Pathophysiology Exam #3, porth patho chapt 22, Chapter 21 Quiz Pathophysiology, Patho Exam 3

A distinguishing feature of viral influenza is:

Abrupt-onset, profound malaise

What description is characteristic of the pathology of interstitial lung disease?

Airways become stiff and resist expansion, leading to hypoxemia.

The patient with airway obstruction may experience perfusion of the lungs without ventilation due to what disorder?

Atelectasis

Decreased pH level could be related to... A. Hypoxemia B. Hypercapnia

B. Hypercapnia

For which client condition will a pulse oximeter reading be inaccurate?

Carbon monoxide poisoning

A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be:

Constriction of the pulmonary vessels in response to hypoxemia

What intervention is appropriate for a client with sarcoidosis?

Corticosteroids

Which of the following is directly responsible for gas exchange? A. Trachea B. Bronchi C. Pulmonary circulation D. Respiratory membrane

D. Respiratory membrane

Due to complications, a male postoperative patient has been unable to mobilize secretions for several days following surgery and develops atelectasis. Which of the following processes would his care team anticipate with relation to his health problem?

Directing blood flow away from the lung regions that are hypoxic

A client is preparing to travel for business and has developed the common cold. The client informs the nurse that she will be flying and does not want to give it to anyone else. When should the nurse inform the client is the most highly contagious period?

During the first 3 days after the onset of symptoms

A client who has no previous history of respiratory disease describes a sensation of shortness of breath and the feeling of not being able to pass enough air during exercise that has just developed over the past month. The client would be documented as having which of these?

Dyspnea

The school nurse is providing education to parents of school-age children during flu season. What should the nurse teach about the importance of early diagnosis of influenza?

Early diagnosis can reduce the inappropriate use of antibiotics.

A pneumonia that occurs 48 hours or more after admission to the hospital is considered:

Hospital-acquired pneumonia.

A client hospitalized for 72 hours has developed symptoms of a lower respiratory tract infection. Sputum cultures reveal S. aureus as the infectious organism. The nurse explains to the client that which of the following is the most likely cause of this infection?

Nosocomial hospital-acquired infection

A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis.

Nosocomial pneumonia

A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has moderate persistent asthma?

PEF 450 ml in AM, 300 ml at noon, symptoms occur daily

As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to:

Pulmonary hypertension

Which description of symptoms would the nurse expect to obtain from a client with exacerbation of sarcoidosis?

Shortness of breath, non-productive cough, and chest pain

A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because:

Trapped, inspired air collapses the lung.

A client is admitted to the hospital suspected to have Legionnaire disease after a cruise. What type of specimen should the nurse collect that is a rapid test to detect the antigens of L. pneumophila?

Urine specimen

You are the nurse working on the respiratory intensive care unit. You are aware that several respiratory conditions can affect the compliance of the lung tissue. Which condition leads to an increase in lung compliance? a. Pulmonary fibrosis b. Emphysema. c. Pleural effusion. d. Acute respiratory distress syndrome.

b. Emphysema.

Bronchiectasis is considered a secondary COPD, and, with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow?

chicken pox

A 65-year-old man has just been diagnosed with hypercalcemia with a chronic cough and hemoptysis. The physician suspects cancer. Which cancer is most likely? a. Adenocarcinoma b. Small cell carcinoma c. Large cell carcinoma d. Squamous cell carcinoma

d. Squamous cell carcinoma

A client reports chest pain to the nurse. Which characteristics of the pain indicate bronchial irritation?

dull pain in mid-chest that is worse when coughing

The client ask the nurse how influenza is spread from person-to-person. The nurse educates her client that influenza is transmitted by:

inhalation of droplet nuclei.

A client comes to an urgent care center. The nurse notes that the client has a fever of 103.2 F (39.5 C), pleuritic pain with each breath, and enlarged lymph nodes in the neck and axilla area. The client also has a productive cough. The nurse should consider tuberculosis if the client's history includes:

intravenous drug abuse and living on the streets.

Which clients are at greatest risk of developing an occupational lung disease? Select all that apply.

• Bricklayer • Coal miner • Farmer • Flour miller

Which of the following statements concerning hypoxemia are true? (Select all that apply.)

• The condition depends on the body's ability to adapt to lowered oxygen levels. • The brain is vulnerable to hypoxia. • When hypoxemia occurs, metabolic acidosis is a possible outcome. • Normally, serum lactate levels are between 1 and 0.5 mmol/L.

