Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines College of Nursing Mid-Term examination NCM 103

Name: ___________________________

Year & Sec. ____________

Date: ____________ Score:

Test I: Multiple Choice: write the letter of your choice on the space provided for. NO ERASURES OR SUPERIMPOSITIONS

_____1. The nurse is teaching a patient about respiratory system. She explains that which of the following is the basic unit of gas exchange? A. lungs C. alveoli B. bronchioles D. surfactant _____2. The primary reason to teach pursed-lip breathing in a client with COPD is to help: A. promote oxygen intake B. strengthen the diaphragm C. promote carbon dioxide elimination D. strengthen the inter costal muscles _____3. The client is scheduled for bronchoscopy . All are pre nursing care, except: A. secure consent B. ask for allergy to seafoods or iodine C. NPO 6-12 hrs prior to procedure D. Instruct client to remove dentures _____4. A patient returned to his room an hour ago following bronchoscopy. He is asking for a glass of water. The nurse should: A. Keep him on NPO until further orders B. Check vital signs C. Check swallowing and gag reflex D. Encourage deep breathing and coughing _____5. Oxygen at the rate of 2L/min via nasal cannula is prescribed for a client with COPD. Which of the following statement BEST describes why oxygen therapy is maintained at a low concentration? A. Oxygen will be lost at a client`s nostril if given at a higher level with nasal cannula B. His condition indicates he would be unable to Absorb oxygen given at a higher rate C. The client`s respiratory center is so accustomed To high carbon dioxide and low blood oxygen concentration that changing these concentrations with oxygen therapy may eliminate the stimulus for breathing D. The cells in the alveoli are so damaged that increased oxygen levels will cause the cells to burst. _____6. The nurse assesses her client`s respiratory status. Which observation would alert the nurse that her client needs more oxygenation? A. Diaphragmatic breathing B. Use of accessory muscles C. Purse-lip breathing D. Controlled breathing _____7. A nurse detects bilateral crackles upon auscultation. Which statement about crackles is true? A. Heard on expiration and may clear with a cough B. Heard on inspiration and sometimes clear with a cough C. Hissing or musical heard on both inspiration and expiration D. Creaking and grating heard over problem area during both expiration and inspiration

_____8. Which of the following laboratory value when monitored routinely would reflect the client`s respiratory status? A. Partial oxygen (PO2) B. Partial carbon Dioxide (PCO2) C. h emoglobin D. oxygen saturation _____9. Which of the following equipments does not interfere with a client`s ability to eat and talk, and can best deliver oxygen in a hypoxic client? A. Oxygen tent B. Oygen mask C. Nasal cannula D. Endotracheal tube Situation: Alrae, 55 years old, was recently diagnosed with bronchial asthma. In the ER he is experiencing shortness of breath, 3 liters of O2 was administered via nasal canula, and stat order of Albuterol 2mg per nebulization. _____10. What type of drug is Albuterol? A. Leukotrine modifier B. Beta agonist bronchodilator C. Anti cholinergic D. Xanthine _____11. Alrae, also inquired about the action of the drug: A. Inhibits inflammatory mediators B. Inhibits components of bronchoconstriction C. Inhibits arachidonic acid to convert into inflammatory mediators D. Relax smooth muscles in the bronchioles _____12. Chest x-ray reveals tension pneumothorax, where the lungs are: A. Compressed to the unaffected side because of decreased pressure on the affected side B. Compressed to the unaffected side because of the increased pressure to the affected side C. Where air enters the pleura on inspiration and transfers to the other side on expiration D. Air is accumulated in the pleural space without a cause _____13. The nurse is giving client instructions on how to obtain sputum specimen properly. A. Rinse mouth with water properly prior to collection B. Rinse mouth with bactidol properly prior to collection C. Brush teeth properly prior to collection D. Brush teeth with salt prior to collection _____14. A bronchoscope is used to view the airways and check for any abnormalities, nursing interventions include: A. Remove dentures and eyeglasses and contact lens B. Empty bladder 2 hours prior to examination C. Assess for allergies to iodine and dyes D. Sitting position is the desired position _____15. A nurse is suctioning fluids from a client through a tracheostomy tube. When suctioning the nurse must limit the suction to a maximum of: A. 5 seconds B. 10 seconds C. 30 seconds D. 1 minute _____16. An emergency room nurse is assessing a client who sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? A. A sucking sound at the site of injury B. Diminished breath sounds C. Low respiratory rate D. Presence of barrel chest

