RNSG 1140 QUESTIONS AND ANSWERS LATEST VERSION
Question 1 Which of the following are age-related structural and functional changes that occur in the respiratory
system? Select all that apply.
Correct response:Decreased elasticity of the alveolar sacs
Increased residual volume
Increased diameter of alveolar ducts
Increased thickness of alveolar sacs
Explanation Refer to Table 8-3 in the text.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 471.
Chapter 20: Assessment of Respiratory Function - Page 471
Question 2 When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system
should the nurse be aware of? (Select all that apply.)
Correct response: Decreased gag reflex
Increased presence of collagen in alveolar
walls Decreased presence of mucus
Explanation: Age-related changes in the respiratory system include a decrease in mucus, decrease in gag reflex,
increase in collagen in the alveolar walls of the lungs, and increase in alveolar duct diameter.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 471.
Chapter 20: Assessment of Respiratory Function - Page 471
Question 3 The nurse is caring for a client who is demonstrating signs of increased respiratory distress related to
laryngeal obstruction. The nurse is calling the physician to report on the client’s condition. Which of the following will
the nurse report? Select all that apply.
Correct response: Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84
Nasal flaring with abdominal retractions
Lung sounds of stridor
Increased respiratory effort
Explanation: The nurse would be calling to report signs of respiratory distress. This includes nasal flaring with
abdominal retractions, stridor and an increased respiratory effort. Also arterial blood gases with an elevated CO2 and
lower oxygen level indicates respiratory compromise. An increased respiratory rate occurs in respiratory compromise.
Administration of a corticosteroid decreases inflammation over a period of time.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, pp. 481, 484.
Question 4 The nurse is caring for a patient who is scheduled for a bronchoscopy. The nurse understands that it is
important to provide the required information and appropriate explanations for any diagnostic procedure to a patient
with a respiratory disorder in order to do which of the following?
Correct response: Manage decreased energy levels
, Explanation:In addition to the nursing management of individual tests, patients with respiratory disorders require
informative and appropriate explanations of any diagnostic procedures they will experience. Nurses must remember that
,for many of these patients, breathing may in some way be compromised and energy levels may be decreased. For that
reason, explanations should be brief, yet complete, and may need to be repeated later after a rest period. The nurse
must also ensure adequate rest periods before and after the procedures. After invasive procedures, the nurse must
carefully assess for signs of respiratory distress.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.,
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 484.
Chapter 20: Assessment of Respiratory Function - Page 484
Question 5 The nurse is responsible for monitoring indicators of potential complications post laryngectomy. Which
of the following indicators would be of concern? Select all that apply.
Correct response: Somnolence and
hypotension Tachycardia and tachypnea
Impaired swallowing
A tracheostomy cuff pressure >20 mmHg
Explanation: Delayed capillary refill and two or more residual volumes of 200 mL or more would be indicators of the
potential complications of hypoxia and tracheostomal stenosis.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 22: Management of Patients With Upper Respiratory Tract
Disorders, pp. 564-5.
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders - Page 564-5
Question 6 The nurse is instructing a patient who is scheduled for a perfusion lung scan. What should be included in the
information about the procedure? (Select all that apply.)
Correct response: A mask will be placed over the nose and mouth during the test.
The patient will be expected to lie under the camera.
The imaging time will amount to 20 to 40 minutes.
Explanation: A ventilation/perfusion lung scan is performed by injecting a radioactive agent into a peripheral vein and
then obtaining a scan of the chest to detect radiation. The isotope particles pass through the right side of the heart and
are distributed into the lungs in proportion to the regional blood flow, making it possible to trace and measure blood
perfusion through the lung. This procedure is used clinically to measure the integrity of the pulmonary vessels relative to
blood flow and to evaluate blood flow abnormalities, as seen in pulmonary emboli. The imaging time is 20 to 40 minutes,
during which the patient lies under the camera with a mask fitted over the nose and mouth. This is followed by the
ventilation component of the scan. The patient need not be NPO for 12 hours prior to the procedure.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 486.
Chapter 20: Assessment of Respiratory Function - Page 486
Question 7 It is important for a nurse to provide required information and appropriate explanations of diagnostic
procedures to patients with respiratory disorders to
Correct response: manage decreased energy levels.
Explanation: In addition to the nursing management of individual tests, patients with respiratory disorders require
informative and appropriate explanations of any diagnostic procedures they will experience. Nurses must remember that
for many of these patients, breathing may in some way be compromised and energy levels may be decreased. For that
reason, explanations should be brief, yet complete, and may need to be repeated later after a rest period. The nurse
, must also ensure adequate rest periods before and after the procedures. After invasive procedures, the nurse must
carefully assess for signs of respiratory distress.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 484.
