Ch. 20 Respiratory Function

What are nursing interventions associated with an angiography?

1. Assess for known allergies 2. Pt NPO for 6 to 8 pre procedure 3. pt may experience warm flushing at injection of dye

What are causes of increased airway resistance?

1. Contraction of bronchial smooth muscle 2. Thickened mucosa 3. Mucous or tumor 4. Decreased elasticity

What are the four basic questions to ask about ABG levels?

1. Is the ABG normal? 2. Is the pH acidotic or alkalotic? 3. Is the cause respiratory or metabolic? 4. Is the cause compensated or uncompensated?

What are nursing interventions for a PET scan?

1. avoid caffeine, alcohol, and tobacco for 24 hours prior to the PET scan 2. abstain from food and fluids for 4 hours prior to the scan

Nursing interventions for a bronchoscopy & thoracoscopy

1. informed consent 2. NPO for 4 to 8 hrs

How do you determine if the cause is respiratory or metabolic?

1. you look at pH and compare it with HcO3 and CO2 2. If the pH is acidotic, you look for whichever value (HcO3 or CO2) that is also acidotic. 3. If the pH is alkalotic, you look for whichever value (HcO3 or CO2) is also alkalotic.

What is a normal inspiratory force?

100 cm H2O

bicarbonate is acidotic when level is less than?

22

Normal bicarbonate range

22 to 26

bicarbonate is alkalotic when level is greater than?

26

Co2 is alkalotic when level is less than?

35

Normal Co2 range

35 to 45

Co2 is acidotic when level is greater than?

45

Normal pH range

7.35 to 7.45

Normal level of SpO2 level

95% to 100%

What is a gallium scan?

Gallium is injected intravenously (IV), and scans are taken at intervals (e.g., 6, 24, and 48 hours) to evaluate gallium uptake by the pulmonary tissues

What is an alkalotic pH?

If the pH is greater than 7.45

What is gas exchange between the lungs and blood and between the blood and tissues? 1. Diffusion 2. Perfusion 3. Respiration 4. Ventilation

Respiration

Is the following statement true or false? The purpose of the cilia is to move the mucus back to the larynx.

True

Can a patient eat or drink before a V/Q scan or gallium scan?

Yes

The nurse is interviewing a patient who says he has a dry, irritating cough that is not "bringing anything up." What medication should the nurse question the patient about taking? a) Angiotensin converting enzyme (ACE) inhibitors b) Cardiac glycosides c) Aspirin d) Bronchodilators

a) Angiotensin converting enzyme (ACE) inhibitors

The nurse auscultated a patient's middle lobe of the lungs for abnormal breath sounds. To do this, the nurse placed the stethoscope on the: a) Anterior surface of the right side of the chest, between the fourth and fifth rib. b) Posterior surface of the right side of the chest, near T3. c) Anterior surface of the left side of the chest, near the sixth rib. d) Posterior surface of the left side of the chest, near the sixth rib.

a) Anterior surface of the right side of the chest, between the fourth and fifth rib.

The nurse is caring for clients on the neurological unit. Which triad of neurological mechanisms does the nurse identify as most responsible when there is abnormality in ventilation control? a) Aortic arch, pons, and CO2 receptor sites b) Medulla oblongata, cerebellum, and heart rate c) Medulla oblongata, mitral valve, and central receptors d) Pons, cerebellum, and oxygen receptors

a) Aortic arch, pons, and CO2 receptor sites

The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months' duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely? a) Asthma b) Adult respiratory distress syndrome c) Pneumothorax d) Acute respiratory obstruction

a) Asthma

The nurse inspects the thorax of a patient with advanced emphysema. What does the nurse expect the chest configuration to be for this patient? a) Barrel chest b) Kyphoscoliosis c) Funnel chest d) Pigeon chest

a) Barrel chest

The nurse auscultates crackles in a patient with a respiratory disorder. With what disorder would crackles be commonly heard? a) Collapsed alveoli b) Pulmonary fibrosis c) Asthma d) Bronchospasm

a) Collapsed alveoli

A son brings his father into the clinic, stating that his father's color has changed to bluish around the mouth. The father is confused, with a respiratory rate of 28 breaths per minute and scattered crackles throughout. The son states this condition just occurred within the last hour. Which of the following factors indicates that the client's condition has lasted for more than 1 hour? a) Cyanosis b) Respiratory rate c) Son's statement d) Crackles

a) Cyanosis

High or increased compliance occurs in which disease process? a) Emphysema b) ARDS c) Pleural effusion d) Pneumothorax

a) Emphysema

A patient with sinus congestion points to a location on the inside of his eye as the area of pain. The nurse documents that the patient is complaining of pain in which sinus? a) Ethmoid b) Frontal c) Sphenoid d) Maxillary

a) Ethmoid

What happens to the diaphragm during inspiration? a) It contracts and flattens. b) It contracts and raises. c) It relaxes and raises. d) It relaxes and flattens.

a) It contracts and flattens.

When assessing a client, which adaptation indicates the presence of respiratory distress? a) Orthopnea b) Respiratory rate of 14 breaths per minute c) Productive cough d) Sore throat

a) Orthopnea Indicates they can't breathe easily when laying down

The nurse is caring for a client with hypoxemia of unknown cause. Which of the following oxygen transport considerations does the nurse identify as crucial to circulate oxygen in the body system? Select all that apply. a) Oxygen is dissolved. b) All systemic oxygen is available for diffusion. c) Oxyhemoglobin circulates to the body tissue. d) High blood pressure disrupts oxygen transport. e) Adequate red blood cells are needed for oxygen transport.

a) Oxygen is dissolved. c) Oxyhemoglobin circulates to the body tissue. e) Adequate red blood cells are needed for oxygen transport.

A patient comes to the emergency department complaining of a knifelike pain when taking a deep breath. What does this type of pain likely indicate to the nurse? a) Pleurisy b) Bacterial pneumonia c) Bronchogenic carcinoma d) Lung infarction

a) Pleurisy

The nurse is working on a busy respiratory unit. In caring for a variety of clients, the nurse must be knowledgeable of diagnostic studies. With which diagnostic studies would the nurse screen the client for an allergy to iodine? Select all that apply. a) Pulmonary angiography b) Lung scan c) Pulmonary functions test d) Fluoroscopy e) Bronchoscopy f) Chest x-ray

a) Pulmonary angiography b) Lung scan d) Fluoroscopy

A client experiences a head injury in a motor vehicle accident. The client's level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client's respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth? a) The pons b) Wernicke's area c) Central sulcus d) The frontal lobe

a) The pons

A client with a suspected pulmonary disorder undergoes pulmonary function tests. To interpret test results accurately, the nurse must be familiar with the terminology used to describe pulmonary functions. Which term refers to the volume of air inhaled or exhaled during each respiratory cycle? a) Tidal volume b) Vital capacity c) Functional residual capacity d) Maximal voluntary ventilation

a) Tidal volume

The nurse is caring for a client with a decrease in airway diameter causing airway resistance. The client experiences coughing and mucus production. Upon lung assessment, which adventitious breath sounds are anticipated? a) Wheezes b) Crackles c) Rubs d) Rhonchi

a) Wheezes

What does pulmonary perfusion mean?

actual blood flow through the pulmonary vasculature

When are chest x-rays usually taken?

after full inspiration because the lungs are best visualized when they are well aerated

What are contraindications of CT scans?

allergy to dye, pregnancy, claustrophobia, and morbid obesity

What influences the rate and depth of respiration?

apneustic center in the lower pons

The nurse is caring for a client with an exacerbation of COPD and scheduled for pulmonary function studies using a spirometer. Which client statement would the nurse clarify? a) "I am ordered a bronchodilator to note lung improvement following use." b) "I will breathe in through my mouth and out through my nose." c) "My study is scheduled for 10AM, several hours after I eat." d) "I brought comfortable clothes and shoes for the test."

b) "I will breathe in through my mouth and out through my nose."

Normally, approximately what percentage of the blood pumped by the right ventricle does not perfuse the alveolar capillaries? a) 4% b) 2% c) 6% d) 8%

b) 2%

What finding by the nurse may indicate that the patient has chronic hypoxia? a) Peripheral edema b) Clubbing of the fingers c) Crackles d) Cyanosis

b) Clubbing of the fingers

The nurse auscultates crackles in a patient with a respiratory disorder. With what disorder would crackles be commonly heard? a) Pulmonary fibrosis b) Collapsed alveoli c) Bronchospasm d) Asthma

b) Collapsed alveoli

During a routine visit to the pulmonologist, a client is told to undergo a mediastinoscopy. After the physician leaves the room, the nurse enters and is asked about this procedure. How should the nurse respond? a) Aspiration of the fluid that has accumulated around the lungs b) Exploration and biopsy of the lymph nodes that drain the lungs c) Inspection and examination of the larynx, trachea, and bronchi d) Injection of radioactive dye to measure the integrity of the lung's blood flow

b) Exploration and biopsy of the lymph nodes that drain the lungs

A patient with sinus congestion complains of discomfort when the nurse is palpating the supraorbital ridges. The nurse knows that the patient is referring to which sinus? a) Maxillary b) Frontal c) Sphenoidal d) Ethmoidal

b) Frontal

The student nurse is learning breath sounds while listening to a client in the physician's office. An experienced nurse is assisting and notes air movement over the trachea to the upper lungs. The air movement is noted equally on inspiration as expiration. Which breath sounds would the nurse document? a) Abnormal bronchial sounds b) Normal bronchovesicular sounds c) Abnormal vesicular sounds d) Normal bronchial sounds

b) Normal bronchovesicular sounds

Which of the following terms will the nurse use to document the inability of a patient to breathe easily unless positioned upright? a) Hypoxemia b) Orthopnea c) Dyspnea d) Hemoptysis

b) Orthopnea

A 53-year-old client sees the physician because he has had laryngitis for 2 weeks. After a thorough examination, the doctor orders medications and instructs the client to follow-up in 1 week if his voice has not improved. What is the primary function of the larynx? a) Protecting the lower airway from foreign objects b) Producing sound c) Preventing infection d) Facilitating coughing

b) Producing sound

The clinical finding of pink frothy sputum may be an indication of which of the following? a) An infection b) Pulmonary edema c) A lung abscess d) Bronchiectasis

b) Pulmonary edema

A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3−of 28 mEq/L. The nurse reports to the physician which finding? a) Metabolic acidosis b) Respiratory acidosis c) Metabolic alkalosis d) Respiratory alkalosis

b) Respiratory acidosis

The arterial blood gas results for your patient show the following: pH = 7.35; pCO2 = 52; H2CO3 = 26. You interpret this reading as: a) Compensated respiratory acidosis b) Respiratory acidosis c) Metabolic acidosis d) Respiratory alkalosis

b) Respiratory acidosis

A client arrives at the physician's office stating 2 days of febrile illness, dyspnea, and cough. Upon assisting the client into a gown, the nurse notes that the client's sternum is depressed, especially on inspiration. Crackles are noted in the bases of the lung fields. Based on inspection, which will the nurse document? a) The client needs a cough suppressant. b) The client has a funnel chest. c) The client has pneumonia in the bases. d) The client has chronic respiratory disease.

b) The client has a funnel chest.

The body of a critically ill client may use which of the following homeostatic mechanisms to maintain normal pH? a) The lungs increase respiratory volume. b) The lungs eliminate carbonic acid by blowing off more CO2. c) The lungs retain more CO2 to lower the pH. d) The kidneys retain more HCO3 to raise the pH.

b) The lungs eliminate carbonic acid by blowing off more CO2

The nurse is caring for a client diagnosed with asthma. While performing the shift assessment, the nurse auscultates breath sounds including sibilant wheezes, which are continuous musical sounds. What characteristics describe sibilant wheezes? a) They result from air passing through widened air passages. b) They can be heard during inspiration and expiration. c) They occur when the pleural surfaces are inflamed. d) They are heard in clients with decreased secretions.

b) They can be heard during inspiration and expiration.

A 53-year-old male is a regular client in the respiratory group where you practice nursing. As with all adults, millions of alveoli form most of the pulmonary mass. The squamous epithelial cells lining each alveolus consist of different types of cells. Which type of the alveoli cells produce surfactant? a) Type IV cells. b) Type II cells c) Type III cells. d) Type I cells

b) Type II cells

A client with chronic bronchitis is admitted with an exacerbation of symptoms. During the nursing assessment, the nurse will expect which of the following findings? Select all that apply. a) Hypoventilatory breathing pattern b) Use of accessory muscles to breathe c) Respiratory rate of 10 breaths per minute d) Purulent sputum with frequent coughing e) Tympany percussed bilaterally over the lung bases

b) Use of accessory muscles to breathe d) Purulent sputum with frequent coughing

A nurse is preparing a client with a pleural effusion for a thoracentesis. The nurse should: a) raise the arm on the side of the client's body on which the physician will perform the thoracentesis. b) assist the client to a sitting position on the edge of the bed, leaning over the bedside table. c) raise the head of the bed to a high Fowler's position. d) place the client supine in the bed, which is flat.

b) assist the client to a sitting position on the edge of the bed, leaning over the bedside table.

How is O2 transported to the cells of the body?

by combining with hemoglobin

A patient visited a health care clinic for treatment of upper respiratory tract congestion, fatigue, and sputum production that was rust-colored. Which of the following diagnoses is likely based on this history and inspection of the sputum? a) Bronchiectasis b) A lung abscess c) An infection with pneumococcal pneumonia d) Bronchitis

c) An infection with pneumococcal pneumonia

In a patient diagnosed with increased intracranial pressure (IICP), the nurse would expect to observe which of the following respiratory rate or depth? a) Tachypnea b) Hypoventilation c) Bradypnea d) Hyperventilation

c) Bradypnea

A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does serous fluid indicate? a) Infection b) Emphysema c) Cancer d) Trauma

c) Cancer

What finding by the nurse may indicate that the patient has chronic hypoxia? a) Crackles b) Cyanosis c) Clubbing of the fingers d) Peripheral edema

c) Clubbing of the fingers

A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs? a) Ineffective airway clearance b) Impaired spontaneous ventilation c) Impaired gas exchange d) Decreased cardiac output

c) Impaired gas exchange

During a preadmission assessment, the nurse finds increased tactile fremitus. She knows this sign is consistent with which of the following diagnoses? a) Emphysema b) Atelectasis c) Pneumonia d) Bronchitis

c) Pneumonia

The nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first? a) Arterial blood gases b) Chest x-ray c) Pulse oximetry d) Pulmonary function test

c) Pulse oximetry

The nurse is caring for a client with chronic obstructive pulmonary disease. The client calls the doctor and states having difficulty breathing and overall feeling fatigued. The nurse realizes that this client is at high risk for which condition? a) Respiratory alkalosis b) Metabolic alkalosis c) Respiratory acidosis d) Metabolic acidosis

c) Respiratory acidosis

The client is returning from the operating room following a broncho scopy. Which action, performed by the nursing assistant, would the nurse stop if began prior to nursing assessment? a) The nursing assistant is asking a question requiring a verbal response. b) The nursing assistant is assisting the client to the side of the bed to use a urinal. c) The nursing assistant is pouring a glass of water to wet the client's mouth. d) The nursing assistant is assisting the client to a semi-Fowler's position.

c) The nursing assistant is pouring a glass of water to wet the client's mouth.

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient? a) Perfusion exceeds ventilation. b) There is an absence of perfusion and ventilation. c) Ventilation exceeds perfusion. d) Ventilation matches perfusion.

c) Ventilation exceeds perfusion.

The nursing instructor is teaching a pre-nursing pathophysiology class. The class is covering the respiratory system. The instructor explains that the respiratory system is comprised of both the upper and lower respiratory system. The nose is part of the upper respiratory system. The instructor continues to explain that the nasal cavities have a vascular and ciliated mucous lining. What is the purpose of the vascular and ciliated mucous lining of the nasal cavities? a) Moisten and filter expired air b) Move mucus to the back of the throat c) Warm and humidify inspired air d) Cool and dry expired air

c) Warm and humidify inspired air

What does a low V/Q ratio mean?

causes shunting of blood and results in hypoxia (no gas exchange) Perfusion > ventilation

What should be performed before a V/Q scan?

chest x-ray

What happens within the body during inspiration?

contraction of the diaphragm (movement of chamber floor downward) and contraction of external intercostal muscles increases space in thoracic chamber, lowering intrathoracic pressure (negative pressure); air enters the airways and inflates the lungs

The nurse is caring for a patient diagnosed with pneumonia. The nurse will assess the patient for tactile fremitus by completing which of the following? a) Asking the patient to say "one, two, three" while auscultating the lungs b) Instructing the patient to take a deep breath and hold it while the diaphragm is percussed c) Placing the thumbs along the costal margin of the chest wall and instructing the patient to inhale deeply d) Asking the patient to repeat "ninety-nine" as the nurse's hands move down the patient's thorax

d) Asking the patient to repeat "ninety-nine" as the nurse's hands move down the patient's thorax

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation? a) Egophony b) Absent breath sounds c) Bronchial breath sounds d) Crackles at lung bases

d) Crackles at lung bases

Which of the following ventilation-perfusion ratios is exhibited when a patient is diagnosed with pulmonary emboli? a) Silent unit b) Low ventilation-perfusion ratio c) Normal perfusion to ventilation ratio d) Dead space

d) Dead space

A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs? a) Decreased cardiac output b) Ineffective airway clearance c) Impaired spontaneous ventilation d) Impaired gas exchange

d) Impaired gas exchange

The nursing instructor is talking with senior nursing students about diagnostic procedures used in respiratory diseases. The instructor discusses thoracentesis, defining it as a procedure performed for diagnostic purposes or to aspirate accumulated excess fluid or air from the pleural space. What would the instructor tell the students purulent fluid indicates? a) Inflammation b) Heart failure c) Cancer d) Infection

d) Infection

The nurse is caring for a client in the immediate post-thoracentesis period. In which position is the client placed? a) In the high Fowler's position b) In the supine position c) Prone with a pillow under the head d) Lying on the unaffected side

d) Lying on the unaffected side

The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation? a) pH b) PaO2 c) SaO2 d) PaCO2

d) PaCO2

A student nurse is working with a client who is diagnosed with head trauma. The nurse has documented Cheyne-Stokes respirations. The student would expect to see which of the following? a) Period of cessation of breathing b) Periods of normal breathing followed by periods of apnea c) Irregular breathing at 14 to 18 breaths per minute d) Regular breathing where the rate and depth increase, then decrease

d) Regular breathing where the rate and depth increase, then decrease

Which of the following ventilation-perfusion mismatch would correlate with acute respiratory distress syndrome (ARDS)? a) Shunt b) Normal c) Dead space d) Silent unit

d) Silent unit

The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse's priority? a) Presence of carotid pulse b) Medication allergies c) Ability to deep breathe d) Swallow reflex

d) Swallow reflex

The nurse answers the call light of a male patient. The patient is complaining of an irritating tickling sensation in the throat, a salty taste, and a burning sensation in the chest. Upon further assessment, the nurse notes a tissue with bright red, frothy blood at the bedside. The nurse can assume the source of the blood is likely from which of the following? a) The nose b) The stomach c) The rectum d) The lungs

d) The lungs

You are studying for a physiology test over the respiratory system. What should you know about central chemoreceptors in the medulla? a) They respond to changes in CO2 levels in the brain. b) They respond to changes in O2 levels and bicarbonate levels in the cerebrospinal fluid. c) They respond to changes in the O2 levels in the brain. d) They respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid.

d) They respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid.`

The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard? a) Crackles b) Rhonchi c) Rales d) Wheezes

d) Wheezes

The nurse is instructing a patient who is scheduled for a perfusion lung scan. What should be included in the information about the procedure? (Select all that apply.) a) An injection will be placed into the lung during the procedure. b) The patient will be expected to be NPO for 12 hours prior to the procedure. c) The imaging time will amount to 20 to 40 minutes. d) The patient will be expected to lie under the camera. e) A mask will be placed over the nose and mouth during the test.

e) A mask will be placed over the nose and mouth during the test. c) The imaging time will amount to 20 to 40 minutes. d) The patient will be expected to lie under the camera.

When is mechanical ventilation required with an inspiratory force?

force is less than 25 cm

Function of alveoli

gas exchange

What is an uncompensated pH?

if the pH is anywhere outside the normal ranges (greater than 7.45 or less than 7.35)

What is a V/Q lung scan?

injecting a radioactive agent into a peripheral vein and then obtaining a scan of the chest to detect radiation

What does a high V/Q ratio mean?

leads to dead space due to inadequate blood supply for gas exchange ventilation > perfusion

What is a rhonchi sound?

low-pitched, deep, rumbling sound heard on expiration

What causes increased compliance?

lungs have lost their elastic recoil and become overdistended (e.g., in emphysema)

Which are the inhalation and exhalation centers in the brain?

medulla oblongata and pons

What are the signs of a clubbed finger?

nail fold increases to 180 degrees or more nail feels spongy or floating

What percent of the air we breathe is oxygen and nitrogen?

nitrogen: 78.6% oxygen: 20.8%

What causes decreased compliance?

occurs if the lungs and thorax are "stiff." Ex: morbid obesity, pneumothorax, hemothorax, pleural effusion, pulmonary edema

What is respiratory compensated metabolic alkalosis?

pH high but within NL CO2 is high Bicarbonate is high

What is a compensated pH?

pH is anywhere inside the normal ranges (Anything between 7.35 to 7.45)

What is an acidotic pH?

pH is below 7.35

What is respiratory alkalosis?

pH is high CO2 is low Bicarbonate is within NL

What is compensated respiratory alkalosis?

pH is high but within NL CO2 is low Bicarbonate is low

What is metabolic alkalosis?

pH is high, CO2 is WNL, bicarbonate is high

What is respiratory acidosis?

pH is low CO2 is high Bicarbonate is within NL

What is compensated respiratory acidosis?

pH is low but within NL CO2 is high Bicarbonate is high

What is metabolic acidosis?

pH is low, CO2 is within NL, bicarbonate is low

What is respiratory compensated metabolic acidosis?

pH low but within NL CO2 is low Bicarbonate is low

What pH match would mean that it is a respiratory cause?

pH matches with CO2

What pH match would mean that is is a metabolic cause?

pH matches with HCO3 or bicarbonate

What influences the pattern of respiration?

pneumotaxic center in the upper pons

Function of Type 2 alveolar cells

produces Type 1 cells and surfactant

What happens during expiration?

relaxation of the diaphragm (movement of chamber floor upward) relaxation of external intercostal muscles, increasing intrathoracic pressure (positive pressure), air exits the airways, deflation and elastic recoil of the lungs

Function of Type 1 alveolar cells

serve as a barrier between the air and the alveolar surface

What is the purpose of a gallium scan?

to look for swelling, infection or cancer of the lung or body