Upper or Lower Airway?:

Traps organisms entering nose and mouth; traps particles not filtered by nares.

Upper or Lower Airway?:

Contains the trachea and cilia to move mucus to trachea.

Upper or Lower Airway?:

Contains pleura and alveoli, which are used for gas exchange.

Upper or Lower Airway?:

Contains the pharynx (throat), larynx, and epiglottis.

Upper or Lower Airway?:

Place where the trachea divides into the right and left bronchi.

Upper or Lower Airway?:

Dividing point where solid foods and fluids are separated from air.

Diffusion, Perfusion, or Ventilation?:

Exchange of oxygen and carbon dioxide in the capillary-alveolar network.

Diffusion, Perfusion, or Ventilation?:

Pumping of oxygenated blood through the body.

Diffusion, Perfusion, or Ventilation?:

Movement of air in and out of the lungs.

The pt. comes to the Dr.'s office for an annual physical. The pt. reports having a persistent nagging cough. Which Q does the RN ask 1st?:

a. "When did the cough start?"

b. "Do you have a fam hx of lung CA?"

c. "Have you been running a fever?"

d. "Do you have sneezing and congestion?"

Answer: a

The most important thing to ascertain is when the cough began; b, c, & d can be determined later in the assessment

PFTs are scheduled for a pt. w/ a hx of smoking who reports dyspnea and chronic cough. What will the pt. teaching information about PFTs include?

a. do not smoke for @ least 2 wks before the test

b. bronchodilator drugs may be w/held 2 days before the test

c. the pt. will breathe through the mouth and wear a nose clip during the test

d. the pt. will be expected wo walk on a treadmill during the test

Answer: c

Even if a is true, it does not pertain to the actual test procedure; b is not correct, as bronchodilators may be used in emergency situations; and d does not describe a PFT procedure

The pt. is scheduled to have a PFT. Which type of info. does the RN include in nursing hx so that PFT results can be apporpriately determined?

a. age, gender, race, ht., wt., and smoking status

b. occupational status, activity intolerance for ADLs

c. Rx hx and hx of allergies to contrast media

d. hx of chronic medical conditions and surgical problems

Answer: a

a is correct b/c differences may be seen among all of these different groups; b, c, and d are not relevant to interpreting the results of the PFT

The nurse is caring for an older adult who is temporarily confined to bed. Which intervention is important in promoting pulmonary hygiene r/t age and decr. mobility?

a. obtain an order for PRN oxygen via nasal cannula

b. encourage pt. to turn, cough, and deep breathe

c. reassure pt. that inmobility is temporary

d. monitor the resp. rate and check pulse ox readings

Answer: b

b is the only intervention that would r/t pulmonary hygiene (i.e. clearing of lungs and airways, etc.); b, c, and d may be right but refer to other aspects of care, not pulmonary hygiene

The RN is assessing an older adult pt. who reports a decr. tolerance for exercise and that she must work harder to breathe. Which Q assists the RN in determining if these are normal changes r/t aging?

a. "how old are you?"

b. "when did you 1st notice these S/S?"

c. "do you or have you ever smoked?"

d. "how often do you exercise?"

Answer: b

b will inform the RN how long these S/S have been occurring and give insight into whether there may be an underlying condition; a will already be in the pt.'s EHR; c and d do not have anything to do with age-related changes

The pt. has a bronchoscopy and was NPO for several hrs. Now a few hrs. after the test, the pt. is hungry and would like to eat a meal. What will the RN do?

a. order a meal b/c the pt. is now A&O

b. check pulse ox to be sure oxygen sat has returned to normal

c. check for gag reflex before allowing the pt. to eat

d. assess for nausea from the Rx given for the test

Answer: c

the Rx given prior to bronchoscopy can depress the CNS, which may cause dysphagia so the gag reflex will need to be checked before allowing anything PO; 'a' should not be done until gag reflex is checked; 'b' is irrelevant for eating; and 'd' is not a reason to keep the pt. NPO

After a bronchoscopy, the pt. coughs up sputum which contains blood. What is the best RN intervention for this pt.?

a. assess V/S and resp status, then notify Dr. of findings

b. monitor the pt. for 24 hrs. to see if blood continues in sputum

c. send sputum to lab for cytology for possible lung CA

d. reassure the pt. that this is a normal response after a bronchoscopy

Answer: a

while 'c' and 'd' are also correct, b/c some pts. will experience dark-brown blood in sputum for a day or 2 after the procedure, the RN will still want to ensure that the pt. is stable, so 'a' is the BEST answer; 'c' is not relevant at this time unless CA is suspected

