Ch. 17- Learning: Restrictive Lung Disorders
Which statement describes the development of pleural effusion? A. "An increase in pleural fluid is produced when increased hydrostatic filtration force pushes excess fluid into the pleural space." B. "An increase in pleural fluid results when the lymph system drains fluid out of the lungs." C. "An increase in pleural fluid results when plasma proteins are increased." D. "An increase in pleural fluid results when a decrease in capillary permeability allows fluid to leak into the pleural space."
A. "An increase in pleural fluid is produced when increased hydrostatic filtration force pushes excess fluid into the pleural space." - Pleural effusions can develop when there is either an excess production of pleural fluid or a decrease in the drainage of the fluid. - Excess pleural fluid is produced when an increased hydrostatic filtration force pushes excess fluid into the pleural space (e.g., heart failure or cirrhosis) or there is an increase in capillary permeability because of an inflammatory process or disease (e.g., tuberculosis, rheumatoid arthritis) or a more negative pleural pressure facilitates the accumulation of pleural fluid (e.g., atelectasis). - Inadequate drainage of pleural fluid can occur when the lymphatic system is blocked (e.g., tumor) or when the plasma proteins are decreased so that adequate reabsorption does not occur.
A patient on bedrest asks the nurse why they need to deep breathe, cough, and change positions. Which explanation by the nurse is accurate? A. "Bedrest can cause shallow breathing, which allows air sacs in the lungs to collapse." B. "Bedrest causes your lungs to become infected with viruses that are in the room." C. "Bedrest increases the risk of aspiration and can cause airways to be blocked." D. "Bedrest causes increased mucus production, which can plug the airways."
A. "Bedrest can cause shallow breathing, which allows air sacs in the lungs to collapse." - The diagnosis of atelectasis, collapsed air sacs in the lungs, is based on the clinical presentation, physical exam, and x-ray confirmation. - Treatment is focused on the cause of the atelectasis and includes vigorous pulmonary toilet: deep breathing, coughing, and frequent changes of position. - Bedrest alone does not cause infection in the lungs, increased mucus production, or aspiration.
The nurse is discussing smoking with a patient and how it can affect lung function. Which patient statement alerts the nurse that further instruction is needed? A. "I can quit smoking whenever; this idea that smoking damages lungs is not true." B. "Men are more likely to contract emphysema than women." C. "Smoking destroys lung tissue." D. "Genetic factors sometimes lead to the destruction of lung tissue."
A. "I can quit smoking whenever; this idea that smoking damages lungs is not true." - Smoking has addictive properties and it is hard for patients to quit. - The truth is that smoking damages lung tissue. - Genetic factors do play an important part in emphysema. - Men are more likely to contract emphysema than women.
The nurse is teaching a safety class for parents of toddlers. Which statement should the nurse include regarding the risk of aspiration? A. "Toddlers are at higher risk due to lack of molars." B. "Toddlers are at higher risk due to chronic dysphagia." C. "Toddlers are at higher risk due to lack of gag reflex." D. "Toddlers are at higher risk due to impaired muscle control."
A. "Toddlers are at higher risk due to lack of molars." - Among healthy individuals, children under 4 years of age are at the highest risk of aspiration because they have no molar teeth and a strong tendency to put things in their mouths. - Adults are at risk due to conditions such as lack of gag reflex, impaired muscle control, and dysphagia.
A patient has been diagnosed with atelectasis. Pulmonary toilet has been prescribed. Which description of pulmonary toilet is accurate? A. Deep breathing, coughing, and frequent changes of position to help breathing B. Deep breathing and supplemental oxygen to help ease breathing C. Forceful coughing to help open the alveoli D. Frequent changes of position to help keep secretions from pooling in the airways
A. Deep breathing, coughing, and frequent changes of position to help breathing - Treatment via pulmonary toilet involves deep breathing, coughing, and frequent changes of position, which can often prevent atelectasis. - While oxygen may be used, it will not help the underlying issue of collapsed alveoli. - Just a change of position, or coughing alone, is not enough to prevent pulmonary issues.
