Test Bank For Adult Health Nursing 6th Edition Christensen

Test Bank for Adult Health Nursing, 6th Edition:
Christensen
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ensen/
Test Bank for Adult Health Nursing, 6th Edition: Christensen
Chapter 09: Care of the Patient with a Respiratory Disorder
MULTIPLE CHOICE
1. Which nursing intervention does the nurse add to the care plan to help a patient with
thick sputum mobilize and expectorate those secretions?
a. Drink salty fluids such as broth and bouillon.
b. Drink 3 to 4 L of water a day.
c. Inhale cool mist from a vaporizer for 15 minutes four times a day.
d. Sit in a tub of hot water three times a day.
ANS: B
Encourage fluids to liquefy secretions and aid in their expectoration.
DIF: Cognitive Level: Analysis

REF: Pages 396, 423, Nursing Diagnoses boxes OBJ: 10
TOP: Secretions KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
2. The circulation of the lungs is through the

a. coronary arteries and coronary veins.
b. celiac arteries and celiac veins.
c. pulmonary arteries and pulmonary veins.
d. carotid arteries and jugular veins.
ANS: C
The lungs receive their blood supply, which comes directly from the heart, through the
pulmonary arteries. The blood, now rich in oxygen, is returned to the heart for
circulation to the body via the pulmonary veins to the left atrium.
DIF: Cognitive Level: Knowledge REF: Page 378 OBJ: 4

TOP: Circulation of the lungs KEY: Nursing Process Step: Assessment
3. A 52-year-old patient has had a laryngectomy in treatment of cancer. A nursing

diagnosis for the patient with a laryngectomy would be social isolation related to
impaired verbal communication related to removal of the larynx. The correct nursing
intervention would be
a. complete care quickly.
b. provide a pad and pencil or magic slate available.
c. refrain from conversations with the patient to reduce his stress level.
d. offer books or jigsaw puzzles for entertainment.
ANS: B
Provide patient with implements for communication. Rapidly completing care and
provision of solitary activities does not reduce social isolation.
DIF: Cognitive Level: Application REF: Page 390, Nursing Daignoses box
OBJ: 20 TOP: Cancer of larynx
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KEY: Nursing Process Step: Implementation
4. A 62-year-old patient is seen in the emergency department with an epistaxis. When a

patient has an epistaxis, the correct nursing interventions would be
a. place the patient in Fowler’s position with the head forward.
b. place the patient in low-Fowler’s position with the head hyperextended.
c. compress the nostrils tightly below the bone and hold for 1 minute.
d. place hot compresses over the nose.
ANS: A
Elevate head of bed. Place patient in Fowler’s position with the head forward.
Compression of nostrils should be for 10-15 minutes. Hot compresses will increase
bleeding-ice should be applied.
DIF: Cognitive Level: Application REF: Page 385, Nursing Diagnoses box
OBJ: 10 TOP: Epistaxis KEY: Nursing Process Step:
Implementation
5. A 68-year-old male patient has chronic obstructive pulmonary disease (COPD). He has a
markedly increased need for protein and calories to maintain an adequate nutritional
status. To help him get the nutrition he needs, the nurse would encourage him to
a. eat three meals a day.
b. rest 30 minutes before eating.
c. drink fluids only with meals.
d. perform bronchial drainage 30 minutes after eating.
ANS: B
The nurse can assist the patient in maintaining nutritional intake by advising rest for 30
minutes before eating.
DIF: Cognitive Level: Analysis REF: Pages 423, 426

OBJ: 18 TOP: Chronic obstructive pulmonary disease (COPD)
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
6. The patient, age 72, is admitted with acute pulmonary edema. In pulmonary edema, the
medical management will often include
a. IV infusion of D5LR at less than 30 mL/hr.
b. intravenous sodium.
c. supine position.
d. atropine to decrease respiratory rate.
ANS: A
Medications for acute pulmonary edema will include diuretics such as Lasix and a
narcotic analgesic, usually morphine sulfate. A patent IV line must be maintained,
usually at a very slow rate to keep the vein open for medication administration (i.e., 30
mL/hr) per infusion pump.
DIF: Cognitive Level: Analysis REF: Page 416 OBJ: 13

