OPIANA CHRISTIAN JOSEPH I.

BSN4 BLOCK 6
N036 NCM 118N
PULMONARY THERAPEUTIC MANAGEMENT

1. A 92-year-old female patient is being admitted to the emergency department

with severe shortness of breath. Being aware of the patient’s condition, what
approach should the nurse use to assess the patient’s lungs (select all that
apply)?

a. Apex to base

b. Base to apex

c. Lateral sequence

d. Anterior then posterior

e. Posterior then anterior

ANSWER: b. Base to apex

e. Posterior then anterior

2. What keeps alveoli from collapsing?

a. Carina

b. Empyema

c. Surfactant

d. Thoracic cage

ANSWER: c. Surfactant

3. What accurately describes the alveolar sacs?

a. Line the lung pleura

b. Warm and moisturize inhaled air

c. Terminal structures of the respiratory tract

d. Contain dead air that is not available for gas exchange ANSWER: c. Terminal

structures of the respiratory tract

4. What covers the larynx during swallowing?

a. Trachea

b. Turbinates

c. Epiglottis

d. Parietal pleura

ANSWER: c. Epiglottis

5. Priority Decision: A 75-year-old patient who is breathing room air has the
following arterial blood gas (ABG) results: pH 7.40, PaO2 74 mm Hg, SaO2 92%,
PaCO2 40 mm Hg. What is the most appropriate action by the nurse?

a. Document the results in the patient’s record.

b. Repeat the ABGs within an hour to validate the findings.

OPIANA CHRISTIAN JOSEPH I.
BSN4 BLOCK 6
N036 NCM 118N
c. Encourage deep breathing and coughing to open the alveoli.

d. Initiate pulse oximetry for continuous monitoring of the patient’s oxygen

status.

ANSWER: a. Document the results in the patient’s record

6. A patient’s ABGs include a PaO2 of 88 mm Hg and a PaCO2 of 38 mm Hg, and

mixed venous blood gases include a PvO2 of 40 mm Hg and PvCO2 of 46 mm Hg.
What do these findings indicate?

a. Impaired cardiac output

b. Unstable hemodynamics

c. Inadequate delivery of oxygen to the tissues

d. Normal capillary oxygen–carbon dioxide exchange

ANSWER: d. Normal capillary oxygen–carbon dioxide exchange

7. Priority Decision: A pulse oximetry monitor indicates that the patient has a
drop in SpO2 from 95% to 85% over several hours. What is the first action the
nurse should take?

a. Order stat ABGs to confirm the SpO2 with a SaO2.

b. Start oxygen administration by nasal cannula at 2 L/min.

c. Check the position of the probe on the finger or earlobe.

d. Notify the health care provider of the change in baseline PaO2.

ANSWER: c. Check the position of the probe on the finger or earlobe.

8. Pulse oximetry may not be a reliable indicator of oxygen saturation in which

patient?

a. Patient with a fever

b. Patient in hypovolemic shock

c. Patient who is anesthetized

d. Patient receiving oxygen therapy

ANSWER: b. Patient in hypovolemic shock

9. A 73-year-old patient has an SpO2 of 70%. What other assessment should the
nurse consider before making a judgment about the adequacy of the patient’s
oxygenation?

a. What the oxygenation status is with a stress test

b. Trend and rate of development of the hyperkalemia

c. Comparison of patient’s SpO2 values with the normal values

d. Comparison of patient’s current vital signs with normal vital signs

OPIANA CHRISTIAN JOSEPH I.
BSN4 BLOCK 6
N036 NCM 118N
ANSWER: d. Comparison of patient’s current vital signs with normal vital
signs

10. Which values are indicators of the criteria needed for the use of continuous
oxygen therapy?

a. SpO2 of 92%; PaO2 of 65 mm Hg

b. SpO2 of 90%; PaO2 of 60 mm Hg

c. SpO2 of 95%; PaO2 of 70 mm Hg

d. SpO2 of 88%; PaO2 of 55 mm Hg

ANSWER: d. SpO2 of 88%; PaO2 of 55 mm Hg

11. Why does a patient’s respiratory rate increase when there is an excess of
carbon dioxide in the blood?

a. CO2 displaces oxygen on hemoglobin, leading to a decreased PaO2.

b. CO2 causes an increase in the amount of hydrogen ions available in the body.

c. CO2 combines with water to form carbonic acid, which lowers the pH of
cerebrospinal fluid.

d. CO2 directly stimulates chemoreceptors in the medulla to increase respiratory

rate and volume.