A patient presents with difficulty breathing. The patient has a history of gastroesophageal reflux disease that has impaired lung function. Which condition should the nurse suspect? A. Idiopathic pulmonary fibrosis (IPF) B. Asthma C. Chronic obstructive pulmonary disease (COPD) D. Pulmonary edema
A. Idiopathic pulmonary fibrosis (IPF) - Idiopathic pulmonary fibrosis (IPF) results from an aberrant repair of alveolar epithelial type II cells after repetitive injuries such as gastric contents, toxins, viral exposures, radiation, or chemotherapy. - Chronic obstructive pulmonary disease (COPD), asthma, and pulmonary edema are not related to the cause of lung damage from gastric contents and fibrosis in the lungs.
A patient diagnosed with a right-sided pneumothorax reports no discomfort. Based on this clinical manifestation, how much lung volume does the pneumothorax involve? A. Less than 15% B. Greater than 35% C. Approximately 25% D. Greater than 55%
A. Less than 15% - When a small, spontaneous pneumothorax involves less than 15% of the lung volume, up to 10% of individuals are asymptomatic or may not seek medical care. - When the pneumothorax involves more than 40% of the lung, the presentation includes acute ipsilateral (one-sided) chest pain and dyspnea that is generally proportional to the size of the pneumothorax and may include cough.
Which explanation best describes how idiopathic pulmonary fibrosis (IPF) is usually diagnosed? A. Other lung diseases are eliminated to determine whether a patient has IPF. B. A chest x-ray will reveal IPF. C. Pulmonary function tests (PFTs) are performed to be diagnosed with IPF. D. Oxygen therapy is used to see if the patient improves; if the patient improves, the IPF diagnosis is made.
A. Other lung diseases are eliminated to determine whether a patient has IPF. - The diagnosis of idiopathic pulmonary fibrosis (IPF) is a diagnosis of exclusion, because there are no specific tests for it, and it is based on clinical evidence. - Results of pulmonary function tests (PFTs) and chest x-rays deteriorate with disease progression, but they are not diagnostic. - Initially, PFTs may be normal or nearly so, which means lung function has not been greatly changed by the disease. - A chest x-ray shows nonspecific diffuse reticular opacities, but high-resolution computed tomography (HRCT) is more sensitive and specific for IPF. - Oxygen is used to help with low O2 levels, but it is not a diagnostic test.
A patient presents with increased shortness of breath, dyspnea, and has dullness to percussion over the right lower lung. Which condition should the nurse suspect? A. Pleural effusion B. Tension pneumothorax C. Aspiration D. Nontension pneumothorax
A. Pleural effusion - A pleural effusion is a collection of excess fluid in the pleural space and can cause shortness of breath, dyspnea, and has dullness to percussion. - Pneumothorax is the presence of air between the visceral and parietal pleurae that produces lung tissue compression, subsequently compromising lung function. - In a tension pneumothorax, the lung or bronchial injury acts as a one-way valve, allowing air into the pleural space but preventing air from escaping during exhalation. - Aspiration is the entry of secretions or foreign material into the trachea and lungs. While aspiration and pneumothorax can cause shortness of breath and dyspnea, dullness to percussion in the lung is not an expected sign.
A patient is diagnosed with a pleural effusion on the right side. With the patient in the upright position, where should the nurse expect the fluid to be located? A. Right base of lung B. Lung apices C. Right middle lobe D. Right upper lobe
A. Right base of lung - Gravity moves pleural fluid into the dependent pleural space, so in an upright patient, fluid would move to the bases. - The upper and middle lobe would not be the best place for assessment of the effusion. - The apices are the top of the lungs.
The parents of a 29-week-gestational premature infant ask the nurse why the infant is having trouble breathing. Which explanation by the nurse is best? A. "A premature baby has decreased alveolar surface tension that makes it difficult to breathe." B. "A premature baby has too little surfactant to open up the lung tissue." C. "A premature baby is born with decreased surface tension that causes alveolar collapse." D. "A premature baby lacks the amount of lung tissue needed to breathe."