TOP: Pulmonary edema KEY: Nursing Process Step:
Implementation
7. An 83-year-old patient is admitted with a temperature of 102° F (38.8° C), chest pain,
and fatigue. The chest radiograph reveals an accumulation of fluid in the pleural space,
which the physician removes by performing a thoracentesis. The nurse correctly records
the purulent exudate as:
a. effusion.
b. emphysema.
c. sputum.
d. empyema.
ANS: D
If the fluid between the lung and the membrane lining the pleural cavity becomes
infected, it is called empyema.
DIF: Cognitive Level: Knowledge REF: Pages 406, 408

OBJ: 6 TOP: Empyema KEY: Nursing Process Step: Assessment
8. Which instruction by the nurse is inappropriate for teaching the proper technique for
collection a sputum specimen?
a. Bring the sputum up from the lungs.
b. Maintain adequate fluid intake.
c. Collect specimens after meals.
d. Notify the staff as soon as the specimen is collected so it can be sent to the
laboratory without delay.
ANS: C
Collecting specimens before meals will avoid possible emesis from coughing after
eating.
DIF: Cognitive Level: Application REF: Page 381, Box 9-2

OBJ: 8 TOP: Diagnostic procedures
9. The patient has been admitted for possible carcinoma of the larynx. The first sign or
symptom that may be present in carcinoma of the larynx is often
a. pain in the larynx.
b. hemoptysis.
c. persistent hoarseness.
d. dysphagia.
ANS: C
Progressive or persistent hoarseness is an early sign.

TOP: Cancer of larynx KEY: Nursing Process Step: Assessment
10. A patient, age 69, has emphysema. On assessing him, the nurse notes the presence of a
“barrel chest.” This pathology results from a(n)
a. increase in the lateromedial area from hypertrophy of mucous glands in the
bronchi.
b. increased anteroposterior diameter caused by overinflation of the alveoli.
c. decrease in anteroposterior diameter caused by chronic dilation of the bronchi.
d. widening of the sternocostal area secondary to chronic constriction of smooth
muscles in the airways leading to bronchospasms.
ANS: B
The patient will eventually appear barrel chested (an increased anteroposterior diameter
caused by overinflation).

TOP: Emphysema KEY: Nursing Process Step: Assessment
11. A patient, age 22, is admitted with acute asthma. It is important to monitor his oxygen
saturation levels. The quickest way to assess his saturation of oxygen is to
a. get arterial blood gases.
b. use pulse oximetry.
c. do a pulse pressure assessment.
d. do a pulmonary function test.
ANS: B
In acute asthma, oxygen therapy should be started immediately, and its administration
should be monitored by pulse oximetry. Pulse oximetry is noninvasive and provides
continuous monitoring of SaO2.
DIF: Cognitive Level: Analysis REF: Pages 384, 406, 427

OBJ: 10 TOP: Asthma KEY: Nursing Process Step: Assessment
12. The appropriate nursing intervention for a patient, age 40, who is diagnosed with active
tuberculosis would be to
a. place the patient in drainage and secretion precautions.
b. place the patient in acid-fast bacillus (AFB) isolation precautions.
c. maintain the patient in enteric isolation.
d. place the patient in any isolation precautions.
ANS: B
If TB is suspected, permission to place the patient in acid-fast bacilli (AFB) isolation
precautions should be requested immediately.
DIF: Cognitive Level: Analysis REF: Pages 400, 403, Nursing Diagnoses
box
OBJ: 13 TOP: Tuberculosis
MSC: NCLEX: Safe, Effective Care Environment
13. A patient, age 54, is on postoperative day 2 after undergoing an open cholecystectomy.
Immediately after the surgery, she vomited and may have aspirated some emesis. The
nurse is concerned that the patient will develop pneumonia. In planning for her care, the
nurse suspects the patient may have
a. bacterial pneumonia.
b. aspiration pneumonia.
c. viral pneumonia.
d. atypical pneumonia.
ANS: B
Aspiration pneumonia occurs most commonly as a result of aspiration of vomitus when
the patient is in an altered state of consciousness due to a seizure, drugs, alcohol,
anesthesia, acute infection, or shock.
DIF: Cognitive Level: Application REF: Page 404 OBJ: 12

