Chapter 29
Which structure is responsible for preventing food from entering the lower respiratory tract during swallowing?
A. Trachea
B. Pharynx
C. Epiglottis
D. Larynx
C. Epiglottis
A nurse is caring for a patient with posterior epistaxis. Which nursing intervention is the highest priority?
A. Applying an ice pack to the back of the neck
B. Instructing the patient to blow the nose to remove clots
C. Monitoring for signs of airway obstruction
D. Encouraging fluids to keep the mucosa moist
C. Monitoring for signs of airway obstruction
Posterior nosebleeds can be severe and may lead to airway compromise. Monitoring for airway obstruction is critical. Blowing the nose can worsen bleeding, and while ice and hydration help, they are not the priority in this situation.
A patient with COPD is admitted with increasing dyspnea and productive cough. The nurse notes the patient is using accessory muscles and has an SpO₂ of 88% on room air. What is the nurse’s priority intervention?
A. Administer bronchodilator as prescribed
B. Apply 4L nasal cannula oxygen immediately
C. Encourage coughing and deep breathing exercises
D. Elevate the head of the bed and reassess oxygenation
D. Elevate the head of the bed and reassess oxygenation
Positioning is the immediate action to reduce work of breathing and improve oxygenation. Administering O₂ without a controlled approach in COPD risks CO₂ retention. Meds and exercises follow once the airway is optimized.
This chronic respiratory disorder is characterized by bronchospasm, inflammation, and reversible airway obstruction, often triggered by allergens, cold air, or exercise.
asthma
Asthma involves airway hyperresponsiveness leading to wheezing, dyspnea, and coughing. It is reversible with proper treatment, unlike COPD. Common triggers include allergens and irritants.
This common bronchodilator is often used in the management of asthma and COPD to relieve bronchospasm by relaxing the smooth muscles of the airways.
albuterol
Albuterol is a short-acting beta-agonist used for acute relief of bronchospasm in asthma and COPD. It helps to dilate the airways and improve airflow.
While assessing a patient’s lungs, the nurse hears short, high-pitched popping sounds during inspiration that do not clear with coughing. Which condition is most consistent with this finding?
A. Chronic bronchitis
B. Atelectasis
C. Asthma
D. Emphysema
B. Atelectasis
Fine crackles, often heard at lung bases during inspiration and not cleared by coughing, are classic signs of atelectasis or pulmonary fibrosis.
A patient recently diagnosed with moderate obstructive sleep apnea (OSA) expresses frustration during a follow-up visit:
"I’ve tried using my CPAP, but I can’t tolerate it. I feel claustrophobic and end up taking it off in the middle of the night."
Which nursing response is the best to improve the patient's adherence to therapy?
A. “Let’s explore alternatives like nasal strips or over-the-counter sleep aids.”
B. “I understand it’s uncomfortable. You can try using it every other night at first.”
C. “I can refer you to a respiratory therapist to discuss mask fitting and desensitization strategies.”
D. “You may not need CPAP if you avoid sleeping on your back and lose weight.”
C. “I can refer you to a respiratory therapist to discuss mask fitting and desensitization strategies.”
Many patients struggle with CPAP adherence, especially early on. A referral for mask re-fitting and gradual desensitization can help improve compliance. Telling the patient to skip nights or use sleep aids undermines treatment and risks complications. Weight loss helps, but it’s a long-term strategy—not an alternative to therapy.
A post-op patient suddenly becomes anxious and reports sharp chest pain and dyspnea. The nurse notes tachycardia and a drop in SpO₂ to 89%. What is the most likely cause?
A. Atelectasis
B. Pulmonary embolism
C. Pneumothorax
D. Pleural effusion
B. Pulmonary embolism
Acute chest pain, anxiety, hypoxia, and tachycardia in a post-op patient are hallmark signs of PE, a surgical emergency. Atelectasis may cause mild hypoxia but not acute chest pain or sudden instability.
This infection leads to consolidation of lung tissue, presents with fever, chills, productive cough, and is commonly diagnosed with a chest X-ray.
pneumonia
Pneumonia is an infection of the alveoli, causing them to fill with fluid or pus. It can be bacterial, viral, or fungal. Diagnosis includes imaging and auscultation of crackles or bronchial breath sounds.
A patient with pneumonia is receiving antibiotics. Which of the following should the nurse monitor closely to evaluate the effectiveness of the treatment?
