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Unit VI
Respiratory Disorders
Critical Concepts
Assessment & Pathophysiology
Diagnostic Tests & Procedures
Upper Respiratory Disorders
Lower Respiratory Disorders
Pharmacology: Anti-tussives Mucolytics
!pectorants "ronchodilators
Anti-in#ectives
Identification
$% These are lipoproteins secreted y the alveolar cells which act to reduce sur#ace tension in
the lungs' preventing its collapse% (((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((
)% These are cells in the respiratory passages that secrete mucus' providing protection to the
airways% ((((((((((((((((((((((((((
*% +t is the single most important ris, #actor #or respiratory disorders%
(((((((((((((((((((((((((((((((((((((((((((((((((((((((
% +t is the structure in etween the laryn! and the ronchi and is also called the windpipe%
((((((((((((((((((((((((((((((((((((((
.% The space in etween the pleural cavities that contains all thoracic tissues outside the lungs%
(((((((((((((((((((((((((((((((((((
/% +t is the site o# o!ygen and caron dio!ide e!change in the lungs%
(((((((((((((((((((((((((((((((((((((((((((((((((((((((
0% +t re#ers to the aility o# the lungs to distend' e!pand or stretch%
(((((((((((((((((((((((((((((((((((((((((((((((((((((((
1% This condition in the alveoli occurs i# there is a high ventilation 2 per#usion ratio%
((((((((((((((((((((((((((((((((((((((((((
3% The percentage o# the partial pressure o# o!ygen in atmospheric air%
((((((((((((((((((((((((((((((((((((((((((((((((((((
$4% +t is the respiratory center o# the rain% (((((((((((((((((((((
$$% +t is a symptom o# respiratory pathology that means e!pectoration o# lood #rom the
respiratory tract% (((((((((((((((
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$)% +t is a test o# peripheral circulation per#ormed prior to collecting specimen #or arterial
lood gas analysis% ((((((((((((((((((((((
$*% +t is the inaility to reathe easily e!cept in an upright position%
(((((((((((((((((((((((((((((((((((((((((((((((((((((((
$% +t re#ers to the amount o# air that moves in and out o# the lungs in a normal respiration%
((((((((((((((((((((((((((((((((((((((
$.% +t re#ers to the closure or collapse o# the alveoli% (((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((
True or False
((((($% 5oreign odies are more li,ely to e dislodged and ostruct the le#t main ronchus%
((((()% The main #unction o# the laryn! is #or vocali6ation%
(((((*% The parietal pleura is a serous memrane covering the lungs%
(((((% 7ydrothora! and8or pneumothora! a##ect pulmonary #unction y increasing lung
compliance%
(((((.% The pulmonary veins receive lood #rom the right ventricle%
(((((/% The pulmonary artery delivers deo!ygenated lood%
(((((0% A shunt occurs i# there is low ventilation 2 per#usion ratio in the alveoli%
(((((1% A low o!ygen level is the primary stimulus #or reathing%
(((((3% An increase in caron dio!ide levels stimulates the peripheral chemoreceptors to
send signals to the rain to increase respiration%
((((( $4% 7yperventilation leads to respiratory al,alosis%
Matching Type
Set A. Anatomy !hysiology
Column A Column "
Anatomy Physiology
((((($% Laryn! A% involved in immune #unction
((((()% piglottis "% produces voice
(((((*% Trachea 9% passageway to the lungs and stomach
(((((% inuses D% lightens the s,ull
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(((((.% Tonsils % windpipe
Set ". Assessment !athophysiology
Column A Column "
Assessment Pathophysiology
((((($% dyspnea A% severe o!ygen desaturation
((((()% cyanosis "% compensation #or hypo!emia
(((((*% pleuritic chest pain 9% increased respiratory e##ort
(((((% pin,' #rothy sputum D% ruing o# pleural layers
(((((.% tachycardia % rupture o# #luid-#illed alveoli
Set C. Diagnostic Tests
Column A Column "
Diagnostic Test Purpose / Indication
((((($% Arterial lood gas A% diagnoses pulmonary emolus
((((()% Laryngoscopy "% measures acidity or al,alinity
(((((*% 9hest !-ray 9% determines e!posure PT"
(((((% Pulmonary angiography D% detects cavitations in the lungs
(((((.% Mantou! test % visuali6es the laryn!
Set D. !harmacology
Column A Column "
Medications Indications/Purpose
((((($% Aminophylline A% ,ills microorganisms
((((()% 9romolyn sodium "% prevents asthmatic attac, (((((*% Methylprednisolone 9% reduces in#lammation
(((((% ryhtromycin D% dilates the ronchial tree
(((((.% De!tromethorphan 7"r % reduces coughing episodes
Set #. Respiratory Infections
Column A Column "
Infection Causative Agent
((((($% Pneumonia A% "ordetella pertussis
((((()% Tuerculosis "% 9och;s acillus (((((*% ore throat 9% Pneumococcus
(((((% 5lu D% +n#luen6a virus
(((((.% <hooping cough % =roup A eta-hemolytic
treptococcus
Set F. Respiratory Disorders I
Column A Column "
Respiratory Disorder Description
((((($% "ronchial asthma A% pus in the lungs and pleura
((((()% mphysema "% in#lammation o# the ronchi
(((((*% mpyema 9% overdistention o# the alveoli
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(((((% "rochiectasis D% hyperactive airways
(((((.% "ronchitis % distention o# ronchial tree
Set $. Respiratory Disorders II
Column A Column "
Respiratory Disorder Description
((((($% 5lail chest A% air in the pleural space
((((()% Pleurisy "% in#lammation o# the pleura
(((((*% Pneumothora! 9% #luid in the pleural space
(((((% 7ydrothora! D% ri #racture with parado!ical
(((((.% ucutaneous movement o# the chest
emphysema % air in the #atty tissues
Multiple Choice
Choose the letter of the %est ans&er. Some items may ha'e multiple ans&ers.
((((($% A school nurse is conducting a health education to a group o# high school students on
the e##ects o# smo,ing to the respiratory system% The school nurse is correct when she says'
>mo,ing:
A% decreases sputum production%?
