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MED SURG II

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					     MED-SURG II
      RESPIRATORY QUESTIONS


Cara Allen, John Wildgust & Saheel Patel
1. A nurse is instructing a hospitalized
client with a diagnosis of emphysema
about measures that will enhance the
effectiveness of breathing during dyspneic
periods. Which of the following positions
will the nurse instruct the client to
assume?

a.   Sitting up in bed
b.   Side-lying in bed
c.   Sitting in a recliner chair
d.   Sitting on the side of the bed and leaning on
     an over-bed table
  Correct Answer is D

Rationale:
  Positions that will assist the client with emphysema with
  breathing include sitting up and leaning on an overbed
  table, sitting up and resting the elbows on the knees, and
  standing and leaning against the wall.
  Level of Cognitive Ability - Application
  Client Needs - Physiological Integrity
  Integrated Process - Teaching and Learning
  Content Area - Adult Health—Respiratory
    “Assume the position!”

Strategy
   Use the process of elimination. Eliminate options 1 and 3
   first because they are comparative or alike. Next, eliminate
   option 2 because this position will not enhance breathing.
   If you had difficulty with this question, review the
   positions that will decrease the work of breathing in a
   client with emphysema.
2.     A nurse performs an admission
     assessment on a client with a
     diagnosis of tuberculosis. The nurse
     reviews the results of which
     diagnostic test that will confirm this
     diagnosis?

      a.   Bronchoscopy
      b.   Sputum culture
      c.   Chest X-ray
      d.   Tuberculin skin test
  Correct Answer is B

Rationale:
  Tuberculosis is definitively diagnosed through culture and
  isolation of Mycobacterium tuberculosis. A presumptive
  diagnosis is made based on a tuberculin skin test, a sputum
  smear that is positive for acid-fast bacteria, a chest x-ray,
  and histological evidence of granulomatous disease on
  biopsy.
  Level of Cognitive Ability - Analysis
  Client Needs - Physiological Integrity
  Integrated Process - Nursing Process—Assessment
  Content Area - Adult Health—Respiratory

Strategy
  Note the strategic word confirm in the question.
  Confirmation is made by identifying M. tuberculosis. If you
  had difficulty with this question, review the diagnostic
  procedures related to tuberculosis.
3.    A nurse is caring for a client with
     emphysema who is receiving
     oxygen. The nurse assesses the
     oxygen flow rate to ensure that it
     does not exceed:

      a.   1 L/min
      b.   2 L/min
      c.   6 L/min
      d.   10 L/min
  Correct Answer is B

Rationale:
  Oxygen is used cautiously and should not exceed 2 L/min.
  Because of the long-standing hypercapnia that occurs in
  emphysema, the respiratory drive is triggered by low
  oxygen levels rather than increased carbon dioxide levels,
  as is the case in a normal respiratory system.
  Level of Cognitive Ability - Analysis
  Client Needs - Physiological Integrity
  Integrated Process - Nursing Process—Assessment
  Content Area - Adult Health—Respiratory

Strategy
  Use the process of elimination, focusing on the client's
  diagnosis. Recalling that in the client with emphysema,
  respiratory drive is triggered by low oxygen levels will
  direct you to option 2. If you are unfamiliar with this
  important concept, review this content.
4.    Which of the following arterial blood
     gas results indicates metabolic alkalosis?


a. pH of 7.34, Pco2 of 50mm Hg,     HCO3 of
   32 mEq/L , PO2 of 70mm Hg
b. pH of 7.46, Pco2 of 30mm Hg,     HCO3 of
   26 mEq/L , PO2 of 80mm Hg
c. pH of 7.38, Pco2 of 45mm Hg,     HCO3 of
   22 mEq/L , PO2 of 50mm Hg
d. pH of 7.47, Pco2 of 40mm Hg,     HCO3 of
   36 mEq/L , PO2 of 78mm Hg
  Correct Answer is D

Rationale:
  In a metabolic alkalosis, the pH is elevated, along with the
  bicarbonate level (HCO3). Option 4 is the only option that
  reflects these values.
  Level of Cognitive Ability - Analysis
  Client Needs - Physiological Integrity
  Integrated Process - Nursing Process—Analysis
  Content Area - Adult Health—Respiratory