Before a bronchoscopy procedure, the pt. receives benzocaine spray as a topical anesthetic to numb the oropharynx. The RN is assessing the pt. after the procedure. Which findings suggest that the pt. is developing methemoglobinemia?

a. the pt. has a decr. Ht level

b. the pt. does not respond to supplemental oxygen

c. the blood sample is a bright cherry red color

d. the pt. experiences sedation and amnesia

Answer: b

'b' (SOB not relieved with O₂) is the only correct S/S listed; 'a' is incorrect b/c with this disorder, Hgb would be affected, not Ht and lab values are not obtained during assessment; 'c' and 'd' are not S/S of acquired methemoglobinemia

The RN is caring for several pts. who had dx testing for resp disorders. Which dx test has the highest risk of postprocedure complication of pneumothorax?

a. bronchoscopy

b. laryngoscopy

c. CT of lungs

d. percutaneous lung biopsy

Answer: d

'd' would carry the highest risk of pneumothorax b/c it is the most invasive lung procedure, which involves penetrating delicate lung pleura and tissues; 'a,' 'b,' and 'c' are all less invasive procedures

The pts.'s pulse ox is 89%. What is the RN's priority action?

a. recheck reading with a different oximeter

b. apply supplemental oxygen and recheck the oximeter reading in 15 min

c. assess the pt. for resp distress and recheck the oximeter reading

d. place the pt. in the recovery position and monitor frequently

Answer: c

'c' is correct b/c unless the pt. has a normal O₂ reading in this range (as w/ COPD), then a pulse ox reading this low may indicate impending or ongoing resp distress; 'a,' 'b,' and 'd' are not priorities

The pt. demonstrates labored shallow respirations and a RR of 32/min w/ a pulse ox of 85%. What is the priority RN intervention?

a. notify RT to give pt. a breathing tx

b. start O₂ via nasal cannula at 2 L/min

c. Obtain an order for a stat ABG

d. encourage coughing and deep breathing exercises

Answer: b

'b' is correct b/c this pt. appears to be in resp distress and needs to start breathing effectively STAT; 'a' and 'c' are not first priorities; 'd' would exacerbate work of breathing

The RN is reviewing ABG results from an 86-yr-old pt. Which results would be considered normal findings for a pt. this age?

a. Normal pH, normal Pao₂, normal Paco₂

b. Normal pH, decr. Pao₂, normal Paco₂

c. Decr. pH, decr. Pao₂, normal Paco₂

d. decr. pH, decr. Pao₂, decr. Paco₂

Answer: b

pH should always be normal, regardless of age

The RN is caring for an older adult pt. and id's a RN dx of Ineffective Airway Clearance. Which etiology for this dx is r/t the normal aging process?

a. decr. muscle strength and cough

b. incr. carbon dioxide exchange

c. decr. residual volume

d. incr. elastic recoil of the lungs

Answer: a

'a' is the only EXPECTED finding r/t to the NORMAL aging process

Upon performing a lung sound assessment of the anterior chest, the RN hears moderately loud sounds on inspiration that are equal in length with expiration. In waht area is this lung sound considered normal?

a. trachea

b. primary bronchi

c. lung fields

d. larynx

Answer: b

Which sounds in the smaller bronchioles and the alveoli indicate normal lung sounds?

a. harsh, hollow, and tubular blowing

b. nothing; normally no sounds are heard

c. soft, low rustling like the wind in the trees

d. flat and dull tones with moderate pitch

Answer: c

'a' is indicative of adventitious breath sounds; 'b' would imply your pt. is DEAD!; 'd' may indicate the presence of fluid build-up

What is the characteristic of normal lung sounds that should be heard throughout the lung fields?

a. short inspiration, long expiration, loud, harsh

b. soft sound, long inspiration, short quiet expiration

c. mixed sounds of harsh and soft, long inspiration and long expiration

d. loud, long inspiration, and short, loud expiration

Answer: b

breath sounds should always be soft in tone; loudness and/or harshness may indicate issues in respiration

Upon assessing the lungs, the RN hears short, discrete popping sounds "like hair being rolled between fingers near the ear" in the bilateral lower lobes. How is this assessment documented?

a. rhonchi

b. wheezes

c. fine crackles

d. coarse crackles

Answer: c

'a' resembles a sound of snoring; 'b' is a high-pitched sound heard upon expiration; 'd' would have a longer duration and louder sound