A child is having symptoms of spasmodic croup again after a previous admission to the hospital for the same diagnosis. What care does the parent provide at home that demonstrates understanding of the education received by the nurse at the hospital? Select all that apply.

• The parent brings the child into the bathroom where a warm shower is running to provide humidification. • The parent takes a child outside in the cool air. • The parent turns on the cold water room humidifier in the child's room.

A client from Texas is suspected of being infected with coccidioidomycosis and has been admitted to the hospital with fever, cough, pleuritic chest pain, and skin lesions. When performing a health history, which question would be most valuable to assist with diagnosis?

"Do you work in construction and dig soil?"

A client recovered from influenza two days ago and informs the nurse that she is feeling better but now has a fever, chills, pain when breathing, and a productive cough. What complication does the nurse anticipate the client will be treated for?

A secondary bacterial pneumonia

A patient with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms should the nurse use to document this finding?

Barrel chest

For a client with which of the following is the use of oxygen at a rate above 2 L/minute inappropriate?

Chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%

A client arrives in the emergency department suffering a traumatic brain injury as a result of a car accident. While assessing this client, the nurse notices the client has an irregular breathing pattern consisting of prolonged inspiratory gasps interrupted by expiratory efforts. The underlying physiological principle for these signs would include:

Damage has occurred at the connection between the pneumotaxic and apneustic centers.

Which classification of medications used to self treat the common cold should be avoided by those with a history of hypertension?

Decongestants

A client has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the client's immediate recovery?

Deep-breathing exercises and early mobilization

When there is a mismatching of ventilation and perfusion within the lung itself, insufficient ventilation occurs. There is a lack of enough oxygen to adequately oxygenate the blood flowing through the alveolar capillaries, creating a physiologic shunt. What causes a physiologic right-to-left shunting of blood in the respiratory system?

Destructive lung disease or heart failure

When developing the plan of care for a child with respiratory distress, what nursing intervention can the nurse provide that will facilitate respiratory movements and avoid airway compression?

Elevate the head of the bed.

The early stages of influenza pass by as if the infection were any other viral infection. What is the distinguishing feature of an influenza viral infection that makes it different from other viral infections?

Rapid onset of profound malaise

A client has experienced a bout of coughing after aspirating some of his secretions. The client's coughing was triggered by which of the following?

Signals from receptors in the tracheobronchial wall

Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders?

Smaller airways create a susceptibility to changes in airway resistance and airflow.

A client reports chest pain to the nurse. Which characteristics of the pain indicate pleuritis?

Sudden sharp pain in one side made worse by deep breathing

The pathogenic capacity of the tubercle bacillus is related to:

The initiation of a cell-mediated immune response

The nurse is calculating the minute volume of a patient. Select the correct categories of measurement.

Tidal volume × respiratory rate

A nurse is caring for a child with an airway obstruction. It is most important for the nurse to avoid:

Using a tongue depressor to assess the child's tonsils

The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond?

You have a 25% chance that your next child will have CF.

What does adequate gas exchange depend on? a. The shunting of blood in the lungs b. An adequate ventilation--perfusion ratio. c. The diffusion of gas in the shunted blood d. The perfusion/diffusion ratio.

b. An adequate ventilation--perfusion ratio.

"My doctor said I have cor pul-something, which is a heart problem," says Mr. Garabedian. "I thought I just had these bad lungs that can't be fixed. How can that make my heart go bad?" Which mechanism leads to the development of cor pulmonale, which should serve as the basis for your response to Mr. Garabedian? a. Impaired ventilation causes decreased PaO2, which precipitates cardiac dysrhythmias. b. Increased resistance to pulmonary arterial flow leads to compensatory right ventricular hypertrophy. c. Left ventricular failure causes pulmonary venous congestion and pulmonary edema d. Pneumothorax causes compression atelectasis, decreased alveolar ventilation, and impaired oxygenation.

b. Increased resistance to pulmonary arterial flow leads to compensatory right ventricular hypertrophy.

A patient arrives in the emergency room with an attack of acute bronchiectasis. The nurse knows that the principle pathologic finding in the diagnosis of bronchiectasis includes what? Select one: a. Increase in the red blood cell concentration in the blood. b. Leakage of fluid into the alveolar interstitial spaces c. Obstruction of the pulmonary vasculature by a clot d. Chronic, irreversible dilation of the bronchi and bronchioles.

d. Chronic, irreversible dilation of the bronchi and bronchioles.