ANSWER: c. CO2 combines with water to form carbonic acid, which

lowers the pH of cerebrospinal fluid.

12. Which respiratory defense mechanism is most impaired by smoking?

a. Cough reflex

b. Mucociliary clearance

c. Filtration of air

d. Reflex bronchoconstriction

ANSWER: b. Mucociliary clearance

13. Which age-related changes in the respiratory system cause decreased

secretion clearance (select all that apply)?

a. Decreased functional cilia

b. Small airway closure earlier in expiration

c. Decreased force of cough

d. Decreased functional immunoglobulin A (IgA)

e. Decreased chest wall compliance

ANSWER: a. Decreased functional cilia

c. Decreased force of cough

14. The abnormal assessment findings of dullness and hyperresonance are found
with which assessment technique?
OPIANA CHRISTIAN JOSEPH I.
BSN4 BLOCK 6
N036 NCM 118N
a. Inspection

b. Percussion

c. Palpation

d. Auscultation

ANSWER: b. Percussion

15. Palpation is the assessment technique used to find which abnormal

assessment findings (select all that apply)?

a. Stridor

b. Limited chest expansion

c. Finger clubbing

d. Increased tactile fremitus

e. Tracheal deviation

f. Use of accessory muscles

ANSWER: a. Stridor

d. Increased tactile fremitus

e. Tracheal deviation

16. How does the nurse assess the patient’s chest expansion?

a. Put the palms of the hands against the chest wall.

b. Put the index fingers on either side of the trachea.

c. Place the thumbs at the midline of the lower chest.

d. Place one hand on the lower anterior chest and one hand on the upper
abdomen.

ANSWER: c. Place the thumbs at the midline of the lower chest

17. When does the nurse record the presence of an increased anteroposterior
(AP) diameter of the chest?

a. There is a prominent protrusion of the sternum.

b. The width of the chest is equal to the depth of the chest.

c. There is equal but diminished movement of the two sides of the chest.

d. The patient cannot fully expand the lungs because of kyphosis of the spine.

ANSWER: b. The width of the chest is equal to the depth of the chest

18. How is the presence of bronchovesicular breath sounds in the peripheral lung
fields described?

a. Rhonchi

b. Adventitious sounds
OPIANA CHRISTIAN JOSEPH I.
BSN4 BLOCK 6
N036 NCM 118N
c. Crackles

d. Abnormal lung sounds

ANSWER: d. Abnormal lung sounds

19. Match the descriptions or possible etiologies with the appropriate

abnormal assessment findings.
___7__ a. Finger clubbing exudate 1. Lung consolidation with fluid or

___6__ b. Stridor 2. Air trapping

___5__ c. Wheezes 3. Atelectasis

___8__ d. Pleural friction rub 4. Interstitial filling with fluid

___1__ e. Increased tactile fremitus 5. Bronchoconstriction

6. Partial obstruction of trachea or
___2__ f. Hyperresonance larynx

___4__ g. Fine crackles 7. Chronic hypoxemia

___3__ h. Absent breath sounds 8. Pleurisy

20. A nurse has been exposed to tuberculosis (TB) during care of a patient
with TB and has a TB skin test performed. When is the nurse considered infected?

a. There is no redness or induration at the injection site.

b. There is an induration of only 5 mm at the injection site.

c. A negative skin test is followed by a negative chest x-ray.

d. Testing causes a 10-mm red, indurated area at the injection site.

ANSWER: d. Testing causes a 10-mm red, indurated area at the injection

site.

21. What is a primary nursing responsibility after obtaining a blood specimen for
ABGs?

a. Adding heparin to the blood specimen

b. Applying pressure to the puncture site for 2 full minutes

c. Taking the specimen immediately to the laboratory in an iced container

d. Avoiding any changes in oxygen intervention for 20 minutes following the

procedure

ANSWER: c. Taking the specimen immediately to the laboratory in an iced

container

22. What should the nurse do when preparing a patient for a pulmonary
angiogram scan?

a. Assess the patient for iodine allergy.

b. Implement NPO orders for 6 to 12 hours before the test.

OPIANA CHRISTIAN JOSEPH I.
BSN4 BLOCK 6
N036 NCM 118N
c. Explain the test before the patient signs the informed consent form.

d. Inform the patient that radiation isolation for 24 hours after the test is
necessary.

ANSWER: a. Assess the patient for iodine allergy

23. The nurse is preparing the patient for and will assist the physician with a
thoracentesis in the patient’s room.

Number the following actions in the order the nurse should complete them. Use 1
for the first action and 7 for the last action.

___6___ a. Verify breath sounds in all fields.

___1___ b. Obtain the supplies that will be used.

___7___ c. Send labeled specimen containers to the lab.

___2___ d. Direct the family members to the waiting room.

___5___ e. Observe for signs of hypoxia during the procedure.

___4___ f. Instruct the patient not to talk during the procedure.

___3___ g. Position the patient sitting upright with the elbows on an over-thebed
table.

24. After which test should the nurse observe the patient for symptoms of a
pneumothorax?

a. Thoracentesis

b. Ventilation-perfusion scan

c. Pulmonary function test

d. Positron emission tomography (PET) scan

ANSWER: a. Thoracentesis

25. The health care provider orders a pulmonary angiogram for a patient
admitted with dyspnea and hemoptysis. For which problem is this test most
commonly used as a diagnostic measure?

a. Tuberculosis (TB)

b. Airway obstruction

c. Cancer of the lung

d. Pulmonary embolism

ANSWER: d. Pulmonary embolism

26. Match the following pulmonary capacities and function tests with their
descriptions.
___3___ a. Vt 1. Amount of air exhaled in first second of forced
vital capacity
___7___ b. RV 2. Maximum amount of air lungs can contain
___2___ c. TLC 3. Volume of air inhaled and exhaled with each
OPIANA CHRISTIAN JOSEPH I.
BSN4 BLOCK 6
N036 NCM 118N
breath
___4___ d. VC 4. Maximum amount of air that can be exhaled after
maximum inhalation
___5___ e. FVC 5. Amount of air that can be quickly and forcefully
exhaled after maximum inspiration

___6___ f. PEFR 6. Maximum rate of airflow during forced expiration

___1___ g. FEV1 7. Amount of air remaining in lungs after forced
expiration
____8__ h. FRC 8. Volume of air in lungs after normal exhalation

Case Study Respiratory Care Modalities

1. Charles Navarro, 65 years of age, is a male patient diagnosed with chronic

obstructive pulmonary disease (COPD). He is going to be discharged with home
oxygen at 2 L/min per nasal cannula. According to Medicare guidelines, the
patient falls into the group 1 patient category, the patient’s O2 saturation on
room air was less than 88% and his PaO2 was less than 55 mm Hg, which was
obtained from an arterial blood gas (ABG) at room air. The physician completed
the script for the home oxygen therapy according to Medicare guidelines. The
information that needed to be included on the script was the documented
diagnosis, the prescribed liter flow, the frequency of use in hours per day, and
the number of months in duration. The results of the pulse oximetry and the ABG
were also included in the script to justify the need for the home oxygen therapy.
The nurse needs to make arrangements with the social worker to obtain an
agency to supply the oxygen equipment needed and to provide follow-up on a
regular basis. The supplier makes arrangements to deliver an oxygen
concentrator and portable tanks or concentrated oxygen and oxygen regulators,
and needed supplies, including 50 feet of tubing, and nasal cannulas.

a. What home care considerations need to be made before the patient is

discharged and what considerations need to be made once the patient arrives
home?

