Respiratory

Respiratory Rationale: The respiratory center
Questions in section: 55 in the medulla responds primarily to

increased carbon dioxide
To go to the related information as concentration in the blood.
listed below, close or minimize this Related information: Chapter 6,
application and select the Content section 57
Menu button. Be sure to print or
note the specific section(s) you
wish to review. Question 5: Oxygen dissociation
from hemoglobin and therefore oxygen
delivery to the tissues are
Question 1: A client is admitted accelerated by:
and the physician suspects Selected Choice: A decreasing
atelectasis. When assessing this oxygen pressure and/or an increasing
individual, the nurse would expect: carbon dioxide pressure in the blood
Selected Choice: Diminished breath Your Selection: Correct
sounds Rationale: The lower the PO2 and
Your Selection: Correct the higher the PCO2, the more
Rationale: Since atelectasis rapidly oxygen dissociates from the
involves collapsing of the alveoli oxyhemoglobin molecule.
distal to the bronchioles, breath Related information: Chapter 6,
sounds would be diminished in the section 57
lower lobes.
Related information: Chapter 6,
section 70 Question 6: A client is admitted
with carbon monoxide poisoning. The
nurse understands that the poisonous
Question 2: The efficacy of the nature of carbon monoxide results
abdominal-thoracic thrust (Heimlich from:
maneuver) to expel a foreign object Selected Choice: The bubbles it
in the larynx demonstrates the gas tends to form in blood plasma
volume related to the individual's: Your Selection: Incorrect
Selected Choice: Tidal volume Correct Choice: Its preferential
Your Selection: Incorrect combination with hemoglobin
Correct Choice: Residual volume Rationale: Carbon monoxide (CO)
Rationale: The residual volume is binds with hemoglobin more avidly
the amount of air remaining in the than does oxygen. The progressive
lungs after maximum exhalation. results are dyspnea, asphyxia, and
Related information: Chapter 6, death.
section 57 Related information: Chapter 6,
section 80
Question 3: A client who undergoes

a submucosal resection should be Question 7: With an oxygen debt,
observed carefully for: muscle shows:
Selected Choice: Spitting up or Selected Choice: Low levels of ATP
vomiting of blood Your Selection: Correct
Your Selection: Correct Rationale: With an oxygen debt, a
Rationale: After a submucosal muscle would show primarily low
resection (SMR), hemorrhage from the levels of oxygen and low levels of
area is frequently detected by ATP caused by the low levels of
vomiting of blood that has been aerobic respiration and high levels
swallowed. of lactic acid formation.
Related information: Chapter 6, Related information: Chapter 6,
section 21 section 164
Question 4: The nurse understands Question 8: Clients who are