Which of the following clients are likely experiencing a shift to the right in the dissociation curve? Select all that apply.

-A client with respiratory influenza with a temperature of 102.6°F -A COPD client with pneumonia with blood gas pH level of 7.31 -A renal failure client with admitting hemoglobin level of 8.0 mg/dL

Which of the following neurological patient's is most likely to have abnormalities in breathing regulation?

A 34-year-old male with damage to his upper and lower pons following a blow to the back of the head.

Upon admission to the ICU, a patient with a history of cor pulmonale will likely be exhibiting which of the following clinical manifestations of right heart failure? Select all that apply.

• +4 pitting edema in lower extremities. • Jugular vein distension. • Altered level of consciousness.

Which are the earliest manifestations that a client is developing hypoxemia? Select all that apply.

• Diaphoresis • Tachycardia

The nurse assesses a 65-year-old female client who reported to the emergency department with exacerbation of asthma during her daughter's wedding reception. Select all of the triggers that may have precipitated the attack.

• Emotional stress • Dancing • Aspirin

A family brings their elderly father to emergency department. He has been exposed to pneumococcal pneumonia at his retirement home. Today, they noted a change in his mental status. They thought he might need some oxygen. Which of the other assessment findings would correlate with this diagnosis? Select all that apply.

• Increase in chest pain with deep inspiration • Loss of appetite for past few days • Purulent sputum with bloody patches

A client with cystic fibrosis reports recent weight loss without fever or cough. What interventions will the nurse implement to promote health for the client? Select all that apply.

• Increase protein intake • Increase pancreatic enzymes

A client diagnosed with rhinosinusitis asks the nurse what type of nonpharmacologic measures can be used to reduce the nasal stuffiness that occurs with the disorder. What suggestion can the nurse give to the client? Select all that apply.

• Mist humidification • Saline nasal spray • Nasal irrigation

A child with asthma is walking outside and develops a bronchospasm. The school nurse knows this bronchospasm has what effects on bronchioles with airflow? Select all that apply

• Narrowing of bronchioles • Impairs airflow

A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be:

"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques."

A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply.

-Surgery to remove tumor -Radiation therapy -Chemotherapy

Which of the following clients at the clinic should be encouraged to receive the pneumococcal polysaccharide vaccine (PPSV23)? A client: Select all that apply.

-Who is 65 years old with chronic asthma -With a smoking history

A prison inmate contracted tuberculosis during a recent outbreak. The nurse caring for these inmates correctly identifies which of the following as the mode of transmit for this disease?

Airborne droplets

Which of the following is the most common cause of hypercapnia?

Alterations in respiratory rate

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?

Alters vitamin K, reducing its ability to participate in the coagulation of the blood

A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:

Apply a Vaseline gauze (airtight) dressing over the insertion site

A client has sudden severe dyspnea, fear, asymmetrical chest movement and decreased lung sounds on the right side. Which intervention is most appropriate?

Assist to high-Fowler's position and prepare for chest tube insertion.

A client is brought into the ER with rapid, deep respirations at a rate of 25 breaths per minute and decreased level of consciousness. A stat MRI shows a lesion in the brain stem which may have infiltrated which of the following regulators of respiratory function responsible for detecting changes in carbon dioxide levels?A client is brought into the ER with rapid, deep respirations at a rate of 25 breaths per minute and decreased level of consciousness. A stat MRI shows a lesion in the brain stem which may have infiltrated which of the following regulators of respiratory function responsible for detecting changes in carbon dioxide levels?

Central chemoreceptors

A 3-year-old boy has been diagnosed with croup (acute laryngotracheobronchitis). The nurse anticipates the plan of care to include:

Cool, humidified air to relieve airway spasms

A client with primary lung disease has developed right heart failure. The health care provider would document this as:

Cor pulmonale

A patient with chronic obstructive pulmonary disease presents to the emergency department with difficulty breathing. Physical examination reveals bluish skin, nail beds, and mucous membranes. Which of the following terms correctly describes this condition?

Cyanosis

A patient diagnosed with asthma is scheduled for a pulmonary function test. During the test, the technician instructs the patient to forcefully exhale air for 1 second to evaluate:

Forced expiratory volume

When evaluating the pulmonary function test results for a COPD client, which one correlates to the mismatch of ventilation and perfusion associated with this diagnosis?

Forced expiratory volume (FEV) is decreased.

The health care provider suspects a newly admitted client may have a hemothorax. The client most likely experienced

Fractured or dislocated ribs

Which of the following manifestations typically accompanies an asthmatic attack?

