A&P of respiratory system
A nurse is assessing a patient's chest configuration. Which anteroposterior (AP) to transverse diameter ratio is considered normal?
A. 1:1
B. 1:2
C. 2:1
D. 1:3
The normal AP ratio is 1:2, meaning the anteroposterior diameter should be less than the side-to-side (transverse) diameter. An increase in AP diameter (approaching 1:1) creates a "barrel chest" appearance, which may result from normal aging or lung hyperinflation conditions like emphysema.
The nurse is setting up oxygen therapy equipment. Which components are essential for oxygen administration? (Select all that apply)
A. Oxygen source
B. Flowmeter
C. Humidifier
D. Suction catheter
E. Appropriate delivery appliance
Answer: A, B, C, E
Essential equipment for oxygen therapy includes the oxygen source, flowmeter (to regulate the amount given), humidifier (to supply moisture), tubing, and the appropriate appliance for the delivery method ordered. A suction catheter is not part of the oxygen delivery system.
What is an advantage of using a nasal cannula for oxygen delivery?
Allows the patient to eat and drink
A nasal cannula is useful for patients who require oxygen during meals, as it does not obstruct the mouth. It is a low-flow system that supplements oxygen needs but does not deliver the total amount of oxygen needed by the body.
A nurse is caring for patients from diverse cultural backgrounds. Which ethical principle requires the nurse to view all patients as having equal worth?
A. Autonomy
B. Beneficence
C. Respect for people
D. Justice
C. Respect for people
Respect for people is the most fundamental ethical principle, leading us to view all human life as sacred with each individual having inherent worth. To the nurse, this means no one person is more important than another; each patient has the same worth and is always entitled to respect.
Which statement best describes the nurse's role in the informed consent process?
A. Obtaining informed consent from the patient
B. Explaining the risks and benefits of the procedure
C. Witnessing the patient's signature on the consent form
D. Determining if the patient is competent to sign
C. Witnessing the patient's signature on the consent form
Obtaining informed consent is the responsibility of the health care provider performing the procedure. The nurse's role is witnessing the signature, providing comfort and support to the patient, and explaining nursing care expected after the procedure. A nurse's signature as a witness means the patient appeared to voluntarily give consent, appeared capable to give consent, and signed the form in the nurse's presence.
When should discharge planning ideally begin for a hospitalized patient?
At the time of admission
The discharge plan begins at the time of a patient's admission ideally and is revised as the patient progresses and as outcomes are set by health care providers. With the emphasis on decreased length of stay in hospitals, discharge planning with coordination of services must begin the moment a patient is admitted.
A provider orders 500 mg of amoxicillin. The medication is available as 400 mg/5 mL. How many mL should the nurse administer?
6.25 mL
Using ratio and proportion: 400 mg : 5 mL = 500 mg : x mL. Cross-multiply: 400x = 2500. Divide both sides by 400: x = 6.25 mL. Always label the answer and verify it's close to your estimate.
The nurse is auscultating a patient's lungs. What is the normal inspiratory to expiratory (I/E) ratio?
Inspiration should take half as long as expiration, creating an I/E ratio of 1:2. Changes in this ratio can indicate respiratory pathology, such as prolonged expiration in obstructive lung diseases.
What does the term FiO₂ represent in oxygen therapy?
FiO₂ refers to the fraction of inspired oxygen, which is the percentage or concentration of oxygen delivered to the patient. The flow rate (L/min) does not directly correlate with the percentage of oxygen delivered—this depends on the type of delivery device used.
A patient requires oxygen therapy via simple face mask. What is the minimum flow rate the nurse should set to prevent rebreathing of exhaled CO₂?
6 L/min
If a mask system is used, the flow rate through the mask must be a minimum of 6 L/min. Lesser flow rates are not adequate to wash out exhaled CO₂ and will cause the patient to rebreathe exhaled CO₂.
A patient asks the nurse for advice about whether to undergo a surgical procedure. Which ethical principle guides the nurse's response?
The nurse should respect the patient's right to make their own decision
Autonomy refers to freedom of personal choice and the right to be independent and make decisions freely. The nurse does not have the authority to make decisions for the patient, even when the patient asks for opinions or assistance.
A patient is about to sign an informed consent form but tells the nurse, "I'm not sure I understand what they're going to do." What is the nurse's best action?
