Name: Espiritu, Julie Ann C.

N015 - NCM 118

BSN 4 - Block 3 M-W 4:00pm-6:00pm

NURSING MANAGEMENT RESPONSES TO

ALTERED VENTILATORY FUNCTION

Lets Us Review
1. Conducting a pulmonary clinical assessment, the nurse focuses her inspection in the following
areas (select all that apply)
a. Flaring of the nares
b. Thoracic expansion
c. Tongue and sublingual area
d. Position of the trachea
e. Chest wall configuration
f. Respiratory effort
2. Which of the following terms is used to describe inability to breathe easily except in an upright
position?
a. Dyspnea
b. Hemoptysis
c. Hypoxemia
d. Orthopnea
3. The nurse is observing the clients cough for the following (select all that apply)
a. Characteristics
b. Severity
c. Onset and duration
d. History of smoking
e. Pattern
f. Associated symptoms
g. Work environment
4. The nurse observes the patient’s respiration to be faster than 20 breaths per minute she would
be correct to document this symptom as:
a. Bradypnea
b. Tachypnea
c. Hyperpnea
d. Normal
5. When a client is manifesting a rapid deep and labored breathing the nurse notes this to be:
a. Hyperpnea
b. Kussmaul’s
c. Tachypnea
d. Biot’s
6. In relation to the structure of the larynx, the cricoid cartilage is
a. the valve flap of cartilage that covers the opening to the larynx during swallowing.
b.used in vocal cord movement with the thyroid cartilage.
c. the largest of the cartilage structures.
d. the only complete cartilaginous ring in the larynx.
7. Palpating a client suspected of respiratory conditions the nurse is correct to focus on which of
the following areas; (select all that apply)
a. Confirmation of the position of the trachea;
b. Assessment of thoracic expansion
c. Evaluation of fremitus.
d. Chest wall configuration
8. Percussing the client’s thoracic region, the nurse is correct to note that a normal percussion
tone of the lung should reveal
a. Dullness
b. Tympany
c. Resonance
d. Flatness
9. A hyper-ressonant chest may indicate that a client may be suffering from
a. Pneumonia
b. Pulmonary edema
c. Pneumothorax
d. Atelectasis
10. Listing to client’s breath sounds the nurse is to focus on the following areas (select all that
apply)
a. Evaluation of normal breath sounds
b. Vocal vibrations
c. Assessment of voice sounds
d. Percussion tones
e. Fremitus
f. Identificationofabnormalbreathsounds
11. The nurse is correct to recall that characteristic normal breath sounds are all of the following
except:
a. Ronchi
b. Bronchovesicular
c. Bronchial
d. Vesicular
12. Crackling breath sounds may indicate the client to be suffering from (select all that apply)
a. Bronchiectasis
b. Asthma
c. Pneumonia
d. Bronchitis
e. Pulmonary edema
f. Pulmonaryfibrosis
g. Bronchospasm
h. Atelectasis
13. This voice sound is described as a condition in which the spoken voice is heard on
auscultation with higher intensity and clarity than usual.
a. Ralles
b. Whispering pectoriloquy
c. Egophony
d. Bronchophony
14. The nurse is correct to suspect a client to be suffering from asthma if the client exhibits which
of the following breath sound?
a. Inspiration > Expiration Pitch: Low Intensity: Soft Adventitious Sounds: Crackles (Sometimes
Disappear After)
b. Inspiration > Expiration Pitch: Low Intensity: Soft
c. Inspiration = Expiration Pitch: Moderate Intensity: Soft Adventitious Sounds: Expiratory Sibilant
Wheezes
d. Inspiration = Expiration Pitch: High Intensity: Loud Adventitious Sounds: Inspiratory Crackles In
Terminal Third of Inspiration
15. Auscultation should be done in a systematic sequence. The nurse would be correct in
performing auscultation using the following sequence.
a. Posteriorly and laterally then side-to-side, top-to-bottom and anteriorly
b. Anteriorly then posteriorly, top-to-bottom, side-to-side and laterally,
c. side-to-side, top-to-bottom, posteriorly, laterally, and anteriorly.
d. top-to-bottom, side-to-side, laterally, posteriorly, and anteriorly.
16. Which respiratory volume is the maximum volume of air that can be inhaled after maximal
expiration?
a. Inspiratory reserve volume
b. Expiratory reserve volume
c. Residual volume
d. Tidal volume
17. While conducting the physical examination during assessment of the respiratory system,
which of the following does a nurse assess by inspecting and palpating the trachea?
a. Evidence of exudate
b. Color of the mucous membranes
c. Deviation from the midline
d. Evidence of muscle weakness
18. Which of the following signs and symptoms should a nurse monitor during a pulmonary
angiography? Which indicates an allergic reaction to the contrast medium?
a. Absent distal pulses
b. Urge to cough
c. Difficulty in breathing
d. Hematoma
19. A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from
the pleural wall for diagnostic purposes. What does serous fluid indicate?
a. Trauma
b. Cancer
c. Infection
d. Emphysema
20. Why should a nurse provide required information and appropriate explanations of diagnostic
procedures to clients with respiratory disorders?
a. To aid the care givers of the client
b. To ensure adequate rest periods
c. To manage decreased energy levels
d. To manage respiratory distress
21. Which of the following results in decreased gas exchange in older adults?
a. The alveolar walls contain fewer capillaries.
b. The elasticity of lungs increases with age.
c. The alveolar walls become thicker.
d. The numbers of alveoli decrease with age.
22. The individual who demonstrates displacement of the sternum is described as having a
a. akyphoscoliosis.
b. pigeon chest.
c. funnel chest.
d. barrel chest.
23. When the nurse auscultates chest sounds that are harsh and cracking, sounding like two
pieces of leather being rubbed together, she records her finding as
a. sibilant wheezes.
b. sonorous wheezes.
c. pleural friction rub.
d. crackles.
24. Which of the following terms is used to describe hemorrhage from the nose?
a. Epistaxis
b. Rhinorrhea
c. Xerostomia
d. Dysphagia
25. Which type of sleep apnea is characterized by lack of airflow due to pharyngeal occlusion?
a. Mixed
b. Central
c. Obstructive
d. Simple
26. When the patient who has undergone laryngectomy suffers wound breakdown, the nurse
monitors him very carefully because he is identified as being at high risk for
a. dehydration.
b. pulmonary embolism.
c. carotid artery hemorrhage.
d. pneumonia
27. Which of the following terms refers to lung tissue that has become more solid in nature due
to a collapse of alveoli or infectious process?
a. Bronchiectasis
b. Empyema
c. Consolidation
d. Atelectasis
28. When interpreting the results of a Mantoux test, the nurse explains to the patient that a
reaction occurs when the intradermal injection site shows
a. redness and induration.
b. tissue sloughing.
c. bruising.
d. drainage.
29. Which of the following actions is most appropriate for the nurse to take when the patient
demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after
chest surgery?
a. Apply a compression dressing to the area.
b. Report the finding to the physician immediately.
c. Measure the patient's pulse oximetry.
d. Record the observation.
30. Which of the following methods is the best method for determining nasogastric tube
placement in the stomach?
a. Testing of pH of gastric aspirate
b. Placement of external end of tube under water
c. Observation of gastric aspirate
d. X-ray