Hyperinflation of the lungs

A client with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia?

Increased heart rate

Talc lung can occur from injected or inhaled talc powder that has been mixed with heroin, methamphetamine, or codeine as a filler. What are people with talc lung very susceptible to?

Interstitial lung disease

Most respiratory disorders in infants produce a decrease in:

Lung compliance

Elderly people are very susceptible to pneumonia in all its varieties. The symptoms the elderly exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are elderly people with pneumonia less likely to experience than people with pneumonia in other age groups?

Marked elevation in temperature

A motor vehicle accident has resulted in critical injury for the driver of the car. The driver has hit the steering wheel with his chest and fractured his sternum and some ribs. Which of the following manifestations would lead the staff to suspect the driver has developed a tension pneumothorax? Select all that apply.

Mediastinal shift of the trachea toward one side

Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person to chronic respiratory infections from a small group of organisms. Which organisms create chronic infection in a child with cystic fibrosis?

Pseudomonas aeruginosa and Staphylococcus aureus

Premature infants who are treated with mechanical ventilation, mostly for respiratory distress syndrome, are at risk for developing bronchopulmonary dysplasia (BPD), a chronic lung disease. What are the signs and symptoms of BPD?

Rapid and shallow breathing and chest retractions

The nurse is educating the client with a cold about the use of over-the-counter decongestants. What expected outcome does the nurse anticipate with the use of this medication?

Reduction of nasal swelling

A nurse is providing care for a patient who has been admitted with a newly diagnosed bilateral pleural effusion. Which of the following findings from the nurse's initial assessment of the patient is incongruent with the patient's diagnosis and would require further investigation?

The client complains of sharp pain exacerbated by deep inspiration.

A 23-year-old woman goes to the drugstore to buy a medication to ease the symptoms of her cold. Her friends have told her to buy a medication with an antihistamine in it to help dry up her runny nose and make it easier to breathe. The woman talks with the pharmacist, who has known her many years. The pharmacist recommends that this young woman not buy a cold medication with a decongestant in it. Why would he do that?

The client has a history of hyperthyroidism.

The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis.

The client who is postop total knee replacement and receiving client-controlled analgesia

A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. What medication education will the nurse provide to the client?

The client will need education about the administration of INH and the importance of taking it as prescribed.

An infant born prematurely is in the neonatal intensive care unit (NICU) for observation and to ensure hemodynamic stability when the nurse observes the infant beginning to have nasal flaring. What does the nurse understand that this may indicate?

The infant is using nasal flaring to take in more air.

A client presents to the physician's office with a chronic cough, shortness of breath, and wheezing that has gotten progressively worse, with recent episodes of hemoptysis. Diagnostic tests reveal a lung mass. Based on these symptoms, the nurse is anticipates which of the following has occurred?

The lesion has eroded blood vessels in the lungs.

A 60-year-old male hospital patient with a diagnosis of chronic obstructive pulmonary disease (COPD) is undergoing lung function tests to gauge the progression of his disease. Which of the following aspects of the lung volumes will the respiratory therapist be most justified in using to guide interpretation of the test results?

Vital capacity will equal the patient's combined inspiratory reserve, expiratory reserve, and tidal volume.

A patient is diagnosed with restrictive lung disease caused by fibrosis. Which of the following clinical manifestations is expected? Select all that apply.

• Decreased tidal volume • Increased respiratory rate • Nonproductive cough • Clubbing of fingers

The nurse caring for a male child with respiratory problems is concerned he may be developing respiratory failure. Upon assessment, the nurse knows that which of the following are clinical manifestations of respiratory failure? Select all that apply.

• Grunting on expiration. • Nasal flaring. • Severe accessory muscle retractions.

The nurse is performing a health history for a male client who is having a series of diagnostic test to determine the presence of squamous cell carcinoma. What question would be most beneficial for the nurse to ask that would correlate with this suspicion?

"Do you have a history of smoking, and if so, how much?"

A family physician is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year's vaccine. Which of the following statements by the patient best reflects an accurate understanding of the flu virus?

"I could come down with viral or bacterial pneumonia as a result of a bad flu bug."

A nurse runs into an old high school friend after 20 years. She notes her friend continues to smoke after all these years. The friend asks, "Do you think I sound hoarse?" Upon further assessment, the nurse/friend notes her friend has several warning signs of cancer. Which manifestations would lead to this conclusion? Select all that apply.

