ATI Respiratory Questions with Correctly Solved Answers, Exams of Cardiology

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ATI Respiratory Questions with Correctly

Solved Answers

1.A nurse is assessing a patient who has a chest tube in place following a thoracic surgery. Which of the following findings indicates a need for inter- vention:

1. Fluctuation of drainage in the tubing with inspiration.
2. Continuous bubbling in the water seal chamber.
3. Drainage of 75 mL in the first hour after surgery.
4. Several small, dark-red blood clots in the tubing.: 2. Continuous bubbling in the water seal chamber. Continuous bubbling in the water seal chamber suggests an air leak. 2.A nurse is caring for an elderly patient who suffers from COPD with pneumo- nia. The nurse should monitor the patient for which of the following acid-base imbalances?
5. Respiratory alkalosis
6. Respiratory acidosis
7. Metabolic alkalosis
8. Metabolic acidosis: 2. Respiratory acidosis Respiratory acidosis is a common complication of COPD. This complication occurs because patients who have COPD are unable to exhale carbon dioxide due to a loss of elastic recoil in the lungs. 3.A nurse is preparing to administer cisplatin IV to a patient with lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication?
9. Hallucinations
10. Pruritis
11. Hand and foot syndrome
12. Tinnitis: 4. Tinnitis An adverse effect of cisplatin is ototoxicity, which can cause tinnitis. 4.A nurse is preparing to assist a provider to withdraw arterial blood from a patient's radial artery for measurement of ABG. Which of the following actions should the nurse plan to take?

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1. Hyperventilate the patient with 100% oxygen prior to obtaining the speci- men.
2. Apply ice to the site after obtaining the specimen.
3. Perform an Allen's test prior to obtaining the specimen.
4. Release pressure applied to the puncture site 1 minute after the needle is withdrawn.: 3. Perform an Allen's test prior to obtaining the specimen. The nurse should ensure that circulation to the hand is adequate from the ulnar artery in case the radial artery is injured from the blood draw. The most common site for withdrawal of arterial blood gases is the radial artery. 5.A nurse is providing instructions about pursed-lip breathing for a patient who has COPD with emphysema. The nurse should explain that this breathing technique accomplishes which of the following:
5. Increases oxygen intake
6. Promotes carbon dioxide elimination
7. Uses the intercostal muscles
8. Strengthens the diaphram: 2. Promotes carbon dioxide elimination A patient who has COPD with emphysema should use pursed-lip breathing when experiencing dyspnea. This is one of the simplest ways to control dyspnea. It slows the patient's pace of breathing, making each breath more effective. Pursed-lip breathing releases trapped air in the lungs and prolongs exhalation to slow the breathing rate. This improved breathing pattern moves carbon dioxide out of the lungs more efficiently. 6.A nurse is preparing a patient for a thoracentesis. In which of the following positions should the nurse place the patient:
9. Lying flat on the affected site
10. Prone with arms raised over the head
11. Supine with the head of the bed elevated
12. Sitting while leaning forward over the bedside table: 4. Sitting while leaning forward over the bedside table When preparing a patient for a thoracentesis, the nurse should have the patient sit on the edge of the bed and lean forward over the

3 / 40 bedside table because this position maximizes the space between the patient's ribs and allows for aspiration of accumulated fluid and air. 7.A nurse on a med-surg unit is caring for a patient who is postoperative following a hip replacement surgery. The patient reports feeling apprehensive and restless. Which of the follow findings should the nurse recognize as an indication of a PE:

1. Sudden onset of dyspnea
2. Tracheal deviation
3. Bradycardia
4. Difficulty swallowing: 1. Sudden onset of dyspnea Clinical manifestations of a PE have a rapid onset. Dyspnea occurs due to reduced blood flow to the lungs. 8.A nurse is planning care for a patient who has COPD and is malnourished. Which of the following recommendations to promote nutritional intake should the nurse include in the plan:
5. Eat high-calorie foods first
6. Increase intake of water at meal times
7. Perform active range of motion exercises before meals
8. Keep saltine crackers nearby for snacking: 1. Eat high-calorie foods first The client who has COPD often experiences early satiety. Therefore, the patient should eat high-calorie foods first. 9.A nurse is developing a teaching plan for a patient about preventing acute asthma attacks. Which of the following points should the nurse plan to discuss first:
9. How to eliminate environmental triggers that precipitate attacks
10. The patient's perception of the disease process and what might have trig- gered attacks in the past
11. The patient's medication regimen
12. Manifestations of respiratory infections: 2. The patient's perception of the disease process and what might have triggered attacks in the past The nurse should apply the nursing process priority-setting framework.

4 / 40 The nurse can use the nursing process to plan patient care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in a patient's status, the nurse must first collect adequate data from the patient. Assessing the patient will provide the nurse with knowledge to make an appropriate decision. Therefore, the first step the nurse should take is to assess the patient's current knowledge. 10.A nurse in a provider's office is assessing a patient who states he was recently exposed to TB. Which of the following findings is a clinical manifes- tation of pulmonary TB:

1. Pericardial friction rub
2. Weight gain
3. Night sweats
4. Cyanosis of the fingertips: 3. Night sweats Night sweats and fevers are clinical manifestations of TB. 11.A nurse is planning care for a patient following placement of a chest tube 1 hour ago. Which of the following actions should the nurse include in the plan of care:
5. Clamp the chest tube if there is continuously bubbling in the water seal chamber
6. Keep the chest tube drainage system at the level of the right atrium 3.Tape all of the connections between the chest tube and the drainage system
7. Empty the collection chamber and record the amount of drainage every 8 hours: 3. Tape all of the connections between the chest tube and the drainage system The nurse should tape all of the connections to ensure that the system is airtight and prevent the chest tubing from accidentally disconnecting. 12.A nurse on a medical unit is caring for a patient who apirated gastric con- tents prior to admission. The nurse administers 100% oxygen by nonbreather mask after the patient reports severe dyspnea. Which of the following findings is a clinical manifestation of acute respiratory distress syndrome (ARDS):

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1. Tympanic temperature of 38 C (100.4 F)
2. PaO2 50 mm Hg
3. Rhonchi
4. Hypopnea: 2. PaO2 50 mm Hg The patient who has manifestations of ARDS has a low PaO2 level even with the administration of oxygen. Hypoxemia after treatment with oxygen is a manifestation of ARDS. 13.A nurse is providing teaching to a patient about pulmonary function tests. Which of the following tests measures the volume of air the lungs can hold at

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1. Total lung capacity
2. Vital lung capacity
3. Functional residual capacity
4. Residual volume: 1. Total lung capacity Pulmonary function tests are used to examine the effectiveness of the lungs and identify lung problems. Total lung capacity measures the amount of air the lungs can hold after maximum inhalation. 14.A nurse is preparing discharge teaching to a patient who is postoperative following a rhinoplasty. Which of the following instructions should the nurse include:
5. Apply warm compresses to the face
6. Take aspirin 650mg by mouth for mild pain
7. Close your mouth while sneezing
8. Lie on your back with your head elevated 30 degrees while resting: 4. Lie on your back with your head elevated 30 degrees while resting The nurse should instruct the patient to rest in the semi-fowlers position to prevent aspiration of nasal secretions. 15.A nurse in the emergency department is assessing a patient for a closed pneumothorax and significant bruising of the left chest following a MVA. The client reports severe left chest pain on inspiration. The nurse should assess the patient for which of the following manifestations of a pneumothorax:
9. Absence of breath sounds
10. Expiratory wheezing
11. Inspiratory stridor
12. Rhronchi: 1. Absence of breath sounds A patient who has pneumothorax experiences severely diminished or absent breath sounds on the affected side. 16.A nurse in a clinic is providing teaching for a patient who is to have a tuberculin skin test. Which of the following information should the nurse include:

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1. If the test is positive, then you have an active case of TB.