that in the absence of pathology, a emotionally disturbed and upset may
client's respiratory center is threaten to hold their breaths
stimulated by: unless the staff meets their
Selected Choice: Carbon dioxide demands. The nurse understands that
Your Selection: Correct if the threats are carried out:
Selected Choice: Accumulated CO2 Your Selection: Correct
will force resumption of breathing Rationale: Tidal volume (TV) is
Your Selection: Correct defined as the amount of air exhaled
Rationale: Accumulated carbon normally after a normal inspiration.
dioxide (CO2) will powerfully Related information: Chapter 6,
stimulate the breathing center of section 62
the brainstem, forcing resumption of
respiration even if the person has
fainted first. Question 13: Air rushes into the
Related information: Chapter 6, alveoli as a result of the:
section 57 Selected Choice: Lowered pressure
in the chest cavity
Your Selection: Correct
Question 9: A nurse initially will Rationale: Thoracic pressure is
use an AmbuBag in the intensive care reduced because thoracic volume is
unit when: increased as the diaphragm descends.
Selected Choice: A respiratory Related information: Chapter 6,
arrest occurs section 57
Rationale: An Ambu Bag is a piece
of equipment that can be compressed Question 14: A client is scheduled
at regular intervals by hand for for a pulmonary function test. The
temporary ventilation of the client nurse explains that during the test
in respiratory arrest. the respiratory therapist will ask
Related information: Chapter 6, the client to breathe normally to
section 62 measure the:
Selected Choice: Expiratory reserve
Your Selection: Incorrect
Question 10: Cutting the left Correct Choice: Tidal volume
phrenic nerve results in: Rationale: The tidal volume is the
Selected Choice: Paralysis of the amount of air inhaled and exhaled
left side of the diaphragm while breathing normally.
Your Selection: Correct Related information: Chapter 6,
Rationale: The phrenic nerves section 57
conduct motor impulses to the
diaphragm; cutting one phrenic nerve
will paralyze the portion of the Question 15: To facilitate maximum
diaphragm innervated by that nerve. air exchange, a client should be
Related information: Chapter 6, placed in the:
section 58 Selected Choice: Orthopneic
position
Question 11: The nurse obtains a Rationale: The orthopneic position
laboratory report that shows acid- is a sitting position that permits
fast rods in a client's sputum. maximum lung expansion for gaseous
These are presumed to be: exchange, since the abdominal organs
Selected Choice: Mycobacterium do not provide pressure against the
tuberculosis diaphragm and gravity facilitates
Your Selection: Correct the descent of the diaphragm.
Rationale: This is the acid fast Related information: Chapter 6,
causative organism of tuberculosis. section 57
section 72
Question 16: A client begins to
expectorate blood. The nurse
Question 12: A client states that describes this episode as:
the physician said the tidal volume Selected Choice: Hemoptysis
is slightly diminished and asks the Your Selection: Correct
nurse what this means. The nurse Rationale: Hemoptysis is
explains that tidal volume is the expectoration of blood-stained
amount of air: sputum derived from the lungs,
Selected Choice: Exhaled normally bronchi, or trachea.
after a normal inspiration
Question 17: The position in which Question 21: The nurse is aware
a client with dyspnea should be that when emphysema is present there
placed is: is a decreased oxygen supply because
Selected Choice: Orthopneic of:
Your Selection: Correct Selected Choice: Loss of aerating
Rationale: Orthopneic position surface
refers to sitting up and leaning Your Selection: Correct
slightly forward. This drops the Rationale: Destruction of the
diaphragm, allowing the lungs more alveolar walls leads to diminished
room for expansion. surface area for gaseous exchange
Related information: Chapter 6, and an increased CO2 level in the
section 57 blood.
section 73
Question 18: The nurse must
establish and maintain an airway in
a client who has experienced a near Question 22: To assist a client in
drowning. The nurse should recognize obtaining maximum benefits after
that one danger of near drowning postural drainage, the nurse should:
that must be assessed for is: Selected Choice: Encourage the
Selected Choice: Pulmonary edema client to cough deeply
Your Selection: Correct Your Selection: Correct
Rationale: This may occur because Rationale: Coughing is needed to
of the high osmotic pressure of the raise the secretions for
aspirated ocean water. expectoration.
Question 19: The common factor of Question 23: The nurse administers
puerperal sepsis, scarlet fever, oxygen at 2 L/minute via nasal
otitis media, bacterial cannula to a client with emphysema.
endocarditis, rheumatic fever, and The nurse should observe the client
glomerulonephritis is that all: closely for:
Selected Choice: Result from Selected Choice: Drowsiness and
streptococcal infections that enter decreased respirations
via the upper respiratory tract Your Selection: Correct
Your Selection: Correct Rationale: Clients with COPD
Rationale: Streptococcal organisms (chronic obstructive pulmonary
are present on the skin, mucous disease) respond only to the