"I seem to have more trouble holding my urine than I use to."

An adult client has been diagnosed with polycystic kidney disease. Which of the client's following statements demonstrates an accurate understanding of this diagnosis?

"I suppose I should be tested to see if my children might inherit this."

A college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. Which of the following statements shows that the student has an accurate understanding of her upper respiratory infection?

"I suppose I should have been washing my hands more in the past few days."

A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the man's following statements demonstrates a sound understanding of his new diagnosis?

"If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis."

The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be:

"Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."

An elderly patient who was recently diagnosed with emphysema asks the nurse what caused the disease. Which of the following statements is the best response?

"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"

While administering a tuberculin (TB) skin test, a client who is HIV positive asks, "I heard from my friends, this test may not work on me since I have HIV." The health care provider's best response would be:

"Sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction."

A client refuses to take the 81 mg of aspirin ordered by the physician, stating, "I do not have any pain." The best response by the nurse would be:

"The 81 mg of aspirin daily will help protect you from a stroke or a heart attack."

While educating a smoking cessation class, a client asks the nurse, "If I can still get lung cancer, what should I be looking for?" Which response by the nurse is best?

"The earliest symptoms relate to a chronic cough and shortness of breath."

A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, "Is our baby's kidneys not working right? Why is he so swollen?" The nurse bases his or her reply on which of the following physiological principles?

"The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen."

When educating a student who lives in a crowded apartment and diagnosed with tuberculosis, the college school nurse will emphasize:

"To destroy this bacterium, you must strictly adhere to a long-term drug regimen."

A 51 year-old female client who is two days post-operative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse is most appropriate?

"You should breath deeply and cough to help your lungs expand as much as possible while you're in bed."

While lecturing on COPD, the instructor mentions emphysema. The instructor asks the students, "If the client is a smoker, explain the physiology behind cellular changes occurring in the lung which allow destruction of the alveoli." Which students have an accurate response? Select all that apply.

-"Antiprotease production and release is not adequate to neutralize the excess protease production." -"There is 1-antitrypsin deficiency, so this enzyme can't protect the lung from damage."

Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply.

-A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation -A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food -A school-aged child with severe asthma controlled by steroids admitted for an exacerbation

A toddler seems to have a little "cold" and runny nose. At bedtime, he appears to be OK. A few hours later, parents awaken hearing a "tight" coughing sound. They recognize the child is not breathing well, so they rush to the emergency department. On arrival, the nurses suspect bronchial asthma based on which of the following assessment data? Select all that apply.

-Audible wheezing -Respiratory rate—44 with prolonged exhalation -Sitting upright, leaning forward, and using accessory muscles to breathe

Soon after delivery, the mother grabs the nurses arm and states, "Something's wrong...I can't get my breath." Which of the following assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply.

-BP 90/65; pulse 130, irregular; respiratory rate 35, shallow. -Productive cough with blood-streaked sputum.

A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply.

-Bluish discoloration of the skin and mucous membranes (central cyanosis) -Substernal retractions with each breathe -Expiratory grunting

Following a dust storm in Arizona, several clients have presented to the clinic complaining of productive cough, fever, and night sweats. The health care provider suspects a fungal infection related to breathing dust. One particular client is critical. They suspect the infection has progressed outside the lung when they observe the client has: Select all that apply.

-Generalized lymph node enlargement -An enlarged liver via palpation -Copious bleeding at the site where the lab technician drew some blood

A family brings their elderly father to emergency department. He has been exposed to pneumococcal pneumonia at his retirement home. Today, they noted a change in his mental status. They thought he might need some oxygen. Which of the other assessment findings would correlate with this diagnosis? Select all that apply.

-Increase in chest pain with deep inspiration -Loss of appetite for past few days -Purulent sputum with bloody patches

A 2-year-old child is admitted to pediatric unit with bronchiolitis. The nurse calls the physician fearing the child is going into respiratory failure based on which of the following assessment findings? Select all that apply.

-Increased respiratory rate to 44 breaths/minute -Substernal retractions becoming more pronounced -New-onset expiratory grunting

A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic with the following complaints: auscultation of breath sounds reveal absent/diminished breath sounds in the right lower lobe. Which other manifestations lead the health care provider to suspect the client may have developed atelectasis? Select all that apply.

-Respiratory rate—32; pulse rate—122 beats/minute. -"Having a hard time catching my breath." -Using accessory muscles to help him breathe.