TOP: Pneumonia KEY: Nursing Process Step: Planning
14. The patient, age 91, has COPD and complains of dyspnea and fatigue. Activity
intolerance, related to an imbalance between the oxygen supply and demand, is a nursing
diagnosis for COPD. Which nursing intervention would be inappropriate?
a. Teach pursed-lip breathing.
b. Provide oxygen therapy as ordered.
c. Plan care to provide optimum rest.
d. Provide a cool shower.
ANS: C
Nursing interventions will be directed at attempting to decrease the patient’s anxiety and
promote optimal air exchange. The nurse should allow sufficient rest periods and should
assist the patient in activities of daily living.
DIF: Cognitive Level: Application REF: Page 423, Nursing Diagnoses box
15. A patient is on postoperative day 4 after undergoing a total hip replacement. He is

diagnosed as having a pulmonary embolism. Pulmonary embolism may occur as a
postoperative complication of
a. arterial thrombosis.
b. venous thrombosis.
c. shallow, ineffective respirations.
d. rapid infusion of intravenous fluids.
ANS: B
Venous status, venous wall injury, and increased coagulability of blood cause the
formation of a venous thrombosis. The thrombus (usually in the deep veins of the lower
extremities) dislodges and travels through the venous circulation; it passes through the
right side of the heart and enters the pulmonary artery, where it becomes lodged.
DIF: Cognitive Level: Comprehension REF: Page 417 OBJ: 22
TOP: Pulmonary embolism KEY: Nursing Process Step: Assessment
16. The patient has COPD. To teach him pursed-lip breathing, the nurse should instruct him
to inhale slowly through his
a. mouth, then exhale quickly through pursed lips.
b. nose, then exhale more slowly through pursed lips.
c. mouth, then make his exhalation last three times as long as his inhalation.
d. nose, making his inhalation last three times as long as his exhalation.
ANS: B
The nurse should instruct the patient and family on effective breathing techniques (such
as pursed-lip breathing) and relaxation exercises for anxiety control. The patient should
inhale through the nose and exhale through pursed lips. The exhalation should be 2 – 3
times longer than the inhalation.

TOP: Chronic obstructive pulmonary disease (COPD)
17. A patient, age 68, has a long history of COPD and is admitted to the hospital with cor
pulmonale. He says his doctor said his heart was failing and asks whether he is having a
heart attack. Which explanation by the nurse is most correct?
a. “You aren’t having a heart attack, but your heart has been damaged by changes in
your lungs caused by your respiratory disease.”
b. “It could be a heart attack, and when the heart is damaged it causes respiratory
damage, too.”
c. “It isn’t a heart attack, but your heart has gradually weakened over the years,
causing respiratory disease.”
d. “It is probably a heart attack, since cor pulmonale means that the heart isn’t getting
enough blood and becomes too weak to pump effectively.”
ANS: A
COPD can lead to cor pulmonale, an abnormal cardiac condition characterized by
hypertrophy of the right ventricle of the heart as a result of hypertension of the
pulmonary circulation. Cor pulmonale results in the presence of edema in the lower
extremities as well as in the sacral and perineal area, distended neck veins, and
enlargement of the liver with ascites.

TOP: Chronic obstructive pulmonary disease (COPD)
18. The nurse identifies a nursing diagnosis of Ineffective airway clearance for a patient, age
64, who has undergone a pneumonectomy. A common etiology for this nursing
diagnosis in patients who have had a pneumonectomy is
a. thick, copious secretions.
b. surgical incision pain.
c. presence of chest tubes.
d. mechanical ventilation.
ANS: B
Nursing interventions are often directed at postsurgical interventions, including
facilitating recovery and preventing complications by promoting effective airway
clearance through frequent repositioning, coughing, and deep breathing. Surgical
incisional pain prevents the patient from breathing deeply and coughing effectively.

