Pathophyiology Exam 3: Respiratory practice test

Which of the following complications is a patient with obstructive sleep apnea at higher risk for? (select all that apply) A. daytime sleepiness B. Left sided heart failure C. Right sided heart failure D. Stroke E. Type 2 diabetes

A,C,D,E pg 300 Goulds

A client in respiratory distress is admitted with arterial blood gas results of: PH 7.30; PO2 58, PCO 34; and HCO3 19. The nurse determines that the client is in? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis

A These lab values indicate metabolic acidosis; The PH is low, PCO2 normal; and bicarbonate level is low

The accumulation of fluids in the pleural space is called: a. Pleural effusion b. Hemothorax c. Hydrothorax d. Pyothorax

A a. Pleural effusion b. Hemothorax - blood c. Hydrothorax - water d. Pyothorax

A patient who will be sedeted has been told not ingest anything because aspiration of vomitius can lead to which respiratory disorder? A. Pneumonia B. Athsma C. Emphesema D. Pneumothorax

A - chemical and asipiration pneumia can form from stomach contents damaging the lungs

During a physical assessment, the nurse documents eupnea on the client's medical record. What does this finding suggest? a. Normal respirations b. Slow respirations c. Irregular respirations d. Rapid respirations

A

The amount of air inspired and expired with each breath is called: A. tidal volume. B. residual volume. C. vital capacity. D. dead-space volume

A

A 19-year-old male patient with CF and his wife are considering having a child. Which statement by the patient indicates that the nurse's teaching has been effective? a. "We will plan on having genetic counseling before we make a decision." b. "My erectile dysfunction will make it more difficult to have a child." c. "It is likely that I will die before any children we have are grown." d. "There should not be any problems as long as I take my medications."

A Rationale: Children of patients with CF are either CF carriers or have the disease. Most men with CF are sterile, but erectile dysfunction is not associated with CF. The life expectancy for CF is getting longer, with a mean age of 35. Despite appropriate therapy, the couple is likely to experience problems becoming pregnant.

A nurse is caring for a male client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client? a. Stridor b. Occasional pink-tinged sputum c. A few basilar lung crackles on the right d. Respiratory rate of 24 breaths/min

A The nurse reports stridor to the physician immediately. This is a high-pitched, coarse sound that is heard with the stethoscope over the trachea. Stridor indicates airway edema and places the client at risk for airway obstruction

You are preparing to care for a client with a history of COPD on the med surg floor, who has been admitted with acute exacerbation of COPD. What findings would you expect when you assess this client? Select all that apply A. Decreased 02 saturation on mild exertion. B. Widened diaphragm on chest radiology. C. Increased vital capacity during pulmonary function testing. D. Hypocapnia E. Hyperinflated lung on chest x-ray.

A&E A.: Correct /true , due to narrowed airway clearance and inability to exchange oxygen for c02 your client will exhibit low 02 saturation levels. Clients with COPD usually sat around 85%. B: Incorrect/ false in a client with COPD the diaphragm will appear flat on x-ray due to accumulated scar tissue and decreased lung compliance from long standing hyperinflation damage. C: incorrect / False: We will see a decreased vital capacity due to damage to the lung tissue and diaphragm D: Incorrect,/false, we know that a client suffering from COPD will have hypercapnia . This occurs because of narrowing airways and inability to exchange 02 and co2. You may also see ABG results showing respiratory acidosis because of this. E: Correct/true , this is a clinical manifestation of COPD. Hyperinflated lungs can be caused by blockages in the air passages or by air sacs that are less elastic, which interferes with the expulsion of air from the lungs

The nurse is admitting a client with suspected tuberculosis (TB) to the acute care unit. The nurse places the client in airborne precautions until a confirmed diagnosis of active TB can be made. Which of the following tests is a priority to confirm the diagnosis? A.Sputum culture positive for Mycobacterium Tuberculosis B. Positive purified protein derivative (PPD) test C. Chest x-ray that is positive for lung lesions D. Sputum positive for blood (haemoptysis)

A. Acid Fast test is required a PPD test may provide a false positive if the patient has had an vaccine in the past. The most accurate way to diagnose TB is by sputum culture. Identifying the presence of tubercle bacilli is essential for a definitive diagnosis. Although haemoptysis is associated with more advanced cases of TB, it is not a confirmatory clinical manifestation. A positive PPD indicates exposure to TB, but gives no information about active disease. A chest x-ray with lesions may be present in a number of other diseases, not just TB

A nurse assessing a 3 year old making note that the child exhibited a hoarse, barking cough, and inspiratory stridor. The patient is likely to contracted which respiratory infection? A. Laryngotracheobronchitis B. Epiglottis C. Bronchiolitis

A. Croup aka Laryngotracheobronchitis

A female client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? a. Dyspnea b. Bradypnea c. Bradycardia d. Decreased respiratory

Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain

An unconscious male client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, a normal oxygen level, and an elevated potassium level. These results indicate the presence of: a. Metabolic acidosis b. Respiratory acidosis c. Overcompensated respiratory acidosis d. Combined respiratory and metabolic acidosis

Answer A. In an acidotic condition, the pH would be low, indicating the acidosis. In addition, a low bicarbonate level along with the low pH would indicate a metabolic state. Therefore, options B, C, and D are incorrect.

A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of: a. Right pneumothorax b. Pulmonary embolism c. Displaced endotracheal tube d. Acute respiratory distress syndrome

Answer A. Pneumothorax is characterized by restlessness, tachycardia, dyspnea, pain with respiration, asymmetrical chest expansion, and diminished or absent breath sounds on the affected side. Pneumothorax can cause increased airway pressure because of resistance to lung inflation. Acute respiratory distress syndrome and pulmonary embolism are not characterized by absent breath sounds. An endotracheal tube that is inserted too far can cause absent breath sounds, but the lack of breath sounds most likely would be on the left side because of the degree of curvature of the right and left main stem bronchi.

A nurse is assessing a male client with chronic airflow limitations and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitations? a. Emphysema b. Bronchial asthma c. Chronic obstructive bronchitis d. Bronchial asthma and bronchitis

Answer A. (Pink Puffer) The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, referred to as "barrel chest." The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion.

A nurse is caring for a male client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? a. Hypocapnia b. A hyperinflated chest noted on the chest x-ray c. Increase oxygen saturation with exercise d. A widened diaphragm noted on the chest x-ray

Answer B. Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, - hypercapnia,- dyspnea on exertion and at rest- oxygen desaturation with exercise- and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened (not widened) diaphragm if the disease is advanced.

A nurse is caring for a female client diagnosed with tuberculosis. Which assessment, if made by the nurse, is inconsistent with the usual clinical presentation of tuberculosis and may indicate the development of a concurrent problem? a. Cough b. High-grade fever c. Chills and night sweats d. Anorexia and weight loss

Answer B. The client with tuberculosis USUALLY experiences cough (productive or nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever

An emergency room nurse is assessing a female client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? a. A low respiratory b. Diminished breathe sounds c. The presence of a barrel chest d. A sucking sound at the site of injury

Answer B. This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury.

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed: a. 1 L/min b. 2 L/min c. 6 L/min d. 10 L/min

Answer B. Oxygen is used cautiously and should not exceed 2 L/min. Rationale is important! Because of the long-standing hypercapnia that occurs in emphysema, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels, as is the case in a normal respiratory system.

A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza? A. Septicemia B. Pneumonia C. Meningitis D. Pulmonary edema

Answer B. Pneumonia is the most common complication of influenza. It may be either primary influenza viral pneumonia or pneumonia secondary to a bacterial infection. Other complications of influenza include myositis, exacerbation of chronic obstructive pulmonary disease, and Reye's syndrome. Myocarditis, pericarditis, transverse myelitis, and encephalitis are rare complications of influenza. Although septicemia may arise when any infection becomes overwhelming, it rarely results from influenza. Meningitis and pulmonary edema aren't associated with influenza.

Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? A. Myasthenia gravis B. Type 1 diabetes mellitus C. Extreme anxiety D. Narcotic overdose

Answer C. Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, and injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes mellitus may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul's respirations) don't cause excessive CO2 loss. Myasthenia gravis and narcotic overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

A nurse is assessing a female client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute respiratory distress syndrome? a. Bilateral wheezing b. Inspiratory crackles c. Intercostal retractions d. Increased respiratory rate

Answer D. The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: a. Promote oxygen intake. b. Strengthen the diaphragm. c. Strengthen the intercostal muscles. d. Promote carbon dioxide elimination.

Answer D. Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options A, B, and C are not the purposes of this type of breathing.

A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? A. Activity intolerance related to fatigue B. Anxiety related to actual threat to health status C. Risk for infection related to retained secretions D. Impaired gas exchange related to airflow obstruction

Answer D. A patent airway and an adequate breathing pattern are the top priority for any client, making impaired gas exchange related to airflow obstruction the most important nursing diagnosis. The other options also may apply to this client but are less important.

A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? A.pH, 5.0; PaCO2 30 mm Hg B. pH, 7.40; PaCO2 35 mm Hg C. pH, 7.35; PaCO2 40 mm Hg D. pH, 7.25; PaCO2 50 mm Hg

Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange in the lungs.

Presence of overdistended and non-functional alveoli is a condition called: a. Bronchitis b. Emphysema c. Empyema d. Atelectasis

Answer: B. An overdistended and non-functional alveoli is a condition called emphysema. Atelectasis is the collapse of a part or the whole lung. Empyema is the presence of pus in the lung.

As a patient arrives to the emrgency room the EMT explains the patient had just arrived from an international fight and stopped and used a massage chair for her legs and back. The nuse begins to suspect which condition may have developed: A. SARS from poor ventalation in the plane B. Patient may have developed a pulonary embolus from a Deep Vein Thrombosis C. The US air is too thin for them to adequately ventelate the patient D. The patient developed secondary polycythemia becuse of the air density change with flight altitude

B

The amount of air remaining after forced expiration is called: A. tidal volume. B. residual volume. C. vital capacity. D. dead-space volume

B

A patient with pulmonary hypertention ask how can high pressure in their lungs lead to a chage in SpO2? (Hes really informed). A. Water from the air fills his lunds B. Pulmonary edema leads to fluid collection in the alveoli impairing gas exchange C. Pulmonary edema leads to fluid collection in the bonchioles impairing gas exchange D. Right sided Heart failure causes fluid to back up in the lungs (pumonary edema)

B "Pulmonary edema refers to the fluid collecting in thr alveoli and interstital area... this accumulation of fluid reduces the amount of oxygen diffusing into the blood and interferes with lung expansion, also reducing oxygenation of the blood" pg. 309

When teaching a patient with chronic obstructive pulmonary disease (COPD) about reasons to quit smoking, the nurse will explain that long-term exposure to tobacco smoke leads to a a. weakening of the smooth muscle lining the airways. b. decrease in the area available for oxygen absorption. c. lesser number of red blood cells for oxygen delivery. d. decreased production of protective respiratory secretions.

B Rationale: Tobacco smoke leads to an increase in proteolytic enzymes, which break down alveolar walls and lead to less alveolar surface area for gas exchange. Bronchial smooth muscle is not weakened by chronic smoking. Polycythemia is a common compensatory mechanism for patients with COPD. The quantity of respiratory secretions increases as a result of smoking.

The nurse caring for a patient with CF recognizes that the manifestations of the disease are caused by the pathophysiologic processes of a. inflammation and fibrosis of lung tissue. b. altered function of exocrine glands. c. failure of the mucus-producing goblet cells. d. thickening and fibrosis of the pleural linings.

B Rationale: CF is characterized by abnormal secretions of exocrine glands, mainly of the lungs, pancreas, and sweat glands. Damage to lung tissue develops late in the disease. The goblet cells continue to produce mucus.

The nurse is caring for a client with a hemopneumothorax. The client has a chest tube. The nurse would EXPECT which of the following color of drainage? A. Yellow B. Red C. Clear D. Brown

B. "Hemo" implies a bloody pneumothorax, therefore red drainage. Hemopneumothorax, or haemopneumothorax, is a medical term describing the combination of two conditions: pneumothorax, or air in the chest cavity, and hemothorax (also called hæmothorax), or blood in the chest cavity.

Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true? A. A positive reaction indicates that the client has active tuberculosis (TB). B. A positive reaction indicates that the client has been exposed to the disease. C. A negative reaction always excludes the diagnosis of TB. D. The PPD can be read within 12 hours after the injection.

B. A positive reaction means the client has been exposed to TB; it isn't conclusive of the presence of active disease. A positive reaction consists of palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after the injection. In clients with positive reactions, further studies are usually done to rule out active disease. In immunosuppressed clients, a negative reaction doesn't exclude the presence of active disease.

This genetic disorder causes excessive amounts of thick, sticky, mucous to obstruct ducts of exocrine glands: A. Chronic Bronchitis B. Emphysema C. Cystic Fibrosis D. Cerebral Palsy

C

When taking an admission history of a patient with possible pneumonia the patient is employed by a Air Conditioning Reparir company and often forgoes the use of respirators as they infringe on his rights. After rolling her eyes, the nuse now suspect what may have caused his pneumonia? A. irritation from the hot air breathed in by the patient B. Possible exposure to streptococcus pneumoniae C. possible exposure to legionella pneumophila D. Possible exposure to Chlamydia pneumoniae

C

Which of the following organisms most commonly causes community-acquired pneumonia in adults? A. Haemophilus influenzae B. Klebsiella pneumoniae C. Streptococcus pneumoniae D. Staphylococcus aureus

C

A immunosuppressed patient is at risk of developing which respiratory disease? A. COPD B. Asthma C. Histoplasmosis D. Scarlet Fever

C

A seven-month-pregnant female is sitting quietly in the waiting room, and her respiratory rate is 20 and shallow. What does this finding suggest to the nurse? a. She has a history of smoking. b. She is using accessory muscles to breathe. c. She is in pending respiratory failure. d. Nothing. This is normal.

C

. A patient with a history of asthma is admitted to the hospital in acute respiratory distress. During assessment of the patient, the nurse would notify the health care provider immediately about a. a pulse oximetry reading of 90%. b. a peak expiratory flow rate of 240 ml/min. c. decreased breath sounds and wheezing. d. a respiratory rate of 26 breaths/min.

C Rationale: Decreased breath sounds and wheezing would indicate that the patient was experiencing an asthma attack, and immediate bronchodilator treatment would be indicated. The other data indicate that the patient needs ongoing monitoring and assessment but do not indicate a need for immediate treatment.

When discussing assessment data with the provider, the provider mentions the possibility of Epiglottitis. The nurse knows this condition is especially dangerous due to: A. Inflammation of the bronchioles B. Fluid accumulation in the lungs C. Possible airway obstruction D. Inflammation and damage to the aveoli

C. Epiglottitis is the inflammation of the Eppiglottis which lies at the opening of the trachea. obstruction will collapse the airway.