Answer: Depending on the patient's condition and needs, home visits by a nurse
or respiratory therapist may be arranged. It is important to evaluate the patient's
home environment, physical and psychological status, and the need for additional
education. The nurse emphasizes educational points on how to use oxygen safely
and effectively, as well as fire safety precautions. To ensure consistent quality of
care and to maximize the patient's financial reimbursement for home oxygen
therapy, the nurse ensures that the primary provider's prescription includes the
diagnosis, prescribed oxygen flow, and use conditions. The nurse reminds the
patient and family that it is essential to keep follow-up appointments with the
patient's primary provider. The patient is advised to see their primary care
physician every six months, or more frequently if necessary. Arterial blood gas
measurements and laboratory tests are performed at least once a year, or more
frequently if the patient's condition changes.

b. What patient and family education must the nurse provide in regard to
home oxygen therapy?

Answer:At times, the patient must be given oxygen at home. The nurse teaches
the patient or family how to safely administer oxygen and informs them that
OPIANA CHRISTIAN JOSEPH I.
BSN4 BLOCK 6
N036 NCM 118N
oxygen is available in gas, liquid, and concentrated forms. There are gas and
liquid forms.

portable devices that allow the patient to leave the house while receiving oxygen
therapy To counteract the dry, irritating effects of compressed oxygen on the
airway, humidity must be provided while oxygen is used (except with portable
devices).

2. Beth Morris, a 60-year-old patient, is admitted with the diagnosis of small cell
carcinoma of the left lower lobe. She had a left lower lobectomy removing the
cancerous mass. After surgery, the patient has a chest tube to a closed waterseal
drainage system, the Atrium Ocean at 20 cmH2O. A quick view sheet helps to
guide the nurse with managing the drainage
system:http://www.atriummed.com/PDF/OceanSetupLetterSize.pdf.

1. What are the nursing responsibilities when caring for a patient with a chest
tube to a drainage system?

Answer:Examine the drainage color in the drainage tubing and collection

chamber. It is important to understand that old drainage in the collection
chamber may not accurately reflect current drainage as shown in the tubing.
Document the amount of drainage and its characteristics on the clinical flow sheet
at regular intervals (at least every 8 hours). Report any sudden fluctuations or
changes in chest-tube output (particularly an increase from previous drainage) or
changes in character (particularly bright red blood or free-flowing red drainage,
which could indicate hemorrhage). Frequent position changes, coughing, and
deep breathing all aid in lung expansion and fluid drainage.

2. How should the nurse reposition the patient in this case study?

Answer:The patient is positioned flat with a small wedge or bolster (several

folded towels or a blanket) is placed under the shoulder blades to elevate the
body and allow the practitioner easier access. The arm on the procedural side
must be kept out of the way; it is usually draped over the patient's head and
secured. Pendulous breasts or excess adipose tissue may also need to be moved
out of the way. The precise insertion site may differ depending on the condition
being treated. A chest tube is commonly inserted between the fourth and fifth
ribs on a line lateral to the nipple at the midaxillary line.

The nurse ensures the patient's comfort in each position by providing an emesis
basin, sputum cup, and paper tissues. The nurse instructs the patient to stay in
each position for 10 to 15 minutes, breathing in slowly through the nose and out
slowly through pursed lips to keep the airways open and secretions draining. If a
position is intolerable, the nurse assists the patient in assuming a modified
position. When the patient changes positions, the nurse instructs him or her on
how to cough and remove secretions.

3. The chest tube accidently is disconnected from the drainage system and the
drainage system is cracked. What should the nurse do?

Answer: Immerse the chest tube end in 1 inch of sterile water. The client will
require a new drainage system; the water is only a temporary solution.