[Osborn] chapter 33

Learning Outcomes [Number and Title ]

Learning Outcome 1
Compare and contrast normal and adventitious breath sounds.
Learning Outcome 2
Defend the importance of obtaining information on recent
travel as a component of the patient history.
Learning Outcome 3
Describe the relationship of data obtained from the review of a
patients social and occupational history with risk for
pulmonary disease.
Learning Outcome 4
Describe the essential components of a physical assessment of
the pulmonary system.
Learning Outcome 5
Compare and contrast adjuncts used during physical assessment
of the pulmonary system.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

1. The nurse knows that the caregiver of a client with a respiratory illness understands
discharge teaching when which statement is made by the caregiver?
1. Adventitious sounds may be heard during inspiration or expiration because of
secretions or inflammation.
2. I will know I am hearing adventitious breath sounds if I hear any sounds when I
listen over the lower chest.
3. If I hear extra sounds during a deep breath, I know I am hearing adventitious
sounds.
4. I can expect to hear adventitious sounds only in the mornings; the rest of the day,
breath sounds should be normal.
Correct Answer: Adventitious sounds may be heard during inspiration or expiration
because of secretions or inflammation.
Rationale: Adventitious or abnormal breath sounds may be heard at any time of day or
night, during inspiration and expiration, over any portion of the chest or back, and do not
require that the client take a deep breath for the sounds to be heard.
Cognitive Level: Analysis
Nursing Process: Evaluation
Client Need: Physiological Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

2. Which indicates normal variations in breath sounds?

Select all that apply.
1.
2.
3.
4.
5.

Tracheal breath sounds equal in inspiration and expiration

Bronchial breath sounds with expiration longer than inspiration
Vesicular breath sounds with expiration longer than inspiration
Bronchovesicular breath sounds with inspiration longer than expiration
Tracheovesicular breath sounds with inspiration longer than expiration

Correct Answer:
1. Tracheal breath sounds equal in inspiration and expiration
2. Bronchial breath sounds with expiration longer than inspiration
3. Vesicular breath sounds with expiration longer than inspiration
Rationale: Tracheal breath sounds equal in inspiration and expiration. Tracheal,
bronchial, and vesicular breath sounds describes a place where breath sounds are most
prominent with auscultation. Breath sounds heard over the tracheal region sound equal in
inspiration and expiration. Bronchial breath sounds with expiration longer than
inspiration. Tracheal, bronchial, and vesicular breath sounds describes a place where
breath sounds are most prominent with auscultation. For bronchial breath sounds,
expiration sounds longer than inspiration. Vesicular breath sounds with expiration
longer than inspiration. Tracheal, bronchial, and vesicular breath sounds describes a place
where breath sounds are most prominent with auscultation. For vesicular breath sounds,
expiration sounds longer than inspiration. Bronchovesicular breath sounds with
inspiration longer than expiration. Bronchovesicular breath sounds are heard equally
during inspiration and expiration. Tracheovesicular breath sounds with inspiration
longer than expiration. Tracheovesicular breath sounds do not exist.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

3. Upon auscultation of the chest, the nurse reports to the preceptor what is heard. About
which statement should the preceptor be most concerned?
1.
2.
3.
4.

I heard crackles earlier, but now I am not able to hear anything.

I hear wheezing in the right lobes, but clear on the left.
There are coarse crackles that clear with coughing.
The client was clear, but now there are scattered wheezes bilaterally.

Correct Answer: I heard crackles earlier, but now I am not able to hear anything.
Rationale: The preceptor would be most concerned about the nurse not hearing anything.
This statement needs immediate follow-up assessment as to whether the nurse hears
nothing, or no adventitious breath sounds. The other options indicate adventitious breath
sounds, but none is indicative of the need for immediate action.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

