MS 1 Final Exam Review - Respiratory

Question 1

The nurse will instruct a patient with asthma to perform the steps for using a peak flow meter in which order?

1. Take a deep breath.
2. Place the mouthpiece in your mouth.
3. Blow out as hard and fast as you can.
4. Move the indicator to the bottom of the numbered scale.

Answer 1

1. Move the indicator to the bottom of the numbered scale.
2. Take a deep breath.
3. Place the mouthpiece in your mouth.
4. Blow out as hard and fast as you can.

Question 2

Which instruction will the nurse give to a patient who has a prescription for beclomethasone?

1 Use this medication only PRN.
2 Rinse mouth thoroughly after each use.
3 Use the inhaler at the onset of an asthma attack.
4 Avoid use of a spacer to increase the amount of medication absorption.

Answer 2

2 Rinse mouth thoroughly after each use.

Inhaled corticosteroids can cause oral candidiasis, which can be prevented through rinsing the mouth with water or mouthwash after each use. This medication should be used on a schedule, not PRN. Beclomethasone is used to prevent asthma attacks and would not be used to treat dyspnea in an acute attack. A spacer is frequently used with beclomethasone to improve dispersion of the medication into the lungs.

Question 3

The nurse provides care for a patient who has a chest drainage unit (CDU) in place. Which assessment finding indicates the need for the nurse to contact the health care provider immediately?

1 The drainage is clear.
2 The drainage is 120 mL/hr.
3 The water level in the suction control chamber is at the 20-cm mark.
4 The water level in the water-seal chamber is at the 2-cm mark.

Answer 3

2 The drainage is 120 mL/hr.

The normal flow of drainage is below 100 mL/hr. Fluid level drainage of 120 mL/hr indicates excessive drainage or/and increases the risk of further complications, and this requires the immediate attention of the health care provider. The presence of yellow or bloody fluid would indicate that the patient may have complications; however, the fluid is clear, indicating no risk of injury or infection. While adjusting the chest drainage tube, the nurse should ensure that the water level in the suction chamber is 20 cm and that in the water-seal chamber is 2 cm. This will ensure that the suction is appropriate.

Question 4

Following a bronchoscopy, a patient must present with which assessment finding before beginning oral intake of food and fluids?

1 Stable vital signs
2 Return of gag reflex
3 Brisk pupil reaction to light
4 Clear bilateral breath sounds

Answer 4

2 Return of gag reflex

A patient who is given food or fluid before the gag reflex returns may aspirate food or drink and possibly experience respiratory distress as a result. Vital signs, pupil reaction, and breath sounds are routine assessments after a procedure such as a bronchoscopy, but they are secondary to assessing the patient for the return of the gag reflex.

Question 5

Which immediate action does the nurse take when discovering that a patient’s chest tube is disconnected from the chest drainage unit (CDU)?

1 Apply a clamp to the distal end of the chest tube.
2 Place the patient in a supine position.
3 Wrap a petroleum (airtight) gauze over the end of the chest tube.
4 Immerse the distal end of the chest tube in sterile water.

Answer 5

4 Immerse the distal end of the chest tube in sterile water.

If the drainage system breaks, the nurse should place the distal end of the chest tubing connection in a sterile water container at a 2-cm level as an emergency water seal. This will reduce the risk of air entering the pleural space. Applying a clamp to the tube will accumulate fluid or air in the pleural space. There is no information given related to respiratory status to determine correct patient positioning. Wrapping a petroleum (airtight) gauze over the end of the chest tube will accumulate fluid or air in the pleural space.

Question 6

Which chest palpation finding is a medical emergency?

1 Increased tactile fremitus
2 Trachea moved to the left
3 Decreased tactile fremitus
4 Diminished chest movement

Answer 6

2 Trachea moved to the left

Tracheal deviation is a medical emergency when it is caused by a tension pneumothorax. Tactile fremitus increases with pneumonia or pulmonary edema and decreases in pleural effusion or lung hyperinflation. Diminished chest movement occurs with barrel chest, restrictive disease, and neuromuscular disease.

Question 7

Which action would the nurse include when suctioning a patient’s tracheostomy tube?

1 Suction for five minutes at a time.
2 Oxygenate for 30 seconds after suctioning.
3 Adjust the suction pressure to 140 to 150 mm Hg.
4 Insert the suction catheter until meeting resistance.

Answer 7

2 Oxygenate for 30 seconds after suctioning.

The nurse should supply oxygen for 30 seconds after suctioning and before starting the next suction to prevent hypoxemia. To avoid hypoxemia, suctioning should be performed for a short period, such as for 10 to 15 seconds. Suction pressures should not exceed 125 mm Hg with the tubing occluded. To avoid trauma to the carina, the suction catheter should be inserted only until the patient coughs.

Question 8

A sputum study will help diagnose which condition?

1 Asthma
2 Lung cancer
3 Bacterial lung infection
4 Chronic obstructive pulmonary disease

Answer 8

3 Bacterial lung infection

A sputum study is often used to diagnose bacterial lung infection via culture and sensitivity results. Sputum studies are not used to diagnose asthma, lung cancer, or chronic obstructive pulmonary disease.