IDENTIFICATION Short Answers

Write the word or phrase that best completes each statement or answers the question.
31. An increase in in the Anteroposterior diameter configuration of the chest is suggestive of
what disorder:
CYSTIC FIBROSIS
32. A sensation felt by a hand placed on a part of the body (such as the chest) that vibrates
during speech.
TACTILE FREMITUS
33. Are coarse, rumbling, low-pitched sounds produced by airflow over secretions in the larger
airways or narrowing of the large airways
RHONCHI
34. A condition in which the spoken voice is heard on auscultation with higher intensity and
clarity than usual.
BRONCHOPHONY
35. Short, discrete popping or crackling sounds produced by fluid in the small airways or alveoli
or by the snapping open of collapsed airways during inspiration.
CRACKLES
36. Collection of fluid in pleural space; if pleural effusion is prolonged, fibrous tissue may also
accumulate in pleural space; clinical picture depends on amount of fluid or fibrosis present and
rapidity of development; fluid tends to gravitate to most dependent areas of thorax, and adjacent
lung is compressed.
PLEURAL EFFUSION
37. Consolidation occurs when alveolar air is replaced by fluid or tissue; physical findings depend
on amount of parenchymal tissue involved is a condition called.
PULMONARY CONSOLIDATION
38. A permanent hyperinflation of lung beyond terminal bronchioles, with destruction of alveolar
walls; airway resistance is increased, especially on expiration.
EMPHYSEMA
39. Collapse of alveolar lung tissue, and findings reflect presence of a small, airless lung; this
condition is caused by complete obstruction of a draining bronchus by a tumor, thick secretions,
or an aspirated foreign body, or by compression of lung is a condition called.
ATELECTASIS
40. High-pitched, squeaking, whistling sounds a common symptom of Bronchial Asthma and
Bronchospasm
WHEEZING

