METHODICAL INSTRUCTION FOR STUDENTS
OF THE BSN 4yr. PROGRAM 4 COURSE
Nursing Faculty
LESSON № 2 (QUIZ – 6 HOURS)
Theme: Unit – test 2 (Disorders of Respiratory System)
introductory part of the class (9:00 am till 09:15 am)
Unit-test includes the following topics:
1. Anatomy and physiology of the Respiratory System. Assessment of the Respiratory System. Interventions for clients requiring oxygen therapy or tracheostomy
2. Noninfectious problems of the upper respiratory tract. Interventions for clients with noninfectious problems of the upper respiratory tract
3. Noninfectious problems of the lower respiratory tract. Interventions for clients with noninfectious problems of the lower respiratory tract.
4. Infectious problems of the upper and lower respiratory tract. Interventions for clients with infectious problems of the upper and lower respiratory tract.
5. Interventions for critically ill clients with respiratory problems
writing test(9:15 am till 11:00 am)
Each tests contain 60 questions. Examples of multiple choice tests
1. The client has a hoarse, whispery voice. Which change in respiratory structure or function might produce this problem?
a. Paralysis of the left recurrent laryngeal nerve
b. Obstruction of the frontal and maxillary sinuses
c. Failure of the epiglottis to close during coughing
d. Swelling of the mucous membranes covering the middle and inferior turbinates
2. What problem would result from a swollen epiglottis?
a. The airway would be unprotected during swallowing, increasing the risk for aspiration.
b. The vocal cords would be stretched, causing the voice to be deeper.
c. The airway would be obstructed, causing a decrease in ventilation.
d. Swallowing would be impossible.
3. For what problem is the client who cannot breathe through the nose because of a congenital bone obstruction at greater risk?
a. Dry respiratory tract membranes
b. Frequent episodes of tonsillitis
c. Development of nasal polyps
d. Difficulty swallowing
4. What age-related change decreases an older person’s exercise tolerance?
a. Vocal cords become slack.
b. Ciliary efficiency is reduced.
c. Kyphoscoliosis occurs or progresses.
d. Coughing effectiveness is decreased.
5. A client has all of the following family and personal factors. Which one greatly increases the risk for the client to develop respiratory problems?
a. The client has long-standing hypertension.
b. The client’s father died of lung cancer at age 82.
c. The client’s sister has a child with cystic fibrosis.
d. The client has a deficiency of alpha1-antitrypsin.
6. Your 84-year-old client has an SaO2 of 96% on room air. What is your best action?
a. Document the finding as the only action.
b. Verify the measurement.
c. Notify the physician.
d. Apply oxygen.
7. You observe that the 60-year-old client’s anteroposterior (AP) chest diameter is the same as her lateral chest diameter. What is your best next question in regard to this finding?
a. No questions are needed regarding this normal finding.
b. “Do you have any chronic breathing problems?”
c. “How often do you perform aerobic exercise?”
d. “What are your hobbies?”
8. The client with long-standing pulmonary problems is classified as having class III dyspnea. Based on this classification, what type of assistance will you need to provide for ADLs?
a. Dyspnea is minimal and no assistance is required.
b. The client may complete activities of daily living without assistance but requires rest periods during performance.
c. The client is severely dyspneic with activity and requires assistance for some but not all tasks.
d. The client is severely dyspneic at rest and cannot participate in any self-care.
9. When measuring the client’s pulse oximetry you find the client to have a reading of 85%, down from 92% 1 hour ago. Which action should you perform first?
a. Administer oxygen by mask or cannula.
b. Document the finding.
c. Verify the measurement.
d. Notify the physician.
10. What is the physiologic consequences of CO2 narcosis?
a. Excessive sleepiness in the client with hypercarbia
b. Failure of rising blood levels of CO2 to trigger more rapid and deeper respirations
c. A change in the ventilation-perfusion ratio, in which ventilation exceeds perfusion
d. Increase in the percentage of oxygen delivered to the client does not result in an increased PaO2
Answers
1. A
The vocal cords move toward each other, create turbulent airflow, and vibrate during speech. The movement of the vocal cords is controlled by the pair of recurrent laryngeal nerves. When one of the pairs is paralyzed, the vocal cord on that side does not move to the middle, there is less obstruction to airflow, and the airflow is less turbulent. Instead of being strong and clear, the voice is soft, breathy, and whispery.