B. "A premature baby has too little surfactant to open up the lung tissue." - In premature infants, especially those who are born before 34 weeks of gestation, there is insufficient surfactant production, which increases the risk for development of atelectasis. - Surfactant reduces alveolar surface tension and helps prevent alveolar collapse. Due to insufficient surfactant production, premature infants have increased surface tension within the alveoli, not decreased.
The nurse is caring for a patient with chronic gastroesophageal reflux disease who presents with difficulty breathing. The patient is diagnosed with idiopathic pulmonary fibrosis (IPF) disease. Which statement accurately describes the IPF in this patient? A. "IPF is repair of alveolar epithelial cells from a genetic disorder that was passed down through family genetics." B. "IPF is aberrant repair of alveolar epithelial cells after repetitive injury to the lungs." C. "IPF is aberrant repair of alveolar epithelial cells, resulting from traumatic injury to the chest wall tissue." D. "IPF is aberrant repair of alveolar epithelial cells resulting from inadequate lung expansion."
B. "IPF is aberrant repair of alveolar epithelial cells after repetitive injury to the lungs." - Idiopathic pulmonary fibrosis (IPF) results from an aberrant repair of alveolar epithelial type II cells after repetitive injuries such as gastric contents, toxins, viral exposures, radiation, or chemotherapy. - Inadequate lung expansion does not cause fibrotic changes. - Trauma to the chest wall tissues does not cause fibrotic changes. = While genetics may increase susceptibility in some patients, IPF is not a genetic disease.
A patient presents with a right-sided chest wound. A sucking sound is heard during inspiration. The patient asks, "What is making that sound?" Which explanation by the nurse is accurate? A. "That is the sound of air becoming trapped in your chest between breaths." B. "That is the sound of air entering your lung space when you take a breath." C. "That is the sound of your lung collapsing when you let a breath out." D. "That is the sound of the lung expanding when you take a breath."
B. "That is the sound of air entering your lung space when you take a breath." - With an open pneumothorax, there can be a "sucking" sound as air enters the pleural space, not the sound of the lung expanding or collapsing. - If air was becoming trapped, this would be a tension pneumothorax and the trachea would be deviated to the left.
A patient has been in bed for two days after chest surgery and is now reporting dyspnea and shortness of breath. Which respiratory disorder is most likely to be the cause? A. Pectus excavatum B. Atelectasis C. Flail chest D. Idiopathic pulmonary fibrosis (IPF)
B. Atelectasis - Atelectasis refers to partial lung collapse or inadequate inflation of a portion of the lung. - The partial lung collapse can cause shortness of breath and dyspnea. Idiopathic pulmonary fibrosis (IPF) results from an aberrant repair of alveolar epithelial type II cells after repetitive injuries to the lung tissue. - Flail chest is a complication of blunt chest trauma with multiple rib fractures, causing an unstable chest wall. - Pectus excavatum, also known as a sunken or funnel chest, gives a concave appearance to the anterior chest wall. - IPF, flail chest, and pectus excavatum are not expected complications.
A patient has been diagnosed with a 55% right-sided pneumothorax from scuba diving. Which treatment should the nurse expect the patient to undergo? A. Serial chest X-rays B. Chest tube insertion C. Pleurodesis D. Thoracotomy
B. Chest tube insertion - A larger pneumothorax is treated by the insertion of a chest tube between the ribs into the intrapleural airspace. - A small pneumothorax may be observed and changes in the size of the pneumothorax can be documented by serial chest x-rays, but this is not a small pneumothorax. - Thoracostomy or thoracotomy (chest surgery) may be required for a traumatic pneumothorax. - Multiple recurring spontaneous pneumothoraces may be treated by pleurodesis, which promotes adhesion between pleural surfaces by the insertion of an irritating substance into the pleural space or by mechanically roughing the pleural surfaces.