Respiratory Care Modalities

1. Bill McDonald, 65 years of age, is a male patient diagnosed with chronic obstructive pulmonary
disease (COPD). He is going to be discharged with home oxygen at 2 L/min per nasal cannula.
According to Medicare guidelines, the patient falls into the group 1 patient category, the patient’s
O2 saturation on room air was less than 88% and his PaO2 was less than 55 mm Hg, which was
obtained from an arterial blood gas (ABG) at room air. The physician completed the script for the
home oxygen therapy according to Medicare guidelines. The information that needed to be
included on the script was the documented diagnosis, the prescribed liter flow, the frequency of
use in hours per day, and the number of months in duration. The results of the pulse oximetry
and the ABG were also included in the script to justify the need for the home oxygen therapy. The
nurse needs to make arrangements with the social worker to obtain an agency to supply the
oxygen equipment needed and to provide follow-up on a regular basis. The supplier makes
arrangements to deliver an oxygen concentrator and portable tanks or concentrated oxygen and
oxygen regulators, and needed supplies, including 50 feet of tubing, and nasal cannulas.
A. What home care considerations need to be made before the patient is discharged and what
considerations need to be made once the patient arrives home?
The nurse should prepare all supplies and equipment required for at-home oxygen therapy are
ordered and set up prior to the patient's discharge. Working with the social worker to find a
company that can provide the necessary oxygen equipment is part of this. It is imperative that
the nurse instructs the patient and their family on the safe and efficient operation of the oxygen
equipment. This includes instructing them on how to correctly set up and adjust the nasal
cannula, connect the tubing to the oxygen source, and maintain proper hygiene and equipment
maintenance.
The nurse must evaluate the patient's living situation as soon as they get home to make sure it is
appropriate for home oxygen therapy. This involves making certain that the oxygen equipment is
not in close proximity to any potential fire hazards, such as open flames or flammable materials.
Along with providing safety instructions and guidelines for using oxygen at home, the nurse
should also teach the patient and their family how to handle any emergencies or complications
related to home oxygen therapy. These include not smoking or being near open flames while
using oxygen, checking oxygen levels frequently, making sure there is an adequate supply of
oxygen, and knowing how to handle any emergencies.
A plan for routine follow-up and monitoring of the patient's condition and response to home
oxygen therapy should also be established by the nurse. This can entail arranging for routine
phone calls or visits to evaluate the patient's progress, respond to any worries or inquiries, and
modify the oxygen therapy plan as needed. In the event that the patient or members of their
family require immediate assistance or have any questions concerning home oxygen therapy, the
nurse should also make sure that they have access to emergency contact information.
B. What patient and family education must the nurse provide in regard to home oxygen therapy?
The nurse notifies the patient and family that oxygen is available in gas, liquid, and concentrated
forms and teaches them on how to administer it safely. The liquid and gas forms are

packaged in portable devices, allowing the patient to receive oxygen therapy while on the go.
When using oxygen, humidity must be supplied (unless portable devices are being used) to
mitigate the dry, irritating effects of compressed oxygen on the airway.
2. April Long, a 60-year-old patient, is admitted with the diagnosis of small cell carcinoma of the
left lower lobe. She had a left lower lobectomy removing the cancerous mass. After surgery, the
patient has a chest tube to a closed water-seal drainage system, the Atrium Ocean at 20 cmH2O.
A. What are the nursing responsibilities when caring for a patient with a chest tube to a drainage
system?
Postural drainage is done twice or four times a day, before bed time to avoid aspiration, nausea,
and vomiting. Before postural drainage, prescribed bronchodilators, water, or saline can be
nebulized and inhaled to dilate the bronchioles, lessen bronchospasm, thin mucus and sputum,
and fight edema of the bronchial walls. Positions to drain the lower lobes should come first in the
suggested order, then positions to drain the upper lobes.
B. Howshouldthenurserepositionthepatientinthiscasestudy?
The nurse offers an emesis basin, a sputum cup, and paper tissues while also ensuring the patient
is as comfortable as possible in each position. In order to help keep the airways open and allow
secretions to drain, the nurse instructs the patient to stay in each position for ten to fifteen
minutes while breathing in slowly through the nose and out slowly through pursed lips. When a
patient is unable to tolerate a position, the nurse assists them in assuming a modified position.
The nurse instructs the patient on coughing up secretions and changing positions.
C. The chest tube accidently is disconnected from the drainage system and the drainage system is
cracked. What should the nurse do?
Immerse the chest tube's end in one inch of sterile water. The water is only temporary, and the
client will require a new drainage system.