Answer: A. C. Set the pump at 45 ml/hour. 12. The theophylline level is reported as 6 mcg/ml. Which of the following would the nurse expect to note on assessment of this client? 16. Being overweight. Studying for respiratory test. B. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the: Contralateral side in a simple pneumothorax. b. larynx. You can also copy this exam and make a printout. When the high-pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts to check for the cause. Like Us on Facebook. Learn. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive. Having the client take deep breaths Restricting fluid intake to 1,000 ml per day Answer: A. Erythromycin (Erythrocin). In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Respiratory System Assessment for Nurses Cheat Sheet Your Ultimate Guide to the Nursing Respiratory Assessment + a FREE Cheat Sheet! The other options also may apply to this patient but less important. Normally, thoracic expansion is symmetrical; unequal expansion may indicate pleural effusion, atelectasis, pulmonary embolus, or a rib or sternum fracture. external repiration. 38. Impaired color discrimination indicates color blindness; increased urinary frequency and increased appetite accompany diabetes mellitus. When reviewing the ABG report, the nurses sees many abbreviations. D. Elevated white blood cell (WBC) count. A. A. Bronchoscopy Morphine is a respiratory center depressant and is contraindicated in this situation. C. Eating a high-protein snack at bedtime. Such conditions include: A. A. Diaphragmatic breathing B. 1 minute 5. The nurse is admitting a client who complains of fever, chills, chest pain, and dyspnoea. The tube is quickly withdrawn, and an airtight dressing is taped in place. When the chest tube is removed, the client is asked to perform the Valsalva maneuver (take a deep breath, exhale, and bear down). Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn’t one of them. 50. During suctioning, the nurse should monitor the client closely for side effects, including hypoxemia, cardiac irregularities such as a decrease in heart rate resulting from vagal stimulation, mucosal trauma, hypotension, and paroxysmal coughing. Other modes — simple mask, face tent, and nasal cannula — deliver lower levels of FIO2. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm. Normally, nasal drainage in acute rhinitis is clear. Nervousness The respiratory center in the medulla oblongata controls respiration. 2. 24. A male adult client is suspected of having a pulmonary embolus. This syndrome results from: Increased pulmonary capillary permeability. Face tent 18. It helps prevent early airway collapse. The initial nursing action is to: A. Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. Anhydrous theophylline and other methylxanthine agents make the central respiratory center more sensitive to CO2 and stimulate the respiratory drive. B. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. 27. Post navigation. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. Dull sounds are thudlike and of medium pitch. The 10 most popular quizzes : 1 - the skeleton: test your knowledge of the bones of the full skeleton. Also, this page requires javascript. Usually, with lung cancer, there is a tumor that grows in the lungs a… Do you know all there is to this specific system? C. Stop the procedure and reoxygenate the client Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, then gradually lengthen this interval according to the client’s respiratory status. The nurse assesses vocal sounds to evaluate air flow when checking for tactile fremitus; after asking the client to say “99,” the nurse palpates the vibrations transmitted from the bronchopulmonary system along the solid surfaces of the chest wall to the nurse’s palms. Answer: A. Auscultating the lungs for bilateral breath sounds. It decreases use of accessory breathing muscles, It prolongs the inspiratory phase of respiration. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity. A nurse is preparing to obtain a sputum specimen from a male client. Option b is incorrect. ARDS may be caused by sepsis, trauma, pulmonary infection, blood transfusions, smoke inhalation, narcotics, aspiration and shock. 9. Included topics in this practice quiz are: Follow the guidelines below to make the most out of this exam: In Exam Mode: All questions are shown and the results, answers and rationales (if any) will only be given after you’ve finished the quiz. Answer: D. Impaired gas exchange related to airflow obstruction. Continue to monitor the client C. Call the respiratory therapy department to reinsert the tracheotomy The nurse should: A. After a laryngectomy, edema interferes with the ability to swallow and necessitates tube (enteral) feedings. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. 