An elderly client with pneumonia may appear with which of the following symptoms first? A. Altered mental status and dehydration B. Fever and chills C. Hemoptysis and dyspnea D. Pleuritic chest pain and cough

Correct Answer: A. Altered mental status and dehydration Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response. A small fraction of patients may have an altered mental status, abdominal pain, chest pain, and other systemic findings. Option B: Historically, the chief complaints in case of pneumonia include systemic signs like fever with chills, malaise, loss of appetite, and myalgias. These findings are more common in viral pneumonia as compared to bacterial pneumonia. Option C: Pulmonary findings include cough with or without sputum production. Bacterial pneumonia is associated with purulent or rarely blood-tinged sputum. Viral pneumonia is associated with watery or occasionally mucopurulent sputum production. Option D: There may be an associated pleuritic chest pain with the concomitant involvement of the pleura. Dyspnea and a diffuse heaviness of the chest are also seen occasionally. The cough may be either nonproductive or productive with mucoid, purulent, or blood-tinged sputum.

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following? A. Develop infections easily. B. Maintain current status. C. Require less supplemental oxygen. D. Show permanent improvement.

Correct Answer: A. Develop infections easily. A client with COPD is at high risk for development of respiratory infections. In emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils and macrophages are recruited and release multiple inflammatory mediators. Oxidants and excess proteases leading to the destruction of the air sacs. The protease-mediated destruction of elastin leads to a loss of elastic recoil and results in airway collapse during exhalation. Option B: COPD is slowly progressive; therefore, maintaining current status is an unrealistic expectation. COPD is an inflammatory condition involving the airways, lung parenchyma, and pulmonary vasculature. The process is thought to involve oxidative stress and protease-antiprotease imbalances. Emphysema describes one of the structural changes seen in COPD where there is destruction of the alveolar air sacs (gas-exchanging surfaces of the lungs) leading to obstructive physiology. Option C: This is an unrealistic expectation. The prognosis of COPD is variable based on adherence to treatment including smoking cessation and avoidance of other harmful gases. Patients with other comorbidities (e.g., pulmonary hypertension, cardiovascular disease, lung cancer) typically have a poorer prognosis. The airflow limitation and dyspnea are usually progressive. Option D: Treatment may slow progression of the disease, but permanent improvement is highly unlikely. As the disease progresses, impairment of gas exchange is often seen. The reduction in ventilation or increase in physiologic dead space leads to CO2 retention. Pulmonary hypertension may occur due to diffuse vasoconstriction from hypoxemia.

Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD? A. Increased PaCO2 B. Increased PaO2 C. Increased pH D. Increased oxygen saturation

Correct Answer: A. Increased PaCO2 As COPD progresses, the client typically develops increased PaCO2 levels and decreased PaO2 levels. This results in decreased pH and decreased oxygen saturation. These changes are the result of air trapping and hypoventilation. Arterial blood gas (ABG) analysis provides the best clues as to acuteness and severity of disease exacerbation. Option B: Patients with mild COPD have mild to moderate hypoxemia without hypercapnia. As the disease progresses, hypoxemia worsens and hypercapnia may develop, with the latter commonly being observed as the FEV1 falls below 1 L/s or 30% of the predicted value. Lung mechanics and gas exchange worsen during acute exacerbations. Option C: In general, renal compensation occurs even in chronic CO2 retainers (ie, bronchitis); thus, pH usually is near normal. Generally, consider any pH below 7.3 to be a sign of acute respiratory compromise. Option D: The compensation to respiratory acidosis consists in a secondary increase in bicarbonate concentration, and the arterial blood gas analysis is characterized by a reduced pH, increased pCO2 (initial variation), and increased bicarbonate levels (compensatory response).

Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD? A. Increased anteroposterior chest diameter. B. Underdeveloped neck muscles. C. Collapsed neck veins. D. Increased chest excursions with respiration.

Correct Answer: A. Increased anteroposterior chest diameter. (emphysema) Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance (chronic bronchitits) . In addition, coarse crackles beginning with inspiration may be heard. Option B: Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. Use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign). Option C: Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump into pulmonary vasculature. In advanced disease, cyanosis, elevated jugular venous pulse (JVP), and peripheral edema can be observed. Option D: Diminished, not increased, chest excursion is associated with COPD. The sensitivity of a physical examination in detecting mild to moderate COPD is relatively poor; however, physical signs are quite specific and sensitive for severe disease. Patients with severe disease experience tachypnea and respiratory distress with simple activities.

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings? A. It is likely that the client is developing a secondary bacterial pneumonia. B. The assessment findings are consistent with influenza and are to be expected. C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions D. The client has not been taking her decongestants and bronchodilators as prescribed.

Correct Answer: A. It is likely that the client is developing a secondary bacterial pneumonia. Pneumonia is the most common complication of influenza, especially in the elderly. The development of a purulent cough and crackles may be indicative of a bacterial infection that is not consistent with a diagnosis of influenza. Option B: Diagnosis of influenza can be reached clinically, especially during the influenza season. Most of the cases will recover without medical treatment, and they would not need a laboratory test for the diagnosis. Signs and symptoms of influenza in mild cases include a cough, fever, sore throat, myalgia, headache, runny nose, and congested eyes. A frontal or retro-orbital headache is a common presentation with selected ocular symptoms that include photophobia and pain with different qualities. Option C: These findings are not indicative of dehydration. The clinical presentation of influenza ranges from mild to severe depending on the age, comorbidities, vaccination status, and natural immunity to the virus. Usually, patients who received the seasonal vaccine present with milder symptoms, and they are less likely to develop complications. Option D: Decongestants and bronchodilators are not typically prescribed for the flu. Influenza infection is self-limited and mild in most healthy individuals who do not have other comorbidities. No antiviral treatment is needed during mild infections in healthy individuals. Antiviral medications can be used to treat or prevent influenza infection, especially during outbreaks in healthcare settings such as hospitals and residential institutions.

Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic patients by which of the following methods? A. The mask provides 100% oxygen to the client. B. The mask provides continuous air that the client can breathe. C. The mask pressurizes at the end of expiration to open collapsed alveoli. D. The mask provides pressurized oxygen so the client can breathe more easily.

Correct Answer: D. The mask provides pressurized oxygen so the client can breathe more easily. The mask provides pressurized oxygen continuously through both inspiration and expiration. Continuous positive airway pressure (CPAP) is a type of positive airway pressure that is used to deliver a set pressure to the airways that is maintained throughout the respiratory cycle, during both inspiration and expiration. Option A: The mask can be set to deliver any amount of oxygen needed. CPAP therapy utilizes machines specifically designed to deliver a flow of constant pressure. Some CPAP machines have other features as well, such as heated humidifiers. Components of a CPAP machine include an interface for delivering CPAP. Option B: By providing the client with pressurized oxygen, the client has less resistance to overcome in taking his next breath, making it easier to breathe. Continuous positive airway pressure (CPAP) is a type of positive airway pressure, where the air flow is introduced into the airways to maintain a continuous pressure to constantly stent the airways open, in people who are breathing spontaneously. Option C: Pressurized oxygen delivered at the end of expiration is positive end-expiratory pressure (PEEP), not continuous positive airway pressure. Positive end-expiratory pressure (PEEP) is the pressure in the alveoli above atmospheric pressure at the end of expiration. CPAP is a way of delivering PEEP but also maintains the set pressure throughout the respiratory cycle, during both inspiration and expiration.

On auscultation, which finding suggests a right pneumothorax? A. Bilateral inspiratory and expiratory crackles. B. Absence of breaths sound in the right thorax. C. Inspiratory wheezes in the right thorax. D. Bilateral pleural friction rub.

Correct Answer: B. Absence of breaths sound in the right thorax In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse. The degree of collapse determines the clinical presentation of pneumothorax. None of the other options are associated with pneumothorax. Option A: Bilateral crackles may result from pulmonary congestion. Pneumonia is an infection in the lungs. It may be in one or both lungs. The infection causes air sacs in the lungs to become pus-filled and inflamed. This causes a cough, difficulty breathing, and crackles. Pneumonia may be mild or life-threatening. Option C: Inspiratory wheezes may signal asthma. Asthma is a heterogeneous syndrome characterized by variable, reversible airway obstruction and abnormally increased responsiveness (hyperreactivity) of the airways to various stimuli. The syndrome is characterized by wheezing, chest tightness, dyspnea, and/or cough, and results from widespread contraction of tracheobronchial smooth muscle (bronchoconstriction), hypersecretion of mucus, and mucosal edema, all of which narrow the caliber of the airways. Option D: A pleural friction rub may indicate pleural inflammation. Auscultation of a pleural friction rub can occur when the normally smooth surfaces of the visceral and parietal pleura become roughened by inflammation. A pleural friction rub is an adventitious breath sound heard on auscultation of the lung. The pleural rub sound results from the movement of inflamed and roughened pleural surfaces against one another during movement of the chest wall. This sound is non-musical, and described as "grating," "creaky," or "the sound made by walking on fresh snow."

A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away? A. Beta-adrenergic blockers B. Bronchodilators C. Inhaled steroids D. Oral steroids

Correct Answer: B. Bronchodilators Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Bronchodilators are indicated for individuals that have lower than optimal airflow through the lungs. The mainstay of treatment is beta-2 agonists that target the smooth muscles in the bronchioles of the lung. Various respiratory conditions may require bronchodilators, including asthma and chronic obstructive pulmonary disease. Option A: Beta-adrenergic blockers aren't used to treat asthma and can cause bronchoconstriction. The catecholamines, epinephrine, and norepinephrine bind to B1 receptors and increase cardiac automaticity as well as conduction velocity. B1 receptors also induce renin release, and this leads to an increase in blood pressure. In contrast, binding to B2 receptors causes relaxation of the smooth muscles along with increased metabolic effects such as glycogenolysis. Option C: Inhaled steroids may be given to reduce the inflammation but aren't used for emergency relief. Inhaled corticosteroids have potent glucocorticoid activity and work directly at the cellular level by reversing capillary permeability and lysosomal stabilization to reduce inflammation. The onset of action is gradual and may take anywhere from several days to several weeks for maximal benefit with consistent use. Option D: Corticosteroids produce their effect through multiple pathways. In general, they produce anti-inflammatory and immunosuppressive effects, protein and carbohydrate metabolic effects, water and electrolyte effects, central nervous system effects, and blood cell effects. Oral administration is more common for chronic treatment. Patients should receive non-systemic therapy whenever possible, to minimize systemic exposure.

An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? A. A low respiratory rate. B. Diminished breath sounds. C. The presence of a barrel chest. D. A sucking sound at the site of injury.

Correct Answer: B. Diminished breath sounds. This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse. Option A: An increase in central venous pressure can result in distended neck veins, hypotension. Patients may have tachypnea, dyspnea, tachycardia, and hypoxia. Clinical presentation of a pneumothorax can range anywhere from asymptomatic to chest pain and shortness of breath. Option C: Barrel chest could also be present which consists in increased anterior-posterior diameter of the chest wall and is a normal finding in children, but it is suggestive of hyperinflation with chronic obstructive pulmonary disease (COPD) in adults (chronic bronchitis). Option D: A sucking sound at the site of injury would be noted with an open chest injury. Open "sucking" chest wounds are treated initially with a three-sided occlusive dressing. Further treatment may require tube thoracostomy and/or chest wall defect repair.

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: A. Pleural effusion B. Pulmonary edema C. Atelectasis D. Oxygen toxicity

Correct Answer: C. Atelectasis In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. Adults with COPD have extensive collateral ventilation secondary to airway destruction and thus are less likely to develop resorption atelectasis in the presence of an obstructing lesion (i.e., intrathoracic tumor). The use of high inspiratory oxygen concentration (high FiO2) during induction and maintenance of general anesthesia also contributes to atelectasis via absorption atelectasis. Option A: An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Common causes of transudates include conditions that alter the hydrostatic or oncotic pressures in the pleural space like congestive left heart failure, nephrotic syndrome, liver cirrhosis, hypoalbuminemia leading to malnutrition and the initiation of peritoneal dialysis. Option B: Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Noncardiogenic pulmonary edema is caused by lung injury with a resultant increase in pulmonary vascular permeability leading to the movement of fluid, rich in proteins, to the alveolar and interstitial compartments. Option D: Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough. Extended exposure to above-normal oxygen partial pressures, or shorter exposures to very high partial pressures, can cause oxidative damage to cell membranes leading to the collapse of the alveoli in the lungs. Pulmonary effects can present as early as within 24 hours of breathing pure oxygen.

A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions? A. Adult respiratory distress syndrome (ARDS) B. Asthma C. Chronic obstructive bronchitis D. Emphysema

Correct Answer: C. Chronic obstructive bronchitis Because of his extensive smoking history and symptoms, the client most likely has chronic obstructive bronchitis. Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) that is defined as a productive cough of more than 3 months occurring within a span of 2 years. Patients typically present with chronic productive cough, malaise, and symptoms of excessive coughing such as chest or abdominal pain. Option A: Clients with ARDS have acute symptoms of and typically need large amounts of oxygen. Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by poor oxygenation and non-compliant or "stiff" lungs. The disorder is associated with capillary endothelial injury and diffuse alveolar damage. Once ARDS develops, patients usually have varying degrees of pulmonary artery vasoconstriction and may subsequently develop pulmonary hypertension. Option B: Clients with asthma tend not to have a chronic cough or peripheral edema. Asthma is a common disease and has a range of severity, from a very mild, occasional wheeze to acute, life-threatening airway closure. It usually presents in childhood and is associated with other features of atopy, such as eczema and hayfever. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. Option D: Most patients present with very nonspecific symptoms of chronic shortness of breath and cough with or without sputum production. As the disease process advances, the shortness of breath and cough progressively gets worse. Initially, there is exertional dyspnea with significant physical activity, especially arm work at or above shoulder level with progression to dyspnea with simple daily activities and even at rest. Some patients may present with wheezing because of the airflow obstruction.

The term "blue bloater" refers to which of the following conditions? A. Adult respiratory distress syndrome (ARDS) B. Asthma C. Chronic obstructive bronchitis D. Emphysema

Correct Answer: C. Chronic obstructive bronchitis Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema, cyanotic nail beds, and, at times, circumoral cyanosis. People with chronic bronchitis are sometimes called "blue bloaters" because of their bluish-colored skin and lips. Blue bloaters often take deeper breaths but can't take in the right amount of oxygen. Option A: Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen. Clients with ARDS have acute symptoms and typically need large amounts of oxygen. Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by poor oxygenation and non-compliant or "stiff" lungs. The disorder is associated with capillary endothelial injury and diffuse alveolar damage. Once ARDS develops, patients usually have varying degrees of pulmonary artery vasoconstriction and may subsequently develop pulmonary hypertension. Option B: Clients with asthma don't exhibit characteristics of chronic disease. Asthma is a common disease and has a range of severity, from a very mild, occasional wheeze to acute, life-threatening airway closure. It usually presents in childhood and is associated with other features of atopy, such as eczema and hayfever. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. Option D: Clients with emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting). Emphysema comes on very gradually and is irreversible. People with emphysema are sometimes called "pink puffers" because they have difficulty catching their breath and their faces redden while gasping for air.

Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is: A. Yellow B. Green C. Clear D. Gray

Correct Answer: C. Clear Normally, nasal drainage in acute rhinitis is clear. Anterior rhinoscopy typically reveals swelling of the nasal mucosa and thin, clear secretions. The inferior turbinates may take on a bluish hue, and cobblestoning of the nasal mucosa may be present. On physical examination, clinicians may notice mouth breathing, frequent sniffling and/or throat clearing, transverse supra-tip nasal crease, and dark circles under the eyes (allergic shiners). Option A: Yellow drainage indicates spread of the infection to the sinuses. Yellow mucus is a sign that whatever virus or infection the client has is taking hold. The body is fighting back. The yellow color comes from the cells — white blood cells, for example — rushing to kill the offending germs. Once the cells have done their work, they're discarded in the drainage and tinge it a yellowish-brown. Option B: Green drainage may also indicate infection. If the immune system kicks into high gear to fight infection, the drainage may turn green and become especially thick. The color comes from dead white blood cells and other waste products. Some sinus infections may be viral, not bacterial. Option D: Gray drainage may indicate a secondary infection. This could be a fungal sinus infection. These are different from viral or bacterial infections because the fungi feeds on the nasal tissue—and reproduces. Fungal sinus infections may occur due to a previous nasal injury or long-term nasal inflammation, as well as a weakened immune system. Growths called "fungus balls" develop in the cheek sinus as clumps of fungal spores. The fungus balls must be removed by surgery.

Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder? A. Circumoral cyanosis B. Increased forced expiratory volume C. Inspiratory and expiratory wheezing D. Normal breath sounds

Correct Answer: C. Inspiratory and expiratory wheezing Inspiratory and expiratory wheezes are typical findings in asthma. Patients will show some respiratory distress, often sitting forward to splint open their airways. On auscultation, a bilateral, expiratory wheeze will be heard. In life-threatening asthma, the chest may be silent, as air cannot enter or leave the lungs, and there may be signs of systemic hypoxia. Option A: Circumoral cyanosis may be present in extreme cases of respiratory distress. In many cases, circumoral cyanosis is considered a type of acrocyanosis. Acrocyanosis happens when small blood vessels shrink in response to cold. In older children, circumoral cyanosis often appears when they go outside in cold weather or get out of a warm bath. This type of cyanosis should go away once they warm up. If it doesn't, seek emergency medical treatment. Circumoral cyanosis that doesn't go away with heat could be a sign of a serious lung or heart problem, such as cyanotic congenital heart disease. Option B: The nurse would expect the client to have a decreased forced expiratory volume because asthma is an obstructive pulmonary disease. Peak expiratory flow measurement is common today and allows one to document response to therapy. A limitation of this test is that it is effort-dependent. Spirometry should be done before treatment to determine the severity of the disorder. A reduced ratio of FEV1 to FVC is indicative of airway obstruction, which is reversible with treatment. Option D: Breath sounds will be "tight" sounding or markedly decreased; they won't be normal. Asthma is a condition mediated by inflammation. The resulting physiologic response in the airways is bronchoconstriction and airway edema. This response is triggered by an irritant, allergen, or infection. As air moves through these narrowed airways, the primary lung sound is high-pitched wheeze.

Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection? A. Emotional B. Extrinsic C. Intrinsic D. Mediated

Correct Answer: C. Intrinsic Intrinsic asthma doesn't have an easily identifiable allergen and can be triggered by the common cold. In intrinsic asthma, IgE is usually only involved locally, within the airway passages. Unlike extrinsic asthma, which is triggered by commonly known allergens, intrinsic asthma may be triggered by a wide range of non-allergy-related factors. Unlike people with extrinsic asthma, those with intrinsic asthma usually have a negative allergy skin test, so they often won't benefit from allergy shots or allergy medications. Option A: Asthma caused by emotional reasons is considered to be in the extrinsic category. Strong emotions and stress are well-known triggers of asthma. There is evidence of a link between asthma, anxiety, and depression, though the outcomes are sometimes not consistent. Anxiety and depression may be associated with poor asthma control. Option B: Extrinsic asthma is caused by dust, molds, and pets; easily identifiable allergens. Extrinsic asthma is simply asthma caused by an allergic reaction, especially a chronic one. If the asthma is allergic, the client will have higher levels of IgE (Immunoglobulin E) present in the blood test. Option D: Mediated asthma doesn't exist. When airflow is obstructed as a result of exercise, it's known as exercise-induced bronchoconstriction (EIB), which is a subcategory of asthma. EIB was previously known as exercise-induced asthma; however, exercise-induced asthma incorrectly implies that exercise is the underlying cause of asthma when it is actually its trigger, not the cause.

A pulse oximetry gives what type of information about the client? A. Amount of carbon dioxide in the blood B. Amount of oxygen in the blood C. Percentage of hemoglobin carrying oxygen D. Respiratory rate

Correct Answer: C. Percentage of hemoglobin carrying oxygen. The pulse oximeter determines the percentage of hemoglobin carrying oxygen. This doesn't ensure that the oxygen being carried through the bloodstream is actually being taken up by the tissue. Pulse oximetry is a non-invasive monitor that measures the oxygen saturation in the blood by shining light at specific wavelengths through tissue (most commonly the fingernail bed). Option A: A CO2 blood test measures the amount of carbon dioxide in the blood. Too much or too little carbon dioxide in the blood can indicate a health problem. A CO2 blood test is often part of a series of tests called an electrolyte panel. Electrocytes help balance the levels of acids and bases in the body. Most of the carbon dioxide in the body is in the form of bicarbonate, which is a type of electrolyte. An electrolyte panel may be part of a regular exam. Option B: A blood oxygen level test is used to check how well the lungs are working and measure the acid-base balance in the blood. A blood oxygen level test also checks the balance of acids and bases, known as pH balance, in the blood. Too much or too little acid in the blood can mean there is a problem with the lungs or kidneys. Option D: The respiration rate is the number of breaths a person takes per minute. The rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises.

The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan? A. Clubbing of nail beds B. Hypertension C. Peripheral edema D. Increased appetite

Correct Answer: C. Peripheral edema Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Right heart failure is most commonly a result of left ventricular failure via volume and pressure overload. Clinically, patients will present with signs and symptoms of chest discomfort, breathlessness, palpitations, and body swelling. Option A: Clubbing of nail beds is associated with conditions of chronic hypoxia. Clubbing is a medical condition first described by Hippocrates in which the fingers (and/or toes) have the appearance of upside-down spoons. It is caused by a build-up of tissue in the distant part of the fingers (terminal phalanges), that causes the end of the fingers to become enlarged and the nails to curve downward. Option B: Hypertension is associated with left-sided heart failure. When hemodynamic instability is present, vasopressors are indicated. Norepinephrine is the pressor of choice to improve systemic hypotension and restore cerebral, cardiac and end-organ perfusion. Option D: Clients with heart failure have decreased appetites. A poor appetite can also result from the accumulation of fluid in the liver and digestive system. Fluid accumulation, edema, is a common symptom of heart failure. The accumulation of fluid that is responsible for the abdominal swelling can decrease the appetite and result in nausea as well as discomfort from the weight gain.

