Test Bank Unit 7: Understanding Medical-Surgical
Nursing 6th Edition Linda S. Williams Paula D. Hopper
Chapter 29. Respiratory System Function, Assessment, and Therapeutic Measures
Answer Section
MULTIPLE CHOICE
1. ANS: C
Carbon dioxide is usually the major regulator of respiration because even small changes in its blood level
change the pH. A. Fluctuations in oxygen level have no effect on pH, and an adequate oxygen level in the
blood can be maintained even if breathing ceases for a few minutes. B. Nitrogen does not control respirations.
D. Hemoglobin level affects tissue oxygenation but is not the most important regulator of respiration.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
2. ANS: D
Functional residual capacity is the air remaining in lungs after normal expiration. C. Forced vital capacity is
the maximum amount of air expired forcefully after maximum inspiration. B. Expiratory reserve is the
amount of air beyond tidal volume in the most forceful exhalation. A. Tidal volume is the air inspired and
expired in one breath.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
3. ANS: B
Most carbon dioxide is carried in the blood in the form of bicarbonate ions in the plasma. A. C. Hydrogen ions
do not transport CO2, and it is not carried in plasma as CO2. D. Hemoglobin carries oxygen.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
4. ANS: D
Hemoglobin carries oxygen in the blood. B. C. Hemoglobin is in red blood cells, not on cell membranes or in
plasma. A. Oxygen is not transported free in plasma.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
5. ANS: A
The mucosa in the nose and trachea is ciliated epithelium; mucus with trapped dust and microorganisms is
swept upward toward the pharynx and is usually swallowed. D. Simple squamous epithelium does not have
cilia. B. Alveolar macrophages destroy foreign particles in the alveoli, not the trachea. C. Connective tissue
does not fight pathogens.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
6. ANS: B
Expiratory reserve is the amount of air beyond tidal volume in the most forceful exhalation. C. Forced vital
capacity is the maximum amount of air expired forcefully after maximum inspiration. D. Peak expiratory flow
rate is the maximum flow rate of air expired during forced vital capacity. A. Tidal volume is the air inspired
and expired in one breath.
PTS: 1 DIF: Moderate
, KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
7. ANS: B
Gas exchange occurs in the alveoli. A. C. D. The nasal passages, larynx, and bronchi transport air.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
8. ANS: A
The respiratory centers are located in the medulla oblongata and pons. B. The cerebrum controls some motor
functions, sensation, vision, and conscious thought, among other functions. C. The cerebellum controls
movement. D. The hypothalamus controls a variety of functions.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
9. ANS: C
Dyspnea or shortness of breath is subjective and can best be described using a 0-to-10 scale. A. B. D.
Describing it, observing the patient, and respiratory rate all provide good information but do not quantify
severity like a rating scale does.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
10. ANS: B
Use of the sternocleidomastoid (accessory) muscles causes the shoulders to rise during labored inspiration. C.
Fatigued muscles would contract less, not more, making the shoulders rise. A. Hyperinflation can occur with
respiratory disease but does not cause shoulders to rise. D. Breathing exercises include diaphragmatic and
pursed-lip breathing, not raising the shoulders.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis
11. ANS: A
A barrel-shaped chest is associated with air trapping that would be further assessed by the rate and character
of the respirations. C. Chest tenderness is not associated with respiratory disease. B. D. Respiratory acidosis
and cough are associated with pulmonary disease but do not cause a barreled chest and are not the priority at
this time.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
12. ANS: D
Comparing sounds on each side can help identify normal versus abnormal sounds. A. B. C. Having another
nurse or physician listen or questioning the patient are good strategies, but the first step is to listen on both
sides to verify differences.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
13. ANS: D
Asking the patient to breathe deeply through the mouth can help enhance the sounds. Allow the patient to rest
at intervals to prevent hyperventilation. A. If this does not work, then trying another stethoscope may be
helpful. C. Sitting, not side-lying, best helps the patient to take deep breaths. B. Having the patient rest is
helpful if he or she is fatigued or dyspneic but will not make breath sounds easier to hear.