_____17. An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery system would the nurse anticipate to be prescribed? A. Venture mask B. Aerosol mask C. Face tent D. Tracheostomy collar _____18. A nurse is assessing a client with chronic airflow limitation and notes that the client has a barrel chest. The nurse interprets that this client has which of the following forms of chronic airflow limitation? A. Chronic obstructive bronchitis B. Emphysema C. Bronchial asthma D. Bronchial asthma and bronchitis _____19. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be reported immediately to the physician? A. Blood- streaked sputum B. Dry cough C. Hematuria D. Bronchospasm _____20. A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning procedure the nurse notes on the monitor that the heart rate decreases. Which of the following is the most appropriate nursing intervention? A. Continue to suction B. Ensure that the suction is limited to 15 seconds C. Stop the procedure and reoxygenate client D. Notify physician immediately _____21. Clubbing of the fingers could be a sign of: A. Viral infection B. Upper respiratory infection C. Chronic obstructive pulmonary disease D. Nothing, it is inherited _____22. A person more susceptible to chronic obstructive pulmonary disease would be: A. Long term- smoker B. Long time firemen C. A farmer that deals with pesticide D. All of the above _____23. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for the client? A. Activity intolerance r/t fatigue B. Anxiety r/t actual threat to health status C. Risk for infection r/t retained secretions D. Impaired gas exchange r/t airflow obstruction a meal _____24. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform the procedure? A. Immediately after a meal B. Atleast 2 hours after a meal C. When bronchospasms occur D. When secretions have mobilized _____25. A nurse is caring for a male who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is: A. Helping him communicate B. Keeping his airway patent C. Encouraging him to perform activities of daily living D. Preventing him from developing an infection

_____26. For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway? A. Restrict fluid intake to 1,000 mL/day B. Enforcing bedrest C. Teaching client how to perform controlled coughing D. Administer prescribed sedatives regularly and in large amounts _____27. For a male client who has a chest tube connected to a closed-water seal drainage system, the nurse should include which action in the plan of care? A. Measuring and documenting the drainage in the collection chamber B. Maintaining continuous bubbles in the water seal chamber C. Keeping the collection chamber at chest level D. Stripping chest tube every hour _____28. A black male client with asthma seeks emergency care for acute respiratory distress. Because of the client`s dark skin, the nurse should assess for cyanosis by inspecting the: A. Lips B. Mucous membrane C. Nail beds D. Ear lobes _____29. A nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which of the following positions will the nurse instruct client to assume? A. Side-lying in bed B. Sitting in a recliner chair C. Sitting up in bed D. Sitting on the side of the bed and leaning on an overbed table Situation II: A client is admitted to the hospital with acute exacerbation of long- standing chronic obstructive pulmonary disease (COPD) brought about by an upper respiratory tract infection. He is tachypneic and acutely short of breath. Both he and his wife are extremely anxious. _____30. The client is admitted to room 13, but he states that he does not want to remain in the room because the number will bring him bad luck. Personnel in the admitting office say that a change can be made if the nurse feels that it is wise to do so. Which of the following statements offers the bets guide for the nurse in the situation? A. Move the client; the client`s fears, even when unfounded can impede recovery B. Move the client; superstitions have a chance of coming true if one believes in them C. Do not move the client; having the client use the room will help him overcome his fear D. Do not move the client; client may become unmanageable and demanding when he knows he can have his way _____31. Oxygen at the rate of 2L/min via nasal cannula is prescribed for the client. Which of the following statements best describes why the oxygen therapy is maintained at the relatively low concentration? A. The oxygen will be lost at the clients nostrils if given at the higher level with a nasal cannula. B. The client`s long history of respiratory problems indicates that he would be unable to absorb oxygen given at a higher rate. C. The cells in alveoli are so damaged by the client`s long history of respiratory problems that increased oxygen levels and reduced carbon dioxide levels likely will cause the cells to burst. D. The client respiratory center is so accustomed to high carbon dioxide and low blood oxygen concentrations that changing these concentrations with oxygen therapy may eliminate his stimulus for breathing. _____32. The clients reports steady weight loss and that he is too tired from just breathing to eat which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client. A. Altered nutrition: less than body requirements related to fatigue. B. Altered nutrition: less than body requirements related to COPD. C. Weight loss related to COPD D. Ineffective breathing patterns related to alveolar hypoventilation