membranes, and in the environment at chemical stimulus of low oxygen
all times. The most frequent portals levels. Administration of high
of entry are the respiratory tract concentrations of oxygen will
and breaks in the skin. eliminate the stimulus to breathe,
Related information: Chapter 6, leading to decreased respirations
section 60 and lethargy.
section 73
Question 20: An example of a
rapidly acting diuretic that can be
administered intravenously to Question 24: When the alveoli lose
clients with acute pulmonary edema their normal elasticity as a result
is: of emphysema, the nurse teaches the
Selected Choice: Furosemide client exercises that lead to
Your Selection: Correct effective use of the diaphragm
Rationale: Furosemide (Lasix) acts because:
on the loop of Henle by increasing Selected Choice: Inspiration has
the excretion of chloride and been markedly prolonged and
sodium. difficult
Your Selection: Incorrect Your Selection: Correct
Correct Choice: The residual Rationale: There are several modes
capacity of the lungs has been for the administration of oxygen.
increased Selection is based on the disease
Rationale: Loss of elasticity and the client's adaptation. Oxygen-
causes difficult exhalation, with induced hypoventilation is a
subsequent air trapping. Clients who particular concern for clients with
have emphysema are taught to use COPD.
accessory abdominal muscles and to Related information: Chapter 6,
breathe out through pursed lips to section 62
help keep the air passages open
until exhalation is complete.
Related information: Chapter 6, Question 28: As a result of
section 73 fractured ribs, the client may
develop:
Selected Choice: Pneumothorax
Question 25: A client with a Your Selection: Correct
history of emphysema is now Rationale: The ribs may penetrate
terminally ill with cancer of the the pleura and lung, allowing air to
esophagus. The client is weak, fill the pleural space and collapse
dyspneic, emaciated, and apathetic. the lung.
The plan of care includes a soft Related information: Chapter 6,
diet, modified postural drainage, section 75
and nebulizer treatments. The
nursing care plan for this client
should give priority to: Question 29: A client with
Selected Choice: Hygiene and emphysema experiences a sudden
comfort episode of shortness of breath. The
Your Selection: Correct physician diagnoses a spontaneous
Rationale: Since the client's pneumothorax. The nurse is aware
condition is described as terminal, that the probable cause of the
the nursing priority should be spontaneous pneumothorax is a:
directed toward providing comfort. Selected Choice: Rupture of a
Related information: Chapter 2, subpleural bleb
section 24 Your Selection: Correct
Rationale: The etiology of a
spontaneous pneumothorax is commonly
Question 26: A terminally ill the rupture of blebs on the lung
client is visited frequently by the surface. Blebs are similar to
spouse, a 16-year-old daughter, and blisters.
a 20-year-old son. In view of the Related information: Chapter 6,
client's extreme weakness and section 75
dyspnea, nursing care plans should
include:
Selected Choice: Encouraging family Question 30: When a spontaneous
members to feed and assist the pneumothorax is suspected in a
client client with a history of emphysema,
Your Selection: Correct the nurse should call the physician
Rationale: Since family members are and:
old enough to understand the Selected Choice: Give O2 2L per
client's needs, they should be minute via nasal cannula
encouraged to participate in the Your Selection: Correct
care. Rationale: Oxygen is supplied to
Related information: Chapter 4, prevent anoxia but cannot be given
section 15 in higher concentrations because, in
an individual with emphysema, a low
PO2 (not high PCO2) is the only
Question 27: When determining the respiratory stimulus.
method of oxygen administration to Related information: Chapter 6,
be used for a specific client, the section 62
major concern is:
Selected Choice: Pathologic
condition
Question 31: When teaching a client Rationale: Pressure within the
about a spontaneous pneumothorax, pleural cavity causes a shift of the
the nurse bases the explanation on heart and great vessels to the
the understanding that: unaffected side. This not only
Selected Choice: Inspired air will decreases the capacity of the
move from the lung into the pleural unaffected lung but also impedes the
space filling of the right side of the
Your Selection: Correct heart and leads to a decreased
Rationale: As a person with a tear cardiac output.
in the lung inhales, air moves Related information: Chapter 6,
through that opening into the section 75
intrapleural space. This creates a
positive pressure and causes partial
or complete collapse of the lung. Question 35: The physician inserts
Related information: Chapter 6, a chest tube in a client who has
section 75 been stabbed in the chest and
attaches it to a closed-drainage
system. When caring for the client,
Question 32: Following a the nurse should:
spontaneous pneumothorax, the client Selected Choice: Observe for fluid
becomes extremely drowsy and the fluctuations in the waterseal
pulse and respirations increase. The chamber
nurse should suspect: Your Selection: Correct
Selected Choice: Hypercapnia Rationale: Fluctuations occur with