PTS: 1 DIF: Moderate
, KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
14. ANS: C
Fast deep respirations alternated with periods of apnea are Cheyne-Stokes respirations. D. Hyperventilation is
deep breathing. B. A. Kussmaul’s are slow and deep, and tachypnea is a rate that is too fast.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
15. ANS: C
Thirty-six breaths per minute is too fast (normal 12 to 20), which describes tachypnea. B. Bradypnea is slow
respirations. A. Apnea is no respirations. D. A normal adult respiratory rate is 12 to 20 breaths per minute.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
16. ANS: C
Moist bubbling sound heard on inspiration or expiration is described as coarse crackles. B. Fine crackles
occur with heart failure or atelectasis and are finer and less bubbly. A. D. Wheezing sounds like violins, and a
friction rub sounds like leather rubbing together.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
17. ANS: A
A loud crowing noise from airway obstruction is called stridor. B. Wheezes are from narrowed airways and
are not as loud as stridor. C. Crackles are bubbling noises. D. A friction rub sounds like leather rubbing
together.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
18. ANS: B
Patients with asthma have narrowed airways that cause wheezing. A. D. Diminished breath sounds and
crackles are less common with asthma. C. Friction rub is associated with pleurisy.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
19. ANS: C
Deep breathing can trigger a cough and help raise sputum. A. B. Suctioning and bronchodilators may help but
are more invasive and would not be tried first. D. A cotton-tipped swab can obtain a throat culture, not a
sputum specimen.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
20. ANS: B
Pressure must be held for 5 minutes as the pressure in an artery can cause bleeding. A. D. There is no reason
to call the physician or increase oxygen. C. Holding a fist may increase bleeding.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
21. ANS: A
A normal PaCO2 is 35 to 45 mm Hg, so 68 is abnormally high. The physician should be notified. B. C.
Removing oxygen or breathing into a paper bag will worsen the PaCO2. D. Fowler’s position, not side-lying,
will help ventilation.
, PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
22. ANS: C
A low pH with a high PaCO2 indicates respiratory acidosis. B. D. Alkalosis is associated with a high pH. A.
Metabolic acidosis is associated with a low pH and HCO3.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis
23. ANS: D
Oxygen saturation measures the percentage of hemoglobin that is saturated with oxygen. A. Oxygen
saturation does not reflect the percent of oxygen in the lungs. B. The partial pressure of oxygen describes a
blood gas, not saturation. C. Oxygen does not saturate lymphocytes.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis
24. ANS: A
89% is low, and the first action is to raise the patient’s head to increase ventilation. This may be enough to
raise the saturation. B. The respiratory therapist may be needed, but 89% is usually not an emergency. C. A
supine position will worsen breathing. D. This is not a normal oxygen saturation level.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
25. ANS: A
After angiography, place the patient flat in bed for 3 to 8 hours as ordered by the physician. Monitor vital
signs, and observe the injection site for bleeding. A sandbag may be used to place pressure on the site.
Encourage fluid intake to promote excretion of the dye. C. D. The gag reflex and gastrointestinal (GI) system
are not affected by angiography. B. Fowler’s position may increase risk of bleeding.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
26. ANS: C
The patient is NPO following bronchoscopy until the gag reflex returns. Check for the gag reflex by touching
the pharynx with a cotton swab. A. B. After the gag reflex returns, ask the patient to swallow a sip of water
before offering foods or fluids. D. Touching the roof of the mouth with a gloved finger does not assess for the
gag reflex.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
27. ANS: D
Using abdominal and pursed-lip breathing will help the patient calm down and increase carbon dioxide
excretion. A, B, and C have not been shown to improve gas exchange.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
28. ANS: B
Fowler’s or semi-Fowler’s position helps keep abdominal contents from crowding the lungs, allowing
maximum lung expansion. C. Accessory muscle use is a sign of respiratory distress. D. Relieving stress on the
back and chest does not necessarily improve breathing. A. Fowler’s is not a bronchodilator.