_____33.when developing the clients discharge plan, the nurse should be guided by an understanding that the client is most likely to A. Develop infection easily B. Maintain his currents status C. Require less supplemental oxygen D. Show permanent improvement. _____34. On hospital discharge, outcome criteria for the client would include A. Promises to do pursed-lip breathing. B. States action to reduce risk of respiratory infections. C. Exhibits temperature not exceeding 100F D. Agrees to call the physicians if dyspnea on exertion occurs. _____35. For the client with productive cough and difficulty breathing, the nurse should obtain the body temperature at what site? A. Mouth B. Groin fold C. Rectum D. Axilla _____36.which of the following behaviors could indicate that client with pneumonia is experiencing hypoxia? A. Anger B. Apathy C. Anxiety D. Aggression _____37.during postural drainage, movement of secretions from the lower respiratory tract to the upper respiratory tract occurs due to A. Friction sodium retention. B. Increased calcium excretion C. Increased insulin utilization D. Increased red blood cell production. _____38. For a client with COPD who has trouble raising respiratory secretions, which of the following nursing measures would help reduce the tenacity of secretions? A. Ensuring that the client diet is low in salt. B. Ensuring that the client oxygen therapy is continuous C. Helping the client maintain a high fluid intake. D. Keeping the client in a semi sitting position as much as possible. ____39. Which of the following statements contains one of the basic rules to follow when caring for a client with chest tube and water seal drainage system? A. Ensure that the air vent on the water seal drainage system is capped when the suction is off. B. Strip the chest and drainage tubes atleast every 4 hours if excessive bleeding occurs C. Ensure that the collection and suction bottles are below the client`s chest level at all times D. Ensure that the collection and suction bottles are at the client`s chest level at all times _____40. Assuming a nasal cannula provides one to six L per minute of oxygen, what oxygen concentration can it deliver? A. 40 to 60 percent. B. 17 to 21 percent. C. 25 to 45 percent. D. 60 to 100 percent _____41. Which of the following statements about an oral airway is true? A. Before insertion, a petroleum-based lubricant should be applied to the airway. B. If it is not inserted improperly, the airway may result in an obstruction. C. They are tolerated with relative ease by responsive or semi responsive patients. D. They are accepted as the ideal way to manage the airway during a cardiac arrest

_____42. How should you proceed after further assessment shows that patient has gurgling respirations of about 4 per minute: A. Apply suction to the patient's upper airway. B. Start chest compressions to clear an airway obstruction. C. Use the pulse oximeter to check the patient's oxygen saturation D. Apply pads to the patient's chest.

_____43. Continuing from the previous question, assume the patient's respirations continue at the same rate, with barely visible chest movement during each of his breaths. All of the following devices for delivering oxygen would be undesirable to use in this situation except: A. Nasal cannula (4 L/minute) B. Simple face mask ( 4 L/minute C. Nonrebreather mask (15 L/minute) D. Bag mask device with supplemental oxygen and reservoir (15 L/minute) _____44. The nurse observes a constant gentle bubbling in the water seal bottle of an under-water seal chest drainage system. This observation should prompt the nurse to: A. Continue monitoring as usual; this is a normal observation B. Check the connectors between the chest and drainage tubes and where the drainage tube enters the collection bottle C. Decrease the suction to 15cm H2O or less and continue observing the system for changes in bubbling over the next several hours D. Drain half the water from the under-water seal chamber _____45. Which of the following findings would suggest pneumothorax in a trauma victim? A. Pronounced crackles B. Inspiratory wheezing C. Dullness on percussion D. Absent breath sounds _____46. Complications associated with a tracheostomy tube include: A. Decrease cardiac output B. Damage to the laryngeal nerve C. Pneumothorax D. Adult respiratory distress syndrome _____47. A priority goal for the hospitalized client with a new tracheostomy would be to: A. Decrease secretions B. Instruct client in caring for the tracheostomy C. Relieve anxiety related to the tracheostomy D. Maintain a patent airway _____48. When oxygen therapy via nasal cannula is ordered for a patient, the first action by the nurse is to: A. Post an oxygen in use sign on the door to the room B. Adjust the oxygen level before applying the cannula C. Explain the rules of fire safety and oxygen use D. D. Lubricate the nares with water-soluble jelly _____49. A patient with a history of chronic respiratory disease begins to have difficulty breathing. The adaptations that are the most serious would be: A. Orthostatic hypotension when rising and the need to sit in the orthopneic position. B. The need to sit in the orthopneic position and wheezing sounds on inspiration. C. Wheezing sounds on inspiration and mucus tinged with frank red streaks. D. Mucus tinged with frank red streaks and chest pain.
_____50. The adequacy of tissue oxygenation is most accurately measured by:

A. B. C. D.

Hematocrit values Hemoglobin levels Arterial blood gases Pulmonary function tests