Withhold obtaining the signature until questions are answered
If the patient has questions or seems confused about the procedure or treatment, the nurse, as the patient's advocate, should not obtain the patient's signature until all questions have been answered. The health care provider performing the procedure is responsible for explaining the procedure.
Which patients are at highest risk and require priority discharge planning? (Select all that apply)
A. Patient with poor health literacy
B. Patient with limited financial resources
C. Older adult with cognitive impairment
D. Patient with chronic illness
E. Young adult with acute appendicitis
A, B, C, D
Some patients are more in need of discharge planning because of their health-related risks. Patients with poor health literacy, limited financial resources, or limited family support; those with long-term disabilities or chronic illnesses; and older adults with cognitive and/or hearing or visual impairments affecting their attention to discharge instructions require priority planning.
The nurse needs to convert 0.5 grams to milligrams. What is the correct conversion?
500 mg
In the metric system, milli- means 1/1000 of the basic unit. To convert grams to milligrams, multiply by 1000 (move decimal point three places to the right): 0.5 g × 1000 = 500 mg.
A patient presents with respiratory distress. Which respiratory rate would the nurse identify as tachypnea in an adult?
The normal adult respiratory rate is 12 to 20 breaths/min. A rate above 20 breaths/min is considered tachypnea and may indicate respiratory distress or other pathology.
A nurse is checking the oxygen delivery system at the beginning of the shift. Which actions are appropriate? (Select all that apply)
A. Verify the flow rate matches the provider's order
B. Check that tubing is not kinked
C. Ensure tubing is connected to the oxygen source
D. Allow smoking if the patient uses a low flow rate
E. Confirm the patient is wearing the delivery device
Answer: A, B, C, E
Nursing management includes verifying the correct flow rate, checking for kinked tubing, ensuring proper connection to the oxygen source, and confirming the patient is wearing the device. Smoking is never allowed when oxygen is in use because oxygen supports combustion and creates a fire hazard.
A provider orders high-flow nasal cannula (HFNC) oxygen therapy. What differentiates this from standard oxygen delivery?
Delivers humidified compressed air mixed with oxygen
High-flow oxygen therapy provides oxygen from the source to the high-flow machine, where humidified compressed air is mixed with the oxygen. The patient receives the prescribed percentage of oxygen (21%–100%) and flow rates up to 60 L/min. By delivering oxygen under pressure, better gas exchange occurs.
Which ethical principle is demonstrated when a nurse acts to promote a patient's well-being?
A. Nonmaleficence
B. Beneficence
C. Justice
D. Fidelity
B. Beneficence
Beneficence means doing good or acting for someone's good; this principle is of primary importance to nurses. The nurse has an ethical duty to protect life and promote the well-being of all patients.
Which elements must be included in informed consent? (Select all that apply)
A. Risks and benefits of the proposed treatment
B. Possible consequences of not having the procedure
C. Alternative treatments available
D. Name of the health care professional performing the procedure
E. Cost of the procedure
A, B, C, D
Informed consent must include four elements: (a) the risks and benefits of the proposed treatment, (b) the possible consequences of not having the procedure done, (c) alternatives to the treatment, and (d) the name of the health care professional who will perform the procedure. The explanation must be in nontechnical terms and in a language the patient can understand.
What is the primary goal of discharge planning?
To ensure the patient transitions to a setting where health care needs can be met
The focus of discharge planning is to ensure that the patient transitions to a setting in which health care needs can be appropriately met. A discharge plan should include activities that guide patients to appropriate community services after being discharged from any care setting.
The provider orders 40 mg of a medication. The pharmacy supplies 80 mg tablets. How many tablets should the nurse administer?
0.5 tablet
Using ratio and proportion: 80 mg : 1 tablet = 40 mg : x tablet. Cross-multiply: 80x = 40. Divide: x = 0.5 tablet. Medications are not always dispensed in the unit ordered; nurses must convert available units to desired doses.
During auscultation, where should the nurse expect to hear bronchovesicular breath sounds?
Bronchovesicular sounds are normally heard over the main branches of the bronchi in both anterior and posterior chest. Bronchial sounds are heard over the trachea, while vesicular sounds are heard over the peripheral lung fields.
Which safety principle should the nurse teach a patient being discharged with home oxygen therapy?
Patients should have an all-purpose fire extinguisher nearby and know how to use it. While oxygen itself is not explosive, it supports combustion, making any spark or flame dangerous. Smoking and open flames are not allowed when oxygen is in use, regardless of location.