The RN is taking a hx on a pt. who reports sleeing in a recliner chair at night because lying on the bed causes shortness of breath. How is this documented?

a. orthopnea

b. paroxysmal nocturnal dyspnea

c. orthostatic nocturnal dyspnea

d. tachypnea

Answer: a

'a' refers to SOB experienced while lying down, which is relieved by sitting upright; 'b' refers to SOB that awakens a pt., regardless of sleeping position, generally in first 1-2 hrs. of sleep; 'c' occurs when in an upright position; 'd' is simply an incr. in the work of breathing

Which pt. has an incr. risk for probs. of the resp. system?

a. 45-yr-old man who breeds and raises pigeons

b. 25-yr-old woman who enjoys body surfing

c. 68-yr-old woman who does needlework for relaxation

d. 56-yr-old man who ties flies for trout fishing

Answer: a

'a' has is at highest risk due to the toxins and allergens that are associated with birds and their feces; while 'c' has an incr. risk due to normal aging, there is nothing else in the description that would indicate an abnomal risk; 'b' and 'd' would only be at incr. risk if they had environmental allergies, but the description does not indicate that

What observations does the RN take when performing a general assessment of the pt.'s lungs and thorax?

(select all that apply)

a. symmetry of chest movement

b. rate, rhythm, and depth of respirations

c. use of accessory muscles

d. comparison of the anteroposterior diameter with the lateral diameter

e. measurement of the length of the chest cavity

f. assessment of chest expansion and respiratory excursion

Answer: a, b, c, d

'e' and 'f' are not included in a GENERAL assessment

Which assessment finding is an objective sign of chronic oxygen deprivation?

a. continuous cough productive of clear sputum

b. audible inspiratory and expiratory wheeze

c. chest pain that incr. with deep inspiration

d. clubbing of fingernails and a barrel-shaped chest

Answer: d

'd' is correct b/c for either of these S/S to manifest, the oxygen deprivation must have been occuring for >6 months; 'a' may be indicative of an acute problem, such as allergies or a cold; 'b' may be due to conditions such as asthma but do not give clues to chronic oxygen deprivation; 'c' is not objective, as pain is always a subjective S/S relayed by the pt.

The RN is palpating the pt.'s chest and id's an incr. tactile fremitus (vibrating) produced when the pt. speaks. What does the RN do next?

a. observe for other findings assoc. w/ subcutaneous emphysema

b. document the observation as an expected, normal finding

c. observe the pt. for other findings assoc. w/ pneumothorax

d. document the observation as a pleural friction rub

Answer: c

'c' would indicate the escaping of air into the chest cavity,which is a tell-tale S/S of a pneumothorax; 'a' would appear as a bulging of the skin that produces an unusual crackling sensation when palpated, not vibrating; 'b' is incorrect b/c fremitus is an abnormal finding; 'd' is incorrect b/c it is only found by auscultation

The nurse reviews the CBC for a pt. w/ COPD and lives in a high mountain area. What lab result does the RN expect to see for this pt.?

a. incr. RBCs

b. decr. neutrophils

c. decr. eosinophils

d. incr. lymphocytes

Answer: a

'a' is common for ppl w/ COPD or for high altitudes, as the body is attempting to make more RBCs for oxygenation; 'b,' 'c,' and 'd' are all r/t WBCs and are not affected by COPD or high altitudes

What is the best position for a pt. to assume for a thoracentesis?

a. side-lying, affected side exposed, head slightly raised

b. lying flat w/ arm on affected side across the chest

c. sitting up, leaning forward on the overbed table

d. prone position with arms above head

Answer: c

'c' is the best position, as it allows for a stretching of the posterior thorax, which makes the insertion of the needle for drainage into the space between the ribs into the lung easier

Which RN intervention is the priority when preparing the client for PFT?

a. administer bronchodilator Rx on call

b. encourage clear fluid intake 12 hrs before the procedure

c. ensure no smoking 6 hrs before the test

d. provide supplemental oxygen as testing begins

Answer: c

the purpose of a PFT is to determine the level of functioning of a person's pulmonary system, choices 'a,' 'b,' and 'd' would not be the priority when preparing a pt. for this test

Oxygenation & Assessment of Resp. System:

What are the components of the upper resp. tract?

Oxygenation & Assessment of Resp. System:

What are the components of the lower respiratory tract?