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2. If the test is positive, you should have another tuberculin skin test in 3 weeks.
3. You must return to the clinic to have the test read in 2 to 3 days.
4. A nurse will use a small lancet to scratch the skin of your forearm before applying the tuberculin substance.: 3. You must return to the clinic to have the test read in 2 to 3 days. The patient should have the test read in 2 to 3 days. An area of induration after 48 to 72 hours indicates exposure to tubercle bacillus. If the patient does not return to have the test read within 72 hours, another skin test is necessary. 17.A nurse is teaching about daily chest physiotherapy with a patient who has cystic fibrosis. The nurse should instruct the patient that which of the following is the purpose of the treatments:
5. To encourage deep breaths
6. To mobilize secretions in the airways
7. To dilate the bronchioles
8. To stimulate the cough reflex: 2. To mobilize secretions in the airways The purpose of chest physiotherapy is to loosen the patient's secretions and pro- mote drainage of secretions from the lungs. Chest physiotherapy includes percus- sion, vibration, and promotion of drainage by gravity. 18.A nurse in an urgent care clinical is collecting data from a patient who reports exposure to anthrax. Which of the following findings is an indication of the prodromal stage of inhalation anthrax:
9. Dry cough
10. Rhinitis
11. Sore throat
12. Swollen lymph nodes: 1. Dry cough A dry cough is a clinical manifestation found in the prodromal stage of having inhalation anthrax. During this stage, it is difficult to distinguish from influenza or pneumonia because there is no sore throat or rhinitis. 19.A nurse is providing preoperative teaching to a patient who is to undergo a pneumoectomy. The patient states "I am afraid it will hurt to cough after surgery." Which of the following statements by the nurse is

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1. After the surgeon removes your lung you will not need to cough.

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2. I'll make sure you get a cough suppressant to keep you from straining the incision when you cough.
3. Don't worry. You will have a pump that delivers pain medication as you need it, so you will have very little pain.
4. I will show you how to splint your incision while you cough.: 4. I will show you how to splint your incision while you cough. The patient who had a pneumoectomy should cough to clear secretions from the remaining lung. The nurse should show how to splint the incision to reduce pain while coughing. 20.A patient is admitted to the emergency department following a motorcycle crash. The nurse notes a crackling sensation upon palpation on the right side of the patient's chest. After notifying the provider, the nurse should document the finding as which of the following:
5. Friction rub
6. Crackles
7. Crepitus
8. Tactile frementis: 3. Crepitus Crepitus, also called subcutaneous emphysema, is a coarse crackling sensation that the nurse can feel when palpating the skin surface over the patient's chest. Crepitus indicates an air leak into the subcutaneous tissue, which is often a clinical manifestation of a pneumothorax. 21.A nurse is caring for a patient who has a tracheostomy with an inflated cuff in place. Which of the following findings indicates that the nurse should suction the patient's airway secretions:
9. The patient is unable to speak.
10. The patient's airway secretions were last suctioned 2 hours ago.
11. The patient coughs and expectorates a large mucous plug. 4.The nurse auscultates course crackles in the lung field.: 4. The nurse auscul- tates course crackles in the lung field. The nurse should auscultate coarse crackles of rhonchi, identify a moist cough, hear or see secretions in the tracheostomy tube, and then suction the patient's airway secretions. 22.A nurse working in the ED is caring for a patient following a chest trauma. Which of the following findings indicates a tension pneumothorax:

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1. Collapsed neck veins on the affected side
2. Collapsed neck veins on the unaffected side
3. Tracheal deviation to the affected side
4. Tracheal deviation to the unaffected side: 4. Tracheal deviation to the unaffect- ed side A tension pneumothorax results from free air filling the chest cavity, causing the lung to collapse and forcing the trachea to deviate to the unaffected side. 23.A nurse is caring for a patient who is scheduled for a thoracentesis. Prior to the procedure, which of the following actions should the nurse take:
5. Position the client in an upright position, leaning over the bedside table.
6. Explain the procedure.
7. Obtain ABGs.
8. Administer benzocaine spray.: 1. Position the client in an upright position, leaning over the bedside table. Positioning the patient in an upright position and bent over the bedside table widens the intercostal space for the provider to access the pleural fluid. 24.A nurse is reviewing ABG laboratory results of a patient who is in respira- tory distress. The results are pH 7.47, PaCO2 32 mm Hg, HCO3 22 mm Hg. The nurse should recognize that the client is experiencing which of the following acid-base imbalances:
9. Respiratory acidosis
10. Respiratory alkalosis
11. Metabolic acidosis
12. Metabolic alkalosis: 2. Respiratory alkalosis A patient who is experiencing respiratory alkalosis will have an increased pH and a decreased PaCO2. Possible causes of respiratory alkalosis include hyperventilation, fever, and respiratory infections. 25.A nurse is assessing a patient following a bronchoscopy. Which of the following findings should the nurse report to the provider:
13. Blood-tinged sputum

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2. Dry, nonproductive cough
3. Sore throat

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4. Bronchospasms: 4. Bronchospasms Bronchospasms can indicate the patient is having difficulty maintaining a patent airway. The nurse should notify the provider immediately. 26.A nurse is caring for a patient who is scheduled for a throacentesis. Which of the folowing supplies should the nurse ensure are in the patient's room? (Select all that apply)
5. Oxygen equipment
6. Incentive spirometer
7. Pulse oximeter
8. Sterile dressing
9. Suture removal kit: 1. Oxygen equipment Oxygen equipment is necessary to have in the patient's room if the patient becomes short of breath following the procedure. 3.Pule oximeter Pulse oximetry is necessary to monitor oxygen saturation level during the procedure. 4.Sterile dressing A sterile dressing is necessary to apply to the puncture site following the procedure. 27.A nurse is caring for a patient following a throacentesis. Which of the fol- lowing manifestations should the nurse recognize as risks for complications? (Select all that apply)
10. Dyspnea
11. Localized bloody drainage on the dressing
12. Fever
13. Hypotension
14. Report of pain at the puncture site: 1. Dyspnea Dyspnea can indicate a pneumothorax or a reaccumulation of fluid. The nurse should notify the provider immediately. 28.A nurse is preparing to care for a patient following chest tube placement.

14 / 40 Which of the following items should be available in the patient's room? (Select all that apply)

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1. Oxygen
2. Sterile water
3. Enclosed hemostat clamps
4. Indwelling urinary catheter
5. Occlusive dressing: 1. Oxygen Oxygen should be readily available in case the patient develops respiratory distress following chest tube placement
6. Sterile water If the chest tubing becomes disconnected, the end of the tubing should be placed in sterile water to restore the water seal. 5.Occlusive dressing If the chest tubing becomes disconnected, the nurse should immediately place a gauze dressing of the site. An occlusive dressing can also be necessary to prevent the redevelopment of a pneumothrorax. 29.A nurse is caring for a patient who has a chest tube and drainage system in place. The nurse observes that the chest tube was accidentally removed. Which of the following actions should the nurse take first?
7. Obtain chest x-ray
8. Apply sterile gauze to the insertion site
9. Place tape around the insertion site
10. Assess respiratory status: 2. Apply sterile gauze to the insertion site Using ABC, application of a sterile gauze to the site should be the first action for the nurse to take. This allows air to escape and reduces the risk for development of a tension pneumothorax. 30.A nurse is assessing a patient who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply)
11. Continuous bubbling in the water seal chamber
12. Gentle constant bubbling in the suction control chamber

