Chapter 26 Elseveir

A 65-year-old male recently has a cerebrovascular accident that resulted in dysphagia. He now has aspiration of gastric contents. The nurse assesses the patient for which complication?

Pneumonia Aspiration of stomach contents could lead to pneumonia.

An 80-year-old female is in the hospital for a bone fracture. While there she develops a large, nonlethal pulmonary embolus. Which of the following is direct result of the obstruction to pulmonary blood flow?

Pulmonary hypertenison Significant obstruction of the pulmonary vasculature leads to increased pulmonary artery pressures (pulmonary hypertension).

A 25-year-old male presents with chronic bronchitis of 5 months' duration. Which of the following is the most significant concern for the nurse to monitor in this patient?

Recurrent pulmonary infections Recurrent pulmonary infections are a significant concern for this patient.

A 60-year-old female with a history of cirrhosis presents with dyspnea, impaired ventilation, and pleural pain. A diagnosis of pleural effusion is made, and a watery fluid is drained. When giving report, the nurse will refer to this fluid as:

Transudative Pleural effusions that enter the pleural space from intact blood vessels can be transudative (watery).

Which of the following patients is at highest risk for developing pulmonary embolism (PE)?

72-year-old male who is recovering from hip replacement surgery in the hospital The 72-year-old is at risk for immobility and at increased risk for PE

A 30-year-old male prison inmate contracted tuberculosis during an outbreak. While planning interactions, the nurse realizes the patient can transmit this disease through:

Airborne droplets Tuberculosis is transmitted through airborne droplets.

A 53-year-old male with a 20-year history of smoking is diagnosed with emphysema. When the nurse is asked what causes this, what is the nurse's best response? Changes in his lungs are caused by:

Alpha-1-antirypsin deficiency Changes in the lungs are associated with alpha-1-antitrypsin deficiency.

When the pulmonologist discusses the condition in which a series of alveoli in the left lower lobe receives adequate ventilation but do not have adequate perfusion, which statement indicates the nurse understands this conditon? When this occurs in a patient it is called:

Alveolar dead speace When certain areas of the alveoli experience inadequate perfusion, it is referred to as dead space.

Which of the following shows a correct cause and effect sequence in the development of acute respiratory distress syndrome (ARDS)?

Alveolocapillary membrane injury causing a massive inflammatory response All disorders causing ARDS cause massive pulmonary inflammation that injures the alveolocapillary membrane and produces severe pulmonary edema and inflammation.

A 25-year-old male presents with chronic bronchitis of 5 months' duration. When obtaining the patient's history, which of the following findings is most likely to cause this condition?

Cigarette smoke The most likely cause of chronic bronchitis is cigarette smoke.

A 50-year-old male with a 30-year history of smoking was diagnosed with lung cancer. He was previously exposed to air pollution, asbestos, and radiation at his job. Which of the following should the nurse realize had the greatest impact on the development of his cancer?

Cigarette smoking The most common cause of lung cancer is tobacco smoking.

A nurse recalls asthma is classified by:

Clinical severity The National Asthma Education and Prevention Program offers stepwise guidelines for the diagnosis and management of chronic asthma based on clinical severity.

An 80year-old female develops pneumonia in the hospital. She becomes cyanotic, tachycardic, and develops a fever and cough. Chest x-rays reveals pus in the pleural space. Which of the following is the most likely diagnosis documented on the chart?

Empyema The presence of microorganisms in the pleural space is termed empyema.

A group of mountain climbers experience confusion, tachycardia, edema, and decreased renal output after climbing Mount Rainer. A nurse recalls this condition is caused by:

Decreased inspired oxygen The mountain climbers are experiencing decreased inspired oxygen. Bronchoconstriction would result in wheezing. Hypoventilation would result in retained CO2. The mountain climbers are experiencing decreased inspired air, not diffusion problems

A 57-year-old male presents with couch, sputum production, dyspnea, and decreased lung volume. He is diagnosed with pneumocoriosis. When taking the patient's history, which finding is the most probable cause of his illness?

Inhalation of silica, asbestos, mica The dusts of silica, asbestos, and coal are the most common causes of pneumoconiosis.

When the nurse is asked what causes asthma, how should the nurse respond? Asthma is thought to be caused by:

Interactions between genetic and environmental factors Asthma is an interaction between genetic and environmental factors.

A 60-year-old female with emphysema is having difficulty expiring a given volume of air. When giving report, the nurses will relay that the patient is most likely experiencing ____ pulmonary disease.

Obstructive Emphysema is a form of obstructive pulmonary disease.

Which of the following assessment findings would be expected in pulmonary embolism (PE)? (Select all that apply)

- Chest pain - Tachycardia - Tachypnea - Fever - Hemoptysis An individual with PE usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety. Occasionally syncope (fainting) or hemoptysis occurs. With large emboli, a pleural friction rub, pleural effusion, fever, and leukocytosis may be noted. Recurrent small emboli may not be detected until progressive incapacitation, precordial pain, anxiety, dyspnea, and right ventricular enlargement are exhibited. Massive occlusion causes severe pulmonary hypertension and shock.

Which of the following are characteristics of idopathic pulmonary arterial hypertension (IPAH)? (Select all that apply)

- Dyspnea - Jugular vein distention IPAH is a rare condition and usually occurs in women between the ages of 20 and 40. Manifestations of fatigue, chest discomfort, tachypnea, and dyspnea (particularly with exercise) are common. Examination may reveal peripheral edema, jugular venous distension, a precordial heave, and accentuation of the pulmonary component of the second heart sound.

A nurse is monitoring a patient for pulmonary hypertension. Which mean pulmonary artery pressure reading will indicate to the nurse that pulmonary hypertension is occurring? Pulmonary artery pressure above ___ mm Hg.

25

A 50-year-old diabetic male did not take his medication and is now in metabolic acidosis. He is experiencing Kussmaul respirations. What type of breathing will the nurse observe upon assessment?

A slightly increased ventilatory rate, large tidal volumes, and no expiratory pause Kussmaul respirations are characterized by a slightly increased ventilatory rate, very large tidal volumes, and no expiratory pause.

A 26-year-old female recently underwent surgery and is now experiencing dyspnea, cough, fever, and leukocytosis. Tests reveal that she has a collapsed lung caused by removal of air from obstructed alveoli. What condition will the nurse observe on the chart?

Absorption atelectasis Absorption atelectasis results from removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated oxygen or anesthetic agents.

A 42-year-old female presents with dyspnea; rapid, shall breathing; inspiratory crackles; decreased lung compliance; and hypoxemia. Tests reveal a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury. Which of the following is the most likely diagnosis the nurse will observe on the chart?

Acute respiratory distress syndrome (ARDS) The patient is experiencing ARDS.

A 60-year-old female with a 25-year history of smoking is diagnosed with emphysema. She has an increased anterior-posterior chest diameter. The nurse attributes this finding to:

Air trapping Air trapping expands the thorax, putting the respiratory muscles at a mechanical disadvantage.

A 30-year-old male prison inmate contracted tuberculosis during an outbreak. When the nurse reviews the lab results, the organism that caused this condition is a:

Bacterium The organism that causes tuberculosis is a bacterium.

A 70-year-old female is in the hospital for pelvic fracture. She develops pulmonary thrombo embolism. The nurse realizes this embolus is composed of:

Blood clot A thromboembolism is composed of a blood clot.

A 45-year-old male undergoes lung transplantation. He now suffers from airway occlusion secondary to fibrosis. Which diagnosis will the nurse see on the chart?

Bronchiolitis obliterans Bronchiolitis is a serious complication of stem cell and lung transplantation and can progress to bronchiolitis obliterans, a fibrotic process that occludes airways and causes permanent scarring of the lungs.

A 50-year-old male is diagnosed with pulmonary embolism (PE). Which of the following symptoms most likely occurred before treatment?

Chest pain and shortness of breath An individual with PE usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety.

A 30-year-old female received a severe head injury in a motor vehicle accident. She is now experiencing respiratory abnormalities characterized by alternating periods of deep and shallow breathing with periods of apnea. What term should the nurse use when charting this condition?

Cheyne-Strokes Cheyne-Stokes respirations are characterized by alternating periods of deep and shallow breathing, with periods of apnea lasting from 15 to 60 seconds.

A 65-year-old female with emphysema presents to the ER for difficulty breathing. Physical exam reveals bluish skin and mucous membranes. How should the nurse chart this condition? Patient has:

Cyanosis Cyanosis is a blue color to the skin.

A 15-year-old female is diagnosed with restrictive lung disease caused by fibrosis. The patient had a pulmonary functions test. Which of the following findings is expected?

Decreased functional residual capacity Fibrosis progressively obliterates the alveoli, respiratory bronchioles, and interstitium (fibrosing alveolitis), which can result in chronic pulmonary insufficiency, and functional residual capacity declines.

When the nurse observes a diagnosis of nosocomial pneumonia, the patient generally acquires this pneumonia:

During hospitalization Nosocomial infections are acquired in the hospital.

A 10-year-old female develops pneumonia. Physical exam reveals subcostal and intercostal retractions. She reports that breathing is difficult and she feels she cannot get enough air. What term should the nurse use to document this condition?

Dyspnea Dyspnea is defined as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity."

Individuals with a recent diagnosis of emphysema should be assessed for which most common presenting factor?

Dyspnea Dyspnea is the most common presenting factor of emphysema.

A 30-year-old male is involved in motor vehicle accident and sustains trauma to the lungs and chest wall. He experiences respiratory failure. Which of the following lab values would the nurse expect?

Elevated PaCO2 In respiratory failure, inadequate gas exchange occurs such that PaO2 = 50 mm Hg or PaCO2 = 50 mm Hg with pH = 7.25.

A nurse is preparing to teach the staff about asthma. Which information should the nurse include? Airway hyper-responsiveness in asthma is related to:

Exposure to an allergen causing mast cell degranulation Hyper-responsiveness is due to mast cell degranulation.

A 28-year-old male reports to his primary care provider that he has had a cold for a week and is coughing up bloody secretions. When giving report, what term should the nurse use to describe this condition?

Hemoptysis Hemoptysis is the coughing up of bloody secretions.

A 20-year-old male is in acute pain. An arterial blood gas reveals decreased carbon dioxide (CO2) levels. Which of the following does the nurse suspect is the most likely cause?

Hyperventilation Individuals with hyperventilation blow off CO2.

A nurse is reviewing the results of an ABG and finds reduced oxygenation of arterial blood. What term should the nurse use to describe this condition?

Hypoxemia Hypoxemia is a reduction of oxygen in arterial blood.

A nurse is teaching staff about pulmonary edema. Which information should the nurse include? The most common cause of pulmonary edema is:

Left heart failure The most common cause of pulmonary edema is left-sided heart disease.

Which patient would the nurse assess for paroxysmal nocturnal dyspnea (PND)? A patient with:

Left ventricular failure Some individuals with cardiac disease awake at night gasping for air and have to sit up or stand to relieve the dyspnea (PND).

A 53-year-old male with a 20-year history of smoking is diagnosed with emphysema. When a staff member asks why the patient's airways are obstructed, how should the nurse respond? The airways are obstructed because of:

Loss of elastic recoil The major mechanism of airflow limitation is loss of elastic recoil.

A nurse is preparing to teach the staff about asthma. Which information should the nurse include? Airway obstruction contributing to increased airflow resistance and hypoventilation in asthma is caused by:

Mucus secretion, bronchoconstriction, and airway edema The mediators of asthma cause vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchospasm), and mucus secretion from mucosal goblet cells with narrowing of the airways and obstruction to airflow.

A 60-year-old male with a 40-year history of smoking presents with chest pain, cough, sputum production, and pneumonia. Tests reveal widespread metastatic cancer, and the primary care provider plans radiation therapy. Which of the following is the most likely type of cancer to be documented on the chart?

Non-small cell carcinoma For individuals with non-small cell carcinoma, adjunctive radiation and chemotherapy may improve outcomes.

A 20-year-old male presents to his primary care provider reporting difficulty breathing when laying down. What term should the nurse use to document this condition?

Orthopnea Orthopnea is dyspnea that occurs when an individual lies flat

A 47-year-old male is diagnosed with pulmonary edema. Which assessment findings will the nurse observe?

Pink, frothy sputum In severe pulmonary edema, pink frothy sputum is expectorated.

A 60-year-old male undergoes surgery for a bone fracture. Which of the following nursing measures would be most effective for preventing pulmonary embolism (PE) in this patient?

Prevent deep vein thrombosis formation PE most commonly results from embolization of a clot from deep venous thrombosis (DVT) involving the lower leg; thus preventing these will help prevent pulmonary emboli.

When a patient has a massive pulmonary embolism (PE), what complications will the nurse monitor for?

Shock and death A massive PE will lead to shock and death.

A nurse remembers a low ventilation-perfusion ratio results in:

Shunting Hypoxemia caused by inadequate ventilation of well-perfused areas of the lung is a form of mismatching called shunting.

A 54-year-old male is diagnose with empyema. Upon receiving and reviewing the culture result, which organism does the nurse suspect is the most likely cause?

Staphlococus aureus The most likely cause of empyema is Staphylococcus aureus.

A 10-year-old male is brought to the ER with prolonged bronchospasm and severe hypoxemia. The most likely diagnosis on the chart is:

Status asthmaticus When bronchospasm is not reversed by usual measures, the individual is considered to have severe bronchospasm or status asthmaticus.

A 50-year-old male presents with hypotension, hypoxemia, and tracheal deviation to the left. Tests reveal that the air pressure in the pleural cavity exceeds barometric pressure in the atmosphere. Based upon these assessment findings, what does the nurse suspect the patient is experiencing?

Tension pneumothorax Tracheal deviation suggests tension pneumothorax

A 22-year-old female presents with chronic bronchitis. Tests reveal closure of the airway during expiration. While planning care, a nurse recalls this condition is most likely caused by:

Thick mucus from hypertrophied glands Chronic bronchitis is defined by hypersecretion of thick mucus.

A patient asks what causes pneumonia. How should the nurse reply? Pneumonia is caused by:

Viral or bacterial infections Pneumonia is caused by a viral or bacterial infection.