TOP: Pneumonectomy KEY: Nursing Process Step: Planning
19. The surgeon administers nasal epinephrine to a patient after nasal surgery. The nurse
explains to the patient that this is done primarily to
a. anesthetize the nares.
b. reduce the possibility of bleeding.
c. enhance respiration
d. dry up the nasal mucus.
ANS: B
1:1,000 epinephrine promotes local vasoconstriction and reduced the possibility of
bleeding. Epinephrine does act as a bronchodilator, but is used primarily for
vasoconstriction post nasal surgery.
DIF: Cognitive Level: Application REF: Pages 385, 392, Table 9-3
OBJ: 10 TOP: Nasal surgery
20. Which position is the most beneficial for a patient after surgery for creation of a
tracheostomy?
a. Trendelenburg
b. Dorsal recumbent
c. Lithotomy
d. Mid-Fowler’s
ANS: D
Maintain head of bed elevation of 30 degrees or higher (mid-Fowler’s).

TOP: Tracheostomy KEY: Nursing Process Step:
Implementation
21. Prevention of acute respiratory complications in surgical patients is a nursing goal that
involves which intervention?
a. Obtaining baseline pulmonary function tests for all preoperative patients.
b. Teaching all preoperative patients how to use incentive spirometers and how to
cough and deep breathe effectively.
c. Obtaining baseline arterial blood gases for all preoperative patients over the age of
65.
d. Keeping at-risk patients in an upright position during the postoperative course.
ANS: B
Postoperatively, patients should be reminded to cough, deep breathe, and change
positions every 1 to 2 hours.
DIF: Cognitive Level: Application REF: Pages 404, 411, Health Promotion
box
OBJ: 7 TOP: Postoperative complications
22. During discharge teaching of a pulmonary emphysema patient who is going home with
oxygen, what does the nurse emphasize?
a. “Use the oxygen only when you experience shortness of breath.”
b. “Use the maximum amount of oxygen that this unit will deliver.”
c. “Use the oxygen only when exercising.”
d. “Keep low flow oxygen at 1 to 2 L by nasal cannula.”
ANS: D
Low-flow oxygen therapy is required for patients with COPD, because higher oxygen
concentrations depress the body’s own respiratory regulatory centers.
DIF: Cognitive Level: Application REF: Pages 423, 430-431, Key Points
23. What does a nurse teach an adult male who has had a tonsillectomy?
a. Eat solid food during the first 24 hours.
b. Do not eat or drink anything for the first 24 hours.
c. Apply a heating pad to the neck during the first 24 hours.
d. Avoid coughing and clearing the throat during the first week postoperatively.
ANS: D
The nurse should teach the patient to avoid attempting to clear the throat immediately
after surgery and to avoid coughing, sneezing, or vigorous nose blowing for 1 to 2
weeks. Maintain IV fluids until the nausea subsides, at which time the patient may begin
drinking ice-cold clear liquids. The diet is advanced to custard and ice cream and then to
a normal diet as soon as possible. Apply an ice collar to the neck for comfort and to
reduce bleeding by vasoconstriction.

TOP: Tonsillectomy KEY: Nursing Process Step:
Implementation
24. The nurse is caring for a patient with bronchiectasis. Based on an understanding of the
pathologic changes that occur with this disease, which intervention to promote clearance
of respiratory secretions does the nurse plan?
a. Postural drainage
b. Intermittent positive pressure breathing
c. Pursed-lip breathing
d. Diaphragmatic breathing
ANS: A
Encourage postural drainage. Suction the patient as needed and provide assistance in
turning, coughing, and deep breathing every 2 hours. Assist with chest physiotherapy.

TOP: Bronchiectasis KEY: Nursing Process Step:
Implementation
25. Which test is a quick and reliable aid to diagnosis latent TB?
a. PPD skin test
b. Sputum smears
c. QFT-G
d. TB tine test
ANS: C
Sputum smears, cultures and PPD skin test are still done. However, QFT-G offers a
quick and reliable diagnosis for the patient and health care provider. The results of
QFT-G are greater specificity and results are available 24 hours after the blood is
collected.
DIF: Cognitive Level: Application REF: Pages 400, 430-431, Key Points
OBJ: 14 TOP: Tuberculosis
KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity
26. Tuberculosis (TB) is treated with multiple drugs to which organisms are susceptible.
How many drugs are usually preferred to increase the therapeutic effectiveness?
a. One
b. Two
c. Three
d. Four
ANS: D
At least four drugs, in combination, are used to prevent the emergence of organisms
resistant to the others, thus increasing the therapeutic effectiveness.