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3. Rise and fall in the level of water in the water seal chamber with inspiration and expiration

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4. Exposed sutures without dressing
5. Drainage system upright at chest level: 2. Gentle constant bubbling in the suction control chamber Gentle bubbling in the suction control chamber is an expected finding as air is being removed.
6. Rise and fall in the level of water in the water seal chamber with inspiration and expiration A rise and fall of the fluid level in the water seal chamber upon inspiration and expiration indicates that the drainage system is functioning properly. 31.A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the patient to do?
7. Lie on his left side
8. Use the incentive spirometer
9. Cough at regular intervals
10. Perform the Valsalva maneuver: 4. Perform the Valsalva maneuver The patient should be instructed to take a deep breath, exhale, and bear down as the chest tube is being removed. This increases intrathroacic pressure and reduces the risk of an air embolism. 32.A nurse is planning care for a patient following the insertion of a chest tube and drainage system. Which of the following should be included in the plan of care? (Select all that apply)
11. Encourage the patient to cough every 2 hours
12. Check for continuous bubbling in the suction chamber
13. Strip the drainage tubing every 4 hours
14. Clamp the tube once a day
15. Obtain a chest x-ray: 1. Encourage the patient to cough every 2 hours The nurse should instruct the patient to cough every 2 hours. This promotes oxy- genation and lung reexpansion.
16. Check for continuous bubbling in the suction chamber

18 / 40 The nurse should check for continuous bubbling in the suction chamber to verify that

19 / 40 suction is being maintained at the appropriate level. 5.Obtain a chest x-ray A chest x-ray is obtained following the procedure to verify chest tube placement. 33.A nurse is discharging a patient who has pulmonary TB and is to start therapy with rifampin. The nurse should plan to include which of the following in the patient's teaching plan:

1. Ringing in the ears is expected.
2. Purified protein derivative skin test results will improve in 4 months.
3. Urine and other secretions will be orange.
4. Take the medication with meals.: 3. Urine and other secretions will be orange. Rifampin will turn urine and other secretions orange. 34.A nurse is caring for a patient who has bacterial pneumonia. The nurse should expect which of the following assessment findings:
5. Decreased fremitus
6. SaO2 95% on room air
7. Temperature 38.8 C ( 101.8 F)
8. Bradypnea: 3. Temperature 38.8 C ( 101.8 F) An elevated temperature is an expected finding for a patient who has bacterial pneumonia. 35.A nurse is caring for a patient receiving mechanical ventilation. The low pressure alarm sounds. Which of the following should the nurse recognize as a cause for the alarm:
9. Excess secretions
10. Kinks in the tubing
11. Artificial airway cuff leak
12. Biting on the endotracheal tube: 3. Artificial airway cuff leak An artificial airway cuff leak interferes with oxygenation and causes the low pressure alarm to sound. 36.A nurse is caring for a patient who has acute respiratory distress syn-

20 / 40 drome. Which of the following assessment findings indicates a decline in the patient's condition:

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1. Increase in respiratory rate
2. Increase in oxygen saturation
3. Decrease in carbon dioxide retention
4. Decrease in intercostal retractions: 1. Increase in respiratory rate An increase is respiratory rate indicates increased work of breathing and the need for improvement in oxygen delivery. 37.A nurse is caring for a patient with a PE. Which of the following interven- tions is the priority:
5. Provide a quiet environment
6. Encourage use of incentive spirometry ever 1 to 2 hours
7. Initiate continuous cardiac monitoring
8. Administer heparin via continuous IV fusion: 4. Administer heparin via contin- uous IV fusion Using the ABC approach, the nurse should place priority on stabilizing circulation to the lungs by administering heparin to prevent further clot formation.
9. A nurse is planning care for a patient who has COPD. Which of the following interventions should the nurse include in the plan of care:
10. Schedule respiratory treatments after meals
11. Have the patient sit in a chair for 2-hour periods 3x a day
12. Provide a diet high in calories and protein
13. Combine activities to allow for longer rest periods between activities:
14. Provide a diet high in calories and protein The nurse should provide a patient who has COPD with a diet that is high in protein and low on carbs 39.A nurse is caring for a patient who has COPD. Which of the following findings should the nurse report to the provider:
15. Oxygen saturation 89%
16. Productive cough with green sputum
17. Clubbing of fingers
18. Pursed lipped breathing with exertion: 2. Productive cough with green sputum