The nurse is preparing to administer oxygen via partial rebreather mask. Which feature distinguishes this mask from other oxygen delivery devices?
A partial rebreather mask has a reservoir bag attached that must remain at least one-third to one-half full during inspiration. This mask allows mixing of exhaled air with oxygen. Flow rates are typically 6 to 11 L/min, delivering approximately 60% to 75% FiO₂.
A nurse refuses to administer a medication that could potentially harm the patient. Which ethical principle is the nurse upholding?
A. Autonomy
B. Justice
C. Nonmaleficence
D. Beneficence
C. Nonmaleficence
Nonmaleficence means to do no harm. It is paramount to nursing practice to act in the patient's best interest, and it is both an ethical and legal duty to do nothing that has a harmful effect on the patient.
A patient received preoperative medication 30 minutes ago and now needs to sign the surgical consent form. What should the nurse do?
Wait until the medication effects wear off
Informed consent must be obtained when the patient is not under the influence of medication such as opioids. A person is considered incompetent if under the influence of mind-altering drugs (including narcotics used as premedication). Consent must be given freely without coercion.
Which required discharge instruction topics must the nurse include? (Select all that apply)
A. Discharge medications
B. Follow-up care
C. List of medications changed or discontinued
D. Dietary needs
E. Hospital billing information
A, B, C, D
Required discharge instruction topics include: discharge medications, follow-up care (if needed), list of all medications changed and/or discontinued, dietary needs, and follow-up tests or procedures.
The provider orders 750 mg of a medication. The available concentration is 500 mg/2 mL. How many mL should the nurse administer?
3 mL
Using ratio and proportion: 500 mg : 2 mL = 750 mg : x mL. Cross-multiply: 500x = 1500. Divide both sides by 500: x = 3 mL. Always label your answer and verify it's reasonable.
What pulse oximetry reading (SpO₂) indicates adequate oxygen saturation?
An SpO₂ of 90% to 100% is needed to adequately replenish oxygen in plasma. Values below 90% indicate hypoxemia and require intervention.
Which assessment finding would indicate a complication from nasal cannula use?
Skin breakdown noted on the ears and in the nostrils
Skin breakdown over the ears and in the nostrils is common when oxygen tubing is placed tight against the skin. The nurse should assess for excoriation of the nares and pressure injuries on the ears. A Velcro holder may be placed on top of the head to prevent tubing from causing pressure injuries.
Which oxygen delivery device provides the highest FiO₂?
Non-rebreather mask
A non-rebreather mask delivers the highest oxygen concentration of the mask systems, providing 80% to 95% FiO₂ at flow rates of 10 to 15 L/min. It has one-way valves that prevent exhaled air from entering the reservoir bag and room air from entering through side ports.
A teenage patient with diabetes is eating food not allowed on their meal plan. The nurse experiences conflict between protecting the patient's health and respecting their independence. Which ethical principles are in conflict?
B. Beneficence and autonomy
This represents an ethical dilemma between acting with beneficence to protect the patient's health and respecting their autonomy to make personal choices. Beneficence supports seeking the action that is best for the patient, while autonomy supports respecting the patient's right to make personal choices.
What legal consequence may result from performing a procedure without proper informed consent?
Battery
Failure to secure informed consent may result in civil liability for battery. Civil battery is the unlawful touching of a person; an intent to harm is not necessary. Patients have the right to accept or reject proposed care after understanding the benefits, risks, alternatives, and consequences.
What barrier to effective discharge planning should the nurse anticipate?
A. Patient refusal to participate
B. Inconsistent communication among team members
C. Excessive hospital resources
D. Too much family involvement
Inconsistent communication among team members
Barriers to effective discharge planning within health care agencies include: time to develop and follow up with a plan, inconsistent communication, and clarity in responsibility for discharge planning. An interprofessional discharge planning process individualized to specific patient needs can help reduce hospital readmission rates.
A medication order reads: "Give 0.25 mg IV now." The vial contains 0.5 mg/mL. How many mL should the nurse prepare?
0.5 mL
Using ratio and proportion: 0.5 mg : 1 mL = 0.25 mg : x mL. Cross-multiply: 0.5x = 0.25. Divide: x = 0.5 mL. Pay careful attention to decimal points, as misplacement could lead to a tenfold or greater overdose.