Your Selection: Correct normal inspiration and expiration
Rationale: A pneumothorax results until the lung is fully expanded. If
in decreased surface area for these fluctuations do not occur, the
gaseous exchange. If the unaffected chest tube may be clogged or kinked;
pleural regions cannot compensate, coughing should be encouraged.
carbon dioxide builds up in the Related information: Chapter 6,
blood (hypercapnia). The client section 62
becomes drowsy and may lose
consciousness. The body attempts to
compensate by increasing the Question 36: Complete lung
respiratory and pulse rates and by expansion before the removal of
the renal retention of bicarbonate. chest tubes is evaluated by:
Related information: Chapter 6, Selected Choice: Comparison of
section 75 chest radiographs
Rationale: Chest x-ray films or
Question 33: When assessing an radiographs reveal the degree to
individual with a spontaneous which the lung fills the pleural
pneumothorax, the nurse should cavity and also the presence of any
expect dyspnea and: mediastinal shift.
Selected Choice: Unilateral chest Related information: Chapter 6,
pain section 62
Rationale: Sudden chest pain occurs
on the affected side; it may also Question 37: While receiving
involve the arm and shoulder. metaproterenol sulfate (Alupent) for
Related information: Chapter 6, asthma the client complains of
section 75 palpitation, chest pain, and a
throbbing headache. In view of these
symptoms, the most appropriate
Question 34: When a client suffers nursing action would be to:
a complete pneumothorax, there is Selected Choice: Withhold the drug
danger of a mediastinal shift. If until additional orders are obtained
such a shift occurs, it may lead to: from the physician
Selected Choice: Rupture of the Your Selection: Correct
pericardium or aorta Rationale: Alupent is a selective
Your Selection: Incorrect beta-2 adrenergic antagonist that
Correct Choice: Decreased filling causes increased heart contraction
of the right heart (positive inotropic effect) and
increased heart rate (positive
chronotropic effect). If toxic Question 41: During the immediate
levels are reached, side effects postoperative period the nurse
occur and the drug should be should give the highest priority to:
withheld until the physician is Selected Choice: Checking the vital
notified. signs every 15 minutes
Related information: Chapter 6, Your Selection: Incorrect
section 61 Correct Choice: Maintaining a
patent airway
Rationale: Maintenance of a patent
Question 38: An asthmatic client's airway is always the priority, since
pulmonary function studies are airway obstruction impedes breathing
abnormal. The nurse should realize and may result in death.
that one of the most common Related information: Chapter 6,
complications of chronic asthma is: section 21
Selected Choice: Emphysema
Rationale: As a result of the Question 42: A client has seeds
narrowed airways, exhalation is containing radium implanted in the
difficult, leaving air trapped in pharyngeal area. When caring for
the lung. Distention of alveolar this client, the nurse should:
walls to accommodate this volume Selected Choice: Use rubber gloves
leads to emphysema. when giving the client a bath
Related information: Chapter 6, Your Selection: Incorrect
section 73 Correct Choice: Maintain the client
in isolation
Rationale: During radiation therapy
Question 39: A client with a long with radium implants the client is
history of asthma is scheduled for placed in isolation so exposure to
surgery. Preoperative teaching radiation by family and staff will
should include the fact that the be decreased.
client: Related information: Chapter 6,
Selected Choice: Should try to section 173
limit coughing, because this causes
distention of the chest
Your Selection: Incorrect Question 43: The nurse can expect a
Correct Choice: Will be quite prone client who has had a splenectomy to
to respiratory tract infections complain of:
Rationale: Hypersecretion of the Selected Choice: Pain on expiration
mucous glands provides an excellent, Your Selection: Incorrect
warm, moist medium for Correct Choice: Pain on inspiration
microorganisms. Rationale: Because of the location
Related information: Chapter 6, of the spleen, expansion of the
section 73 thoracic cavity during inspiration
causes pain at the operative site.
Question 40: The nurse should section 21
position a client recovering from
general anesthesia in a:
Selected Choice: Side-lying Question 44: A client has a
position bronchoscopy in ambulatory surgery.
Your Selection: Correct To prevent laryngeal edema, the
Rationale: Turning the client to nurse should:
the side promotes drainage of Selected Choice: Keep the client in
secretions and prevents aspiration, the semi-Fowler's position
especially when the gag reflex is Your Selection: Correct
not intact. This position also Rationale: With the head elevated,
brings the tongue forward, rather than horizontal or dependent,
preventing it from occluding the fluid will not collect in the
airway in the relaxed state. interstitial spaces around the
Related information: Chapter 6, trachea.
section 21 Related information: Chapter 6,
section 62
with saline to prevent mucus
accumulation and occlusion of the
Question 45: After a bronchoscopy tube.
