Respiratory Questions Answers and Rationale

1. An adult client is admitted for diagnosis and treatment of a left

lung lesion. A bronchoscopy was performed under local
anesthesia. What nursing action is of highest priority when he
returns following the bronchoscopy?

1. Collect all sputum for examination.2. Assess level of

consciousness frequently.3. Withhold food and fluids until gag
reflex has returned.4. Monitor blood pressure and pulse at 10
minute intervals.

2. A lower left lobectomy was performed on an adult client. He

was returned to his room following an uneventful stay in the
recovery room. It is most important for the nurse to

1. Encourage him to perform deep breathing and coughing

exercises.2. Assist him with arm exercises to prevent shoulder
ankylosis.3. Help him perform leg exercises to prevent
thrombophlebitis.4. Position him in semi-Fowler’s position on his
left side.

3. A client who has had a lobectomy returns to the nursing unit.

He has a chest tube attached to portable water seal drainage
system and oxygen per nasal cannula. The first nursing measure
concerning the water seal drainage is to

1. Milk the tubing to prevent accumulation of fibrin and clots.2.

Raise the drainage apparatus to bed height to accurately assess
the meniscus level.3. Attach the chest tubes to the bed linen to
assure that airflow and drainage are unhindered by kinks.4. Mark
the time and level of drainage in the collection chamber.

4. An adult client had a left thoracotomy. He has portable water

seal chest drainage. On the first postoperative day the fluid in the
water seal chamber stops fluctuating. What does this most likely
indicate?
1. The chest tube is clogged by fibrin or a clot.2. There is an air
leak in the system.3. Pulmonary edema has occurred due to
increased blood volumes in remaining lung tissue.4. The client’s
left lung has reexpanded.

5. An adult client had a left lower lobectomy. Passive exercises

are started on his left arm after surgery. The exercises are
designed to prevent

1. Hyperflexion of the wrist.2. Ankylosis of the shoulder.3. Flexion

contractures of the elbow.4. Spasticity of the intercostal muscle

6. An adult client is admitted to the acute care hospital with

bacterial pneumonia. On admission she was pale to dusky in
color. Her respirations were 32, temperature 1030F and pulse
110. Auscultation revealed decreased or absent lung sounds in
both bases and rhonchi in both upper lung fields. She was
oriented to person, time and place, but her responses were brief.
Oxygen per nasal cannula is started at 7 l / minute. IV antibiotics
were started. While checking the client one hour after admission
the nurse notes that she is less responsive, answering only yes or
no questions. Her respirations are somewhat more shallow and
have decreased to 27 per minute. What is the best INITIAL action
for the nurse to take?

1. Increase the IV infusion rate to increase the amount of

circulating antibiotics.2. Notify the physician of the client’s
changed mental status and await further orders.3. Increase the
oxygen flow rate to 10 liters / minute.4. Continue to stimulate her
until she responds appropriately.

7. A tracheostomy tube is inserted in a patient who is in

respiratory distress as a result of pneumonia. The family asks
why the tube is inserted. What should the nurse include when
explaining to the patient and family? The purpose of a
tracheostomy tube is to
1. Decrease the client’s anxiety by increasing the size of the
airway.2. Provide increased cerebral oxygenation thereby
preventing further respiratory depression.3. Facilitate nursing
care since tracheal tubes have fewer side effects than
nasotracheal tubes.4. Provide more controlled ventilation and
ease removal of secretions the client is unable to handle.

8. An adult is about to have a tracheostomy performed. Which

action is of highest priority for the nurse before the procedure is
done?

1. Establishing means of postoperative communication.2.

Drawing blood for serum electrolytes and blood gases.3. Inserting
an indwelling catheter and attaching it to dependent drainage.4.
Doing a surgical prep of the neck and upper chest wall.

9. The nurse is performing tracheal suctioning. Which action is

essential to prevent hypoxemia during suctioning?

1. Removal of oral and nasal secretions.2. Encouraging the client

to deep breathe and cough.3. Administer 100% oxygen before
suctioning.4. Auscultate the lungs.

10. An adult is admitted to the hospital with progressive dyspnea

on exertion, which has become increasingly severe during the
last six months. Physical examination reveals crackles at the
base of the lung and clubbing of fingers. The client has asbestosis
that has caused fibrosis in the alveoli. Soon after admission, the
nurse helps the client to the bathroom. Before he returns to bed,
he is very short of breath. Considering the severity of his
symptoms, it is essential for the nurse to include which of the
following in the plan of care.