"% increases sur#actant production in the lungs%?
9% promotes ciliary #unction in the respiratory passages%?
D% increases ris, to respiratory tract in#ections%?
((((()% The process o# movement o# o!ygen and caron dio!ide in and out o# the lungs is
called
A% respiration"% ventilation
9% e!cretion
D% per#usion
(((((*% +nternal respiration involves the e!change o# o!ygen and caron dio!ide etween the
A% lungs and the red lood cells
"% red lood cells and the ody tissues
9% atmosphere and the lungs
D% lungs and the heart
(((((% The process y which o!ygen and caron dio!ide moves #rom an area o# greater to
lower concentration is calledA% per#usion
"% o!ygenation
9% di##usion
D% osmosis
(((((.% Diphenhydramine 79l @"enadryl is prescried #or a patient with allergic rhinitis% An
e!pected physiological e##ect o# this medication is:
A% +ncreased respiratory secretions
"% Decreased respiratory rate
9% +ncreased mental alertness
D% Reduced nasal congestion
(((((/% A patient undergoes ronchoscopy in the morning% <hich o#
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the #ollowing nursing interventions is the most appropriate e#ore the
procedureB
A% C##er the patient oral care in the morning%
"% Let the patient have a light rea,#ast%
9% othing y mouth a#ter midnight%
D% tart an intravenous access%
(((((0% <hich o# the #ollowing must e done prior to collecting specimen #or an arterial
lood gas analysisB
A% Per#orm the Allen test%
"% 9hec, the patient;s lood pressure%
9% <ithhold #oods and #luids #or at least hours%
D% Auscultate the patient;s reath sounds%
(((((1% The patient returns to the ward a#ter laryngoscopy% The most important nursing
responsiility is to
A% C##er ice chips and small sips o# water%
"% 9hec, the patient;s temperature%9% 9hec, #or the presence o# gag re#le!%
D% Assess #or leeding at the insertion site%
(((((3% The nurse suspects viral in#ection o# the respiratory tract i# the patient;s sputum or
drainage has which o# these characteristicsB
A% Eellowish and thic,
"% light rown and #oul-smelling
9% clear and mucoid
D% greenish and copious
((((($4% A patient who has chronic respiratory in#ection such as tuerculosis is e!pected to
have which o# these laoratory results #rom a di##erential 9"9 countBA% increased neutrophil count
"% decreased white lood cell count
9% increased asophil count
D% increased eosinophil count
((((($$% A patient with nasal congestion is ta,ing Pseudoephedrine
@uda#ed% <hich o# the #ollowing signs and symptoms should the
nurse assess as a side-e##ect o# this medicationB
A% +ncreased heart rate
"% Decreased lood pressure
9% Reduced lood glucose
D% +ncreased nasal secretions
((((($)% The nurse understands that mani#estations associated with acute sinusitis are a result
o#:
A% ostruction in the #low o# drainage #rom the nasal cavities
"% inaility o# the sinus cavities to e!pand to accommodate increasing drainage
9% destruction o# the one tissues surrounding the sinus cavities
D% lac, o# o!ygen entering the nasal cavities
((((($*% A priority nursing diagnosis #or a patient with allergic rhinitis is
A% Alteration in com#ort
"% +ne##ective airway clearance
9% Altered ody temperature: increased
D% Ris, #or altered nutrition
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((((($% The nurse assesses #or signs and symptoms associated with acute sinusitis which
include @elect all that apply%:
A% headache
"% nasal congestion
9% #ever
D% otalgia
% odynophagia
((((($.% The presence o# which o# the #ollowing complaints #rom a patient suggests the
presence o# chronic sinusitisB
A% post-nasal drip
"% hoarseness
9% #inger cluing
D% on & o## #ever
((((( $/% <hich o# the #ollowing medications is an intranasal
glucocorticoidBA% 7ydro!y6ine 79l @Atara!
"% 5luticasone @5lonase
9% 5e!o#enadine @Allegra
D% Phenylephrine @eo-ynephrine
((((( $0% A patient with upper respiratory in#ection is given a
codeine preparation% <hich o# the #ollowing assessments indicates
that the patient is responding well to the medicationB
A% +ncreased production o# mucus
"% Reduced nasal congestion
9% Decreased #reFuency o# coughing
D% 5reFuent e!pectoration o# secretions
((((($1% A patient has increased mucus secretion due to respiratory
tract in#ection% <hich o# the #ollowing interventions helps to loosen
and e!pectorate the secretionsB
A% =ive small' #reFuent #eedings%
"% +ncrease oral #luid inta,e%
9% Position the patient in low-5owler;s
D% Administer ronchodilators' as ordered%
((((($3% A patient visits the clinic due to a low-grade #ever' nasal
congestion and productive cough% A diagnosis o# upper respiratory
tract in#ection is made% The patient is advised to ta,eDiphenhydramine hydrochloride @"enadryl ). mg talets po F/ prn%
<hich o# the #ollowing nursing instructions is most appropriate
#or patients ta,ing this medicationB
A% >+t is est to ta,e the medication in the morning%?
"% >Ma,e sure not to drive or operate heavy machines%?
9% >There is no harm i# you drin, wine with meals%?
D% >Eou can ta,e ) talets at night to help you sleep%?
((((()4% The nurse instructs the patient on correct techniFue o# collecting sputum specimen
#or culture and sensitivity% <hich o# these statements made y the nurse is inaccurateB
A% >Eou need to gargle with water e#ore you cough and e!pectorate%?
"% >Do this as soon as you wa,e up in the morning%?
9% >Ma,e sure you cough out directly in to this clean cup%?
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D% >+t;s alright to eat a#ter + collect the specimen%?
((((()$% The most important concern o# the nurse as soon as the patient arrives #rom
ronchoscopy is to assess the
A% urine output
"% pain level
9% color and consistency o# sputum
D% owel sounds
((((())% A patient with cough due to an upper respiratory tract
in#ection is given De!trometorphan romide @Roitussin' an
antitussive medication% Antitussives act y:
A% Decreasing nasal secretions
"% Loosening ronchial secretions
9% "loc,ing the e##ects o# histamine
D% uppressing the cough re#le!
((((()*% A patient is admitted to the D with an acute asthma-li,eattac, a#ter ingesting sea#ood #or lunch% The medication o# choice #or
relieving ronchospasms due to acute anaphyla!is is:
A% Atrovent with Aluterol @9omivent
"% pinephrine hydrochloride @Adrenalin
9% 9romolyn sodium @+ntal
D% Triamcinolone @A6macort
((((()% A patient in ronchospasm will have a priority nursing
diagnosis which is:
A% +mpaired gas e!change
"% +ne##ective reathing pattern
9% +ne##ective airway clearanceD% Activity intolerance
((((().% A patient with wea, pharyngeal muscles is at ris, #or which complicationB
A% aspiration
"% ronchospasm
9% hyperventilation
D% pneumonia
((((()/% A nurse admits an elderly patient and conducts a physical assessment% <hich o# the
#ollowing re#lects a normal physiologic change in the respiratory system associated with the
aging processB
A% reduced cough and gag re#le!"% increased si6e o# airways
9% reduced collagen o# alveolar walls
D% increased elasticity o# alveolar sacs
((((()0% A patient complains o# di##iculty o# reathing% <hich o# these pathophysiologic
mechanisms can lead to dyspneaB
A% reduced airway resistance
"% increased sur#actant production
9% reduced lung compliance
D% increased ciliary #unction
((((()1% A nurse notes the presence o# e!piratory whee6e in a patient during her morning
assessment% This may indicate:
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A% tuerculosis
"% pneumonia
9% ronchial asthma
D% allergic rhinitis
((((()3% The nurse assesses a hypertensive patient complaining o# dry cough% Dry cough is a
side e##ect o# which medicationB A% =uia#enesin @Roitussin
"% 9aptopril @9apoten
9% Lano!in @Digo!in
D% alutamol @Gentolin
(((((*4% A patient is admitted with #ever' cough and chest pain that is aggravated y
coughing or movement% The nurse suspects this as
A% atelectasis
"% acute respiratory #ailure
9% pleuritis
D% pulmonary edema
(((((*$% The patient e!pectorates #oul-smelling sputum% This may e a sign o#
A% viral in#ection
"% lung ascess
9% lung tumor
D% pulmonary edema
(((((*)% The nurse monitors a patient admitted with acute e!aceration o# ronchial asthma
#or mani#estations o# hypo!ia% An early sign or symptom o# hypo!ia is
A% cyanosis
"% chest pain
9% restlessness
D% radycardia
(((((**% A patient is in the medical ward #or chronic ostructive pulmonary disease @9CPD%
A sign o# chronic hypo!ia is
A% tachycardia
"% cluing o# the #ingers
9% cyanosis
D% hemoptysis
(((((*% The nurse doing a physical e!amination notes a arrel chest on her patient% This is a
sign o#
A% pulmonary edema
"% emphysema9% pneumonia
D% ronchial asthma
(((((*.% <hich o# the #ollowing complications o# scoliosis would e the most concern o# the
nurseB
A% dis#igurement
"% respiratory distress
9% ac, pain
D% numness on the arms
(((((*/% A patient is admitted with slow respirations o# 1 reaths per minute% A possile
cause o# this slowed reathing is
A% hemorrhage
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"% aspirin poisoning
9% increased intracranial pressure
D% pneumonia
(((((*0% A patient scheduled #or surgery ecomes moderately an!ious% The nurse e!pects to
see which reathing patternB
A% eupnea
"% radypnea
9% hypopnea
D% tachypnea
(((((*1% A patient with diaetic ,etoacidosis is e!hiiting Hussmaul;s respiration% This is
descried as
A% slow shallow reathing
"% deep rapid reathing
9% irregular reathing
D% asence o# reathing
(((((*3% The nurse reports to the physician that a patient has 9heyne-to,es respiration% This
type o# reathing is descried as
A% alternating periods o# apnea and deep reathing
"% hyperventilation with deep reaths
9% cycles o# reathes with varying depths and apnea
D% cessation o# reathing
(((((4% The nurse per#orms thoracic palpation to a patient with #ractured le#t ris% An
e!pected #inding is that the respiratory e!cursions are
A% increased
"% decreased
9% symmetricalD% asymmetrical
((((($% Cn a routine physical e!amination' the nurse #eels virations on the patient;s chest
wall on palpation% This #inding is
A% normal and should e documented as crepitus
"% anormal and the physician should e noti#ied
9% normal and should e documented as tactile #remitus
D% anormal and it needs #urther assessment
((((()% A patient with increased tactile #remitus most li,ely has
A% pneumothora!
"% pneumonia9% hydrothora!
D% emphysema
(((((*% <hen percussing the thora!' the nurse hears a hyperresonant sound% This may
possily indicate
A% pneumothora!
"% lung cancer
9% empyema
D% pulmonary edema
(((((% During physical assessment' the nurse as,s the patient to pronounce >ninety-nine?
then auscultates the lungs% The nurse hears a louder and clearer >ninety-nine?% This #inding is
,nown as
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A% ronchophony
"% egophony
9% whispered pectoriloFuy
D% normal vocal resonance
(((((.% A patient with cough complains o# chest pain% The nurse auscultates the reath
sound and hears rhonchi% This is due to the presence o#
A% #luids
"% mass
9% air
D% secretions
(((((/% Prior to collecting specimen #or arterial lood gas @A"= analysis' the nurse should
noti#y the physician i# a patient has
A% chest pain
"% high-grade #ever
9% cough
D% peripheral circulation
(((((0% The nurse reviews the A"= result o# a patient complaining o# dyspnea and #inds
that it is normal% <hich o# the #ollowing is a normal A"= resultB
A% p7 2 0%)3' p9C) 2 .4' 79C* 2 *4
"% p7 2 0%*0' p9C) 2 *' 79C* 2 ).
9% p7 2 0%.' p9C) 2 ..' 79C* 2 *.