Chapter 20: Assessment of Respiratory Function - Page 484
Question 8 A young adult client has had a tonsillectomy and is in the immediate postoperative period. To make the
client comfortable, the nurse intervenes by
Correct response:Placing the client prone with the head turned to the side
Explanation: The most comfortable position for the client in the immediate postoperative period is prone, not semi–
Fowler's. The client's head is turned to the side to allow drainage from the mouth. The oral airway is removed after the
gag reflex has returned. An ice collar, not warm compress, is applied to the neck area.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 22: Management of Patients With Upper Respiratory Tract
Disorders, p. 549.
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders - Page 549
Question 9 A 13-year-old soccer player presents to the emergency room with a fractured nose. The patient's mother is
given which of the following post-discharge instructions? Select all that apply.
Correct response: Check for any unusual changes in breathing during the first 48 hours.
Observe for any clear drainage from either nostril.
Elevate the head of the bed for sleeping during the first week.
Restrict from sports activities for 6 weeks.
Explanation: Ice or cold compresses are applied four to six times a day, for several days, until the swelling is decreased.
Packing is inserted to control bleeding. It would not be used to reshape the nose.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 22: Management of Patients With Upper Respiratory Tract
Disorders, pp. 556.
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders - Page 556
Question 10 The nurse assesses a patient with pneumonia and notes bronchial breath sounds over consolidated lung
areas. Which of the following breath sounds are diagnostic for pneumonia? Select all that apply.
Correct response: Crackles , Egophony Whispered pectoriloquy Percussion dullness
Explanation:Physical examination findings may reveal bronchial breath sounds over consolidated lung areas: soft, high-
pitched crackles, inspiratory vesicular sounds that are longer than expired normal breath sounds; increased tactile
fremitus (vocal vibration detected on palpation), percussion dullness, egophony, and whispered pectoriloquy
(whispered sounds are easily auscultated through the chest wall). Wheezes and friction rubs are not diagnostic for
pneumonia.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th
ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 23: Management of Patients With Chest and
Lower Respiratory Tract Disorders, pp. 578.
Chapter 23: Management of Patients With Chest and Lower Respiratory Tract Disorders - Page 578
Question 11 Why is it important for a nurse to provide required information and appropriate explanations of diagnostic
procedures to patients with respiratory disorders?
Question 1 Which of the following are age-related structural and functional changes that occur in the respiratory
system? Select all that apply.
Correct response:Decreased elasticity of the alveolar sacs
Increased residual volume
Increased diameter of alveolar ducts
Increased thickness of alveolar sacs
Explanation Refer to Table 8-3 in the text.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 471.
Chapter 20: Assessment of Respiratory Function - Page 471
Question 2 When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system
should the nurse be aware of? (Select all that apply.)
Correct response: Decreased gag reflex
Increased presence of collagen in alveolar
walls Decreased presence of mucus
Explanation: Age-related changes in the respiratory system include a decrease in mucus, decrease in gag reflex,
increase in collagen in the alveolar walls of the lungs, and increase in alveolar duct diameter.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 471.
Chapter 20: Assessment of Respiratory Function - Page 471
Question 3 The nurse is caring for a client who is demonstrating signs of increased respiratory distress related to
laryngeal obstruction. The nurse is calling the physician to report on the client’s condition. Which of the following will
the nurse report? Select all that apply.
Correct response: Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84
Nasal flaring with abdominal retractions
Lung sounds of stridor
Increased respiratory effort
Explanation: The nurse would be calling to report signs of respiratory distress. This includes nasal flaring with
abdominal retractions, stridor and an increased respiratory effort. Also arterial blood gases with an elevated CO2 and
lower oxygen level indicates respiratory compromise. An increased respiratory rate occurs in respiratory compromise.
Administration of a corticosteroid decreases inflammation over a period of time.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, pp. 481, 484.
Question 4 The nurse is caring for a patient who is scheduled for a bronchoscopy. The nurse understands that it is
important to provide the required information and appropriate explanations for any diagnostic procedure to a patient
with a respiratory disorder in order to do which of the following?
Correct response: Manage decreased energy levels
, Explanation:In addition to the nursing management of individual tests, patients with respiratory disorders require
informative and appropriate explanations of any diagnostic procedures they will experience. Nurses must remember that
,for many of these patients, breathing may in some way be compromised and energy levels may be decreased. For that
reason, explanations should be brief, yet complete, and may need to be repeated later after a rest period. The nurse
must also ensure adequate rest periods before and after the procedures. After invasive procedures, the nurse must
carefully assess for signs of respiratory distress.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.,
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 484.
