WORKSHEET 2

Part 1: MULTIPLE CHOICE

1. Choose the initial part of the respiratory tract that is not considered part of the
gas-exchange airways.

a. Bronchioles

b. Respiratory

c. Alveolar ducts

d. Alveolar sacs

2. Choose the alveolar cells that secrete surfactant.

a. Type I cells

b. Type II cells

c. Type III cells

d. Type I and II cells

3. The pulmonary circulation is considered a:

a. High-pressure, high-resistance system

b. Low-pressure, low-resistance system

c. High-pressure, low-resistance system

d. Low-pressure, high-resistance system

4. A nurse is caring for a patient with a pulmonary embolism understands that a

high ventilation-perfusion ratio exists. This means that:

a. Perfusion exceeds ventilation

b. There is an absence of perfusion and ventilation

c. Ventilation exceeds perfusion

d. Ventilation matches perfusion

5. A nurse understands that a safe but low level of oxygen saturation provides for
adequate tissue saturation. The normal oxygen saturation is:

a. 40 and above mmHg

b. 75 and above mmHg

c. 80 and above mmHg

d. 95 and above mmHg

6. The nurse inspects the thorax of a patient with advanced emphysema. The
nurse expects chest configuration change consistent with a deformity known as:

a. Barrel chest

b. Funnel chest

c. Kyphoscoliosis

d. Pigeon chest

7. Breath sounds that originate in the smaller bronchi and bronchioles and are
high-pitched, sibilant, and musical are called:

a. Wheezes

b. Rhonchi

c. Rales

d. Crackles

8. Crackles, noncontiguous breath sounds, would be assessed for a patient with:

a. Asthma

b. Bronchospasm
c. Pulmonary congestion

d. Pulmonary fibrosis

9. During a preadmission assessment, the nurse would expect to find decreased

tactile fremitus and hyperresonant percussion sounds with a diagnosis of:

a. Bronchitis

b. Emphysema

c. Atelectasis

d. Pulmonary edema

10. Nursing directions to a patient from whom a sputum specimen is to be

obtained should include all of the following except directing the patient to: 30

a. Initially clear his or her nose and throat.

b. Spit surface mucus and saliva into a sterile specimen container.

c. Take a few deep breaths before coughing.

d. Use diaphragmatic contractions to aid in the expulsion of sputum.

11. The nurse should advise the patient who is scheduled for bronchoscopy that
he or she will:

a. Have his or her throat sprayed with a topical anesthetic.

b. Be required to fast for 12 hours before the procedure.

c. Receive postoperative anesthesia after the procedure.

d. Experience all of the above.

Part 2: SHORT ANSWER Read each statement carefully. Write your response in
the space provided.

1. Distinguish between the terms ventilation and respiration.

Ventilation refers to the movement of air in and out of the airways, whereas
respiration refers to the gas exchange between atmospheric air and blood and
between the blood and the cells of the body.

2. Describe the function of the epiglottis.

The epiglottis is a flap of cartilage that covers the opening of the larynx during
swallowing.

3. List four conditions that cause low compliance or distensibility of the lungs: morbid
obesity, atelectasis, pneumothora and hemothorax.

4. Define the term partial pressure.

Pressure excreted by each type of gas (e.g., oxygen, carbon dioxide) in a mixture
of gases.

5. Name two centers in the brain that are responsible for the neurologic control of
ventilation:

The apnuestic center in the lower pons and pnuemotaxic center in the upper pons

6. The alveoli begin to lose elasticity at about age 50 years, resulting in decreased gas
diffusion.

7. List six major signs and symptoms of respiratory disease.

 Dyspnea
 Cough
 Sputum production
 Chest pain
 Wheezing
 Hemoptysis
8. List four conditions that are influenced by genetic factors that affect respiratory
function:

 Asthma
 COPD
 Cystic fibrosis
 Alpha-1 antitrypsin deficiency

9. Explain the breathing pattern characterized as Cheyne–Stokes respirations.

Alternating episodes of apnea (cessation of breathing) and periods deep

breathing; usually associated with heart failure and damage to the respiratory
center.

Part 3: Clinical Situations CASE STUDY: Bronchoscopy Mr. Beacon is scheduled

for a bronchoscopy for the diagnostic purpose of locating a pathologic process.

1. Because a bronchoscopy was ordered, the nurse knows that the suspected
lesion was not in the:

a. bronchus.

b. larynx.

c. pharynx.

d. trachea.

2. Nursing measures before the bronchoscopy include:

a. obtaining an informed consent.

b. supplying information about the procedure.

c. withholding food and fluids for 6 hours before the test.

d. all of the above.

3. The nurse is aware that possible complications of bronchoscopy include all of
the following except:

a. aspiration.

b. gastric perforation.

c. infection.

d. pneumothorax.

4. After the bronchoscopy, Mr. Beacon must be observed for:

a. dyspnea.

b. hemoptysis.

c. tachycardia.

d. all of the above.

5. After the bronchoscopy, Mr. Beacon:

a. can be given ice chips and fluids after he demonstrates that he can perform the
gag reflex.

b. should immediately be given a house diet to alleviate the hunger resulting from the
required fast.

c. should initially be given iced ginger ale to prevent vomiting and possible aspiration of
stomach contents.

d. will need to remain NPO for 6 hours to prevent pharyngeal irritation.

CASE STUDY: Thoracentesis

Mrs. Abad is admitted to the clinical area for a thoracentesis. The physician
wants to remove excess air from the pleural cavity (see figure below).

1. Nursing responsibilities before the thoracentesis should include:

a. informing Mrs. Abad about pressure sensations that will be experienced during the
procedure.

b. making sure that chest radiograms ordered in advance have been completed.

c. seeing that the consent form has been explained and signed.

d. all of the above.

2. For the thoracentesis, the patient is assisted to any of the following positions
except:

a. lying on the unaffected side with the bed elevated 30 to 40 degrees.

b. lying prone with the head of the bed lowered 15 to 30 degrees.

c. sitting on the edge of the bed with her feet supported and her arms and head on a
padded overbed table.

d. straddling a chair with her arms and head resting on the back of the chair.

3. Nursing intervention includes exposing the entire chest even though the
thoracentesis site is normally in the midclavicular line between the:

a. first and second intercostal spaces.

b. second and third intercostal spaces.

c. third and fourth intercostal spaces.

d. fourth and fifth intercostal spaces.

4. Nursing observations after the thoracentesis include assessment for:

a. blood-tinged mucus.
b. signs of hypoxemia.

c. tachycardia.

d. all of the above.

5. A chest x-ray film is usually ordered after the thoracentesis to rule out:

a. pleurisy.

b. pneumonia.

c. pneumothorax.

d. pulmonary edema.