Resp Assessment Questions

Question 1

Which of the following is true about changes in the respiratory system associated with aging? (Select all that apply)
A.Exercise tolerance decreases
B.Respiratory muscle strength increases
C.Cough reflex increases
D.Airways lose cartilage and elasticity
E.Response to hypoxia and hypoxemia decreases
F.Vocal cords become stronger

Answer 1

Answer: A, D, E
With aging - get worse
Diminished cough reflex- might make higher risk for infections
Response to hypoxic and low O2 in bloodstream and tissues - body has less ability to react to that as age - bad thing

Question 2

The nurse is inspecting a patient’s chest and observes an increase in anteroposterior diameter of the chest. When is this an expected finding?
A. In older adults
B. With a pulmonary mass
C. Upon deep inhalation
D. With chest trauma

Answer 2

Answer: A
Anteroposterior Diameter - front and back; increasing with older adults - as age airways lose cartilage and elasticity - so do alveoli and so trap air in base of lungs and as do that have hyperinflation and that increases anteroposter diameter vs lateral; typ lateral than anteroposterior and as age anteroposterior increases and get barrel chest - increase in anteroposterior diameter vs lateral because trap air in base of lungs; not much elasticity and not able fully exhale all residual lung volume

Question 3

Increased vascular resistance - as pumping blood through pulm vasculature more resistance and makes it harder
Decreased pulmonary capillary flow - not much cap flow in alveoli: not getting as much blood supply to alveoli so not good gas exchange
Decreased function of cilia - cilia hairs along airway; not functioning as well not help get rid bacteria, toxins, or allergens; also happens if smoke - paralyzes cilia
Decreased alveolar surface area - also happen with chronic lung disease: emphysema; messes up alveoli and not as many alveoli and less SA and less exchange gases
Decreased elastic recoil - because that increases RV
Increased residual lung volume - More air left in base airways when exhale
Decreased vital capacity
Decreased gas exchange
Increase in AP diameter of chest wall (barrel chest)
All bad things happen when age

Answer 3

What are some other changes associated with aging?

Question 4

A patient reports smoking a pack of cigarettes a day for 9 years. He then quit for 2 years, and then smoked 2 packs a day for the last 30 years. What are the pack-years for this patient?
A. 19.5 years
B. 39 years
C. 41 years
D. 69 years

Answer 4

Answer: D
When Assess for resp func assess if smoke and if do/did ask how many years and how often and calc pack-years
Number years smoked x packs/day

Question 5

Allergies
Drug use
Cough
Skin - clubbing (tell if have chronic hypoxia), cyanosis (late sign of having trouble with breathing); gray like if chronically hypoxic
Endurance/ADLs
Anxiety
Lung sounds
Respiratory rate and effort - fast/slow; deep/shallow
How much smoke
Environmental exposures to inhaled toxins etc
History of resp disease
Surgeries on lungs
On O2
Ever SOB - when experience it
What sputum looks like - one most imp assessments can do for pats with resp issues because gives lots info; thick, color, foamy (concerned about fluids), odor, blood; if have infection; clearing - hard time or not
Have cough - anything up and what looks like
Listen to lungs in all areas
Look to see if have signs of labored breathing - using accessory muscles

Answer 5

What are some other imp assessments specific to respiratory

Question 6

Productive, non-productive, color, amount, etc.

Answer 6

Cough

Question 7

in blood; hypoxemia - decrease O2 in bloodstream - bad - reverse this before get to hypoxia; hypoxia - decreased O2 in tissue - see cyanosis - decreased blood supply and tissues affected - see peripheral first but if central big prob

Answer 7

Emia -

Question 8

Which assessment finding is an objective sign of chronic oxygen deprivation?
A. Continuous cough productive of clear sputum
B. Clubbing of fingernails and a barrel-shaped chest
C. Audible inspiratory and expiratory wheeze
D. Chest pain that increases with deep inspiration

Answer 8

Answer: B
Barrel-chest - more telling chronic retention of residual lung volume
Clubbing also on tip of fingers
Clear sputum - allergy
Wheeze - asthma
Deep inspiration - pleuritic type pain; pneumonia pats - pleural lining irriatated by inflammation in legs and cause pain with inspriation

Question 9

A patient reports fatigue and shortness of breath when getting up to walk to the bathroom; however, the pulse oximetry reading is 99%. The nurse identifies a diagnosis of activity intolerance. Which laboratory value is consistent with the patient’s subjective symptoms?
A. Hemoglobin of 9 g/dL
B. BUN of 15 mg/dL
C. White blood cell count (WBC) of 8000/mm3
D. Glucose 160 mg/dL

Answer 9

Answer: A
Hgb - 12-18; is low; Hgb carries O2; factors affect oxygenation: decreased O2 carrying capacity - low Hgb or low blood volume able not carry enough O2 to tissues; decreased activity tolerance and fatigue because not enough O2 tissues
BUN - normal; 10-20
WBC - 5000-10000
Glucose - high - not affect oxygenation; 70-110

Question 10

Sputum
White Blood Cell count (WBC) with Diff
Arterial blood gases (ABG)
Chest x-rays
CT Chest (computerized tomography)

Answer 10

What are some other labs and imaging assessments to eval?