_____51. When do wheezing breath sounds occur? A. When fluid is in the lung B. When sitting in the orthopneic position C. When air moves through a narrowed airway D. When the pleural sack rubs against the lung surface _____52. Which is most effective for maintaining a patent airway? A. Active coughing B. Incentive spirometry C. Nebulizer treatments D. Abdominal breathing _____53. The nurse is caring a patient with COPD exacerbation, patient`s respiration is 28b/min. with dyspnea on exertion. The client is receiving oxygen at 2L/min via nasal canula, this morning pulse oximetry is 92%. Which nursing intervention is priority? A. Monitor the client B. Notify the physician C. Get an order to increase oxygen D. Place in semi- fowler`s position _____54. The nurse is caring a patient with COPD exacerbation. Which assessment is most indicative of a potential complication? A. RR 32 b/min, increasingly anxious and restless B. Using accessory muscles during respiration C. Pulse oximetry 92%, purse-lip breathing D. Expectorating copious amount of white phlegm _____55. All of the following statements about the nasal airway are correct except: A. nosebleed can result from forceful insertion of the nasal airway. B. For patients with heavy cranio-facial trauma, the proper airway adjunct is the nasal airway. C. A water-soluble lubricant should be used before insertion of a nasal airway. D. A nasal airway can be tolerated by most responsive or semi-responsive patients

_____56. Endotracheal intubation:

_____57. It is the passageway for both the respiratory and digestive tracts: A. B. C. D. Nose Sinuses Larynx Pharynx

_____58. Part of the respiratory that has no cartilage and depend on the elastic recoil of the lung for patency: A. B. C. D. Nose Sinuses Bronchioles Alveoli

_____59. Risk factors for respiratory disease includes all, except: A. B. C. D. Geographic residence Exposure to chemicals Surgery Excessive alcohol intake

_____60. Ritchel, 29 years old, asked the nursing student discussing oxygenation about pulse oximetry, you would explain that pulse oximetry is: A. Sensor that detects changes in saturation levels by monitoring light signals generated by the sensor B. Determines location and extent of pathological processes and to obtain samples for biopsy C. Informs anatomic location and appearance D. None of the above _____61. How would you explain stertorous breathing? A. B. C. D. Sound due to vibration in the pharynx during sleep Crowing sound during sleep Continuous musical sound during sleep Deep, regular sighing breathing whether slow or fast

_____62. On the other hand, kussmaul`s breathing, is: A. B. C. D. Sound due to vibration in the pharynx during sleep Crowing sound during sleep Continuous musical sound during sleep Deep, regular sighing breathing whether slow or fast

_____63. Cheyne- stokes is described as a: A. B. C. D. Crowing sound during sleep Continuous musical sound during sleep Deep, regular sighing breathing whether slow or fast Periods of apnea alternate regularly with series of respiration

_____64. Biot`s breathing is described as a: A. Periods of apnea alternate irregularly with series of breaths of equal depth that terminate abruptly B. Continuous musical sound during sleep C. Deep, regular sighing breathing whether slow or fast D. Periods of apnea alternate regularly with series of respiration _____65. Low-pitched sounds caused by sputum in large airways and frequently clear after coughing. A. B. C. D. Biot`s breathing Cheyne- Stokes breathing Rhonchi Wheezes

_____66. It is Voice vibrations on the chest wall. A. B. C. D. Rhonchi Wheezes Crackles Fremitus

_____67. refers to an afebrile, infectious acute inflammation of the mucous membrane A. B. C. D. Rhinitis Pharyngitis Colds Rhinorrhea

_____68. The sinuses are cavities, or air-filled pockets, normally drain into the nose and are involved in many URIs. How many types of sinuses? A. 5

B. 2 C. 3 D. 4 _____69. Nursing intervention for sinusitis, includes the following, except: A. B. C. D. Increase fluid intake Advised to avoid swimming, diving and air travel during the acute infection Warm saline gargles to sooth the throat All of the above

_____70. Implement nursing intervention according to priority for sinusitis: 1. 2. 3. 4. A. B. C. D. Perform hand hygiene often Eat nutritious foods Avoid individuals with colds or respiratory infection Use disposable tissues 1,2,3,4 1,3,2,4 2,1,3,4 1,4,3,2

Test II: CROSSWORD PUZZLE: Across 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Voice box Loss of consciousness Crowing sound Protects the lungs Whistling sound Snapping open sound Difficulty of breathing Lack of oxygen Deep, regular sighing breathing Sound Vibration Positive-End- Expiratory- Pressure Surgical procedure of the pleura Low- pitch sounds snore Down 1. Humidifies, warms and filters air 2. secretions 3. Informs anatomic location and appearance 4. Thoracic cavity 5. Indicate structures distal to the bronchioles 6. Odorless, colorless and tasteless 7. Nasal passage 8. ache 9. collection 10. Breath- in 11. Magnetic Resonance Imaging 12. Bluish discoloration 13. Thickness of the fingers 14. None- Steroidal- Anti- Inflammatory- Drug 15. mortality

Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines College of Nursing Mid-Term examination NCM 103 Name: ___________________________ Year & Sec. ____________ Date: ____________ Score:

Test I: Multiple Choice: write the letter of your choice on the space provided for. NO ERASURES OR SUPERIMPOSITIONS