Which of the following methods is the best way to confirm the diagnosis of a pneumothorax? A. Auscultate breath sounds. B. Have the client use an incentive spirometer. C. Take a chest x-ray. D. Stick a needle in the area of decreased breath sounds.

Correct Answer: C. Take a chest x-ray A chest x-ray will show the area of collapsed lung if pneumothorax is present as well as the volume of air in the pleural space. Chest radiography, ultrasonography, or CT can be used for diagnosis, although diagnosis from a chest x-ray is more common. Radiographic findings of 2.5 cm air space are equivalent to a 30% pneumothorax. Option A: Listening to breath sounds won't confirm a diagnosis. Clinical presentation of a pneumothorax can range anywhere from asymptomatic to chest pain and shortness of breath. A tension pneumothorax can cause severe hypotension (obstructive shock) and even death. Option B: An IS is used to encourage deep breathing. Do not let a chest radiograph or CT scan delay treatment with needle decompression or thoracostomy tube if the patient is clinically unstable, i.e., tension pneumothorax. Option D: A needle thoracostomy is done only in an emergency and only by someone trained to do it. If a patient is hemodynamically unstable with suspected tension pneumothorax, intervention is not withheld to await imaging. Needle decompression can be performed if the patient is hemodynamically unstable with a convincing history and physical exam, indicating tension pneumothorax.

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected? Normal breath sounds A. Normal breath sounds B. Prolonged inspiration C. Normal chest movement D. Coarse crackles and rhonchi

Correct Answer: D. Coarse crackles and rhonchi Exacerbations of COPD are frequently caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. Crackles are usually due to airway secretions within a large airway and disappear on coughing. These crackles are scanty, gravity-independent, usually audible at the mouth, and strongly associated with severe airway obstruction. Option A: In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. A reduction in breath sound intensity (BSI) is often seen in patients with COPD. Pardee et al. developed a scoring system for BSI. According to this system, the clinician listens sequentially over six locations on the patient's chest: bilaterally over the upper anterior portion of the chest, in the midaxillary, and at the posterior bases. Option B: Expiration, not inspiration, becomes prolonged. Patients with COPD often present with diminished breath sounds, prolonged expiratory time, and expiratory wheezing that initially may occur only on forced expiration. Option C: Chest movement is decreased as lungs become overdistended. Additional findings on physical examination include hyperinflation of the lungs with an increased anteroposterior chest diameter ("barrel chest"); use of accessory muscles of respiration; and distant heart sounds, sometimes best heard in the epigastrium.

Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the: A. Contralateral side in a simple pneumothorax. B. Affected side in a hemothorax. C. Affected side in a tension pneumothorax. D. Contralateral side in hemothorax.

Correct Answer: D. Contralateral side in hemothorax. The trachea will shift according to the pressure gradients within the thoracic cavity. If there is no significant air or fluid accumulation, the trachea will not shift. The pressure gradient inside the thorax changes with a pneumothorax. Normally the pressure of the pleural space is negative when compared to atmospheric pressure. When the chest wall expands outwards, the lung also expands outwards due to surface tension between parietal and visceral pleura. Option A: Tracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response to the release of normal thoracic pressure gradients on the injured side. When there is communication between the alveoli and the pleural space, air fills this space changing the gradient, lung collapse unit equilibrium is achieved, or the rupture is sealed. Pneumothorax enlarges, and the lung gets smaller due to this vital capacity, and oxygen partial pressure decreases. Option B: In hemothorax, accumulation of air or fluid causes a shift away from the injured side. Traumatic pneumothorax can result from blunt or penetrating trauma, these often create a one-way valve in the pleural space (letting the airflow in but not to flow out) and hence hemodynamic compromise. Option C: A tension pneumothorax can cause severe hypotension (obstructive shock) and even death. An increase in central venous pressure can result in distended neck veins, hypotension. Patients may have tachypnea, dyspnea, tachycardia, and hypoxia.

A 69-year-old client appears thin and cachectic. He's short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions? A. ARDS B. Asthma C. Chronic obstructive bronchitis D. Emphysema

Correct Answer: D. Emphysema In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area available for gas exchange. Very little air movement occurs in the lungs because of bronchial collapse, as well. In the early stages of the disease, the physical examination may be normal. Patients with emphysema are typically referred to as "pink puffers," meaning cachectic and non-cyanotic. Expiration through pursed lips increases airway pressure and prevents airway collapse during respiration, and the use of accessory muscles of respiration indicates advanced disease. Option A: In ARDS, the client's condition is more acute and typically requires mechanical ventilation. Clients with ARDS are acutely short of breath and require emergency care. The physical examination will include findings associated with the respiratory system, such as tachypnea and increased effort to breathe. Systemic signs may also be evident depending on the severity of illness, such as central or peripheral cyanosis resulting from hypoxemia, tachycardia, and altered mental status. Despite 100% oxygen, patients have low oxygen saturation. Option B: In asthma, wheezing is prevalent. Patients will usually give a history of a wheeze or a cough, exacerbated by allergies, exercise, and cold. There is often diurnal variation, with symptoms being worse at night. There may be some mild chest pain associated with acute exacerbations. Many asthmatics have nocturnal coughing spells but appear normal in the daytime. Option C: The most common symptom of patients with chronic bronchitis is a cough. The history of a cough typical of chronic bronchitis is characterized to be present for most days in a month lasting for 3 months with at least 2 such episodes occurring for 2 years in a row. A productive cough with sputum is present in about 50% of patients.

A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He's tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders? A. ARDS B. Asthma C. Chronic obstructive bronchitis D. Emphysema

Correct Answer: D. Emphysema These are classic signs and symptoms of a client with emphysema. In the early stages of the disease, the physical examination may be normal. Patients with emphysema are typically referred to as "pink puffers," meaning cachectic and non-cyanotic. Expiration through pursed lips increases airway pressure and prevents airway collapse during respiration, and the use of accessory muscles of respiration indicates advanced disease. Option A: Clients with ARDS are acutely short of breath and require emergency care. The physical examination will include findings associated with the respiratory system, such as tachypnea and increased effort to breathe. Systemic signs may also be evident depending on the severity of illness, such as central or peripheral cyanosis resulting from hypoxemia, tachycardia, and altered mental status. Despite 100% oxygen, patients have low oxygen saturation. Option B: Those with asthma are also acutely short of breath during an attack and appear very frightened. Patients will usually give a history of a wheeze or a cough, exacerbated by allergies, exercise, and cold. There is often diurnal variation, with symptoms being worse at night. There may be some mild chest pain associated with acute exacerbations. Many asthmatics have nocturnal coughing spells but appear normal in the daytime. Option C: Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance. The most common symptom of patients with chronic bronchitis is a cough. The history of a cough typical of chronic bronchitis is characterized to be present for most days in a month lasting for 3 months with at least 2 such episodes occurring for 2 years in a row. A productive cough with sputum is present in about 50% of patients.

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: A. Maintain a fluid intake of 800 ml every 24 hours. B. Experience chills only once a day. C. Cough productively without chest discomfort. D. Experience less nasal obstruction and discharge.