Question 11

Culture and sensitivity
Cytology
Sputum culture - with pneumonia do this; broad spectrum antibiotics get culture and sensitivity narrow down if can get them; sometimes cannot get them if not a productive cough; can induce because so imp - saline breathing treatment, suction them; very imp

Answer 11

Sputum

Question 12

Indication of infection
WBCs - lot times have resp infections so want see if WBC is elevated

Answer 12

White Blood Cell count (WBC) with Diff

Question 13

Data on oxygenation as well as acid base balance
Blood gas - come in with resp sys - do this first

Answer 13

Arterial blood gases (ABG)

Question 14

Very common diagnostic tool
Typically one of the first tools
CXR - come in with resp sys - do this first

Answer 14

Chest x-rays

Question 15

With contrast or without
CT scan - not first; CXR do this and something odd; eval PE do CT angiogram first

Answer 15

CT Chest (computerized tomography)

Question 16

What is a pulse oximeter used to measure?
A. Oxygen perfusion in the extremities
B. Pulse and perfusion in the extremities
C. Hemoglobin saturation
D. Generalized tissue perfusion

Answer 16

Answer: C
Literally measuring Hgb saturation - how much O2 on that Hgb; affected by perfusion of extremities; if Raynaud’s or disease where not get good circ to extremities and put on there not read accurate because affected by perfusion to tissues but mreasuring is how well Hgb saturated with O2
What are the normal values? 95-100%

Question 17

Capnometry and Capnography
Pulmonary function tests (PFTs)
Exercise testing - not done frequently
Skin tests

Answer 17

What are some noninvasive diagnostic tests?

Question 18

Measuring how much CO2 exhaling - very effective tool eval how breathing/RR; effectiveness of respirations; know as breathe in, exchange O2 and CO2, breathe out higher level CO2 than what breathe in; hypoventilating and not breathing as effectively have high levels inhaled CO2 exhalation; ventilators can check; use frequently to check for resp depression - worried about this when on lot opioids to see if too sedated on opioids because much more effective - see decrease CO2 before decrease in O2; cannulas - tools that measure it that attach to it

Answer 18

Capnometry and Capnography

Question 19

Evaluate for Restrictive and obstructive lung disease
Send to RTs/lab - PFTs before bronchodilator and check after given; diagnose asthma, emphysema, chronic bronchitis; measuring exhalation; checking for restriction/obstruction in airway when try exhale not get good volume exhalation out - restrictions in airway harder exhale
Measuring how quickly/much exhale
Forced vital capacity (FVC)
Forced expiratory volume (FEV1)
Peak expiratory flow (PEF)

Answer 19

Pulmonary function tests (PFTs)

Question 20

Volume of air exhaled from full inhalation to full exhalation
Full inhalation and exhalation

Answer 20

Forced vital capacity (FVC)

Question 21

Volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest inhalation
Take deep breath in and push out hard and fast as can and measure in 1st second; this will slowly decrease down as go along
Use age and height for avg should be - %

Answer 21

Forced expiratory volume (FEV1)

Question 22

Fastest airflow rate reached at any time/point during exhalation

Answer 22

Peak expiratory flow (PEF)

Question 23

Allergy testing
Tuberculin skin testing
Done commonly
Checking for rxns - ID - see if body reacting; looking for local rxn

Answer 23

Skin tests

Question 24

The nurse is caring for several patients who had diagnostic testing for respiratory disorders. Which diagnostic test has the highest risk for the post procedure complication of pneumothorax?
A. Bronchoscopy
B. Laryngoscopy
C. Computed tomography of lungs
D. Lung biopsy

Answer 24

Answer: D
Pneumothorax - Air trapped in pleural space - very little space between pleural lining and lungs - if puncture lungs air seep out lungs into cavity and lung will deflate and space fill with air
Bronchoscopy increased risk for it but lung biopsy much higher risk - puncturing out lung tissue; much more likely have needle go too far and cause it; bronchoscopy - also put at risk - visual scope into airways and could easily puncture lung but not as likely as lung biopsy; both procedures get CXR after and monitor for s/s of it
Laryngoscopy less likely - scope to larynx so not not likely

Question 25

After a bronchoscopy procedure, the patient coughs up bright red blood. What is the best nursing action at this time?
A. Assess vital signs and respiratory status and notify the provider of the findings
B. Monitor the patient for 24 hours to see if blood continues in the sputum
C. Send the sputum to lab for cytology for possible lung cancer
D. Reassure the patient this is a normal response after a bronchoscopy

