the patient repeat the instructions immediately after teaching.
c. Accomplish the patient teaching just before the scheduled discharge.
d. Arrange for the patient's caregiver to be present during the teaching. - Answer -ANS:
D
Hypoxemia interferes with the patient's ability to learn and retain information, so having
the patient's caregiver present will increase the likelihood that discharge instructions will
be followed. Having the patient repeat the instructions will indicate that the information
is understood at the time, but it does not guarantee retention of the information.
Because the patient is likely to be distracted just before discharge, giving discharge
instructions just before discharge is not ideal. The patient is likely to be anxious and
even more hypoxemic than usual on the day of admission, so teaching about discharge
should be postponed.
A patient in metabolic alkalosis is admitted to the emergency department, and pulse
oximetry (SpO2) indicates that the O2 saturation is 94%. Which action should the nurse
take next?
a. Administer bicarbonate.
b. Complete a head-to-toe assessment.
c. Place the patient on high-flow oxygen.
d. Obtain repeat arterial blood gases (ABGs). - Answer -ANS: C
Although the O2 saturation is adequate, the left shift in the oxyhemoglobin dissociation
curve will decrease the amount of oxygen delivered to tissues, so high oxygen
concentrations should be given. Bicarbonate would worsen the patient's condition. A
head-to-toe assessment and repeat ABGs may be implemented. However, the priority
intervention is to give high-flow oxygen
The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who
has been admitted with increasing dyspnea over the last 3 days. Which finding is most
important for the nurse to report to the health care provider?
a. Respirations are 36 breaths/minute.
b. Anterior-posterior chest ratio is 1:1.
c. Lung expansion is decreased bilaterally.
d. Hyperresonance to percussion is present. - Answer -ANS: A
, The increase in respiratory rate indicates respiratory distress and a need for rapid
interventions such as administration of oxygen or medications. The other findings are
common chronic changes occurring in patients with COPD
An occupational health nurse works at a manufacturing plant where there is potential
exposure to inhaled dust. Which action, if recommended by the nurse, will be most
helpful in reducing the incidence of lung disease?
a. Treat workers with pulmonary fibrosis.
b. Teach about symptoms of lung disease.
c. Require the use of protective equipment.
d. Monitor workers for coughing and wheezing. - Answer -ANS: C
Prevention of lung disease requires the use of appropriate protective equipment such as
masks. The other actions will help in recognition or early treatment of lung disease but
will not be effective in prevention of lung damage. Repeated exposure eventually results
in diffuse pulmonary fibrosis. Fibrosis is the result of tissue repair after inflammation
The nurse monitors a patient after chest tube placement for a hemopneumothorax. The
nurse is most concerned if which assessment finding is observed?
a. A large air leak in the water-seal chamber
b. 400 mL of blood in the collection chamber
c. Complaint of pain with each deep inspiration
d. Subcutaneous emphysema at the insertion site - Answer -ANS: B
The large amount of blood may indicate that the patient is in danger of developing
hypovolemic shock. An air leak would be expected immediately after chest tube
placement for a pneumothorax. Initially, brisk bubbling of air occurs in this chamber
when a pneumothorax is evacuated. The pain should be treated but is not as urgent a
concern as the possibility of continued hemorrhage. Subcutaneous emphysema should
be monitored but is not unusual in a patient with pneumothorax. A small amount of
subcutaneous air is harmless and will be reabsorbed
A patient experiences a chest wall contusion as a result of being struck in the chest with
a baseball bat. The emergency department nurse would be most concerned if which
finding is observed during the initial assessment?
a. Paradoxic chest movement
b. Complaint of chest wall pain
c. Heart rate of 110 beats/minute
d. Large bruised area on the chest - Answer -ANS: A
Paradoxic chest movement indicates that the patient may have flail chest, which can
severely compromise gas exchange and can rapidly lead to hypoxemia. Chest wall
pain, a slightly elevated pulse rate, and chest bruising all require further assessment or
intervention, but the priority concern is poor gas exchange