2. C
The epiglottis is an elastic structure that has a hingelike action. The epiglottis opens during breathing and coughing. It folds over and closes the entrance to the larynx during swallowing to prevent aspiration.
3. A
When inspired air passes through the nose, it is filtered, warmed, and humidified.
4. C
Kyphoscoliosis is a twisting of the spine that reduces the volume of the chest cavity and prevents full expansion of the lung on the side of the twist. The client is unable to increase his or her tidal volume during exercise to meet the increased tissue demand for oxygen.
5. D
Alpha1-antitrypsin is an enzyme in the lungs that limits the activity of other protein- destroying enzymes in the lungs. Without this limitation, those protein-destroying enzymes break down the collagen and elastin in the lungs, dramatically increasing the risk for developing emphysema at an early age. Other types of severe pulmonary problems are also more common among individuals who are deficient in alpha1-antitrypsin.
6. A
The normal oxygen saturation based on pulse oximetry for adults breathing room air ranges between 94% and 98%. This value may be a little lower for older adults.
7. B
The normal chest has a lateral diameter that is twice as large as the AP diameter. When the AP diameter approaches or exceeds the lateral diameter, the client is said to have a “barrel” chest. Most commonly, a barrel chest occurs as a result of a long-term chronic airflow limitation problem, such as chronic obstructive pulmonary disease or severe chronic asthma. It can also be seen in people who have lived at a high altitude for many years.
8. B
Class III dyspnea occurs during usual activities, such as showering, but the client does not require assistance from others. Dyspnea is not present at rest.
9. C
A pulse oximetry reading in this range indicates desaturation and is considered an emergency requiring immediate intervention. However, the nurse should first verify the accuracy of the reading by measuring pulse oximetry at another body site (nose, earlobe, or forehead). If the measurement shows desaturation at the second site, administer oxygen and notify the physician.
10. B
In the healthy person, a rising PaCO2 level is the drive to breathe and stimulates an increased rate and depth of respiration. When the PaCO2 rises gradually, the central chemoreceptors lose their sensitivity and are no longer the drive to breathe, a condition called CO2 narcosis. Thus, the only trigger to stimulate breathing in clients with CO2 narcosis is hypoxemia, a declining PaO2 level.
checking of the tests (11:10 am till 12:00 pm)
DISCUSSION of test results (12:30 pm till 14:00 pm)
References:
А–Basic:
Required Textbooks:
1. Ignatavicius, D.D. (2012). Clinical Decision-making Study Guide for Medical-Surgical Nursing, (7th ed.) St. Louis: Elsevier
2. Ignatavicius, D.D. & Workman, M.L. (2012). Medical-surgical nursing: Patient centered collaborative care. (7th ed.) St. Louis: Elsevier
3. Potter, P.A. & Perry, A. G. (2013). Fundamentals of nursing, 8th ed.) St. Louis: Mosby/Elsevier.
4. Ackley, B.J. & Ladwig, G. B. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care, (9th ed.) St. Louis: Mosby/Elsevier.
5. Deglin, J. H., Vallerand, A. H., & Sandoski, C.A. (2013). Davis’s Drug Guide for Nurses, (13th ed.) Philadelphia: F. A. Davis.
В – Additional:
Other Textbooks:
1. Ignatavicius, D.D. et.al. (2013). Clinical Companion for Medical-Surgical Nursing: for- Patient-Centered Collaborative Care. (7th ed) St. Louis: Elsevier.
2. Mosby’s Dictionary of Medicine, Nursing, and Health Professions, (2009). (8th ed.) St. Louis: Elsevier
3. Potter, P. A. et al. (2013). Fundamentals of nursing: Study guide, (8th ed.) St. Louis: Elsevier.
4. Pickar, G. & Abemethy, A.P. (2008). Dosage Calculations, (8ft.ed.). Clifton Park, NY: Thomson Delmar.
5. Venes, D. editor (2009) Taber’s Cyclopedia Medical Dictionary (21*ed.). Philadelphia: F A. Davis.
Methodical instruction has been worked out by: B. Lokay, MD, PhD, BSN
Methodical instruction was discussed and adapted at the Department sitting
June 12, 2013. Minute № 13