TOP: Tuberculosis KEY: Nursing Process Step:
Implementation
27. The removal of fluid from the pleural space by thoracentesis presents a possible danger
in removing fluid too rapidly. How much fluid removal is recommended at one time?
a. 1,500 to 2,000 mL at one time
b. 2,200 mL at one time
c. 1,300 to 1,500 mL at one time
d. Entire amount accumulated in less than 15 minutes
ANS: C
A possible danger from the thoracentesis procedure is removing fluid too rapidly; less
than 1,300 to 1,500 mL at one time is recommended.

TOP: Pleural effusion KEY: Nursing Process Step:
Implementation
28. When a patient has experienced a pneumothorax, chest auscultation reveals

a. equal breath sounds with rhonchi over the affected area.
b. deep slowed respirations with equal chest movement.
c. bilateral unequal breath sounds, with no breath sounds over the affected area.
d. respiratory rate less than 16 breaths per minute.
ANS: C
Findings on auscultation are bilaterally unequal breath sounds, with no breath sounds
over the affected area. A larger pneumothorax causes respiratory distress, including
rapid shallow respirations, air hunger, dyspnea, and oxygen desaturation.

TOP: Pneumothorax KEY: Nursing Process Step: Assessment
29. Which are signs of respiratory distress?

a. Nasal flaring, symmetrical chest wall expansion
b. Substernal retracting, SaO2 97%
c. Abdominal breathing, SaO2 89%
d. Symmetrical chest wall expansion, substernal retraction
ANS: C
Observe the patient’s facial expressions and signs of respiratory distress such as flaring
nostrils, substernal or clavicular retractions, asymmetrical chest wall expansion, and
abdominal breathing.
DIF: Cognitive Level: Application REF: Pages 384, 415, 419, 429
OBJ: 6 TOP: Pneumothorax
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
MULTIPLE RESPONSE
30. Which are routes in which the anthrax bacterium may enter the body? (Select all that
apply.)
a. Eyes
b. Lungs
c. Ears
d. Skin
e. Intestine
f. Perineum
ANS: B, D, E
In humans, anthrax gains a foothold when spores enter the body via the skin, intestines,
or lungs.

TOP: Anthrax KEY: Nursing Process Step: Assessment
31. Interventions that contribute to comfort in patients experiencing dyspnea include: (Select
all that apply)
a. Breathing exercises
b. Bed rest
c. Acupuncture
d. Visualization
e. Limiting the amount of oxygen usage
f. Massage
ANS: A, C, D, F
Breathing exercises, acupuncture, visualization and massage help decrease the level of
dyspnea by using distraction and relaxation methods to provide the patient with some
control.
DIF: Cognitive Level: Application

REF: Page 391, Complementary & Alternative Therapies box OBJ: 6
TOP: Complementary and alternative therapy
32. Identify the purposes of chest drainage: (Select all that apply)
a.
Drains air, blood and fluid from pleural space
b. Restores positive pressure in chest cavity
c. Restores negative intrapleural pressure
d. Allows lung to collapse and rest
e. Allows route for medication administration
ANS: A, B, E
A chest tube or tubes may be inserted for continuous drainage of fluid, blood, or air from
the pleural cavity and for medication instillation. To prevent the lung from collapsing, a
closed drainage system is used, which maintains the lung cavity’s normal negative
pressure. The chest tubes are connected to a pleural drainage system with collection,
water-seal, and suction control chambers to drain secretions and reestablish negative
pressure in the pleural space.
Topic: Pleural effusion or empyema
TOP: Chest Tubes KEY: Nursing Process Step: Planning
33. Which interventions are health promotions to prevent pneumonia? (Select all that apply.)
a.
Position patient on the back to prevent aspiration.
b. Encourage elder patients to receive influenza and pneumococcal vaccines.
c. Provide for good health habits (nutrition, hygiene, exercise).
d. Allow new stroke patients to feed themselves to encourage self-care.
e. Check for placement before administering tube feedings.
ANS: B, C, E
Older adults should receive pneumococcal and influenza vaccines. Good health habits
are the basis for preventing disease. Aspiration can occur if the nasogastric tube is not
correctly placed in the stomach. New stroke patients should be assisted with eating until
the gag reflex is established.
DIF: Cognitive Level: Application REF: Pages 404, 406, Health Promotion
box
OBJ: 21 TOP: Pneumonia KEY: Nursing Process Step: Planning
34. Which expected outcome(s) would indicate improvement in a patient with emphysema?
(Select all that apply.)
a.
Patent airway
b. Increased rhonchi and wheezes
c. Normal arterial blood gases (for this patient)
d. Increasing oxygen concentrations
e. Decreased breathe sounds
f. Decreased dyspnea
ANS: A, C, F
Patient will maintain patent airway as evidenced by decreased rhonchi, wheezes,
tachypnea, dyspnea, and arterial blood gas (ABG) values within limits (for this patient).
DIF: Cognitive Level: Application REF: Page 425, NCP 9-1