On physical examination, a patient has a dullness with percussion in the right lower lung and is suspected of having pleural effusion. Which test is best for confirming this diagnosis? A. Lung biopsy B. Computerized tomography (CT) scan of the chest C. Pulmonary function test D. Chest x-ray (CXR)
B. Computerized tomography (CT) scan of the chest - Small amounts of excess pleural fluid may be seen more readily on a CT scan than with a CXR. Since the patient has no shortness of breath, the pleural effusion may be still small. - A biopsy is used for taking tissue samples. - A pulmonary function test evaluates how the lungs are functioning by measuring volume during inspiration and expiration.
A patient with a large left pleural effusion lying supine reports difficulty breathing. The nurse immediately positions the patient in a sitting position. For which reason did the nurse take this action? A. Irritation of lung tissue will be minimized. B. Gravity will move pleural fluid to the lower base of the lung. C. Fluid will drain to the apices of the lungs. D. Patient will have greater ability to cough.
B. Gravity will move pleural fluid to the lower base of the lung. - Pleural effusion is a collection of excess fluid in the pleural space. - Gravity moves pleural fluid into the dependent pleural space. So by positioning the patient in an upright position, the fluid would move to the lower portions of the lung, thereby increasing compliance of the lung fields. - The apices are located at the top of the lungs and by sitting the patient in an upright position, fluid would drain away from the apices. - The fluid does not necessarily cause irritation of the lung tissue. While sitting the patient upright may help with the patient's ability to cough, that is not the reason for moving the patient immediately to this position.
A child presents with dyspnea, tachypnea, and has visible bilateral movement of the muscles between the ribs during inspiration. How should the nurse describe the chest movement? A. Right-sided pneumothorax B. Intercostal retractions C. Pleural effusion D. Pulmonary aspiration
B. Intercostal retractions - In very young children and thin adults who experience severe atelectasis, intercostal retractions (retraction of muscles between the ribs) may be visible during inspiration. - Breath sounds will be diminished or absent in the area of atelectasis during a physical exam. - Pulmonary aspiration, pneumothorax, and pleural effusion are generally not bilateral.
A patient presents with an abnormal anterior-posterior curvature of the spine. The nurse notes that the spine has an abnormal front-to-back curvature with a lateral curvature that leaves the patient's shoulders uneven. Which condition is consistent with the nurse's description? A. Sarcoidosis B. Kyphoscoliosis C. Pectus excavatum D. Pectus carinatum
B. Kyphoscoliosis - Kyphoscoliosis is an abnormal progressive curvature of the spine. It combines an abnormal front-to-back curvature, which causes a dowager's hump, with a lateral curvature that leaves the shoulders or the hips uneven. - Pectus excavatum, also known as a sunken or funnel chest, gives a concave appearance to the anterior chest wall. - Pectus carinatum, also called pigeon chest, gives a convex appearance to the anterior chest wall. - Sarcoidosis is a systemic disease of unknown origin that is characterized by the formation of chronic non-caseating (solid) granulomas.
A teenager is experiencing rapid growth during puberty. His concave chest wall is causing difficulty breathing. Which treatment would most likely be suggested to the patient at this time? A. Oxygen therapy B. Surgical correction C. Physical therapy D. Back brace
B. Surgical correction - Pectus excavatum usually causes a mild restrictive defect with exercise due to increased oxygen requirements that cannot be met, but a major defect may require surgical repair. - A brace, oxygen, and physical therapy will not correct the defect.
A patient is diagnosed with idiopathic pulmonary fibrosis (IPF). The patient asks the nurse which test they used to confirm the diagnosis. Which response by the nurse is accurate? A. "IPF is diagnosed with serial chest x-rays to track changes in the lungs." B. "IPF is diagnosed by using pulmonary function testing." C. "IPF is diagnosed by excluding other possible causes first, and then clinical manifestations." D. "IPF is diagnosed by exercise testing for shortness of breath with exertion."
