Ch. 29 - Respiratory System Functions, Assessment, and Therapeutic Measures.

An LPN enters the room of a patient with chronic lung disease. The patient has removed the oxygen cannula, and it is lying on the bed. The patient does not appear to be in any distress. The pulse oximeter shows an oxygen saturation of 79%. Which of the fo

2. Put the oxygen cannula back on the patient

A patient hospitalized with right-sided pleural effusion calls the nurse and reports feeling short of breath. Which of the following positions should the nurse suggest?
1. Prone
2. Supine with head on pillow
3. Trendelenburg
4. Side lying with good lung d

4. Side lying with good lung dependent
"Good lung down

The nurse is caring for a patient with a transtracheal catheter. Which of the following would the LPN expect to be included in the plan of care?
1. Assist with cleaning the catheter 2 to 3 times a day
2. Provide supplemental oxygen via mask at all times
3

1. Assist with cleaning the catheter 2 to 3 times a day

The wife of a man with cystic fibrosis has been taught how to perform chest physiotherapy. She asks the nurse to explain why this must be done. Which of the following responses is best?
1. "It helps strengthen chest muscles"
2. "It humidifies thick respir

4. "It helps him expectorate secretions

The nurse notes that the suction control chamber on a chest drainage system is bubbling vigorously. Which intervention is appropriate?
1. Check the system for leaks
2. Replace the drainage system with a new one
3. Reduce the wall suction
4. Increase the w

3. Reduce the wall suction.
Bubbling in the water-seal chamber, not the suction chamber, indicates a system leak.

You check Ms. Jessup's vital signs and find her respiratory rate is 36 breaths per minute and shallow.
What adventitious sounds do you expect to hear when you auscultate Ms. Jessup's chest?

Wheezes

You notice that Ms. Jessup is using her shoulder and abdominal muscles to help her breathe.
You recognize that Ms. Jessup's use of ____________________ muscles is a sign of distress.

accessory

You know that smoking will aggravate Ms. Jessup's asthma, and you want to encourage her to quit.
What interventions can you encourage Ms. Jessup to use to stop smoking?
1. Identify and change behaviors, such as drinking coffee, that are associated with sm

1. Identify and change behaviors, such as drinking coffee, that are associated with smoking.
2. Set a quit date.
3. Ask her physician about a prescription for a nicotine patch or other replacement.
4. Consider medications such as varenicline (Chantix).

Respiratory ________________ can be palpated as a rough measurement of chest expansion on inspiration.

excursion

You should be able to see water in the water seal chamber of a chest drainage system moving up and down with respiration, which is called ________________.

tidaling

The sternocleidomastoid, scalene, and abdominal muscles are ______________________ muscles of respiration.

accessory

Any decrease in respiratory rate or efficiency causes an acid-base imbalance called respiratory ___________.

acidosis

Stripping and ___________________ of chest tubes should be avoided, because the resulting negative pressure can cause lung tissue damage.

milking

If a patient on a ventilator has a lot of secretions obstructing his or her endotracheal tube, a(n) ____________-pressure alarm may sound.

high

What is it when a needle is inserted into pleural space to aspirate fluid for diagnosis or to relieve pleural effusion?

thoracentesis

What is a surgical opening through the neck into the trachea?

tracheotomy

What is a long-term opening into the neck for breathing with a tube inserted to maintain patency?

tracheostomy

What are the main muscles of respiratory?

diaphragm,
external intercostal muscles

What is the patient education for Diaphragmatic Breathing?

The patient should be in a sitting, semi-Fowler's, or tripod position.
1. Place one hand on the abdomen and the other on the chest.
2. Concentrate on pushing out the abdomen during inspiration and relaxing the abdomen on expiration. The chest should move very little.

What is the patient education for pursed-lip breathing?

1. Inhale slowly through the nose to the count of two
2. Exhale slowly through pursed lips to the count of four.

Gas exchange occurs in the millions of __________ in the lungs.

Alveoli

A decreased __________ reflex in the elderly contributes to risk of respiratory infection.

Cough

A patient who has smoked 2 packs a day, for 15 years, has a __________ pack-year smoking history.

30

A nurse typically auscultates __________ in a patient with uncontrolled asthma.

Wheezes

Fine ________ are heard on inspiration in a patient with heart failure or atelectasis.

Crackles

A normal oxygen saturation is _______ % to 100%.

95%

The most important intervention for preventing and treating respiratory disease is __________ cessation.

Smoking

_________ coughing keeps the glottis open during coughing.

Huff

A(n) __________ uses a flexible endoscope to examine the larynx, trachea, and bronchial tree.