A client is admitted to hospital to rule out Legionnaire disease following a canoe trip where he was sprayed in the face with a lot of "creek" water. Which of the following manifestations are characteristic of Legionnaire pneumonia? Select all that apply.

-Temperature of 103.5°, pulse 80 -"Talking but not making a lot of sense" (confusion) -Chest x-ray that reveals areas of consolidation suggestive of pneumonia

The neonatal ICU nurse is aware that Type II alveolar cells produce surfactant and they usually develop at how many weeks gestation?

24-28 weeks.

A pregnant client has experienced episodes of premature labor and is concerned about her unborn child's lung development. The client asks the nurse when the fetus begins to produce sufficient surfactant. The best response would be:

27 weeks

At an influenza vaccination clinic, a nurse is screening clients who are requesting the vaccine. The nurse determines that which of the following clients is unable to receive the vaccine?

A 20-year-old healthy female reporting an allergy to eggs

Which of the following individuals is experiencing an immunologic lung disorder affecting ventilation that has caused the formation of a granuloma on chest x-ray?

A 30-year-old African American man who has been diagnosed with sarcoidosis

The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism.

A 62-year-old male postop repair of a fractured femur

The nurse is assigned to care for four clients on a medical floor. Which client is most at risk for viral pneumonia after influenza?

A 76-year-old client with cardiopulmonary disease

A client tells the nurse that he is concerned he may be developing chronic bronchitis and asks how the diagnosis is made. The most appropriate information for the nurse to provide would be:

A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years.

Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?

A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F

Which of the following individuals is most clearly in need of diagnostic testing for lung cancer?

A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia

Which of the following clients is at risk for developing acute respiratory failure?

A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation

Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?

A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking"

Nursing students in an anatomy class are observing lung tissue under the microscope in order to identify regions of the lung. The slide shows a basement membrane, capillary lumen, macrophages, and brush cells. This tissue is identified as which of the following regions of the lung?

Alveoli

Many pharmaceutical agents may cause pulmonary damage. The nurse knows the following cardiac medication has been associated with toxic effects in the lungs:

Amiodarone

Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

An 81 year-old male who has a productive cough and recurrent respiratory infections.

Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination?

An 81-year-old resident of a long-term care facility

The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be:

Antipyretic medications and rest

In the early morning, an African-American woman brings her 5-year-old son to the emergency room. The boy is wheezing, short of breath, and has a dry cough. The mother states that he has always been very healthy. He went to bed with only a slight cold and a runny nose but woke her with his coughing shortly after 4 a.m. His symptoms worsened so dramatically that she brought him to the hospital. The care team would most likely suspect that he has:

Asthma

The parents of an infant bring the child to the emergency room three hours after they put the child to bed in apparent good health. The child is restless, the pulse is 140 beats/ minute, and lung sounds are diminished in all lung fields with intercostal retractions. What is the most likely cause of these symptoms?

Asthma

A patient arrives in the ED after an automobile accident. Which of the following clinical manifestations leads the nurse to suspect a pneumothorax? Select all that apply.

Asymmetrical chest movements, esp. on inspiration. • Diminished breath sounds over painful chest area. • Respiratory rate 34.

Atelectasis is the term used to designate an incomplete expansion of a portion of the lung. Depending on the size of the collapsed area and the type of atelectasis occurring, the nurse may see a shift of the mediastinum and trachea. Which way does the mediastinum and trachea shift in compression atelectasis?

Away from the affected lung

A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication?

Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract.

An infant who was born prematurely and developed respiratory distress syndrome was placed on mechanical ventilation for several weeks. What condition should the nurse monitor the infant for related to the long-term ventilatory support?

Bronchopulmonary dysplasia

The nurse determines that the client has clubbing of the fingertips. Which is the best intervention?

Check the patient's O2 saturation level.

A patient is diagnosed with pulmonary embolism. Which of the following symptoms would most likely be present?

Chest pain and dyspnea

A client with hypercapnia needs to increase calorie intake without increasing work of breathing. What menu selection is the best choice?

Chicken salad, refried beans, and guacamole

Chronic obstructive pulmonary disease (COPD) is a combination of disease processes. What disease processes have been identified as being part of COPD?

Chronic obstructive bronchitis and emphysema

A middle-aged client with a 30-year history of smoking was diagnosed with lung cancer. A health history revealed previous exposure to air pollution, asbestos, and radiation. Which of the following most likely had the greatest impact on development of the lung cancer?