Strategy
  Remember that when an alkalotic condition exists, the pH
  will be elevated. This will assist in eliminating options 1 and
  3. Next, recall that in a metabolic condition, the HCO3 will
  move in the same direction as the pH. The only option that
  represents these conditions is option 4. Review the process
  of blood gas analysis if you had difficulty with this question.
5.      A nurse instructs a client to us the
     purse-lip method of breathing and the
     client asks the nurse about he purpose of
     this type of breathing. The nurse
     responds, knowing that the primary
     purpose of purse-lip breathing is to:

     a.   Promote oxygen intake
     b.   Strengthen the diaphragm
     c.   Strengthen the intercostals muscles
     d.   Promote carbon dioxide elimination
   Correct Answer is D

Rationale:
  Pursed-lip breathing facilitates maximal expiration for clients with
  obstructive lung disease. This type of breathing allows better
  expiration by increasing airway pressure that keeps air passages
  open during exhalation. Options 1, 2, and 3 are not the purposes
  of this type of breathing.
  Level of Cognitive Ability - Comprehension
  Client Needs - Physiological Integrity
  Integrated Process - Teaching and Learning
  Content Area - Adult Health—Respiratory

Strategy
   Visualize the use of this procedure to assist you in answering
   correctly. Knowledge regarding the respiratory conditions in which
   this type of breathing is helpful also will assist in directing you to
   option 4. Review the purpose of this breathing technique, if you
   had difficulty with this question.
6.     A nurse is caring for a client after
     a bronchoscopy and biopsy. Which
     of the following signs, if noted in
     the signs, if noted in the client,
     should be reported immediately to
     the physician?

     a.   Dry cough
     b.   Hematuria
     c.   Bronchospasm
     d.   Blood-streaked sputum
   Correct Answer is C

Rationale:
   If a biopsy was performed during a bronchoscopy, blood-streaked sputum
   is expected for several hours. Frank blood indicates hemorrhage. A dry
   cough may be expected. The client should be assessed for signs of
   complications, which would include cyanosis, dyspnea, stridor,
   bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias.
   Hematuria is unrelated to this procedure.
   Level of Cognitive Ability - Analysis
   Client Needs - Physiological Integrity
   Integrated Process - Nursing Process—Implementation
   Content Area - Adult Health—Respiratory

Strategy
   Use the process of elimination. Eliminate option 2 first because it is
   unrelated to the procedure. Next, eliminate option 1 because a dry cough
   may be expected. Noting that a biopsy has been performed will assist in
   eliminating option 4, because blood-streaked sputum would be expected.
   Note that option 3, the correct option, relates to the airway. If you had
   difficulty with this question, review postprocedure care following
   bronchoscopy with biopsy.
7. A nurse is suctioning fluids from a
  client via tracheostomy tube. When
  suctioning, the nurse must limit the
  suctioning time to a maximum of:

    a. 1 minute
    b. 5 seconds
    c. 10 seconds
    d. 30 seconds
   Correct Answer is C

Rationale:
  Hypoxemia can be caused by prolonged suctioning, which
  stimulates the pacemaker cells in the heart. A vasovagal response
  may occur, causing bradycardia. The nurse must preoxygenate
  the client before suctioning and limit the suctioning pass to 10
  seconds.
  Level of Cognitive Ability - Application
  Client Needs - Physiological Integrity
  Integrated Process - Nursing Process—Implementation
  Content Area - Adult Health—Respiratory

Strategy
   Use the process of elimination. Recall that during suctioning, the
   client's airway is blocked; therefore, you should be able to
   eliminate options 1 and 4 easily. From the remaining options,
   eliminate option 2 because of the short time frame. Five seconds
   does not seem reasonable to achieve removal of secretions.
   Review the procedure for suctioning if you had difficulty with this
   question.
1. Which of the following needs immediate
   medical attention and emergency
   intervention? The client who:
     a. complains of sharp pain upon taking a
     deep breath and excessive coughing
     b. exhibits yellow, productive sputum, low-
     grade fever, and crackles
     c. has a shift of the trachea to the left, with
     no breath sounds on the right
     d.has asthma, and complains of inability to
     ―catch her breath‖ after exercise
2. A postoperative client has a sudden
   onset of shortness of breath. What initial
   action by the nurse is indicated?

  a. notify the physician
  b. assess the oxygen saturation using pulse
     oximetry
  c. assist the client to a high fowler’s position
  d. auscultate the heart and lungs
 3.      Nutritional recommendations for
 the client with chronic obstructive
 pulmonary disease (COPD) should
 include which of the following?