Bronchoscopy

The _________ seal chamber of a chest drainage system allows trapped air to escape from pleural cavity.

Water

Which laboratory result should alert the nurse to perform further assessment on a patient admitted with respiratory distress?
1. PaCO2 <50 mm Hg
2. HCO3 <27 mEq/L
3. PaO2 <90 mm Hg
4. SpO2 <90%

4. A normal SpO2 is 95% to 100%. An SpO2 less than 90% is a cause for concern.

A patient with a continuous positive airway pressure (CPAP) mask develops dry irritated eyes from the blowing air. What nursing intervention will help prevent eye irritation while maintaining the positive pressure ventilation?
1. Offer moisturizing eyedro

3. Repositioning the mask can redirect the air, while keeping the continuous positive airway pressure (CPAP) intact.

A patient with a low oxygen saturation may develop _________.

dyspnea

_________ may develop if air leaks into the tissues from a chest tube site.

Crepitus

A ________ may be necessary to reduce distress from severe pleural effusion.

thoracentesis

The patient with air trapping may develop a ________ -shaped chest.

barrel

The nurse can measure respiratory _________ to check chest expansion.

excursion

Crackles are an example of a(n) _________ sound.

adventitious

A patient who is choking may need an emergency __________.

tracheotomy

The ________ in the water-seal chamber shows that a chest tube is intact.

tidaling

The absence of respirations is called ________.

apnea

A patient is taught to remove the inner cannula of a __________ tube every 8 hours for cleaning.

tracheostomy

Number the following structures in the order in which air flows through them.
nose
trachea
secondary bronchi
primary bronchi
bronchioles
alveoli
larynx
nasopharynx

nose
nasopharynx
larynx
trachea
primary bronchi
secondary bronchi
bronchioles
alveoli

Number the events of breathing in proper sequence, beginning with the medulla.
____The medulla generates motor impulses.
____The chest cavity is enlarged in all directions.
____The diaphragm and external intercostal muscles contract.
____Intrapulmonic pre

____The medulla generates motor impulses.
____Motor impulses travel along the phrenic and intercostal nerves.
____The diaphragm and external intercostal muscles contract.
____The chest cavity is enlarged in all directions.
____The chest wall expands the parietal pleura, which expands the visceral pleura, which in turn expands the lungs.
____Intrapulmonic pressure decreases.
____Air enters the lungs until intrapulmonic pressure equals atmospheric pressure.

Adventitious lung sounds that resemble Velcro being torn apart are considered _________.

Fine crackles

Adventitious lung sounds that resemble faint lung sounds are _________.

Diminished

Adventitious lung sounds that resemble leather rubbing together are _________.

Pleural friction rub

Adventitious lung sounds that resemble a loud crowing noise is ________.

Stridor

Adventitious lung sounds that resemble moist bubbling is considered ________.

Coarse crackles

Adventitious lung sounds that resemble high-pitched violins are _________.

Wheezes

Which of the following structures covers the larynx during swallowing?
1. Hyoid cartilage
2. Vocal cords
3. Soft palate
4. Epiglottis

4. Epiglottis

Where are the respiratory centers located in the brain?
1. Cerebral cortex and cerebellum
2. Medulla and pons
3. Hypothalamus and cerebral cortex
4. Hypothalamus and temporal lobes

2. Medulla and pons

What is the purpose of the serous fluid between the pleural membranes?
1. Enhance exchange of gases
2. Facilitate coughing
3. Destroy pathogens
4. Prevent friction

4. Prevent friction

Within the alveoli, surface tension is decreased and inflation is possible because of the presence of which substance?
1. Tissue fluid
2. Surfactant
3. Pulmonary blood
4. Mucus

2. Surfactant

What is the function of the nasal mucosa?
1. Assist with gas exchange
2. Sweep mucus and pathogens to the trachea
3. Warm and moisten the incoming air.
4. Increase the oxygen content of the air.

3. Warm and moisten the incoming air

Deteriorating cilia in the respiratory tract predispose older adults to which of the following problems?
1. Chronic hypoxia
2. Pulmonary hypertension
3. Respiratory infection
4. Decreased ventilation

3. Respiratory infection

Which of the following adventitious lung sounds is a violin-like sound?
1. Crackles
2. Wheezes
3. Friction rub
4. Crepitus

2. Wheezes

The purpose of pursed-lip breathing is to promote which of the following?
1. Carbon dioxide excretion
2. Carbon dioxide retention
3. Oxygen excretion
4. Oxygen retention

1. Carbon dioxide excretion