Cigarette smoke

A mother rushes her toddler into the emergency department stating, "My baby can't breathe." Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breath. The nurse suspects the child has which of the following acute respiratory infections?

Epiglottitis

A parent calls 911 and states her child is having trouble breathing. The child is rushed to the emergency department. Upon assessment, the child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward. The parent states that the child just developed a sore throat and fever today. The health care provider determines that the child is experiencing:

Epiglottitis

The "cold viruses" are rapidly spread from person to person. The greatest source of spread is:

Fingers

A client's chest x-ray and pathology report identify a granulomatous lesion that contains the tubercle bacilli. The health care provider would interpret this as:

Ghon focus

A nurse is assessing a 2-week-old infant with pulmonary edema. Which of the following symptoms indicates the infant is experiencing respiratory distress?

Grunting during expiration

A client has been diagnosed with an advanced tumor that has invaded the mediastinum. The client would most likely manifest:

Hoarseness and difficulty swallowing

While rock climbing, a 22 year-old male has endured a severe head injury. Which of the following statements best captures expected clinical manifestations and treatments for his immediate condition?

Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.

A patient diagnosed with congestive heart failure has an arterial blood oxygen level (PaO2) of 89%. Which of the following terms should the nurse use to document a reduced oxygenation of arterial blood?

Hypoxemia

The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen in the arterial blood and a decreased in the partial pressure of oxygen. The nurse would interpret this as:

Hypoxemia

A patient is brought into the emergency department with severe crushing injuries to the chest wall and signs of respiratory failure following a motor vehicle accident. Which of the following laboratory values would be expected?

Increase in PCO2

Ventilation is driven by which alteration in arterial blood?

Increased PCO2

As a result of dehydration, a client's epithelial cells are producing insufficient amounts of mucus. Consequently, the client's mucociliary blanket is compromised. Which of the following changes would the care provider anticipate as a direct result of this change?

Increased amounts of bacteria in the lungs

A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be:

Increased turbulence of air moving through the obstructed airways

The nurse is assessing a client who states he felt fine all day and then within five minutes, began to feel extremely weak and tired and began having a fever. What do these symptoms indicate that the client may be experiencing?

Influenza

A client asks the nurse if it is possible to contract influenza by being exposed to wound secretions. On what knowledge should the nurse base her response to the client?

Influenza transmission occurs by inhalation of droplet nuclei.

Following a lecture on hemostasis, a nursing student accidently cuts her hand while preparing supper for her family. She watches the laceration very closely. Sure enough, the first thing she notes is:

Initially, it takes a few seconds for blood to appear as a result of vessel spasm.

Influenza A subtype H5N1 (avian flu) has been documented in poultry in both East and Southeast Asian Countries. This form of avian flu is highly contagious from bird to bird but rarely is passed from human to human. There is a large amount of concern that the H5N1 strain might mutate, making it easier to be passed from human to human, carrying with it a high mortality rate. What is the main concern if the H5N1 strain does mutate?

Initiation of a pandemic

The sensation of chest tightness due to an impending asthmatic attack appears to be related to which of the following physiological causes?

Input from lung receptors that monitor bronchial constriction.

A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:

Insertion of a large-bore needle or chest tube

A client presents to his physician complaining of severe fatigue and intermittent shortness of breath. The physician is concerned that the client has developed anemia, a decreased oxygen carrying capacity of the blood, and has ordered blood work. A deficiency in which of the following would support the diagnosis of anemia secondary to a decrease in oxygen's ability to bind with hemoglobin?

Iron

A client with a history of asthma comes to the clinic complaining of wheezing and difficulty in breathing when harvesting the field. The assessment findings include use of accessory neck muscles, prolonged expiration, intercostal retractions, decreased breath sounds, and expiratory wheezes. Based on these finding the nurse determines which of the following anatomical receptors in the lungs have been stimulated?

Irritant receptors

A nurse is instructing a class for people with newly diagnosed asthma to encourage healthy life style choices. The nurse explains that stimulation of certain lung receptors with things such as smoke, cigarette smoke, inhaled dust, or cold air can lead to constriction of the conducting airways resulting in rapid, shallow breathing. How does the nurse identify these receptors?

Irritant receptors

Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from:

Nasal congestion

COPD clients live with persistently elevated PCO2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population?

PO2 level of 50 mm Hg

A 3-year-old boy has developed croup following a winter cold. His care provider would recognize that which of the following microorganisms and treatments are most likely to be related and effective, respectively?

Parainfluenza virus, treated with a mist tent and oxygen therapy.