1. Give continuous oxygen via nasal catheter.2. Allow the client

to move at his own pace.3. Give bronchodilators to increase his
ability to breathe.4. Keep the client in bed to prevent further
episodes of dyspnea.

11. An order is written for oxygen by nasal cannula at 2 liters per

minute. In assessing the adequacy of the oxygen therapy, which
of the following is most effective?

1. Checking the respiratory rate.2. Checking the color of mucous

membranes.3. Measurement of pulmonary functions.4.
Measurement of arterial blood gasses.

12. A client with asbestosis must see his doctor regularly for a
check up. What is the primary reason for him to have frequent
checkups?

1. Patients with asbestosis are at high risk for developing

bronchogenic cancer.2. His doctor is monitoring him closely to
look for signs of improvement.3. Patients who use low flow
oxygen for long periods are at high risk for developing
neurological symptoms.4. Periodic sputum samples are needed to
follow the progress of the disease.

13. An adult male has had a hacking cough and shortness of

breath for several months. He now has chest pain. His family has
pressured him into seeking medical consultation. He continues to
say, “It is just a smoker’s cough.” The physician examines the
client and arranges for hospital admission for a diagnostic work-
up. The nurse is explaining several types of tests that are
ordered. Which of these tests is most definitive in the process of
ruling out a malignancy?

1. Needle biopsy.2. Thoracentesis.3. Bronchogram.4. Sputum

analysis.

14. Preoperative teaching for the client who is to have a

pneumonectomy should include all of the following. Which is of
highest priority?
1. Management of postoperative pain.2. Turning, coughing and
deep breathing exercises.3. How to move with the least pain.4.
Leg exercises.

15. An adult client has just arrived in the recovery room following
a pneumonectomy. What is the most appropriate initial action for
the nurse?

1. Take his vital signs for baseline data.2. Check the IV solution
for rate and correct solution.3. Administer oxygen through an
appropriate device.4. Auscultate for the presence of breath
sounds.

16. What action is essential because the client had a

pneumonectomy?

1. Observe the tracheal position.2. Auscultate bilateral breath

sounds.3. Assess for hypertension.4. Assess for blood streaked
sputum.

17. The nurse is positioning an adult who has just returned to the
surgical nursing care unit following a pneumonectomy. What is
the most appropriate position in which to place the client?

1. Semi-Fowler’s on the unaffected side.2. Semi-Fowler’s on the

affected side.3. Sims position on the unaffected side.4. Semi-
Fowler’s on his back.

18. Which of the following nursing interventions should be

instituted the day after surgery for the client who has had a
pneumonectomy?

1. Provide range of motion exercises to affected arm.2. Strip

chest tubes every hour.3. Force fluids to 3500 cc / day.4. Monitor
intermittent positive pressure breathing therapy.

19. An adult has been diagnosed as having pulmonary

tuberculosis. Which test(s) would the nurse expect to be ordered
before the client is started on Isoniazid (INH) therapy?

1. LDH, SGOT (AST)2. BUN, serum creatinine3. Skin test for

allergy4. Chest X-ray
20. A patient is admitted with histoplasmosis. Which item in the
patient’s history is most likely related to the onset of the disease?
1. He works in a factory.2. He likes to explore caves.3. He has
three cats.4. He smokes four packs of cigarettes a week.

1. (3) Food and fluids should be withheld to prevent aspiration. The client will
have received a local anesthetic to block the gag reflex during the bronchoscopy.
The nurse should observe sputum for color but it is not necessary to collect it.
Bronchoscopy is usually done under a local anesthetic so level of consciousness is
not a priority. Vital signs may be monitored but preventing aspiration is of
highest priority.

2. (1) Deep breathing and coughing assume highest priority after a thoracotomy.
Arm and leg exercises are also important. He would be positioned in semi-
Fowler’s position on his right side (nonoperative).

3. (4) It is important to monitor the amount of chest drainage. Chest tubes are
milked only if there is an obstruction in the tubing and only with a physician’s
order. The chest drainage system should not be raised above chest level. It
should remain low. Chest tubes should not be attached to the linens.