D% p7 2 0%.4' p9C) 2 *.' 79C* 2 $1
(((((1% A patient with pneumonia has the #ollowing A"= results: p7 2 0%**' p9C) 2 .0
mm7g' pC) 2 03 mm7g' 79C* 2 )/ meF8L% The nurse interprets this as:
A% respiratory acidosis
"% respiratory al,alosis
9% metaolic acidosisD% metaolic al,alosis
(((((3% The nurse cautions the high school students that during active e!ercise'
hyperventilation can lead to
A% respiratory acidosis
"% respiratory al,alosis
9% metaolic acidosis
D% metaolic al,alosis
(((((.4% A non-invasive method o# continuously monitoring the o!ygen saturation o#
hemogloin o# a patient is
A% arterial lood gas analysis"% pulse o!imetry
9% incentive spirometry
D% pulmonary #unction test
(((((.$% The nurse should noti#y the physician i# the patient;s o!ygen saturation as re#lected
in the pulse o!imetry is
A% $44I
"% 3.I
9% 3*I
D% 13I
(((((.)% The nurse monitors the o!ygen saturation @aC) o# a patient with pneumonia and
assesses it to e 34I% The initial nursing action is to
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A% noti#y the physician
"% suction the patient
9% as, the patient to deep reathe
D% administer o!ygen right away
(((((.*% A patient is scheduled #or chest !-ray to evaluate pneumonia% The nurse should
instruct the patient to
A% e on PC /-1 hours e#ore the procedure
"% ta,e a deep reath then hold while !-ray is ta,en
9% cough e#ore !-ray is ta,en
D% sign an in#ormed consent
(((((.% The most important assessment prior to pulmonary angiography is to note #or
patient;s
A% history o# hypertension
"% hypersensitivity to shell#ish
9% previous e!posure to !-rays
D% perception o# the procedure
(((((..% The patient is scheduled #or thoracentesis due to a right hydrothora!% The nurse
should position the patient in
A% right side lying
"% le#t side lying
9% upright with arms at shoulder level
D% #lat on ed
(((((./% A physician per#orms thoracentesis on a patient with hydrothora!% The nurse ,nows
that the needle will e inserted in the
A% second or third intercostal space
"% #ourth or #i#th intercostal space9% si!th or seventh intercostal space
D% tenth or eleventh intercostal space
(((((.0% An important nursing instruction to a patient during thoracentesis is to
A% have deep reaths at regular intervals
"% cough regularly throughout the procedure
9% remain still throughout the procedure
D% hold reath throughout procedure
(((((.1% A patient returns to the ed a#ter a thoracentesis #or a le#t pyothora!% The nurse
positions the patient in
A% le#t side lying"% right side lying
9% prone
D% supine
(((((.3% The nurse noti#ies the physician i# the patient complains o# which o# these a#ter a
thoracentesisB
A% occasional coughs
"% di66iness and #eeling o# #ainting
9% itchiness around insertion site
D% e!pectorates clear sputum
(((((/4% A patient presents to the clinic with allergic rhinitis with rhinorrhea% Rhinorrhea
means
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A% swelling o# the nasal mucous memranes
"% increased nasal discharge
9% e!cessive sputum production
D% sinus congestion
(((((/$% A patient calls the clinic and complains o# discom#ort due to runny nose' snee6ing
and nasal congestion as a result o# common colds% The nurse should advise the patient to
A% decrease oral #luid inta,e
"% snee6e with mouth closed
9% ta,e Diphenhydramine 79l @"enadryl
D% remain #lat on ed
(((((/)% The nurse per#orms transillumination to assess
A% pharyngitis
"% rhinitis
9% sinusitis
D% atelectasis
(((((/*% A patient with sinusitis should e assessed #or history o#
A% trauma to the nose
"% upper respiratory tract in#ection
9% genetic predisposition
D% nutritional inta,e
(((((/% Mani#estations o# acute sinusitis are due to
A% ostruction in the #low o# sinus drainage
"% e!cessive nasal discharge
9% #orce#ul coughing and snee6ing
D% destruction o# tissues around the sinuses
(((((/.% igns and symptoms o# sinusitis include: @elect all that apply%
A% otalgia
"% sore throat
9% #acial congestion
D% decreased sense o# smell
% #ever
(((((//% An appropriate nursing intervention #or patients with acute viral upper respiratory
tract in#ections includes
A% gargle with salt water
"% increase inta,e o# cold liFuids
9% e!ercise regularlyD% administer antiiotics as ordered
(((((/0% The nurse administers a decongestant to patient with upper respiratory tract
in#ection% The nurse should assess #or side-e##ects such as
A% decreased lood pressure
"% increased pulse rate
9% increased nasal discharge
D% decreased coughing
(((((/1% The most common cause o# acute pharyngitis is
A% viruses
"% acteria
9% allergies
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D% ostruction
(((((/3% The patient with acute pharyngitis will most li,ely complain o#
A% di##iculty swallowing
"% chest pain
9% productive cough
D% nasal discharge
(((((04% A patient with pharyngitis complains o# sore throat% To relieve sore throat' the nurse
should
A% restrict inta,e o# lu,ewarm water
"% apply ice collar to the anterior nec,
9% withhold #oods and #luids #or ) hours
D% advise #reFuent throat clearing
(((((0$% A patient returns to the ward a#ter a tonsillectomy & adenoidectomy @T&A% The
priority goal o# post-operative care is
A% prevention o# post-op hemorrhage"% maintain airway patency
9% relieve pain
D% maintain normal vital signs
(((((0)% The nurse determines post-operative leeding on a patient who had a T&A y
assessing
A% complains o# nec, pain
"% pulse rate o# 34 eats per minute
9% #reFuent swallowing
D% drainage in the surgical dressing
(((((0*% To prevent hypostatic pneumonia' the nurse should instruct a post-T&A patient to
per#ormA% deep reathing e!ercise
"% coughing e!ercises
9% deep reathing and coughing e!ercises
D% leg e!ercises
(((((0% A patient with recent T&A surgery complains o# thirst% The nurse should o##er
A% a cup o# water with straw
"% a strawerry-#lavored popsicle
9% a #ew pieces o# ice chips
D% a owl o# soup
(((((0.% The nurse in the recovery room should position a patient a#ter T&A inA% supine with head turned to the side
"% le#t side lying
9% right side lying
D% prone with head turned to the side
(((((0/% The est intervention to prevent swelling and leeding on the surgical site in a