Nursing 6th Edition Linda S. Williams Paula D. Hopper
Chapter 29. Respiratory System Function, Assessment, and Therapeutic Measures
Answer Section
MULTIPLE CHOICE
1. ANS: C
Carbon dioxide is usually the major regulator of respiration because even small changes in its blood level
change the pH. A. Fluctuations in oxygen level have no effect on pH, and an adequate oxygen level in the
blood can be maintained even if breathing ceases for a few minutes. B. Nitrogen does not control respirations.
D. Hemoglobin level affects tissue oxygenation but is not the most important regulator of respiration.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
2. ANS: D
Functional residual capacity is the air remaining in lungs after normal expiration. C. Forced vital capacity is
the maximum amount of air expired forcefully after maximum inspiration. B. Expiratory reserve is the
amount of air beyond tidal volume in the most forceful exhalation. A. Tidal volume is the air inspired and
expired in one breath.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
3. ANS: B
Most carbon dioxide is carried in the blood in the form of bicarbonate ions in the plasma. A. C. Hydrogen ions
do not transport CO2, and it is not carried in plasma as CO2. D. Hemoglobin carries oxygen.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
4. ANS: D
Hemoglobin carries oxygen in the blood. B. C. Hemoglobin is in red blood cells, not on cell membranes or in
plasma. A. Oxygen is not transported free in plasma.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
5. ANS: A
The mucosa in the nose and trachea is ciliated epithelium; mucus with trapped dust and microorganisms is
swept upward toward the pharynx and is usually swallowed. D. Simple squamous epithelium does not have
cilia. B. Alveolar macrophages destroy foreign particles in the alveoli, not the trachea. C. Connective tissue
does not fight pathogens.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
6. ANS: B
Expiratory reserve is the amount of air beyond tidal volume in the most forceful exhalation. C. Forced vital
capacity is the maximum amount of air expired forcefully after maximum inspiration. D. Peak expiratory flow
rate is the maximum flow rate of air expired during forced vital capacity. A. Tidal volume is the air inspired
and expired in one breath.
PTS: 1 DIF: Moderate
, KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
7. ANS: B
Gas exchange occurs in the alveoli. A. C. D. The nasal passages, larynx, and bronchi transport air.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
8. ANS: A
The respiratory centers are located in the medulla oblongata and pons. B. The cerebrum controls some motor
functions, sensation, vision, and conscious thought, among other functions. C. The cerebellum controls
movement. D. The hypothalamus controls a variety of functions.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
9. ANS: C
Dyspnea or shortness of breath is subjective and can best be described using a 0-to-10 scale. A. B. D.
Describing it, observing the patient, and respiratory rate all provide good information but do not quantify
severity like a rating scale does.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
10. ANS: B
Use of the sternocleidomastoid (accessory) muscles causes the shoulders to rise during labored inspiration. C.
Fatigued muscles would contract less, not more, making the shoulders rise. A. Hyperinflation can occur with
respiratory disease but does not cause shoulders to rise. D. Breathing exercises include diaphragmatic and
pursed-lip breathing, not raising the shoulders.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis
11. ANS: A
A barrel-shaped chest is associated with air trapping that would be further assessed by the rate and character
of the respirations. C. Chest tenderness is not associated with respiratory disease. B. D. Respiratory acidosis
and cough are associated with pulmonary disease but do not cause a barreled chest and are not the priority at
this time.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
12. ANS: D
Comparing sounds on each side can help identify normal versus abnormal sounds. A. B. C. Having another
nurse or physician listen or questioning the patient are good strategies, but the first step is to listen on both
sides to verify differences.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
13. ANS: D
Asking the patient to breathe deeply through the mouth can help enhance the sounds. Allow the patient to rest
at intervals to prevent hyperventilation. A. If this does not work, then trying another stethoscope may be
helpful. C. Sitting, not side-lying, best helps the patient to take deep breaths. B. Having the patient rest is
helpful if he or she is fatigued or dyspneic but will not make breath sounds easier to hear.