Correct Answer: D. Experience less nasal obstruction and discharge. A client recovering from an URI should report decreasing or no nasal discharge and obstruction. Decongestants and combination antihistamine/decongestant medications can limit cough, congestion, and other symptoms in adults. Avoid cough preparations in children. H1-receptor antagonists may offer a modest reduction of rhinorrhea and sneezing during the first 2 days of a cold in adults. Option A: Daily fluid intake should be increased to more than 1 L every 24 hours to liquefy secretions. Topical and oral nasal decongestants (i.e., topical oxymetazoline, oral pseudoephedrine) have moderate benefit in adults and adolescents in reducing nasal airway resistance. Evidence-based data does not support the use of antibiotics in the treatment of the common cold because they do not improve symptoms or shorten the course of illness. Option B: The temperature should be below 100*F (37.8*C) with no chills or diaphoresis. According to a Cochrane Review, vitamin C used as daily prophylaxis at doses of =0.2 grams or more had a "modest but consistent effect" on the duration and severity of common cold symptoms (8% and 13% decreases in duration for adults and children, respectively). Option C: A productive cough with chest pain indicated pulmonary infection, not an URI. The presence of classical features for rhinovirus infection, coupled with the absence of signs of bacterial infection or serious respiratory illness, is sufficient to make the diagnosis of the common cold. The common cold is a clinical diagnosis, and diagnostic testing is not necessary.

Which of the following statements best explains how opening up collapsed alveoli improves oxygenation? A. Alveoli need oxygen to live. B. Alveoli have no effect on oxygenation. C. Collapsed alveoli increase oxygen demand. D. Gaseous exchange occurs in the alveolar membrane.

Correct Answer: D. Gaseous exchange occurs in the alveolar membrane. Collapsed aveoli become Dead Space Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse, no exchange occurs, Collapsed alveoli receive oxygen, as well as other nutrients, from the bloodstream. Collapsed alveoli have no effect on oxygen demand, though by decreasing the surface area available for gas exchange, they decreased oxygenation of the blood. Option A: Ventilation is 50% greater at the base of the lung than at the apex. The weight of fluid in the pleural cavity increases the intrapleural pressure at the base to a less negative value. As a result, alveoli are less expanded and have higher compliance at the base, resulting in a more substantial increase in volume on inspiration for increased ventilation. Option B: The exchange of both oxygen and carbon dioxide is perfusion limited. Diffusion of gases reaches equilibrium one-third of the way through the capillary/alveolar interface. Deoxygenated blood from the pulmonary arteries has a PVO2 of 40 mmHg, and alveolar air has a PAO2 of 100 mmHg, resulting in a movement of oxygen into capillaries until arterial blood equilibrates at 100 mmHg (PaO2). Option C: Gas exchange in the alveoli occurs primarily by diffusion. Traveling from the alveoli to capillary blood, gases must pass through alveolar surfactant, alveolar epithelium, basement membrane, and capillary endothelium.

A high level of oxygen exerts which of the following effects on the lung? A. Improves oxygen uptake. B. Increases carbon dioxide levels. C. Stabilizes carbon dioxide levels. D. Reduces amount of functional alveolar surface area.

Correct Answer: D. Reduces amount of functional alveolar surface area. Oxygen toxicity causes direct pulmonary trauma, reducing the amount of alveolar surface area available for gaseous exchange, which results in increased carbon dioxide levels and decreased oxygen uptake. Continued exposure to high concentrations of oxygen results in heightened free radical production. This may damage the pulmonary epithelium, inactivate the surfactant, form intra-alveolar edema, interstitial thickening, fibrosis, and ultimately lead to pulmonary atelectasis. Option A: Oxygen-derived free radicals have been proposed as being the probable etiological cause in the development of oxygen toxicity. Free radicals are generated due to the mitochondrial oxidoreductive processes and also induced by the function of enzymes such as xanthine/urate oxidase at extra-mitochondrial sites, from auto-oxidative reactions, and by phagocytes during the bacterial killing. Option B: 100% oxygen can be tolerated at sea level for about 24-48 hours without any severe tissue damage. Lengthy exposures produce definite tissue injury. There is moderate carinal irritation on deep inspiration after 3-6 hours of exposure of 2 ATA, extreme carinal irritation with uncontrolled coughing after 10 hours, and finally, chest pain and dyspnea ensue. Option C: Extended exposure to above-normal oxygen partial pressures, or shorter exposures to very high partial pressures, can cause oxidative damage to cell membranes leading to the collapse of the alveoli in the lungs. CNS toxicity is expedited by factors such as raised PCO2, stress, fatigue, and cold.

It's highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons? A. All clients are recommended to have these vaccines. B. These vaccines produce bronchodilation and improve oxygenation. C. These vaccines help reduce the tachypnea these clients experience. D. Respiratory infections can cause severe hypoxia and possibly death in these clients.

Correct Answer: D. Respiratory infections can cause severe hypoxia and possibly death in these clients. It's highly recommended that clients with respiratory disorders be given vaccines to protect against respiratory infection. Infections can cause these clients to need intubation and mechanical ventilation, and it may be difficult to wean these clients from the ventilator. Another pneumococcal vaccine, PPSV23, is indicated in the United States for all adults 65 years of age and older, as well as younger patients with conditions that increase the risk for developing pneumococcal pneumonia or invasive pneumococcal disease. Conditions that would indicate PPSV23 in patients younger than 65 years of age are as follows: chronic heart disease excluding hypertension, chronic lung disease including asthma, diabetes mellitus, cerebrospinal fluid leak, cochlear implant, alcohol use disorder, chronic liver disease, cigarette smoking, hemoglobinopathy (including sickle cell disease), etc. Option A: Recommendations are that all patients who received PPSV23 before the age of 65 years be revaccinated at age 65 unless the vaccine is given less than ten years before the patient turns 65 years old, in which case patients should be revaccinated ten years following the first dose. Recommendations are that patients with functional or anatomic asplenia or immunocompromised individuals receive repeat doses of the vaccination every ten years after the first dose. Option B: The vaccines have no effect on bronchodilation or respiratory care. Both vaccines promote active immunization against the serotypes of the conjugate and capsular polysaccharides contained in the formulation of the vaccine. Immunity develops approximately 2 to 3 weeks after vaccination and lasts for five years. In children and the elderly, re-immunization may be necessary sooner. Option C: Studies done on animals have not shown fetal adverse effects or increased risk to the fetus. It is unknown if the vaccine is excreted with breast milk. Caution is necessary when administering this vaccine to breastfeeding women. There is no overdose risk with the administration of the vaccine.

A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this? A. Acute asthma B. Chronic bronchitis C. Pneumonia D. Spontaneous pneumothorax

Correct Answer: D. Spontaneous pneumothorax A spontaneous pneumothorax occurs when the client's lung collapses, causing an acute decrease in the amount of functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. For patients with larger spontaneous pneumothorax (more than 15%), there may be reduced movement of the chest wall, ipsilateral decreased or absent breath sounds, jugular venous distension, pulsus paradoxus, hyperresonance on percussion, and decreased tactile fremitus. Option A: An asthma attack would show wheezing breath sounds. Patients will show some respiratory distress, often sitting forward to splint open their airways. On auscultation, a bilateral, expiratory wheeze will be heard. Option B: Bronchitis would have rhonchi. Uncomplicated chronic bronchitis presents with a cough, and there is no evidence of airway obstruction physiologically. When patients have chronic asthmatic bronchitis, there is usually a wheeze present due to a hyperactive airway leading to intermittent bronchospasm. Option C: Pneumonia would have bronchial breath sounds over the area of consolidation. When bronchial sounds are heard in areas distant from where they normally occur, the patient may have consolidation (as occurs with pneumonia) or compression of the lung. These conditions cause the lung tissue to be dense.