4. Which indicates the need for further discharge teaching for a client with a history of
chronic respiratory disease?
1. As long as I take my medications and use my inhalers as prescribed, I should not
have difficulty when traveling.
2. I should avoid traveling to places at higher elevations, as I will have increased
difficulty breathing.
3. To decrease my risk, any traveling I do should not be to places with recent
outbreaks of respiratory illnesses.
4. If I am acclimated to higher elevations, I should not experience problems with
worsening symptoms.
Correct Answer: As long as I take my medications and use my inhalers as prescribed, I
should not have difficulty when traveling.
Rationale: If the client travels to elevations above 5000 feet without being acclimated,
increased symptoms result from the decreased oxygen in the air at higher elevations. Travel
avoidance to higher elevations and to places with recent outbreaks are correct, so would not
indicate the need for further teaching. Just because the client is acclimated to higher
elevations does not preclude the client from worsening symptoms.
Cognitive Level: Analysis
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

5. Which symptom is a client with high-altitude pulmonary edema most likely to exhibit
first?
1.
2.
3.
4.

Change in the level of consciousness

Polycythemia
Vasoconstriction
Vasodilation

Correct Answer: Change in the level of consciousness

Rationale: High-altitude pulmonary edema results from the decrease in atmospheric
pressure and lower level of oxygen in the air at high altitudes. This results in hypoxemia,
which will cause both fatigue and a change in the level of consciousness. Polycythemia is
a compensatory mechanism, as more red blood cells are formed to try to get more oxygen
to the cells. Vasoconstriction occurs before vasodilation, but both are compensatory
mechanisms occurring later than the initial change in level of consciousness.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

6. A client is admitted with a diagnosis of asbestos-related pulmonary disease. This is

most likely due to working in which environments?
Select all that apply.
1.
2.
3.
4.
5.

Construction
Auto mechanics
Shipyards
Farming
Food industry

Correct Answer:
1. Construction
2. Auto mechanics
3. Shipyards
Rationale:
Construction. Those with a history of working in construction and demolition of
buildings built prior to 1970 risked exposure to asbestos. Auto mechanics. Auto
mechanics work in environments in which asbestos is present. Shipyards. Shipyards are
environments in which asbestos is present. Farming. Farmers are at risk for asthmatic
reactions. Food industry. Food preparers are at risk for asthmatic reactions.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

7. If a client is scheduled to have a magnetic resonance imaging scan (MRI), which

information is most important for the nurse to obtain before the procedure?
1.
2.
3.
4.

Whether or not the client has any metal on, such as a protective amulet
When the client last ate or drank
Whether or not the client is allergic to shellfish
Whether or not the client has any loose teeth

Correct Answer: Whether or not the client has any metal on, such as a protective amulet
Rationale: The nurse must know whether the client is wearing any metal. If the client is
from a culture that believes in the protection provided by amulets, it is important for the
nurse to obtain this information during the history taking. The other options are not
usually applicable as preparation for an MRI.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

8. A clients susceptibility to chronic pulmonary disease is most likely due to which

aspect in the clients history?
1.
2.
3.
4.

Owned and worked a farm

Worked in a hospital
Worked as a air traffic controller
Played in a band

Correct Answer: Owned and worked a farm

Rationale: Farmers are exposed to pesticides every day while they are preparing the land
for farming and while crops are growing. Working in a hospital may increase the risk for
colds and influenza, but does not increase the risk for chronic pulmonary disease. Air traffic
controllers and band members are not more likely to have increased risk of chronic
pulmonary disease.
Cognitive Level: Application
Nursing Process: Diagnosis
Client Need: Physiological Integrity
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

9. A client presents to the emergency department with a history of edema in the lower
extremities. What information is most important to obtain before determining the nurses
next action?
1.
2.
3.
4.

Ask the client for his or her position of comfort.

Auscultate breath sounds.
Inspect the skin for pallor.
Palpate the thorax.

Correct Answer: Ask the client for his or her position of comfort.
Rationale: When the client has edema in the lower extremities, the nurse is concerned about
right-sided heart failure as fluid backs up into the peripheral circulation. If the position of
comfort is upright with an inability to lie supine, pulmonary hypertension is present; the
nurse needs to notify a care provider immediately. Pallor, breath sounds, and palpating the
thorax can also indicate respiratory distress and obstruction, but right-sided heart failure is
the priority.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

10. Which of the following are the correctly included in the evaluation of pulmonary
symptoms?
Select all that apply.
1.
2.
3.
4.
5.