4. (1) Fibrin and clots will obstruct the outflow of air from the patient’s thoracic
cavity. It is too soon for the lung to have reexpanded. An air leak in the system
would cause an absence of bubbling in the suction control chamber not the water
seal chamber.

5. (2) The muscles have been cut during surgery. Range of motion exercises will
help to prevent ankylosis of the shoulder or frozen shoulder. Patients also tend to
splint incisional discomfort by limiting movement on the affected side.

6. (2) Changes in mental status are always significant. Since her respirations
are decreasing it is doubtful if oxygen would be effective.

7. (4) This is the purpose of a tracheostomy. The client may become less
anxious when she is no longer hypoxic. However, relief of anxiety is not the
purpose of a tracheostomy tube.

8. (1) A tracheostomy makes a client unable to speak. Other means of

communication will be necessary.
9. (3) 100% oxygen is given before and after suctioning to prevent hypoxemia.

10. (2) The client is best able to evaluate his symptom of dyspnea. When he
wants to rest, he should be allowed to rest. #1 is not correct. Oxygen may be
ordered, but is often ordered PRN. A nasal cannula is usually ordered. #3 is not
an independent nursing action. #4 is not correct. The client will be allowed to do
as much as he is able to prevent complications of bedrest. The day should be
planned so that periods of exertion are followed by periods of rest.

11. (4) Arterial blood gasses give the most specific information of the adequacy
of the oxygen therapy. #1. The respiratory rate is a good measure but is not the
best measure. #2. Color changes in the mucous membranes are a late sign of
hypoxemia. #3. Pulmonary function tests are used to evaluate pulmonary
function.

12. (1) This is true. The doctor is looking for a change in cough, hemoptysis,
weight loss, etc. #2. The asbestos fibers in the lungs cannot be removed and the
fibrosis is not reversible. Improvement is not expected. #3. is not correct. #4,
sputum production is not a characteristic of this disorder. Also, sputum does not
give information about the progress of the fibrosis.

13. (1) Needle biopsy of the lungs detects peripherally located tumors. It
provides a firm diagnosis in 80% of cases.

14. (2) Turning coughing and deep breathing help to prevent the most frequent,
most life threatening complication likely to occur after thoracic surgery. The
others are important and should be done.

15. (3) An oxygen source is of highest priority as the client is likely to be

hypoventilating due to the effects of anesthesia. Oxygen will prevent hypoxia.
After starting oxygen the nurse will make all of the other assessments.

16. (1) Tracheal shift can occur following pneumonectomy. Tracheal shift would
compromise the client’s unaffected lung. There will be no breath sounds on the
operative sounds. He has only one lung after a pneumonectomy. Hypotension,
not hypertension, is a major sign of hemorrhage. The sputum will probably not be
bloody, as the remaining lung was not operated on. A small amount of blood
streaked sputum could be the result of intubation during surgery.

17. (4) Semi-Fowler’s on the back will neither cause mediastinal shift nor cause
hemorrhage at the pulmonary artery stump site. Positioning the client on his
 affected side could cause hemorrhage at the pulmonary artery stump site.
Positioning the client on his unaffected side could cause mediastinal shift.

18. (1) Range of motion exercises should be started within 4 hours of surgery to
prevent adhesion formation. Intermittent positive pressure breathing therapy will
not be used as the pressure could interrupt the suture line. Most physicians do not
insert chest tubes in these clients, as the fluid is allowed to accumulate and
eventually consolidate in the space. An increased fluid load could lead to
respiratory compromise.

19. (1) Liver function tests, SGOT (AST) and LDH would be performed to serve
as baseline. Liver toxicity can occur with INH. Renal function tests, BUN and
serum creatinine are essential in persons who are receiving streptomycin therapy.
There is not a skin test for allergy to INH. A chest X-ray will have been done as
part of the diagnostic process but is not necessary again before starting INH
therapy.

20. (2) Histoplasmosis is caused by a fungus that grows in chicken and bat
manure. Bats live in caves. Exploring caves is a likely source of exposure to the
fungus. Choice 1, working in a factory, might be related to COPD if the factory
had emissions. Choice 3 would be a possible source of toxoplasmosis, not
histoplasmosis. Choice 4 is not related to histoplasmosis although it could be
related to other respiratory diseases.