PTS: 1 DIF: Moderate
, KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
14. ANS: C
Fast deep respirations alternated with periods of apnea are Cheyne-Stokes respirations. D. Hyperventilation is
deep breathing. B. A. Kussmaul’s are slow and deep, and tachypnea is a rate that is too fast.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
15. ANS: C
Thirty-six breaths per minute is too fast (normal 12 to 20), which describes tachypnea. B. Bradypnea is slow
respirations. A. Apnea is no respirations. D. A normal adult respiratory rate is 12 to 20 breaths per minute.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
16. ANS: C
Moist bubbling sound heard on inspiration or expiration is described as coarse crackles. B. Fine crackles
occur with heart failure or atelectasis and are finer and less bubbly. A. D. Wheezing sounds like violins, and a
friction rub sounds like leather rubbing together.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
17. ANS: A
A loud crowing noise from airway obstruction is called stridor. B. Wheezes are from narrowed airways and
are not as loud as stridor. C. Crackles are bubbling noises. D. A friction rub sounds like leather rubbing
together.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
18. ANS: B
Patients with asthma have narrowed airways that cause wheezing. A. D. Diminished breath sounds and
crackles are less common with asthma. C. Friction rub is associated with pleurisy.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
19. ANS: C
Deep breathing can trigger a cough and help raise sputum. A. B. Suctioning and bronchodilators may help but
are more invasive and would not be tried first. D. A cotton-tipped swab can obtain a throat culture, not a
sputum specimen.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
20. ANS: B
Pressure must be held for 5 minutes as the pressure in an artery can cause bleeding. A. D. There is no reason
to call the physician or increase oxygen. C. Holding a fist may increase bleeding.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
21. ANS: A
A normal PaCO2 is 35 to 45 mm Hg, so 68 is abnormally high. The physician should be notified. B. C.
Removing oxygen or breathing into a paper bag will worsen the PaCO2. D. Fowler’s position, not side-lying,
will help ventilation.
, PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
22. ANS: C
A low pH with a high PaCO2 indicates respiratory acidosis. B. D. Alkalosis is associated with a high pH. A.
Metabolic acidosis is associated with a low pH and HCO3.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis
23. ANS: D
Oxygen saturation measures the percentage of hemoglobin that is saturated with oxygen. A. Oxygen
saturation does not reflect the percent of oxygen in the lungs. B. The partial pressure of oxygen describes a
blood gas, not saturation. C. Oxygen does not saturate lymphocytes.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis
24. ANS: A
89% is low, and the first action is to raise the patient’s head to increase ventilation. This may be enough to
raise the saturation. B. The respiratory therapist may be needed, but 89% is usually not an emergency. C. A
supine position will worsen breathing. D. This is not a normal oxygen saturation level.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
25. ANS: A
After angiography, place the patient flat in bed for 3 to 8 hours as ordered by the physician. Monitor vital
signs, and observe the injection site for bleeding. A sandbag may be used to place pressure on the site.
Encourage fluid intake to promote excretion of the dye. C. D. The gag reflex and gastrointestinal (GI) system
are not affected by angiography. B. Fowler’s position may increase risk of bleeding.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
26. ANS: C
The patient is NPO following bronchoscopy until the gag reflex returns. Check for the gag reflex by touching
the pharynx with a cotton swab. A. B. After the gag reflex returns, ask the patient to swallow a sip of water
before offering foods or fluids. D. Touching the roof of the mouth with a gloved finger does not assess for the
gag reflex.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application
27. ANS: D
Using abdominal and pursed-lip breathing will help the patient calm down and increase carbon dioxide
excretion. A, B, and C have not been shown to improve gas exchange.
PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application
28. ANS: B
Fowler’s or semi-Fowler’s position helps keep abdominal contents from crowding the lungs, allowing
maximum lung expansion. C. Accessory muscle use is a sign of respiratory distress. D. Relieving stress on the
back and chest does not necessarily improve breathing. A. Fowler’s is not a bronchodilator.