A patient who suffered a Cerebrvascular Accident (CVA) is on a NPO order until evaluation of a Speech Language Therapist is complete. The nurse knows this is likely because: A. Food will have no taste because of impaired taste B. Patient will no longer be able to tell the nurse what he enjoys to eat C. The patient will is at higher risk for another CVA if he is inproperly fed D. The patient is at risk for aspiration because of a possible impaired gag reflex

D

A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation? a) "Children this age rarely get epiglottitis; you should not blame yourself". b) "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen". c) "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son's symptoms." d) "Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly."

D - Rapid

The nurse is caring for a client with a pneumothorax. The nurse expects the client to have a chest tube inserted because? A.It will drain the purulent drainage from the empyema that caused it B. It is the appropriate post-operative treatment for a pneumothorax C. It will increase the intrathoracic pressure, restoring it back to normal D. It will drain air out of the thorax, restoring normal intrathoracic pressure

D. With a pneumothorax, which is not the result of a surgical procedure, normal intrathoracic pressure increases as a result of the opening in the thorax which allows outside air to rush in and "collapse" the lung; therefore, draining the air out of the thoracic cage reduces that increased intrathoracic pressure and restores it to normal - essentially re-inflating the collapsed lung.

The nurse assesses a college-age client complaining of shortness of breath after jogging and tightness in his chest. Upon further questioning, the client denies a sore throat, fever, or productive cough. The nurse notifies the physician that this client's clinical manifestations are most likely related to A. Pneumoconiosis. B. Bronchitis. C. Pneumonia. D. Asthma.

D. The exercise may have induced bronchospasms. Lack of fever or productive cough would reduce the possibility of the clinical manifestations representing pneumonia or bronchitis. The occupation as a college student decreases the likelihood of an occupationally related lung disease.

A 32-year-old patient is seen in the clinic for dyspnea associated with the diagnosis of emphysema. The patient denies any history of smoking. The nurse will anticipate teaching the patient about a. 1-antitrypsin testing. b. use of the nicotine patch. c. continuous pulse oximetry. d. effects of leukotriene modifiers.

Dont really gotta know this just gotta know it can have a genetic cause too! A Rationale: When emphysema occurs in young patients, especially without a smoking history, a congenital deficiency in 1-antitrypsin should be suspected. Because the patient does not smoke, a nicotine patch would not be ordered. There is no indication that the patient requires continuous pulse oximetry. Leukotriene modifiers would be used in patients with asthma, not with emphysema. Dont really gotta know this just gotta know it has a genetic cause too!

You are educating a group of high school students in a low socioeconomic area on signs and symptoms of tuberculosis. You assess the teaching has been effective if the students identify which as the one of the first signs of tuberculosis? A. Chest pain B. Night sweats C. Dyspnea D. Bloody sputum E. A productive cough that produces mucus

E Early : Mucus producing cough that lasts more than three weeks, flu like symptoms ➔Late : Dyspnea, night sweats, chills, fever, bloody sputum production A. Incorrect , this is a late manifestation B. Incorrect , this is a late manifestation C. Incorrect , this is a late manifestation D. Incorrect, this is a late manifestation this is a sign that the TB has settled into the lungs E. Correct, development of A lingering productive cough that produces mucus is one of the first signs of TB

You are the nurse on a med surg floor caring for a client admitted with COPD. The client is using his accessory muscles to breathe and is becoming tired. What is your priority action for this client? A. Lower the head of bed B. Call the HCP C. Administer oxygen at 100% D. Educate the client on pursed lip breathing

Interventions for COPD ➔Monitor vitals ➔Administer 02 at low concentrations 1-2 L/min Nasal cannula ➔Monitor oxygen saturation levels ➔Provide respiratory treatments and Chest physiotherapy ➔Educate the client on abdominal, diaphragmatic , and pursed lip breathing to help expel c02 A. Incorrect, lowering the head of the bed will make it harder for them to breathe. You want to elevate the HOB B. Incorrect, think! What else can you do for this client before calling the HCP. This client is not in distress yet. C. Incorrect, you want to Administer 02 at low concentrations 1-2 L/min Nasal cannula D. Correct, Educating the client on abdominal, diaphragmatic , and pursed lip breathing will aid in lung expansion and help expel c02

A community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that late symptoms associated with tuberculosis include: (Select all That Apply) a. Dyspnea b. Chest pain c. A bloody, productive cough d. A cough with the expectoration of mucoid sputum

Options A, B, and C are late symptoms and signify cavitation and extensive lung involvement.

Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why? A. Reducing fluid volume reduces oxygen demand. B. Reducing fluid volume improves clients' mobility. C. Restricting fluid volume reduces sputum production. D. Reducing fluid volume improves respiratory function.

Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in turn, reduces the respiratory rate. It may also reduce edema and improve mobility a little, but exercise tolerance will still be harder to clear airways. As a result, diuretic drugs may be prescribed in COPD for a variety of reasons: pulmonary hypertension and cor pulmonale; pulmonary edema; systemic hypertension; and empirically for severe dyspnoea refractory to maximal conventional therapy. Option B: Diuretic drugs may theoretically improve respiratory health outcomes in COPD through several possible mechanisms. Diuretics may reduce pulmonary hypertension (either subclinical or overt) and cor pulmonale by decreasing preload to the heart and they can also reduce pulmonary edema. The presence of pulmonary hypertension in COPD is associated with increased mortality risk 6 and symptoms related to excessive fluid overload may lead an individual with COPD to present to hospital for acute care Option C: Diuretic drugs may theoretically improve respiratory health outcomes among individuals with chronic obstructive pulmonary disease (COPD), but they may also contribute to respiratory harm. There are minimal and conflicting data regarding the potential respiratory effects of systemic diuretic drugs among individuals with COPD. Option D: Reducing fluid volume won't improve respiratory function but may improve oxygenation. Acetazolamide inhibits the renal carbonic anhydrase enzyme, which reduces serum bicarbonate and contributes to metabolic acidosis, which in turn increases minute ventilation through peripheral and central chemoreceptor stimulation. By stimulating minute ventilation and improving gas exchange, acetazolamide may mitigate dyspnoea crises and respiratory exacerbations among individuals with COPD.

Which phrase is used to describe the volume of air that remains in the lungs following forced expiration and keeps the alveoli inflated? A. Total lung capacity B. Forced vital capacity C. Tidal volume D. Residual volume

Residual volume is the maximal amount of air left in the lung after a maximal expiration. In other words, it is the volume of air that cannot be expelled, thus causing the alveoli to remain open at all times. The residual volume remains unchanged regardless of the lung volume at which expiration was started.

A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise. Select all that apply: A. Avoid warming up before exercise. B. Administer a short-acting beta agonist before exercise. C. Administer a short-acting beta agonist after exercise. D. Avoid exercising when experiencing a respiratory illness

The answer are B and D. Option A is wrong because the patient should warm up for at least 10-15 minutes before exercising, and option C is wrong because the beta agonist should be administered BEFORE exercise (not after).

During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse you know this will lead to? A. bronchoconstriction B. atelectasis C. upper airway blockage D. pulmonary edema

The answer is B. Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales (hence the sac won't collapse). If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue) when there is a decrease production in surfactant.

Select all the following that can trigger an asthma attack: A. Sulfites B. Smoke C. Caffeine D. GERD E. Cold, windy weather F. Beta agonist G. Cockroaches

The answers are A, B, D, E, and G. Caffeine has the same properties as theophylline, which is a bronchodilator and is not known to cause asthma. In addition, beta adrenergic blockers that are nonselective (NOT beta agonist...which are used to treat asthma) can cause an asthma attack.