Severity
Associated factors
Duration
Pressure
Relief

Correct Answer:
1. Severity
2. Associated factors
3. Duration
Rationale:
Severity. The PQRST and COLDSA mnemonics are useful so that pulmonary symptoms
can be assessed systematically; severity is included. Associated factors. The PQRST and
COLDSA mnemonics are useful so that pulmonary symptoms can be assessed
systematically; associated factors is included. Duration. The PQRST and COLDSA
mnemonics are useful so that pulmonary symptoms can be assessed systematically;
duration is included. Pressure. Pressure is not included in the evaluation of pulmonary
symptoms. Relief. Relief is not included in the evaluation of pulmonary symptoms.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

11. The nurse is going over discharge instruction for a client with pulmonary disease.
Which statement indicates learning has been unsuccessful?
1. If I notice a change in the shape of my chest, I should immediately call my
health care provider.
2. When I am assessing changes in my condition, I should notice increased use of
abdominal muscles to exhale.
3. It is important for me to report even subtle changes in energy and ability to
complete daily tasks.
4. I should keep records not only of my respiratory rate, but also the depth and
rhythm for a full minute.
Correct Answer: If I notice a change in the shape of my chest, I should immediately call
my healthcare provider.
Rationale: A change in the shape of the clients chest is not noticeable over a short period
of time. Barrel chest occurs slowly and over a long period of time. The other options are
correct; as the increased use of accessory muscles, changes in energy, and rate, depth, and
rhythm should be noted and reported as needed.
Cognitive Level: Analysis
Nursing Process: Evaluation
Client Need: Health Promotion and Maintenance
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

12. Capnography would most likely be used in which of the following situations?
1. A client in intensive care has been intubated.
2. A client in the emergency department arrives with circumoral cyanosis.
3. A client with a history of chronic obstructive pulmonary disease is admitted for
increased difficulty breathing.
4. An ambulance arrives with a client following a house fire.
Correct Answer: A client in intensive care has been intubated.
Rationale: Capnography indicates the presence of carbon dioxide and is used to assist in
determining whether an endotracheal tube is correctly placed following intubation. The
clients with circumoral cyanosis and chronic obstructive pulmonary disease would at
least require pulse oximetry. The client with an inhalation injury requires an arterial blood
gas.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

13. The nurse is planning a class for nursing assistants. Which should be included as
causing interference with accurate pulse oximeter readings?
Select all that apply.
1.
2.
3.
4.
5.

Ambient light
Nail polish
Inhalation injuries
Arterial pulses
Placement on cartilage

Correct Answer:
1. Ambient light
2. Nail polish
3. Inhalation injuries
Rationale:
Ambient light. Other sources of light can cause inaccurate readings. Nail polish. Nail
polish on fingernails/toenails can cause inaccurate readings. Inhalation injuries. Clients
with inhalation injuries can cause inaccurate readings. Arterial pulses. Venous
pulsations, not arterial, can also cause interference. Placement on cartilage. Cartilage
will prevent the sensors from interacting, which will produce inaccurate readings.
Cognitive Level: Application
Nursing Process: Planning
Client Need: Safe, Effective Care Environment
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.

14. The nurse is caring for a client who was admitted in respiratory distress. Which is the
nurses priority action based on the data obtained from this ABG:
pH: 7.32
PaCO2: 52
PaO2: 94
HCO3: 20
1.
2.
3.
4.

Place the client on O2 via mask.

Document and continue to monitor.
Call the healthcare provider to report the results.
Suction the client using a Yankeur.

Correct Answer: Place the client on O2 via mask.

Rationale: In blood gases, normal pH: 7.357.45; normal PaCO2: 3445 mmHg; normal
PaO2: 80100 mmHg; normal HCO3: 2226 mEq/L; so respiratory acidosis occurs when
the pH drops below 7.35, the PaCO2 is >45 mmHg, the PaO2 is normal or decreased, and
the HCO3 is < 22 mmHg. Thus, this client requires oxygen. Once placed, the nurse can
report the results. Suctioning is not indicated. The nurse should continue to document and
monitor, but not until the patient has been placed on oxygen.
Cognitive Level: Analysis
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.