A. Respiratory rate
B. Oxygen saturation
C. White blood cell count
D. All of the above
D. All of the above
Monitoring respiratory rate, oxygen saturation, and white blood cell count helps assess whether the pneumonia is improving or worsening. These are key indicators of respiratory function and infection response.
A patient is breathing rapidly and has the following ABG results: pH 7.48, PaCO₂ 30 mmHg. What is the most likely acid-base imbalance?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
C. Respiratory alkalosis
pH 7.48 → alkalotic
PaCO₂ 30 mmHg → low (normal is 35–45), indicating a respiratory cause
This is respiratory alkalosis, often caused by hyperventilation (anxiety, pain, or early hypoxia).
A nurse is caring for a patient on postoperative day 1 after a total laryngectomy. The patient is restless, using accessory muscles to breathe, and has diminished breath sounds. What is the nurse’s priority action?
A. Suction the tracheostomy to relieve secretions
B. Notify the surgeon of possible airway edema
C. Administer prescribed IV corticosteroids
D. Assess the tracheostomy tube for displacement or obstruction
D. Assess the tracheostomy tube for displacement or obstruction
Signs of acute airway compromise—like restlessness and use of accessory muscles—indicate a potential tracheostomy obstruction or displacement. Assessing and ensuring patency of the trach is the immediate priority. Suctioning may follow, but only after confirming the airway is secure. Calling the provider or giving meds delays life-saving assessment.
A patient newly diagnosed with idiopathic pulmonary fibrosis is being evaluated in the clinic. Which of the following assessment findings should the nurse report immediately to the provider?
A. Fine inspiratory crackles at the lung bases
B. Fatigue and unintentional weight loss
C. Clubbing of the fingers
D. New onset of oxygen saturation 84% on exertion
D. New onset of oxygen saturation 84% on exertion
While crackles, fatigue, and clubbing are common findings in pulmonary fibrosis, a drop in oxygen saturation to 84% with activity indicates worsening gas exchange and possible need for supplemental oxygen or further pulmonary evaluation. This finding is the most urgent and requires provider notification.
This disorder results from long-term exposure to irritants like cigarette smoke, includes emphysema and chronic bronchitis, and causes progressive airflow limitation.
chronic obstructive pulmonary disease (COPD)
COPD is not fully reversible and involves chronic inflammation, mucus hypersecretion (chronic bronchitis), and alveolar destruction (emphysema). Smoking is the #1 risk factor.
A patient with chronic obstructive pulmonary disease (COPD) is prescribed pulmonary rehabilitation. Which of the following is the primary benefit of this program for COPD patients?
A. Reduces the frequency of respiratory infections
B. Increases the patient's ability to tolerate physical activity
C. Decreases the need for oxygen supplementation
D. Prevents further lung tissue damage
B. Increases the patient's ability to tolerate physical activity?
Pulmonary rehabilitation focuses on improving exercise tolerance, strength, and overall quality of life for patients with COPD. It helps patients manage symptoms better, increase physical endurance, and improve their ability to perform daily activities. It does not prevent lung tissue damage but can enhance functional capacity.
A patient receiving oxygen via nasal cannula at 6 L/min reports nasal dryness and nosebleeds. What is the nurse’s most appropriate action?
A. Switch to a non-rebreather mask
B. Add a humidifier to the oxygen delivery system
C. Lower the oxygen flow to 2 L/min
D. Suction the nares with a Yankauer suction catheter
B. Add a humidifier to the oxygen delivery system
High-flow oxygen (>4 L/min) can dry the mucosa. Humidification helps maintain comfort and airway moisture without compromising oxygen delivery.
Not C-- because it may compromise the pt's O2 need. Goal is to maintain effective oxygenation without causing discomfort.
A patient is on postoperative day 2 after a partial laryngectomy. The nurse enters the room and notes the patient is coughing, has a weak, wet-sounding voice, and is attempting to clear the throat frequently during meals. What should the nurse do first?
A. Encourage the patient to finish the meal slowly and assess after eating
B. Notify the provider to request a modified barium swallow study
C. Instruct the patient to stop eating and perform a focused swallowing assessment
D. Educate the patient on how to use a communication board for safety
C. Instruct the patient to stop eating and perform a focused swallowing assessment
The patient shows signs of silent aspiration—wet voice, coughing during meals, throat clearing—which is especially concerning post-laryngectomy. The priority is to stop oral intake immediately and perform a focused nursing assessment to prevent aspiration pneumonia. The provider should be notified after confirming clinical suspicion.
