Chapter 23 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition


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Chapter 23  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition



Complete Chapter Questions And Answers

Sample Questions


1. A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patient’s increased risk for what complication?

  1. A)  Acute respiratory distress syndrome (ARDS)
  2. B)  Atelectasis
  3. C)  Aspiration
  4. D)  Pulmonary embolism

Ans: B


A shallow, monotonous respiratory pattern coupled with immobility places the patient at an increased risk of developing atelectasis. These specific factors are less likely to result in pulmonary embolism or aspiration. ARDS involves an exaggerated inflammatory response and does not normally result from factors such as immobility and shallow breathing.

2. A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurse’s assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do?

  1. A)  Increase oral fluids unless contraindicated.
  2. B)  Call the nurse for oral suctioning, as needed.
  3. C)  Lie in a low Fowler’s or supine position.
  4. D)  Increase activity.

Ans: A


The nurse should encourage hydration because adequate hydration thins and loosens pulmonary secretions. Oral suctioning is not sufficiently deep to remove tracheobronchial secretions. The patient should have the head of the bed raised, and rest should be promoted to avoid exacerbation of symptoms.

3. The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test?

  1. A)  Administer intradermal injections into the children’s inner forearms.
  2. B)  Administer intramuscular injections into each child’s vastus lateralis.
  3. C)  Administer a subcutaneous injection into each child’s umbilical area.
  4. D)  Administer a subcutaneous injection at a 45-degree angle into each child’s deltoid.

Ans: A


The purified protein derivative (PPD) is always injected into the intradermal layer of the inner aspect of the forearm. The subcutaneous and intramuscular routes are not utilized.

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4. The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurse’s assessment findings would best corroborate this diagnosis?

  1. A)  The patient is experiencing painless hemoptysis.
  2. B)  The patient’s arterial blood gases (ABGs) are normal, but he demonstrates increased

    work of breathing.

  3. C)  The patient’s oxygen saturation level is below 88%, but he denies shortness of breath.
  4. D)  The patient’s pain intensifies when he coughs or takes a deep breath.

Ans: D


The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. The patient’s ABGs would most likely be abnormal and shortness of breath would be expected.

5. The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action?

  1. A)  Smoking decreases the amount of mucus production.
  2. B)  Smoke particles compete for binding sites on hemoglobin.
  3. C)  Smoking causes atrophy of the alveoli.
  4. D)  Smoking damages the ciliary cleansing mechanism.

Ans: D


In addition to irritating the mucous cells of the bronchi and inhibiting the function of alveolar macrophage (scavenger) cells, smoking damages the ciliary cleansing mechanism of the respiratory tract. Smoking also increases the amount of mucus production and distends the alveoli in the lungs. It reduces the oxygen-carrying capacity of hemoglobin, but not by directly competing for binding sites.

6. A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate?

  1. A)  Preparing to assist with intubating the patient
  2. B)  Setting up oxygen at 5 L/minute by nasal cannula
  3. C)  Performing deep suctioning
  4. D)  Setting up a nebulizer to administer corticosteroids

Ans: A


A patient who has ARDS usually requires intubation and mechanical ventilation. Oxygen by nasal cannula would likely be insufficient. Deep suctioning and nebulizers may be indicated, but the priority is to secure the airway.

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