because of suspected cancer of the Related information: Chapter 6,
lung, a client develops pleural section 62
effusion. This is most likely the
result of:
Selected Choice: Extension of Question 49: When suctioning a
cancerous lesions client with a tracheostomy the nurse
Your Selection: Correct must remember to:
Rationale: Cancerous lesions in the Selected Choice: Initiate suction
pleural space increase the osmotic as the catheter is being withdrawn
pressure causing a shift in fluid to Your Selection: Correct
that space. Rationale: During suctioning of a
Related information: Chapter 6, client, negative pressure (suction)
section 66 should not be applied until the
catheter is ready to be drawn out
because, in addition to the removal
Question 46: A client has a right of secretions, oxygen is being
pneumonectomy. During surgery the depleted.
phrenic nerve is accidently severed: Related information: Chapter 6,
Selected Choice: Permitting greater section 62
excursion of the thoracic cavity
Correct Choice: Producing a Question 50: A client complains of
partially atonic diaphragm severe pain 2 days following
Rationale: The phrenic nerve surgery. The nurse's initial action
stimulates the diaphragm; accidental should be to:
severance of one phrenic nerve would Selected Choice: Take the client's
result in partial paralysis of the vital signs
diaphragm. Your Selection: Correct
Related information: Chapter 6, Rationale: Immediately prior to
section 58 administration, an assessment of
vital signs is necessary to
determine whether any
Question 47: The factor that would contraindications to analgesia exist
have little influence in (e.g., hypotension, a respiratory
predisposing an individual to cancer rate of 12 or less).
of the larynx would be: Related information: Chapter 6,
Selected Choice: Poor dental section 18
hygiene
Rationale: Inadequate dental Question 51: The nurse expects that
hygiene may predispose a person to the initial treatment for a client
oral infections but would be only who has a leak of the thoracic duct
remotely involved in laryngeal following radical neck surgery would
neoplasms because of the anatomical include inserting a:
relationship of the oral cavity and Selected Choice: Rectal tube to
the larynx. prevent distention, a low-fat diet,
Related information: Chapter 6, and increased activity
section 78 Your Selection: Incorrect
Correct Choice: Chest tube to drain
the fluid, total parenteral
Question 48: When cleaning a nutrition, and bed rest
tracheostomy tube that has an inner Rationale: A chest tube drains the
cannula, the nurse should plan to leaking chyle from the thoracic
remove the inner cannula: area; TPN provides nutrition, boosts
Selected Choice: In order to immune defenses, and decreases
cleanse it with hydrogen peroxide thoracic duct flow; bed rest is
Your Selection: Correct recommended because lymphatic flow
Rationale: The inner cannula, if increases with activity.
nondisposable, must be removed, Related information: Chapter 6,
cleaned with peroxide, and rinsed section 78
Correct Choice: Hyperoxygenate with
100% oxygen before and after
Question 52: As a result of suctioning
pulmonary tuberculosis, a client has Rationale: Suctioning also removes
a decreased surface area for gaseous oxygen which can cause cardiac
exchange in the lungs. Oxygen and dysrhythmias; the nurse should try
carbon dioxide are exchanged in the to prevent this by hyperoxygenating
lungs by: the client prior to and after
Selected Choice: Diffusion suctioning.
Your Selection: Incorrect Related information: Chapter 6,
Correct Choice: Osmosis section 62
Rationale: The respiratory
membrane, consisting of the alveolar
and capillary walls, is extremely Question total: 55
thin. This thinness facilitates Questions correct: 42
exchange of respiratory gases Score: 76%
without the need for additional
energy.
section 57
Question 53: Before discontinuing

airborne precautions (respiratory
isolation) for a client with
pulmonary tuberculosis, the nurse
must determine that:
Selected Choice: No acid-fast
bacteria are in the sputum
Rationale: The absence of bacteria
in the sputum indicates that the
disease can no longer be spread by
the airborne route.
section 72
Question 54: A thoracentesis is

performed. Following the procedure
it is most important for the nurse
to observe the client for:
Selected Choice: Expectoration of
blood
Rationale: Expectoration of blood
is an indication that the lung
itself was damaged during the
procedure; a pneumothorax may occur.
section 62
Question 55: A client with a

pulmonary embolus is intubated and
placed on mechanical ventilation.
When suctioning the endotracheal
tube, the nurse should:
Selected Choice: Suction two to
three times in quick succession to
remove all secretions

Respiratory

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Respiratory

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Respiratory Rationale: The respiratory center

Questions in section: 55 in the medulla responds primarily to

Question 3: A client who undergoes

Question 4: The nurse understands Question 8: Clients who are

Question 53: Before discontinuing

Question 54: A thoracentesis is

Question 55: A client with a

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