14. A. So, this NCLEX™ practice is beneficial in ruling out what the patient is or is not experiencing. The nurse should administer 0.01 to 0.02 mg/kg I.V. Rifampin may be added to the regimen if erythromycin alone is ineffective; however, it isn’t administered first. A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. 1. Excessive oxygen administration may lead to apnea by removing that stimulus. Sa02 indicates arterial oxygen saturation. C. 30 to 40 minutes. Nurseslabs.com is an education and nursing lifestyle website geared towards helping student nurses and registered nurses with knowledge for the progression and empowerment of their nursing careers. For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? Answer: B. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain. Therefore, gathering information about previous illnesses will help you perform a more accurate respiratory assessment. D. Tracheostomy collar. 14. These cases will present patient history, test results, blood pressure cuff simulation, auscultation and vital signs. Atelectasis is an indication of ... a , it isn't a condition on it's own, it's a symptom. C. Atelectasis. Question the order because it’s too high. An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. every 20 to 60 minutes. Despite the different causes of the various types of pneumonia, all of them share which feature? The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. Answer: A. D. It prolongs the inspiratory phase of respiration. A. Stridor Therefore, the nurse should plan to develop an alternative communication method. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. When caring for a patient who is recovering from a pneumonectomy, the nurse should encourage coughing and deep breathing to prevent pneumonia in the unaffected lung. A male patient is admitted to the healthcare facility for treatment of chronic obstructive pulmonary disease. One of the first pulmonary symptoms is a slight cough with the expectoration of mucoid sputum. Bilateral crackles may result from pulmonary congestion, inspiratory wheezes may signal asthma, and a pleural friction rub may indicate pleural inflammation. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. Inform the physician A. Kinking of the ventilator tubing 53. A sucking sound at the site of injury would be noted with an open chest injury. 44. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? D. Elderly patients. internal respiration. B. Answer: A. Kinking of the ventilator tubing. B. B. Answer: B. Respirationis the delivery of oxygen to the body and the elimination of carbon dioxide from the body. 6 - the heart: name the parts of the human heart After undergoing a thoracotomy, a male client is receiving epidural analgesia. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator. World's Hardest Science Quiz You'll Ever Take! SOA; no lung sounds on affected side; anxiety; unconscious (maybe); and cyanosis are signs and symptoms of a closed. A. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. D. Ensure that the suction is limited to 15 seconds. 39. Keeping the patient in semi-Fowler’s position A nurse is caring for a male client with emphysema who is receiving oxygen. Answer: B. For a male client with an endotracheal (ET) tube, which nursing action is most essential? The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. The client asks the nurse to explain the purpose of this breathing technique. Question 41. What condition does the factors listed below cause:Premature birth; immature lungs; Increased inspired oxygen; (+) pressure ventilation; and infections, What condition is described below:An instability of a portion of the chest that occurs from serious trauma like an accident, ribs are broken, etc. C. A bloody, productive cough D. Milk the chest tube every 2 hours. The nurse assesses the oxygen flow rate to ensure that it does not exceed: A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. Nurse Maureen has assisted a physician with the insertion of a chest tube. B. B. Drinking more than 1,500 ml of fluid daily. Options A, C, and D are incorrect. D. pH, 7.25; PaCO2 50 mm Hg. You may also like these other quizzes and exam tip articles: Did I get same pattern of questions in nclex RN exam. Pulmonary emboli commonly arise from the deep veins in the _______ and _______ . Fluctuation stops if the tube is obstructed, if a dependent loop exists, if the suction is not working properly, or if the lung has reexpanded. Examples ( … Flashcards. Quiz Human Respiratory System Previous Human Respiratory System. C. A few basilar lung crackles on the right Answer: B. Respiratory Medications such as bronchodilators, inhaled glucocorticoids, leukotriene modifiers, antihistamines, nasal decongestants, expectorants and mucolytic agents, antiviral drugs. Stay very still When the high-pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts to check for the cause. The nurse should instruct the client to: A. Exhale slowly Plugging the opening for more than 20 minutes would increase the risk of acute respiratory distress because the client requires an adjustment period to start breathing normally. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin color. A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. Develop an alternative communication method The medical history reveals chronic bronchitis and hypertension. C. pH, 7.35; PaCO2 40 mm Hg Low arterial PaO2 An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Question the order because it’s too low. Which of the following nursing actions will facilitate obtaining the specimen? A. Applying a dressing over the wound and taping it on three sides Assessment of severity of respiratory conditions Respiratory assessment includes: History Onset + duration of symptoms cough / shortness … A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult; however, it doesn’t increase oxygen demands. What is the drug of choice for treating legionnaires’ disease? c. alveoli. A lowercase “a” in an ABG value represents arterial blood. A. Take a quick interactive quiz on the concepts in Nursing Assessment of the Respiratory System or print the worksheet to practice offline. 17. Which explanation should the nurse provide? 59. Frank blood indicates hemorrhage. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD? To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. C. Amantadine (Symmetrel) B. C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis. 1 L/min In 30 minutes Forced vital capacity is the vital capacity performed with a maximally forced expiration. A disconnected ventilator tube or an endotracheal cuff leak would trigger the low-pressure alarm. C. Strengthen the intercostal muscles Nurse Joy is caring for a client after a bronchoscopy and biopsy. A. Acid-base balance Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Make inhalation longer than exhalation. During a routine clinic visit, the client asks the nurse how the drug works. Answer: B. Sudden apprehension; SOB; chest pain; rapid pulse; cough with blood sputum; syncope; and diaphoresis are symptoms of a, Dyspnea on exertion; think; decreased FEVI (less than 70%); barrel chest; tripod positioning, leaned forward; pursed lips; Increased FRC, RV and TLC; dark areas and flattening on x-ray are signs and symptoms of, Mechanical ventilation; surfactant admin; glucocorticoid admin to women to women in pretermlabor are treatments for. 10. 15. A. C. Increased pulmonary capillary permeability Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. What is the drug of choice for treating legionnaires’ disease? B. Absence of breaths sound in the right thorax Residual volume is the maximal amount of air left in the lung after a maximal expiration. B. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for: A. Pleural effusion. C. Numbness and tingling of the extremities The nurse observes respiratory excursion to help assess chest movements. Welcome to Respiratory Cases Set #1. Answer: C. The system has an air leak. Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. A. The presence of a wheal within 2 days doesn’t indicate active tuberculosis. Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. A dry cough may be expected. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnosed asthma. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed? While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. B. Clamp the chest tube once every shift Because of these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Without adequate oxygen supply organ function may be seriously compromised. 22. D. Contralateral side in hemothorax. C. Respiratory alkalosis Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. Since we started in 2010, Nurseslabs has become one of the most trusted nursing sites helping thousands of aspiring nurses achieve their goals. 54. When teaching the patient about this drug, the nurse should explain that it may cause: Albuterol may cause nervousness. Tachynpnea; expiratory grunting, nasal flaring and dusky skin are signs and symptoms of. So these are things like the nose, throat, tonsils, and includes the voice box or the larynx, and all the sinuses. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. The nurse should base her response on the fact that the: A. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. Constant bubbling in the chamber indicates an air leak and requires immediate intervention. Respiratory alkalosis A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. C. Inhale and exhale quickly D. In 4 hours. The initial nursing action is to: Place the tube in bottle of sterile water, Immediately replace the chest tube system, Place a sterile dressing over the disconnection site. Skin test doesn’t differentiate between active and dormant tuberculosis infection. The trachea leads to the: bronchioles bronchii esophagus pulmonary vessel. line. What is described below:Fluid is accumulated in the pleural space, most likely from an infection... A complication of an open pneumothorax. Hallucinations and tinnitus rare are associated with respiratory alkalosis or any other acid-base imbalance. The area between the lungs is known as the a. thoracic cage. The nurse should: Stop the infusion and have the laboratory repeat the theophylline measurement. A. Hypoxia is the main breathing stimulus for a client with COPD. Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. Nurse Salary 2020: How Much Do Registered Nurses Make? Pulmonary edema. Covering the tracheostomy site will block the airway. A. Erythromycin (Erythrocin) Answer: A. Kinking of the ventilator tubing. The theophylline level is reported as 6 mcg/ml. 3. Inhibition of phosphodiesterase is the drug’s mechanism of action in treating asthma and other reversible obstructive airway diseases — not COPD. It can be administered to children age 2 and older. Before administering ephedrine, Nurse Tony assesses the patient’s history. 25. B. The initial nursing action is to: A. Spend your time wisely! Activity intolerance related to fatigue Learn quiz nursing assessment respiratory system with free interactive flashcards. When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. A. D. Blood-streaked sputum. D. Keep the patient flat in bed. Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. Bed rest and sedatives may limit the patient’s ability to maintain a patent airway, causing a high risk for infection from pooled secretions. Neurological Disorder – Stroke Quiz. The nurse asks the patient about the color of the drainage. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. D. Fighting the ventilator. When reviewing the ABG report, the nurses sees many abbreviations. The exchange of gases between blood and cells is called pulmonary ventilation. When suctioning, the nurse must limit the suctioning time to a maximum of: A. Presence of a wheal at the injection site in 2 days indicates active tuberculosis. 2. Nursing2008: October 2008 - Volume 38 - Issue 10 - p 64 doi: 10.1097/01.NURSE.0000337245.47343.9d The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: A nurse is caring for a male client with acute respiratory distress syndrome. D. Metabolic acidosis. © 2021 Nurseslabs | Ut in Omnibus Glorificetur Deus! Quiz Respiratory System. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for: The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. If a V/Q ratio is low, it's a _______ problem. All the best and keep reading up on it and its functions! The client’s condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. 42. C. Morphine. Respiratory system challenge: Test your knowledge with this quick quiz. learning nurse respiratory system quizlet provides a comprehensive and comprehensive pathway for students to see progress after the end of each module. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive. The human respiratory is sorely charged with taking in oxygen and dispersing carbon dioxide. B. Hyperresonance also may occur on the affected side. cellular respiration. 52. Based on the client’s history and physical findings, the physician suspects legionnaires’ disease. What Do You Know About Gluconeogenesis? Caused by Mycobacterium tuberculosis. Therefore, the nurse should question the order. The client asks the nurse to explain the purpose of this breathing technique. Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. QUIZ: RESPIRATORY SYSTEM. 43. Multiple Choice . When assessing the respiratory system the initial assessment should be to approach the patient in a calm manner. D. Nasal cannula. A. 2. B. The pH value reflects the acid-base balance in arterial blood. C. Hallucinations or tinnitus 15. D. A cough with the expectoration of mucoid sputum. Only after covering and taping the wound should the nurse draw blood for laboratory tests, assist with chest tube insertion, and start an I.V. D. A change in the oxygen concentration without resetting the oxygen level alarm. A male patient’s X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). Affected side in a hemothorax B. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. B. Don’t run from a challenge. A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. The optimal time to obtain a specimen is on arising in the morning. Instead run toward it because the only way to escape fear is to trample it beneath your feet. The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD? Chest tube milking is controversial and should be done only to remove blood clots that obstruct the flow of drainage. B. The client is currently receiving 0.5 mg/kg/hour of aminophylline. 33. The physician may need to be notified, but this is not the initial action. C. Chest x-ray The inhaled form of the drug may cause dryness and irritation of the nose and throat, not nasal congestion; insomnia, not lethargy; and hypokalemia (with high doses), not hyperkalemia.
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