a.   weight-reduction guidelines
b.   identification of foods that are calorie –dense
c.   avoidance of between-meal snacks
d.   more than 50% of intake as carbohydrates
              Rationale
Answer is B

COPD pts are often underweight due
to fatigue associated with eating and
hence need to eat foods that help
ingest more calories with less effort
for eating.
4.     Which medication is most
effective for providing quick relief in
patients with acute episodes of
asthma?

a. Corticosteroid via metered-dose
   inhaler as needed
b. Beta-agonist via metered does-inhaler
c. Anti-inflammatory via metered-dose
   inhaler
d. Daily use of bronchodilator inhaler
              Rationale
Answer is B

Mild and acute episodes are treated
with an anti-inflammatory and SABA
(Short Acting Beta Agonist). The
others are good for severe and more
frequent episodes.
5.     A client has a new chest tube located
     at the base of thoracic cavity. Which
     activity is expected during nursing care?
     The nurse should:
     a. Teach the client to clamp the tube before
         ambulating
     b. Palpate the chest wall for crepitus near the
         insertion site
     c. Change the dressing daily, to decrease
         infection
     d. Empty the drainage chamber at the end of the
         shifts
              Rationale
Answer is B

Crepitus is air bubbles under the skin
that can occur around the chest tube.
Dressing changes are not done daily
since the sealed system needs to be
maintained and there is additional
risk of tube displacement with
dressing changes
6.      A client is admitted to the hospital with
      the medical diagnosis of traumatic brain
      injury. From the assessment finding of
      slow, shallow respirations, the nurse
      concludes that which area of the brain is
      affected by the injury?
     a. Anterior pituitary
     b. Hypothalamus
     c. Medulla
     d. Cerebral cortex
              Rationale
Answer is C

The medulla and pons are the areas
of brain tissue that control breathing.
Injury to these tissues would
produce alterations in the client’s
breathing rate and pattern.
 7.    Following placement of a central
 venous line, which of the following data
 should the nurse report immediately to
 the physician?

a.   Pain at the insertion site
b.   Fever
c.   Increased heart rate and/or respiratory rate
d.   Diminished breath sounds in lung bases
              Rationale
Answer is C

These are symptoms of a
pneumothorax caused by puncture of
the pleura. None of the others are
potentially life-threatening initially
               ARDS
1. ARDS (acute respiratory distress
   sydrome) is a form of cardiogenic
   pulmonary edema that can quickly
   lead to respiratory failure.
a. True
b. False
            ANSWER
False. It is non cardiogenic
                ARDS
2. Different types of treatments for
   ARDS usually include all BUT…
a. IV fluid administration to maintain
   BP
b. Sedatives, opiods, neuromuscular
   blockers during mechanical
   ventilation
c. PEEP
d. 2 liters of Oxygen NC
            ANSWER
2 liters of O2 NC
               Asthma
3. Mast cell stabilizers are used in the
   treatment of asthma to:
a. Decrease bronchoconstriction
b. Block acetylcholine
c. Liquify secretions
d. Bock acute obstructive effects of
   antigen exposure
           ANSWER
Mast cell stabilizers block the acute
obstructive effects of antigen
exposure. They inhibit degranulation
of mast cells.
        SARS (Severe Acute
       Respiratory Syndrome)
4.   SARS is caused by
a.   Coronavirus
b.   Mycobacterium
c.   Adenocarcinoma
d.   Deficiency of alpha antitrypsin
          ANSWER
Coronavirus
      Pulmonary Embolism
5. All symptoms are usually associated
   with a pulmonary embolism BUT…
a. Tachycardia
b. Low-grade fever
c. L. sided heart failure
d. Chest pain
            ANSWER
Left side heart failure. Right sided
heart failure can be seen.
6.    S/S commonly manifested in a patient with a PE
                include all BUT :

a.   Crackles
b.   Chest pain
c.   Tachypnea
d.   Pulmonary hypertention
e.   bradycardia
           ANSWER
Bradycardia. Tachycaria is a
common symptom.
 7. All are common findings in
    ARDS patients except…
a.   Low Po2 levels
b.   Abnormal lung sounds
c.   Intercostal retractions
d.   Pulmonary Infiltrates on X-ray
            ANSWER
Abnormal lung sounds.

				
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posted:10/19/2011
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