Chapter 20: Assessment of Respiratory Function - Page 484
Question 5 The nurse is responsible for monitoring indicators of potential complications post laryngectomy. Which
of the following indicators would be of concern? Select all that apply.
Correct response: Somnolence and
hypotension Tachycardia and tachypnea
Impaired swallowing
A tracheostomy cuff pressure >20 mmHg
Explanation: Delayed capillary refill and two or more residual volumes of 200 mL or more would be indicators of the
potential complications of hypoxia and tracheostomal stenosis.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 22: Management of Patients With Upper Respiratory Tract
Disorders, pp. 564-5.
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders - Page 564-5
Question 6 The nurse is instructing a patient who is scheduled for a perfusion lung scan. What should be included in the
information about the procedure? (Select all that apply.)
Correct response: A mask will be placed over the nose and mouth during the test.
The patient will be expected to lie under the camera.
The imaging time will amount to 20 to 40 minutes.
Explanation: A ventilation/perfusion lung scan is performed by injecting a radioactive agent into a peripheral vein and
then obtaining a scan of the chest to detect radiation. The isotope particles pass through the right side of the heart and
are distributed into the lungs in proportion to the regional blood flow, making it possible to trace and measure blood
perfusion through the lung. This procedure is used clinically to measure the integrity of the pulmonary vessels relative to
blood flow and to evaluate blood flow abnormalities, as seen in pulmonary emboli. The imaging time is 20 to 40 minutes,
during which the patient lies under the camera with a mask fitted over the nose and mouth. This is followed by the
ventilation component of the scan. The patient need not be NPO for 12 hours prior to the procedure.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 486.
Chapter 20: Assessment of Respiratory Function - Page 486
Question 7 It is important for a nurse to provide required information and appropriate explanations of diagnostic
procedures to patients with respiratory disorders to
Correct response: manage decreased energy levels.
Explanation: In addition to the nursing management of individual tests, patients with respiratory disorders require
informative and appropriate explanations of any diagnostic procedures they will experience. Nurses must remember that
for many of these patients, breathing may in some way be compromised and energy levels may be decreased. For that
reason, explanations should be brief, yet complete, and may need to be repeated later after a rest period. The nurse
, must also ensure adequate rest periods before and after the procedures. After invasive procedures, the nurse must
carefully assess for signs of respiratory distress.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 20: Assessment of Respiratory Function, p. 484.
Chapter 20: Assessment of Respiratory Function - Page 484
Question 8 A young adult client has had a tonsillectomy and is in the immediate postoperative period. To make the
client comfortable, the nurse intervenes by
Correct response:Placing the client prone with the head turned to the side
Explanation: The most comfortable position for the client in the immediate postoperative period is prone, not semi–
Fowler's. The client's head is turned to the side to allow drainage from the mouth. The oral airway is removed after the
gag reflex has returned. An ice collar, not warm compress, is applied to the neck area.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 22: Management of Patients With Upper Respiratory Tract
Disorders, p. 549.
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders - Page 549
Question 9 A 13-year-old soccer player presents to the emergency room with a fractured nose. The patient's mother is
given which of the following post-discharge instructions? Select all that apply.
Correct response: Check for any unusual changes in breathing during the first 48 hours.
Observe for any clear drainage from either nostril.
Elevate the head of the bed for sleeping during the first week.
Restrict from sports activities for 6 weeks.
Explanation: Ice or cold compresses are applied four to six times a day, for several days, until the swelling is decreased.
Packing is inserted to control bleeding. It would not be used to reshape the nose.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed.
Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 22: Management of Patients With Upper Respiratory Tract
Disorders, pp. 556.
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders - Page 556
Question 10 The nurse assesses a patient with pneumonia and notes bronchial breath sounds over consolidated lung
areas. Which of the following breath sounds are diagnostic for pneumonia? Select all that apply.
Correct response: Crackles , Egophony Whispered pectoriloquy Percussion dullness
Explanation:Physical examination findings may reveal bronchial breath sounds over consolidated lung areas: soft, high-
pitched crackles, inspiratory vesicular sounds that are longer than expired normal breath sounds; increased tactile
fremitus (vocal vibration detected on palpation), percussion dullness, egophony, and whispered pectoriloquy
(whispered sounds are easily auscultated through the chest wall). Wheezes and friction rubs are not diagnostic for
pneumonia.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th
ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 23: Management of Patients With Chest and
Lower Respiratory Tract Disorders, pp. 578.
Chapter 23: Management of Patients With Chest and Lower Respiratory Tract Disorders - Page 578
Question 11 Why is it important for a nurse to provide required information and appropriate explanations of diagnostic
procedures to patients with respiratory disorders?