OBJ: 18 TOP: Emphysema KEY: Nursing Process Step: Assessment
COMPLETION
35. The _________ are the structures of the lung in which gas exchange occurs.
ANS:
alveoli
Test Bank for Adult Health Nursing, 6th Edition: Christensen
The end structures of the bronchial tree are called alveoli. It is in these terminal
structures of the bronchial tree that gas exchange takes place.
DIF: Cognitive Level: Knowledge REF: Page 377 OBJ: N/A

TOP: Lower respiratory tract KEY: Nursing Process Step: Assessment
36. The nurse is caring for a patient with a diagnosis of pleural effusion. The physician is
most likely to order a ______________ to remove fluid from around the lungs so that the
patient may breathe more easily.
ANS:
thoracentesis
Often a thoracentesis will be done not only to obtain a specimen for culture to identify
the causative agent, but to relieve the dyspnea and discomfort.
DIF: Cognitive Level: Application REF: Pages 378, 408

OBJ: 13 TOP: Thoracentesis
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Test Bank for Adult Health Nursing, 6th Edition:

To download the complete and accurate content document, go to:

Chapter 09: Care of the Patient with a Respiratory Disorder

DIF: Cognitive Level: Analysis

2. The circulation of the lungs is through the

DIF: Cognitive Level: Knowledge REF: Page 378 OBJ: 4

3. A 52-year-old patient has had a laryngectomy in treatment of cancer. A nursing

Visit TestBankBell.com to get complete for all chapters

4. A 62-year-old patient is seen in the emergency department with an epistaxis. When a

DIF: Cognitive Level: Analysis REF: Pages 423, 426

DIF: Cognitive Level: Analysis REF: Page 416 OBJ: 13

DIF: Cognitive Level: Knowledge REF: Pages 406, 408

DIF: Cognitive Level: Application REF: Page 381, Box 9-2

DIF: Cognitive Level: Analysis REF: Page 389 OBJ: 8

DIF: Cognitive Level: Analysis REF: Page 421 OBJ: 18

DIF: Cognitive Level: Analysis REF: Pages 384, 406, 427

DIF: Cognitive Level: Application REF: Page 404 OBJ: 12

15. A patient is on postoperative day 4 after undergoing a total hip replacement. He is

DIF: Cognitive Level: Analysis REF: Page 423 OBJ: 18

DIF: Cognitive Level: Analysis REF: Page 421 OBJ: 18

DIF: Cognitive Level: Analysis REF: Page 414 OBJ: 21

DIF: Cognitive Level: Application REF: Page 416 OBJ: 20

DIF: Cognitive Level: Application REF: Page 493 OBJ: 12

DIF: Cognitive Level: Analysis REF: Page 429 OBJ: 18

DIF: Cognitive Level: Application REF: Page 400 OBJ: 14

DIF: Cognitive Level: Application REF: Page 382 OBJ: 8

28. When a patient has experienced a pneumothorax, chest auscultation reveals

DIF: Cognitive Level: Knowledge REF: Page 412 OBJ: 12

29. Which are signs of respiratory distress?

DIF: Cognitive Level: Knowledge REF: Page 398 OBJ: 13

DIF: Cognitive Level: Application

DIF: Cognitive Level: Application REF: Page 425, NCP 9-1

DIF: Cognitive Level: Knowledge REF: Page 377 OBJ: N/A

DIF: Cognitive Level: Application REF: Pages 378, 408

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