patient who underwent T&A is #or the nurse to
A% o##er ice cold #luids
"% apply ice collar
9% position the patient supine
D% inspect surgical dressing #reFuently
(((((00% The nurse providing discharge instructions to a patient who had a T&A should
advise the patient to ta,e which #oodB
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A% mil, and8or yogurt
"% rice and por, chop
9% citrus #ruits and vegetales
D% gelatin and soup
(((((01% A patient with acute viral laryngitis is most li,ely to have
A% a high-grade #ever
"% hoarseness
9% chest soreness
D% cough productive o# yellow sputum
(((((03% An important nursing intervention #or patients with laryngitis is to
A% limit smo,ing
"% whisper when tal,ing
9% rest the voice
D% avoid respiratory irritants
(((((14% <hich o# the #ollowing data #rom a patient ta,en during admission is a ris, #actor#or ostructive sleep apneaB The patient is
A% a 4-year old #emale
"% wor,s in a #actory
9% is oese
D% a smo,er
(((((1$% Patients with ostructive sleep apnea are prone to develop
A% lung cancer
"% pneumonia
9% myocardial ischemia
D% hypotension
(((((1)% <hich o# these mechanical devices is used in the management o# patients with sleep
apneaB
A% mechanical ventilator
"% ivalve positive airway pressure @"iPAP machine
9% incentive spirometer
D% pulse o!imeter
(((((1*% The emergency management o# individuals with epista!is or noseleeding is
A% tilt the head ac,wards
"% let the person low the nose gently
9% apply direct pressure on the Hisselach;s ple!us
D% place a nasal pac,
(((((1% An important nursing intervention #or a patient with posterior nasal pac, is to:
A% provide oral care
"% remove the pac,ing a#ter / hours
9% press the midline anterior nose
D% provide o!ygen per nasal cannula
(((((1.% The nurse is on rea, at the canteen when she oserves a person cho,ing #rom an
ingested #ood% The nurse should initially
A% call #or help
"% as, i# the patient can spea,
9% per#orm 7eimlich maneuver
D% call a physician
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(((((1/% +n per#orming a 7eimlich maneuver in a conscious adult patient' the nurse should
A% position the patient #lat on the #loor
"% per#orm downward adominal thrust
9% place one arm on the patient;s waist
D% position hersel# ehind the patient
(((((10% The nurse conducting a health teaching in#orms the participants that most cases o#
laryngeal cancer occur in the
A% supraglottic area
"% glottic area
9% suglottic area
D% pharyngeal area
(((((11% The nurse e!plains to a group o# adult smo,ers that an early sign o# laryngeal
cancer is
A% throat pain
"% di##iculty swallowing
9% hoarsenessD% dyspnea
(((((13% An important aspect o# pre-operative teaching #or a patient scheduled #or total
laryngectomy is to e!plore ways o#
A% pain relie#
"% preventing complications
9% airway management
D% alternative means o# communication
(((((34% The most common post-operative prolem o# a patient with supraglottic
laryngectomy is
A% di##iculty swallowing"% massive leeding
9% hypostatic pneumonia
D% asence o# voice
(((((3$% <hich o# the #ollowing statements made y a patient a#ter a heath teaching
regarding total laryngectomy needs clari#icationB
A% >+ need to adJust to a new airway%?
"% >My sense o# smell will e a##ected y the surgery%?
9% >+ will lose my voice temporarily%;
D% >+ will have a stoma in my nec, a#ter surgery%?
(((((3)% The nurse instructs the patient who is #or discharge a#ter a total laryngectomy that
he canA% use shower ath instead o# a tu ath
"% still pursue swimming as his #avorite sport
9% engage in recreation and e!ercise
D% only have his laryngeal stoma cleaned y a nurse
(((((3*% The nurse is per#orming a respiratory assessment on her patients% <hich o# these
patients is most at ris, #or atelectasisB
A% A )-year-old athletic patient on acute asthmatic attac,
"% A *.-year-old patient with upper adominal surgery
9% A /-year-old patient who has spinal surgery
D% A //-year-old patient with diaetic neuropathy
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(((((3% The nurse prevents the development o# atelectasis in her patient who had spinal
cord inJury y
A% positioning the patient upright
"% encouraging the patient to deep reath and cough
9% turn the patient every shi#t using log-roll techniFue
D% suctioning the patient #reFuently
(((((3.% The nurse is concerned aout atelectasis in a patient i# assessment reveals
A% asence o# reath sounds
"% increased rate o# reathing
9% e!pectoration o# yellowish sputum
D% resonant sound on chest percussion
(((((3/% A patient is rought to the ward a#ter surgery% Prior to administering Morphine
sul#ate' the nurse should chec, the patient;s
A% pulse rate
"% temperature
9% urine outputD% respiratory rate
(((((30% A patient with pneumonia develops atelectasis% The nurse assesses central cyanosis
in the
A% sclera and conJunctiva
"% mouth and tongue
9% #ingers and toes
D% chest and adomen
(((((31% A patient is admitted #or pneumonia% The nurse ,nows that pneumonia is a
respiratory in#ection characteri6ed y
A% presence o# pus in the thoracic cavity
"% consolidation o# secretions in the lung tissues9% increased secretion o# mucus in the air passages
D% acute in#lammation o# the trachea and ronchial tree
(((((33% The nurse suspects pneumonia in a patient i# she notes which physical assessment
#indingB
A% low-grade #ever
"% pin, #rothy sputum
9% increased tactile #remitus
D% decreased vocal resonance
((((($44% A patient with pneumonia is prescried Ampicillin .44 mg po F/h% The nurse
should emphasi6e to the patient the need toA% ta,e the medication with #ood or #luids
"% ta,e the #ull course o# the prescried medicine
9% have a sputum culture a#ter completing the treatment
D% decrease #luid inta,e to prevent #luid overload
((((($4$% A priority nursing diagnosis #or a patient with pneumonia is
A% Acute chest pain
"% +ne##ective airway clearance
9% +ne##ective reathing pattern
D% Activity intolerance
((((($4)% An important preventive measure #or pneumonia among the elderly is to
A% avoid going to overcrowded places
"% receive regular pneumococcal vaccine
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9% increase oral #luid inta,e up to * liters daily
D% ta,e prophylactic antiiotics
((((($4*% Prior to per#orming postural drainage' the nurse should
A% assess the vital signs
"% auscultate the reath sounds
9% withhold #oods and #luids
D% determine urine output
((((($4% The nurse should plan to per#orm postural drainage
A% e#ore meals
"% a#ter meals
9% at night
D% in the evening
((((($4.% An important nursing intervention a#ter postural drainage is to provide
A% good oral hygiene
"% adeFuate #luid inta,e9% rest and privacy
D% pain relie#
((((($4.% The nurse per#orms postural drainage to a patient with pneumonia% During the
procedure' the patient complains o# di##iculty reathing' chest pain and palpitation% The nurse
should initially
A% chec, the vital signs
"% stop the treatment
9% call the physician
D% position patient upright
((((($4/% The principle involved in postural drainage isA% osmosis
"% di##usion
9% per#usion
D% gravity
((((($40% The nurse notes that postural drainage is e##ective i# a#ter the procedure' the patient
A% has chest pain
"% e!pectorates more sputum
9% is dyspneic
D% has a pulse rate o# $$4 pm
((((($41% A patient with a chronic lung ascess should have a diet that isA% high in calories and protein
"% high in carohydrates and low in protein
9% low in calories and high in protein
D% low in carohydrates and low in protein
((((($43% A patient has empyema and needs antiiotics instilled into the pleural cavity% The
instillation o# medications in the pleural cavity to treat an in#ection is a treatment ,nown as
A% diapedesis
"% pleurodesis
9% paracentesis
D% thoracentesis
((((($$4% <hich o# these statements made y a patient suggests the presence o# pleurisyB
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A% >My reathing is #aster than usual%?
"% >+ have a dull chest pain radiating to my shoulder%?
9% >My chest hurts move when + ta,e a deep reath%?
D% >+ have more sputum than normal%?
((((($$$% An important pain management #or a patient with pleurisy is the administration o#
A% Acetaminophen @Tylenol
"% +ndomethacin @+ndocin
9% Meperidine hydrochloride @Demerol
D% 7ydrocodone @Gicodin
((((($$)% The nurse helps in reducing chest pain in a patient with pleuritis y encouraging
the patient to
A% hold his reath #reFuently
"% ta,e slow deep reaths
9% splint the ri cage when reathing
D% lay down on the una##ected side
((((($$*% A patient with shortness o# reath undergoes an !-ray% The result shows anaccumulation o# #luids in the pleural cavity ,nown as
A% pleural e##usion
"% hydrothora!
9% pyothora!
D% pneumothora!
((((($$% The nurse assessing a patient with pleural e##usion is e!pected to #ind
A% asent reath sounds
"% increased vocal resonance
9% increased tactile #remitus
D% tracheal deviation towards the a##ected side
((((($$.% The nurse ,nows that pulmonary edema is most li,ely to occur as a complication i#
a patient has which pre-e!isitng medical consitionB
A% heart #ailure
"% atelectasis
9% hemorrhage
D% chronic ronchitis
((((($$/% Assessment #indings in a patient with pulmonary edema are @elect all that apply:
A% crac,les
"% pin,' #rothy sputum
9% reduced reath sounds
D% increased tactile #remitus% whispered pectoriloFuy
((((($$0% A patient with pulmonary edema has chest pain% The nurse should prepare to
administer
A% Morphine sul#ate @M
"% 5urosemide @Lasi!
9% Lano!in @Digo!in
D% Acetylsalicylic acid @Aspirin
((((($$1% ursing interventions #or a patient with pulmonary edema includes:
A% position the patient upright
"% maintain #luid inta,e at ) liters8day
9% provide so#t #oods such as pasta and soups
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D% encourage #reFuent amulation
((((($$3% The e!pected arterial lood gas result #or a patient with acute respiratory #ailure is
A% p7 2 0%*4' p9C) 2 /4 mm7g' pC) 2 3 mm 7g
"% p7 2 0%*)' p9C) 2 .. mm7g' pC) 2 04 mm7g
9% p7 2 0%*' p9C) 2 3 mm7g' pC) 2 14 mm7g
D% p7 2 0%4' p9C) 2 4 mm7g' pC) 2 1. mm7g
((((($)4% <hich o# these patients is least prone to develop acute respiratory #ailureB A
patient with
A% multiple sclerosis
"% hyperthyroidism
9% sedative overdose
D% poliomyelitis
((((($)$% The nurse identi#ies respiratory distress i# the patient e!hiits @elect all that
apply:
A% nasal #laring"% chest retractions
9% use o# accessory muscles o# respiration
D% lethargy
% diaphoresis
((((($))% A patient with atelectasis develops acute respiratory #ailure% The nurse anticipates
that this patient needs
A% deep reathing and coughing e!ercises
"% #reFuent oropharyngeal and tracheal suctioning
9% o!ygen per nasal cannula at / liters per minute
D% intuation and mechanical ventilation
((((($)*% A patient with pneumonia develops acute respiratory distress syndrome @ARD%
The maJor characteristic o# ARD is
A% insidious onset o# pulmonary edema
"% reduced amount o# pulmonary in#iltrates
9% hypo!emia unresponsive to o!ygen therapy
D% increased lung compliance
((((($)% The medical +9U nurse recalls that the main pathophysiology o# ARD is
A% lea,age o# #luid into alveolar interstitial spaces
"% severe smooth muscle contraction o# the ronchi
9% accumulation o# secretions in the lung tissues
D% reduced per#usion into the lung tissues
((((($).% An essential component o# ARD medical management is the use o#
A% continuous positive airway pressure @9PAP
"% ivalve positive airway pressure @"iPAP
9% positive end-e!piratory pressure @PP
D% pulmonary artery wedge pressure @PA<P
((((($)/% Prior to mechanical ventilation the nurse may administer
A% Methocaramol @Roa!in
"% Pancuronium @Pavulon
9% Lora6epam @Ativan
D% 7aloperidol @7aldol
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((((($)0% A patient with 4-pac, years o# smo,ing history undergoes a series o# diagnostic
tests% <hich o# the #ollowing procedures determines the presence o# pulmonary hypertensionB
A% intra-arterial lood pressure monitoring
"% pulmonary artery pressure monitoring
9% central venous pressure monitoring
D% continuous o!ygen saturation monitoring
((((($)1% A nurse wor,ing at the pulmonary unit ,nows that the most common cause o#
secondary pulmonary hypertension is
A% ronchogenic carcinoma
"% chronic ostructive pulmonary disease
9% sucutaneous emphysema
D% rheumatic heart disease
((((($)3% The nurse notes cor pulmonale secondary to pulmonary hypertension in a patient i#
he e!hiits
A% chronic cough
"% distended nec, veins9% chest pain
D% rhonchi
((((($*4% A patient with 9CPD and pulmonary hypertension can develop which
complicationB
A% myocardial in#arction
"% cererovascular accident
9% right ventricular hypertrophy
D% le#t ventricular hypertrophy
((((($*$% The most appropriate intervention #or a patient with pulmonary hypertension
includes
A% administration o# intravenous #luids"% o!ygen therapy
9% mechanical ventilation
D% pain management
((((($*)% A patient who developed pulmonary #at emolism may have had a history o#
recent
A% streptococcal in#ection
"% #racture o# the #emur
9% prolonged con#inement in ed
D% dehydration
((((($**% ssential nursing interventions to prevent pulmonary emolism include: @elect allthat apply%
A% turn patient #rom side to side every ) hours
"% passive leg e!ercises
9% ensure adeFuate oral and intravenous #luid inta,e
D% deep reathing and coughing e!ercises
% encourage early amulation
5% use o# elastic stoc,ings
((((($*% The nurse suspects that a patient is developing pulmonary emolism i# she
oserves
A% tachycardia and chest pain
"% hypertension and #ever
9% hemoptysis and radypnea
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D% productive cough and radycardia
((((($*.% To accurately evaluate the presence and location o# a pulmonary emolus' the
physician needs to order which diagnostic testB
A% chest !-ray
"% 9T scan o# the chest
9% electrocardiography
D% coronary angiography
((((($*/% A medical intervention to prevent pulmonary emolism involves the
administration o#
A% no!aparin sodium @Loveno!
"% trepto,inase
9% AFuamephyton @Gitamin H
D% Protamine sul#ate
((((($*0% A patient with pulmonary emolism is started on 7eparin sul#ate ).'444 units
diluted in a ).4 cc o# De!trose in .I <ater% The physician orders the 7eparin drip to run at$.44 units per hour% The nurse should regulate the 7eparin drip at a rate o#
A% $4 cc8hr
"% $. cc8hr
9% )4 cc8hr
D% ). cc8hr
((((($*1% The nurse caring #or a patient on 7eparin drip needs to order which laoratory
testB
A% prothromin time
"% activated partial thromoplastin time
9% clotting time
D% complete lood count
((((($*3% The nurse should have which o# the #ollowing medications at the edside when a
patient is on 7eparin therapyB
A% <ar#arin sodium @9oumadin
"% Atropine sul#ate
9% Protamine sul#ate
D% Gitamin H
((((($4% A patient discharged a#ter treatment o# pulmonary
emolism is prescried <ar#arin sodium @9oumadin . mg po daily%
The nurse instructs the patient to avoid
A% rushing his teeth"% eating green lea#y vegetales
9% using an electric ra6or
D% any type o# sports
((((($$% <hich o# the #ollowing statements is true aout anticoagulants such as 7eparin
sul#ateB Anticoagulants:
A% prevent arterial lood clots%
"% prevent venous lood clots%
9% dissolve e!isting lood clots%
D% decrease leeding time%
((((($)% A nurse has #our patients% <hich o# the #ollowing patients should not receive
7eparin sul#ateB The patient with
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A% hemorrhagic stro,e
"% pulmonary emolism
9% myocardial in#arction
D% disseminated intravascular coagulation
((((($*% 7eparin sul#ate can e given in which o# these routesB @elect all that apply%
A% intramuscular route
"% sucutaneous route
9% intravenous route
D% intradermal route
((((($% +# heparin is given y inJection' which among these sites
will the nurse use to administer the medicationB
A% Lateral aspect o# upper arm
"% Adominal area
9% Cuter aspect o# the thigh
D% =luteal area
((((($.% The nurse is accurate in preparing and administering
heparin inJection i# she
A% Uses a $-ml syringe with )$ gauge needle
"% +nJects the needle at a .-34 degree angle #rom the s,in
9% Aspirates the medication prior to inJecting the drug
D% Massage the inJection site a#ter giving the drug
((((($/% An important nursing consideration #or patients ta,ing
heparin is to
A% Administer other medications y intramuscular inJections
"% Monitor prothromin time and complete lood count
9% Assess #or signs and symptoms o# leedingD% Restrict #luid inta,e and activity level
((((($0% <hat is the mechanism o# action o# <ar#arin sodium
@9oumadinB
A% +t inhiits the hepatic synthesis o# Gitamin H%
"% +t prevents the conversion o# #irinogen into #irin%
9% +t dissolves any e!isting lood clots%
D% +t prevents platelet aggregation%
((((($1% A patient ta,ing <ar#arin sodium @9oumadin has an +R o# .%% The antidote o#
<ar#arin sodium @9oumadin is:
A% Protamine sul#ate"% Gitamin H
9% trepto,inase
D% Gitamin ")
((((($3% To determine the e##ectiveness o# 9oumadin therapy' the
nurse should evaluate the patient;s @elect all that apply
A% Prothromin time @PT
"% +nternational normali6ed ratio @+R
9% Partial thromoplastin time @PTTK
D% Activated partial thromoplastin time @aPTT
((((($.4% A patient is on 7eparin drip at $) cc8hr on a .4-04
protocol% The latest laoratory result shows an aPTT level o# 01
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seconds% The nurse;s most appropriate action ased on an ordered
protocol is to:
A% Do nothing since it is within therapeutic range
"% +ncrease the rate and chec, aPTT a#ter / hours
9% Decrease the rate and chec, aPTT a#ter / hours
D% 9all the physician and reFuest #or another aPTT level
((((($.$% A patient is admitted in the emergency room with chest pain and di##iculty
reathing% The nurse reviews the patient;s medical record and #inds that the patient has a
=reen#ield #ilter% The nurse ,nows that the patient has a history o#
A% 9CPD
"% Pulmonary emolism
9% Lung cancer
D% "ronchial asthma
((((($.)% A patient complains o# #atigue' dyspnea' hemoptysis and cough% A transronchial
iopsy reveals a noncaseating granuloma% This indicates the presence o#
A% pulmonary tuerculosis"% sarcoidosis
9% pneumoconioses
D% pneumonia
((((($.*% A patient presents to the clinic with lac,-colored sputum% The nurse should ta,e
the history y as,ing which relevant FuestionB
A% ><hat type o# #ood did you Just eatB?
"% ><hat type o# wor, do you doB?
9% >7ow many pac,s o# cigarette do you smo,e dailyB?
D% >Do you thin, that is loodB?
((((($.% A patient who is not a smo,er was shoc,ed to #ind out that he has lung cancer% Thenurse e!plains to the patient that other than smo,ing' ris, #actor #or lung cancer includes
A% diet low in #ruits and vegetales
"% living in the rural areas
9% e!posure to #resh air
D% educational attainment
((((($..% The pulic health nurse in#orms the community aout the early warning sign o#
lung cancer which is
A% chest pain
"% chronic cough
9% di##iculty reathing
D% hemoptysis
((((($./% A patient with di##use cancer o# the lungs needs to have his entire le#t lung
removed surgically% This procedure is called
A% segmental resection
"% wedge resection
9% loectomy
D% pneumonectomy
((((($.0% A patient with lung cancer is on chemotherapy% <hich o# the #ollowing
medications is an anti-neoplastic drugB
A% Do!oruicin @Adriamycin
"% +praptropium romide @Atrovent
9% pironolactone @Aldactone
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D% Montelu,ast sodium @Advair
((((($.1% ssential nursing interventions to promote airway clearance in a patient with lung
cancer include which o# the #ollowingB elect all that apply%
A% Deep reathing e!ercises
"% 9hest physiotherapy
9% uctioning
D% Administration o# ronchodilators
% "ronchoscopy
((((($.3% <hich o# the #ollowing assessments indicate that the nurse;s interventions #or a
patient with dyspnea due to lung cancer is e##ectiveB The patient or patient;s
A% ecomes restless and #idgety
"% respiration is ). per minute
9% pulse rate is 11 eats per minute
D% e!pectorates yellowish sputum
((((($/4% A 9CPD patient is scheduled to receive +pratropium romide @Atrovent inhalerFh prn% <hich o# the #ollowing is the e!pected physiological e##ect o# AtroventB
A% Reduces in#lammation in the respiratory tract
"% Promotes dilation o# respiratory passages
9% Prevents the release o# histamines
D% Reduces naso-pharyngeal secretions
((((($/$% Aminophylline @Theophylline is usually prescried among 9CPD patients in an
attempt to:
A% Reverse ronchospasms
"% Decrease respiratory secretions
9% Reduce ronchodilation
D% Decrease in#lammation in the lungs
((((($/)% The nurse is giving instructions to one o# her 9CPD
patients on actions and side-e##ects o# Acetylcysteine' @Mucomyst%
The nurse is correct i# she states:
A% >This medication helps loosen the secretions in your lungs%?
"% >This drug will ma,e you reathe easier y dilating your airways%?
9% >Eou will #eel di66y or sleepy a#ter ta,ing this medication%?
D% >This drug ma,es your mouth dry ecause it decreases oral secretions%?
((((($/*% A mother is as,ing Fuestions to her *-year-old son;s
nurse aout the newly prescried 9romolyn sodium @+ntal #or her
son;s asthma% <hich o# the #ollowing nurse;s statements accuratelyaddresses the mother;s concernB
A% >+t is the drug o# choice #or asthma caused y severe acute anaphyla!is%?
"% >+t is a potent ronchodilator there#ore easing respirations%?
9% >+t is e##ective as a preventive measure #or #uture asthmatic attac,s%?
D% >+t increases the e##ects o# histamine on the lungs%?
((((($/% A patient with 9CPD complains o# a sudden onset
di##iculty o# reathing% The nurse auscultates the patient;s reath
sounds and hears whee6ing sounds upon e!piration% <hich o# the
#ollowing group o# medications is e!pected to e administered to
help the patient reathB
A% Adrenergic loc,ing agents
"% anthine derivatives
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9% Leu,otreine synthesis inhiitors
D% 7istamine-type ) receptor antagonists
((((( $/.% Methylprednisolone @olu-medrol is one o# the
medications used in 9CPD management% The purpose o# giving this
is to
A% Reduce the in#lammatory process within the lung tissues
"% Prevent constriction o# the airways
9% Promote ma!imum dilation o# the ronchi
D% Decrease the e##ects o# histamine and leu,otrienes in the lungs
((((($//% A patient with 9CPD is receiving +soproterinol @+suprel'
a eta-$ and eta-) adrenergic agent% <hich o# the #ollowing should
the nurse watch out #or as a common side e##ect o# this medicationB
A% Decrease in the lood sugar
"% Reduction in the lood pressure
9% +ncrease in heart rate
D% +ncrease in nasal congestion