C. "IPF is diagnosed by excluding other possible causes first, and then clinical manifestations." - The diagnosis of idiopathic pulmonary fibrosis (IPF) is a diagnosis of exclusion, because there are no specific tests for it, and it is based on clinical evidence. - Results of pulmonary function tests (PFTs) and serial chest x-rays deteriorate with disease progression, but they are not diagnostic. Initially, results of PFTs may be normal or nearly so. - A chest x-ray shows nonspecific diffuse reticular opacities, but high-resolution computed tomography (HRCT) is more sensitive and specific for IPF. - Exercise is used to determine whether oxygen is needed to help with low O2 levels, but it is not a diagnostic test.
A patient is undergoing a thoracentesis. The patient asks about the yellow-green color of the fluid removed. Which explanation by the nurse is accurate? A. "The fluid removed indicates that you have had physical trauma to your lungs." B. "The fluid removed indicates that your heart is not pumping effectively." C. "The fluid removed indicates that you have an infection." D. "The fluid removed indicates that you do not have inflammation."
C. "The fluid removed indicates that you have an infection." - Empyema is a yellow-green pus and may indicate pneumonia, lung abscess, infected wound, or sepsis. - Aspirate that indicates no inflammation or that is caused from a heart with ineffective pumping (heart failure) would be straw colored. - Fluid that would indicate physical trauma to the lungs would be bloody.
A patient has been diagnosed with a pneumothorax of 50% of the left lung. Which clinical manifestation(s) should the nurse expect to find during an assessment? A. Asymptomatic due to right lung compensation B. Right-sided hyper-resonance and cough C. Acute left-sided chest pain and dyspnea D. Acute dyspnea and tracheal deviation to the left
C. Acute left-sided chest pain and dyspnea - When the pneumothorax involves more than 40% of the lung, the presentation includes acute ipsilateral (one-sided) chest pain and dyspnea that is generally proportional to the size of the pneumothorax and may include cough. - If this was a tension pneumothorax, the trachea would be deviated to the right side. - The patient would not be asymptomatic due to the amount of lung tissue involved. - Hyperresonance would be on the left side, not the right.
A patient diagnosed with a tumor located in the pleural space develops atelectasis. Which type of atelectasis should the nurse suspect? A. Resorption B. Microatelectasis C. Compression D. Contraction
C. Compression - Compression atelectasis occurs when an accumulation of exudates, fluid, air, blood, or a tumor in the pleural space mechanically collapses lung tissue. - Tumor-related bronchial compression and foreign body aspiration cause resorption atelectasis. - Contraction atelectasis occurs when fibrotic changes in the lung or the pleura confine the lung and diminish lung expansion. - Microatelectasis involves closure or collapse of the alveoli or respiratory microstructures to a degree that usually is undetectable on a chest x-ray.
Which intrinsic restrictive pulmonary disease has an insidious onset and results in "honey-combed" lung tissue? A. Hypersensitivity pneumonitis B. Sarcoidosis C. Idiopathic pulmonary fibrosis (IPF) D. Pleural effusion
C. Idiopathic pulmonary fibrosis (IPF) - Idiopathic fibrotic disease (IPF) has an insidious onset and, as the disease progresses, causes fibrotic areas in the lungs that are often described as "honey-combed." - IPF begins with dyspnea on exertion (DOE) and/or a cough that produces very little sputum. - "Honey-combed" lung tissue is not a manifestation of sarcoidosis, radiation fibrosis, or hypersensitivity pneumonitis.
Which condition should the nurse suspect when a chest computerized tomography (CT) scan reveals fluid in the pleural space of a patient? A. Pneumothorax B. Fungal infection in the alveoli C. Pleural effusion D. Pneumonia
C. Pleural effusion - A pleural effusion is fluid in the pleural space. Pleural effusions can develop when there is either an excess production of pleural fluid or a decrease in the drainage of the fluid. - Pneumonia and fungal infection are infections in the lung tissue. - Pneumothorax is air in the pleural space.
A patient is diagnosed with empyema after a thoracentesis. How should the nurse describe the aspirate? A. Straw-colored clear fluid B. Blood-tinged fluid C. Yellow-green pus D. Milky fluid
C. Yellow-green pus - Empyema is a condition with a purulent, yellow-green pus exudate and indicates infection. - Straw-colored aspirate indicates noninflammatory processes such as heart failure, ascites, or atelectasis. - Blood-tinged aspirate indicates physical trauma causing a hemothorax. - Milky aspirate indicates blockage or damage to the thoracic duct.
Which statement by the nurse provides an accurate explanation of sarcoidosis? A. "Sarcoidosis is a genetic disease present at birth that involves granulomatous inflammation." B. "Sarcoidosis results from exposure to an unknown toxin that triggers granulomatous inflammation." C. "Sarcoidosis involves exposure to a bacterial antigen that triggers granulomatous inflammation." D. "Sarcoidosis involves a genetic predisposition and exposure to an antigen that triggers granulomatous inflammation."
D. "Sarcoidosis involves a genetic predisposition and exposure to an antigen that triggers granulomatous inflammation." - A genetic predisposition to sarcoidosis, plus exposure to an unknown antigen, triggers the granulomatous inflammation. - It is not a genetic disease. - Exposure to an unknown toxin has not been linked as a cause. - An infectious cause has been suspected, but never proven; therefore, bacterial antigen exposure is not correct.
A patient is diagnosed with secondary spontaneous pneumothorax. Which factor in the patient's history would be consistent with this condition? A. Pulmonary atelectasis B. Community-acquired pneumonia C. Pulmonary edema D. Emphysema
D. Emphysema - Pneumothorax is the presence of air between the visceral and parietal pleurae that produces lung tissue compression, subsequently compromising lung function. Secondary spontaneous pneumothorax usually is associated with asthma, emphysema, or tuberculosis but also may be caused by barotrauma related to positive pressure mechanical ventilation. - Pulmonary atelectasis, pulmonary edema, and community-acquired pneumonia do not result in a ruptured bleb and pneumothorax.
During the physical examination of a patient, the nurse notes a concave anterior chest wall. Which deformity is likely to be diagnosed? A. Kyphoscoliosis B. Flail chest C. Pectus carinatum D. Pectus excavatum
D. Pectus excavatum - Pectus excavatum, also known as a sunken or funnel chest, gives a concave appearance to the anterior chest wall. - Pectus carinatum, also called pigeon chest, gives a convex appearance to the anterior chest wall. - Flail chest is a complication of blunt chest trauma with multiple rib fractures that cause an unstable chest wall. - Kyphoscoliosis is an abnormal progressive curvature of the spine.
The nurse examining a patient notes a tracheal shift toward the left side of the chest. Which condition should the nurse suspect? A. Pneumonia B. Pulmonary embolism C. Rib fracture D. Tension pneumothorax
D. Tension pneumothorax - The patient is exhibiting clinical manifestations of a tension pneumothorax. - A tension pneumothorax is a medical emergency because the rapidly accumulating air compromises both ventilation and blood return to the heart and, when untreated, results in loss of consciousness and death. - Pneumonia, rib fracture, and pulmonary embolism do not manifest with a tracheal shift to the unaffected side.
The emergency department staff is having difficulty visualizing, and thus removing, a peanut that has been aspirated by a child. Which is the best explanation for the difficulty in visualizing the obstruction? A. Peanuts are small and can become embedded in the tissue. B. Peanuts are able to move deeper into the lung tissue, which causes difficulty with visualization. C. Peanuts break down in the lung and are absorbed into the tissue. D. The oil on the peanut can cause inflammation, which increases swelling and makes visualization difficult.
D. The oil on the peanut can cause inflammation, which increases swelling and makes visualization difficult. - Oily foods such as peanuts cause inflammation, which makes visualizing and removing the object more difficult. - While they can move deep into the lungs, it is the inflammatory process that causes issues with visualization and removal. - They neither become embedded within the tissue nor get absorbed into the tissue.