A patient is admitted with suspected tuberculosis (TB). Which action by the nurse indicates a breach in infection control?
A. Wearing an N95 respirator while entering the room
B. Placing the patient in a negative pressure room
C. Allowing the patient to leave the room for a CT scan wearing only a surgical mask
D. Placing a surgical mask on the patient during initial triage in the ED
C. Allowing the patient to leave the room for a CT scan wearing only a surgical mask
TB patients must not leave negative pressure rooms unless absolutely necessary—and when they do, a surgical mask is used only with strict coordination to avoid exposing others. Non-urgent scans are delayed. Isolation is critical.
This genetic disorder causes thick, sticky mucus to accumulate in the lungs, leading to chronic respiratory infections, and pancreatic insufficiency.
cystic fibrosis
Cystic fibrosis is a genetic disorder that affects the CFTR gene, leading to thick mucus production. It impairs lung function and increases the risk of infections, while also affecting the digestive system.
This non-invasive technique is used to help patients with atelectasis by deep breathing and coughing to re-expand the collapsed alveoli.
incentive spirometry
Incentive spirometry encourages deep breathing to prevent atelectasis post-surgery and in patients with limited mobility. It helps patients expand their lungs and improve ventilation in the lower airways.
Which statement about chest tubes indicates correct understanding by the nursing student?
A. “Continuous bubbling in the water-seal chamber is expected and normal.”
B. “The drainage system should be above the patient’s chest to facilitate drainage.”
C. “Tidaling in the water-seal chamber reflects normal changes in intrathoracic pressure.”
D. “Chest tubes should be clamped every 2 hours to check for leaks.”
C. “Tidaling in the water-seal chamber reflects normal changes in intrathoracic pressure.”
Tidaling (rising/falling water) is normal during inspiration/expiration. Continuous bubbling suggests an air leak, and chest tubes should never be routinely clamped due to risk of tension pneumothorax.
A 68-year-old patient with a history of COPD presents with a fever, myalgia, and a nonproductive cough. The patient tested positive for influenza A. Which new assessment finding requires immediate intervention?
A. Pulse oximetry reading of 91% on room air
B. Inspiratory wheezes in the lower lobes
C. Productive cough with rust-colored sputum
D. Mild confusion and lethargy
C. Productive cough with rust-colored sputum
Rust-colored sputum is a red flag for secondary bacterial pneumonia, particularly pneumococcal pneumonia—a common and potentially life-threatening complication of influenza in older adults. It requires immediate intervention and antibiotic therapy. The other findings, while important, are common in COPD and flu but not immediately emergent.
Which assessment finding helps the nurse differentiate pleural effusion from pneumonia?
A. Dullness to percussion over affected area
B. Crackles and productive cough
C. Pleuritic chest pain worsened with inspiration
D. Fever and elevated white blood cell count
A. Dullness to percussion over affected area
Pleural effusion presents with dullness to percussion due to fluid accumulation in the pleural space. Pneumonia typically presents with crackles, fever, and productive cough, but dullness is more prominent with effusion.
This condition causes inflammation of the pleura, leading to sharp, localized chest pain that worsens with breathing or coughing, and is often seen in association with viral infections.
pleurisy
Pleurisy, or pleuritis, is inflammation of the pleura, which causes chest pain due to friction between the pleural layers. It may be triggered by infections, autoimmune diseases, or trauma.
A patient with chronic bronchitis and emphysema (a type of COPD) is prescribed fluticasone/salmeterol (Advair). What is the rationale for combining these two medications in the treatment of COPD?
A. Fluticasone is an inhaled corticosteroid that reduces airway inflammation, while salmeterol is a long-acting beta-agonist that relaxes bronchial smooth muscle.
B. Fluticasone increases mucus production, while salmeterol helps reduce airway constriction.
C. Fluticasone works as a bronchodilator, and salmeterol is an anticholinergic agent.
D. Fluticasone improves oxygenation, and salmeterol increases lung volume.
A. Fluticasone is an inhaled corticosteroid that reduces airway inflammation, while salmeterol is a long-acting beta-agonist that relaxes bronchial smooth muscle
The combination of fluticasone (a corticosteroid) and salmeterol (a long-acting beta-agonist) provides a synergistic effect in managing COPD by reducing inflammation and bronchodilating the airways, improving airflow and reducing symptoms such as wheezing and shortness of breath.