22 / 40 A nurse should report a productive cough with green sputum to the provider as it indicates an infection 40.A nurse is caring for a patient who has acute respiratory failure. Which of the following laboratory findings should the nurse expect:

1. Arterial pH 7.50
2. PaCO2 25 mm Hg
3. SaO2 92%
4. PaO2 58 mm Hg: 4. PaO2 58 mm Hg The nurse should expect a patient who has acute respiratory failure to have lower partial pressures of oxygen. 41.A nurse is caring for a patient who is postoperative and is hypoventilating secondary to general anesthesia effects and incisional pain. Which of the following ABG values support the nurse's suspicion of respiratory acidosis:
5. pH 7.50, PO2 99 mm Hg, PaCO2 25 mm Hg, HCO3 22 mEq/L
6. pH 7.50, PO2 87 mm Hg, PaCO2 35 mm Hg, HCO3 30 mEq/L
7. pH 3.30, PO2 90 mm Hg, PaCO2 35 mm Hg, HCO3 20 mEq/L
8. pH 7.30, PO2 80 mm Hg, PaCO2 55 mm Hg, HCO3 22 mEq/L: 4. pH 7.30, PO2 80 mm Hg, PaCO2 55 mm Hg, HCO3 22 mEq/L These ABG values indicate respiratory acidosis. The pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg, which indicates respiratory acidosis. 42.A nurse is assisting with a thoracentesis. Which of the following actions is appropriate for the nurse to take when assisting with this procedure: (Select all that apply)
9. Wear goggles and mask during the procedure
10. Cleanse the area with an antiseptic solution
11. Instruct the patient to take deep breaths during insertion of the needle
12. Position the patient laterally on the affected side
13. Apply pressure to the site after the needle is withdrawn: 1. Wear goggles and mask during the procedure
14. Cleanse the area with an antiseptic solution

23 / 40 5.Apply pressure to the site after the needle is withdrawn

24 / 40 43.A nurse is caring for a patient who is in respiratory distress and requires endotracheal suctioning. Which of the following actions should the nurse take:

1. Use clean technique to suction the patient's endotracheal tube
2. Use a rotating motion to remove the suction catheter
3. Suction the oropharyngeal cavity prior to suctioning the endotracheal tube
4. Suction the patient's endotracheal tube every 2 hours: 2. Use a rotating motion to remove the suction catheter The nurse should rotate the suction catheter during withdrawal to reduce the risk of tissue trauma. 44.A nurse is caring for a patient following the insertion of a chest tube. The nurse should plan to have which of the following items in the patient's room:
5. Extra drainage system
6. Suture removal set
7. Container of sterile water
8. Nonadherant pads: 3. Container of sterile water The nurse should plan to place the open end of tubing if it becomes disconnected into the sterile water to prevent a pneumothorax. 45.A nurse is assessing a patient who has emphysema. The nurse should report which of the following assessment findings:
9. Digital clubbing
10. Elevated temperature
11. Barrel-shaped chest
12. Diminished breath sounds: 2. Elevated temperature Patients who have emphysema are at risk for development of pneumonia and other respiratory infections. A nurse should report an elevated temperature to the provider. 46.A nurse in the emergency department is caring for a patient who is having an acute asthma attack. Which of the following assessments indicates that the respiratory status is declining? (Select all that apply)
13. SaO2 95%

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2. Wheezing
3. Retraction of sternal muscles
4. Pink mucous membranes