Answer 25

Answer: A
Make sure no trauma from bronchoscopy - diagnostic and intervention and remove object from airway
Risk factors: pneumothorax, bleeding and perforation
Intervention and diagnostic, remove: get biopsy because saw something have little bit bleeding - blood tinge speeding; key is coughing up bright red blood - indicates it is fresh new blood; monitor it and VS and BP and things altered if large amount of blood; not ignore it and notify provider; not norm response
Assess always good option

Question 26

What is the best position for a patient to assume for a thoracentesis?
A. Side-lying, affected side exposed, head slightly raised
B. Sitting up, leaning over a bedside table
C. Lying flat with arm on affected side across the chest
D. Prone position with arms above the head

Answer 26

Answer: B
Expands area and safer position
Thoracentesis - Pleural space - collect air/fluid - chronic heart failure/cancer/trauma - fluid builds up in cavity instead of air so put in needle and drain it out so lung can reinflate
Often do in interventional radiology and do US while doing it so really safe; see on scan and do it

Question 27

A patient is recovering after laryngoscopy and bronchoscopy. Which of the following is important to assess in the immediate post-procedure phase of recovery? (Select all that apply)
A.Vital signs
B.Level of consciousness
C.Breath sounds
D.Chest X-ray
E.Presence of bleeding
F.Ability to talk
G.Gag reflex

Answer 27

Answer: A, B, C, D, E, F, G
LOC - some type of anesthesia; something in throat; early sign of hypoxia
BS - hear if air in pleural cavity; diminished or nothing because air not moving out
Ability of talk - go right past vocal cords with laryngoscopy and bronchscopy
Gag reflex - tube down throat and numbed airway before do scope

Question 28

With all have sedation/anesthesia
Larygoscopy
Mediastinoscopy
Bronchoscopy

Answer 28

Endoscopic exams

Question 29

Scope inserted into larynx to assess the function of the vocal cords
Checking function of vocal cords
Uses:

Answer 29

Larygoscopy

Question 30

remove foreign bodies caught in the larynx
obtain tissue samples for biopsy or culture - May take biopsy
Patients receive sedation

Answer 30

Uses: - Larygoscopy

Question 31

Examine for tumors
Obtain tissue samples for biopsy or culture

Answer 31

Uses: - Mediastinoscopy

Question 32

Insertion of a flexible tube through the chest wall just above the sternum into the area between the lungs - do Biopsy above sternum
Uses:
Performed under general anesthesia

Answer 32

Mediastinoscopy

Question 33

Insertion of a tube in the airways, usually as far as the secondary bronchi; down into bronchi
Uses:
Nursing Interventions Post Procedure:

Answer 33

Bronchoscopy

Question 34

View airway structures to check
Obtain tissue samples for biopsy or culture - big one
Remove excessive secretions or foreign bodies - Full secretions do therapeutic can remove a lot via this way if too much
Assist with placing or changing endotracheal tube - intubated and diff - do this as a guide

Answer 34

Uses: - Bronchoscopy

Question 35

Monitor VS, O2 saturation, and breath sounds every 15 min for 2 hours
Frequent monitoring as would with anesthesia/anesthesia
Airway protection -
Assess for possible complications of bleeding, infection or hypoxemia; Pneumonorthoax as well; infection not immediate - s/s not immediate but monitor for it after anything invasive

Answer 35

Nursing Interventions Post Procedure: - Bronchoscopy

Question 36

Needle aspiration of pleural fluid or air from the pleural space for diagnostic or management purposes
Nursing Interventions Post Procedure

Answer 36

Thoracentesis

Question 37

Often performed at the bedside; often times go to IR
Local anesthetic agent to numb area
Help to position patient
Stress the importance not to move, cough, or deep breath during the procedure since not sedated
Not sedated
Numb around the site
Lung inflated - suck all fluid no more than 1 L off and common have nagging cough because lung reinflating

Answer 37

Needle aspiration of pleural fluid or air from the pleural space for diagnostic or management purposes - Thoracentesis

Question 38

CXR to rule out possible pneumothorax (can occur within 24 hours)
Monitor VS, lung sounds, bleeding at puncture site
Not as concerned about resp depression because not undr sedation

Answer 38

Nursing Interventions Post Procedure - Thoracentesis

Question 39

Performed to obtain tissue for histologic analysis, culture, cytologic examination
May be performed:
Nursing Interventions Post Procedure:

Answer 39

Lung biopsy

Question 40

Done variety ways
In the radiology department with the help of fluoroscopy or CT guided
In the OR if an open biopsy is required under general anesthesia - surgery
Through a bronchoscopy
depends on provider

Answer 40

May be performed: - Lung biopsy

Question 41

CT or CXR to rule out pneumothorax - big risk factor for this
Follow-up care:

Answer 41

Nursing Interventions Post Procedure: - Lung biopsy

Question 42

Assess vital signs, breath sounds at least every 4 hours for 24 hours
Assess for respiratory distress
Report reduced/absent breath sounds immediately
Monitor for hemoptysis
Checking for VS, respiratory distress, bleeding

Answer 42

Follow-up care: