NUR 222 - Ch 8 OL study questions

Normally, approximately what percentage of the blood pumped by the right ventricle does not perfuse the alveolar capillaries?

2%

rationale: A V/Q scan is used clinically to measure the integrity of the pulmonary vessels relative to blood flow and to evaluate blood flow abnormalities, as seen in pulmonary emboli.

A gallium scan is a radioisotope scan used to detect inflammatory conditions, abscesses, adhesions, and the presence, location, and size of tumors.

rationale: When ventilation exceeds perfusion a dead space exists. An example of a dead space is a pulmonary emboli.

A low ventilation/perfusion ratio exists in pneumonia or with a mucus plug. A silent unit occurs in pneumothorax or ARDS.

Bronchoscopy is the direct inspection and examination of the larynx, trachea, and bronchi for diagnosis of infectious, inflammatory, and malignant disease of the chest through a flexible or rigid fiberoptic bronchoscope.

A thoracentesis {aspiration of fluid or air from the pleural space} is performed on patients with various problems. A thoracentesis may be used for removal of fluid and air from the pleural cavity or aspiration of pleural fluid for analysis.

rationale: A patient with pulmonary edema would be expected to have crackles in the lung bases, and possible wheezes. Egophony may occur in patients diagnosed with pleural effusion.

Absent breath sounds occurs in pneumothorax. Bronchial breath sounds occur in consolidation, such as pneumonia.

A patient has an order for arterial blood gases (ABG) to be drawn. Which of the following tests must be done prior to the procedure?

Allen test

Which of the following is a deformity of the chest that occurs as a result of overinflation of the lungs?

Barrel chest

rationale: Kussmaul respirations are seen in patients with diabetic ketoacidosis. In Cheyne-Stokes respiration, rate and depth increase, then decrease until apnea occurs.

Biot's respiration is characterized by periods of normal breathing {3 to 4 breaths} followed by a varying period of apnea {usually 10 to 60 seconds}.

In a patient diagnosed with increased intracranial pressure (IICP), the nurse would expect to observe which of the following respiratory rate or depth?

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?

Cancer

rationale: High or increased compliance occurs if the lungs have lost their elasticity {cannot return to normal state} and the thorax is overdistended, as in emphysema. Low or decreased compliance occurs if the lungs and thorax are "stiff" {difficult to stretch}.

Conditions associated with decreased compliance include pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS).

rationale: High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended, as in emphysema.

Conditions associated with decreased compliance include pneumothorax, pleural effusion, and ARDS.

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation?

Crackles at lung bases

A patient diagnosed with a pulmonary embolism (PE) would be expected to have which type of ventilation-perfusion?

Dead space

Which of the following is an age-related change associated with the respiratory system?

Decreased size of the airway

While conducting the physical examination during assessment of the respiratory system, which of the following does a nurse assess by inspecting and palpating the trachea?

Deviation from the midline

Which of the following clinical manifestations should a nurse monitor for during a pulmonary angiography, which indicates an allergic reaction to the contrast medium?

Difficulty in breathing

rationale: Before obtaining an ABG from the radial artery, it is necessary to test the patency of the ulnar artery by performing the Allen test.

Doppler studies, angiography, and pulse oximetry are not necessary prior to ABGs being drawn.

Which of the following is a true statement regarding air pressure variances?

During inspiration, air is drawn through the trachea and bronchi into the alveoli.

rationale: Although the numbers of alveoli remain stable with age, the alveolar walls become thinner and contain fewer capillaries, resulting in decreased gas exchange. The lungs also lose elasticity and become stiffer.

Elasticity of lungs does not increase with age, and the number of alveoli does not decrease with age.

High or increased compliance occurs in which disease process?

Emphysema

Which of the following disease processes cause increased compliance?

Emphysema

rationale: In addition to the nursing management of individual tests, patients with respiratory disorders require informative and appropriate explanations of any diagnostic procedures they will experience. Nurses must remember that for many of these patients, breathing may in some way be compromised.

Energy levels may be decreased. For that reason, explanations should be brief yet complete and may need to be repeated later after a rest period. The nurse must also ensure adequate rest periods before and after the procedures. After invasive procedures, the nurse must carefully assess for signs of respiratory distress.

rationale: Profuse, frothy pink material, often welling up into the throat, may indicate pulmonary edema.

Foul-smelling sputum and bad breath may indicate a lung abscess, bronchiectasis, or an infection caused by fusospirochetal or other anaerobic organisms.

rationale: Patients with orthopnea are placed in a high Fowler's position to facilitate breathing. Dyspnea refers to labored breathing or shortness of breath.

Hemoptysis refers to expectoration of blood from the respiratory tract. Hypoxemia refers to low oxygen levels in the blood.

Bradypnea is associated with which of the following?

Increased intracranial pressure

Which of the following is an age-related change associated with the lung?

Increased thickness of the alveolar membranes

Which respiratory volume is the maximum volume of air that can be inhaled after maximal expiration?

Inspiratory reserve volume

A patient diagnosed with diabetic ketoacidosis would be expected to have which type of respiratory pattern?

Kussmaul respirations

A patient has a negative Allen test when using the right radial artery. The nurse would then try which of the following areas?

Left radial artery

Why is it important for a nurse to provide required information and appropriate explanations of diagnostic procedures to patients with respiratory disorders?

Manage decreased energy levels

Which of the following terms is used to describe inability to breathe easily except in an upright position?

Orthopnea

Which of the following is a deformity of the chest that occurs as a result of displacement of the sternum?

Pigeon chest

rationale: A barrel chest occurs as a result of overinflation of the lungs. There is an increase in the anteroposterior diameter of the thorax. Funnel chest occurs when there is a depression in the lower portion of the sternum, which may result in murmurs.

Pigeon chest occurs as a result of displacement of the sternum. There is an increase in the anteroposterior diameter. Kyphoscoliosis is characterized by elevation of the scapula and a corresponding S-shaped spine. This deformity limits lung expansion within the thorax.

Which diagnostic is more accurate in detecting malignancies than a computed tomography {CT} scan?

Positive emission tomography (PET) scan

Pink, frothy sputum may be an indication of which of the following?

Pulmonary edema

Which of the following is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin {SaO2}?

Pulse oximetry

Patient's arterial blood gas analysis reveals a pH of 7.32 and a PCO2 of 60. Which of the following imbalances do these values reveal?

Respiratory acidosis

rationale: A thoracentesis may be performed to obtain a sample of pleural fluid or to biopsy a specimen from the pleural wall for diagnostic purposes. Bloody fluid typically suggests trauma. Purulent fluid is diagnostic for infection.

Serous fluid may be associated with cancer, inflammatory conditions, or heart failure. Complications that may follow a thoracentesis include pneumothorax and subcutaneous emphysema.

rationale: Adequate ventilation but impaired perfusion {as in pulmonary emboli which is a blood clot in pulmonary vessels} is termed increased dead space.

Shunting occurs when ventilation is impaired and perfusion is adequate. Absence of ventilation and perfusion is a *silent unit*.

Which of the following ventilation:perfusion mismatches would correlate with acute respiratory distress syndrome {ARDS}?

Silent unit

Which ventilation/perfusion ratio is exhibited by acute respiratory distress syndrome {ARDS}?

Silent unit

In which position should the patient be placed for a thoracentesis?

Sitting on the edge of the bed

rationale: Bradypnea is associated with increased intracranial pressure.

Tachypnea is commonly seen in patient with pneumonia, pulmonary edema, and metabolic acidosis.

Which of the following results in decreased gas exchange in older adults?

The alveolar walls contain fewer capillaries.

In relation to the structure of the larynx, the cricoid cartilage is defined as which of the following?

The only complete cartilaginous ring in the larynx.

rationale: If there is a negative Allen test in the right wrist, the nurse should move to the left wrist.

The right radial artery should not be used again at this time. Usually, using the femoral or brachial artery may need a physician's order.

rationale: The cricoid cartilage is located below the thyroid cartilage. The arytenoid cartilages are used in vocal cord movement with the thyroid cartilage.

The thyroid cartilage is the largest of the cartilage structures; part of it forms the Adam's apple. The epiglottis is the valve flap of cartilage that covers the opening to the larynx during swallowing.

rationale: A pH of 7.32 and a PCO2 of 60 correlate with respiratory acidosis. A normal pH is 7.35 to 7.45 and a normal PCO2 is 35 to 45 mm Hg.

These values do not correlated with the other blood gas imbalances listed.

rationale: Normally, about 2% of the blood pumped by the right ventricle does not perfuse the alveolar capillaries.

This shunted blood drains into the left side of the heart without participating in alveolar gas exchange. The other options are inaccurate.

Which of the following alveolar cells secrete surfactant?

Type II

rationale: Type II alveolar cells are metabolically active and secrete surfactant, a phospholipid that decrease the surface tension in the alveoli and prevents their collapse. Type I alveolar cells are epithelial cells that form the alveolar walls.

Type III alveolar cell macrophages are large phagocytic cells that ingest foreign matter and act as an important defense mechanism. Type IV is not a category of alveolar cells.

Which of the following diagnostic studies aids in the diagnosis of a pulmonary embolism {PE}?

V/Q scan

rationale: A PET scan is more accurate in detecting malignancies than CT and has equivalent accuracy in detecting malignant nodules when compared with invasive procedures such as thorascopy. The gallium scan is used to stage bronchogenic cancer

and document tumor regression after chemotherapy or radiation. An MRI is used to characterize pulmonary nodules, to help stage bronchogenic carcinoma, and to evaluate inflammatory activity in interstitial lung disease. Pulmonary angiography is used to investigate thromboembolic disease of the lungs.

rationale: Age-related changes associated with the lung include increased thickness of the alveolar membranes, decreased elasticity of alveolar air sacs,

increased diameter of alveoli ducts, and increased collagen of alveolar membranes.

rationale: Age-related changes that occur in the respiratory system are a decrease in the size of the airway, decreased chest muscle mass,

increased thickening of the alveolar membranes, and decreased elasticity of the alveolar sacs.

rationale: Tidal volume is the volume of air inhaled and exhaled with each breath. Residual volume is the volume of air remaining in the lungs after a maximum expiration. Vital capacity is the

maximum volume of air exhaled from the point of maximum inspiration. Expiratory reserve volume is the maximum volume of air that can be exhaled after a normal inhalation.

rationale: Nurses must determine if the client has any allergies, particularly to iodine, shellfish, or contrast dye. During the procedure, the nurse should check for signs and symptoms of allergic reactions to the contrast medium, such as itching, hives,

or difficulty in breathing. The nurses inspects for hematoma, absent distal pulses, after the procedure. When the contrast medium is infused, an urge to cough is often a sensation experienced by the client.

rationale: If possible place the patient upright or sitting on the edge of the bed with the feet supported and arms and head on a padded over-the-bed table. Other positions in which the patient could be placed are

straddling a chair with arms and head resting on the back of the chair, and lying on the unaffected side with the head of the bed elevated 30 to 45 degrees if unable to assume a sitting position.

rationale: Pigeon chest {pectus carinatum} occurs as a result of displacement of the sternum; there is an increase in the anteroposterior diameter. A barrel chest occurs as a result of overinflation of the lungs; there is an increase in

the anteroposterior diameter of the thorax. Funnel chest occurs when there is a depression in the lower portion of the sternum, which may result in murmurs. Kyphoscoliosis is characterized by elevation of the scapula and a corresponding S-shaped spine. This deformity limits lung expansion within the thorax.

rationale: Pulse oximetry is a noninvasive method of continuously monitoring SaO2. Measurements of blood pH of arterial oxygen and carbon dioxide tensions are obtained when managing patients with respiratory problems and adjusting oxygen

therapy as needed. This is an invasive procedure. Pulmonary function testing assesses respiratory function and determines the extent of dysfunction. Sputum studies are done to identify if any pathogenic organisms or malignant cells are in the sputum.

rationale: Air flows from a region of higher pressure to a region of lower pressure. During inspiration, movement of the diaphragm and other muscles of respiration enlarges the thoracic cavity and

thereby lowers the pressure inside the thorax to a level below that of atmospheric pressure.

rationale: Bradypnea is a slower than normal rate (<10 breaths/minute), with normal depth and regular rhythm. It is associated with IICP, brain injury, central nervous system depressants, and drug overdose.

Tachypnea is associated with metabolic acidosis, septicemia, severe pain, and rib fracture. Hypoventilation is shallow, irregular breathing. Hyperventilation is an increased rate and depth of breathing.

rationale: During the physical examination, the nurse must inspect and gently palpate the trachea to assess for placement and deviation from the midline. The nurse examines the posterior pharynx and tonsils with a tongue blade and light and notes any

evidence of swelling, inflammation, or exudate, as well as changes in color of the mucous membranes. The nurse also examines the anterior, posterior, and lateral chest walls for any evidence of muscle weakness.

rationale: Inspiratory reserve volume is normally 3000 mL. Tidal volume is the volume of air inhaled and exhaled with each breath. Expiratory reserve volume is the maximum volume of air that can be exhaled forcibly after a normal exhalation.

Residual volume is the volume of air remaining in the lungs after a maximum exhalation.

rationale: A silent unit {a combination of shunting and dead-space ventilation} occurs when little or no ventilation and perfusion is present, such as in ARDS. A dead space, which is reduced perfusion to a lung unit, occurs in pulmonary embolism.

Shunting, reduced ventilation to a lung unit, occurs in pneumonia and atelectasis. Patients with ARDS do not have a normal V/Q match.

The volume of air inhaled and exhaled with each breath is termed which of the following?

Tidal volume