A client has presented to an ambulatory clinic complaining of a persistent headache. What assessments should the clinician conduct to differentiate between rhinosinusitis and alternative health problems?

Perform transillumination and see if bending forward exacerbates the headache.

Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?

Pet dander

A patient admitted to the hospital with heart failure tells the nurse he has developed a condition that interferes with movement of blood through sections of the lungs. The nurse recognizes this as which of the following?

Physiologic shunting

A child is brought to the emergency department with a respiratory infection. The child is struggling to breath and is very anxious. The health care providers suspect epiglottitis. Which of the following interventions would be a priority?

Place the child upright in bed and begin preparing for a tracheostomy placement.

A diagnosis of exudative pleural effusion would be based on which of the following?

Pleural fluid protein/serum protein ratio >0.5

A pulmonary embolism occurs when there is an obstruction in the pulmonary artery blood flow. Classic signs and symptoms of a pulmonary embolism include dyspnea, chest pain, and increased respiratory rate. What is a classic sign of pulmonary infarction?

Pleuritic pain

A young adult is brought to the urgent care by a parent. The client states that he just does not feel good. Upon further assessment, the health care provider notes the following: • Unilateral chest pain when the client is asked to cough or move • Rapid respiratory rate • Splinting of the chest • Decreased tidal volume The provider would interpret these manifestations as:

Pleuritis

A short, nonsmoking 44 year old male presents to the emergency room with left-sided chest pain and a cough. He states the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, no cyanosis. Which condition is most likely causing his symptoms?

Pleuritis related to infection

A 40-year-old male presents to the emergency department reporting chest pain and shortness of breath. The health care provider suspects a pulmonary embolism and orders several diagnostic tests. Select the test that would require further follow-up.

Positive D-dimer

A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client's respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support?

Prepare for mechanical ventilation.

A patient recently had surgery for a hip fracture. Which of the following nursing interventions would be most effective for preventing pulmonary emboli in this patient?

Prevention of the development of a deep vein thrombosis

Three days following surgical repair of a hip fracture a client becomes anxious and complains of sudden shortness of breath. What disorder is the client most likely experiencing?

Pulmonary embolism

Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?

Pulmonary vessels constrict

The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement techniques would be:

Pulse Oximetry

A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following drugs will the nurse anticipate administering first?

Short-acting beta 2-adrenergic agonists such as albuterol (SABA)

A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which of the following possible diagnoses?

Small cell lung cancer due to smoking history

When talking to a group of homeless women living in a shelter, the nurse should educate about risk for developing tuberculosis. The nurse should emphasize which lab/diagnostic test as considered to be the "gold" standard for diagnosing tuberculosis?

Sputum or bronchial cultures

An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organism is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function?

Staphylococcus aureus

A client has developed bacterial pneumonia and is admitted to the hospital. The nurse obtains sputum cultures upon admission. What bacteria does the nurse anticipate finding when the results are complete?

Streptococcus pneumoniae

Which description of the onset of symptoms is most characteristic of epiglottitis?

Suddenly onset

A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infant's care?

Supplementary oxygen therapy

Non-small cell lung cancers (NSCLCs) mimic small cell lung cancers (SCLCs) through their abilities to do what?

Synthesize bioactive products and produce paraneoplastic syndromes

Which of the following medications helps treat the inflammatory reaction of asthma clients diagnosed with late-phase asthma response?

Systemic corticosteroids

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse?

The nurse is likely asymptomatic.

A nurse is providing care for an older, previously healthy adult male who has been diagnosed today with pneumococcal pneumonia. Which of the following signs and symptoms is the nurse most likely to encounter?

The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.

The nurse is teaching a group of nursing students about exudative pleural effusion. The nurse determines that teaching was effective when the students' state:

The specific gravity of the pleural exudate is greater than 1.020.

A client has been diagnosed with pneumococcal infection. The nurse shares with the client which statement about the spread of the disease?

The spread of this bacteria, especially the antibiotic-resistant strain, is largely by healthy, colonized individuals.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to:

The stiffening of the lung, making it more difficult to inflate

The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond?

The sweat test measures the concentration of salt in the infant's sweat.

A client arrives in the clinic with a cough, fever, and chest discomfort and is diagnosed with community-acquired pneumonia. What education does the nurse anticipate providing prior to discharging the client from the clinic?

The use of antibiotics

An elderly client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the client's most recent health problem?

Thoracentesis

Which of the following situations is most likely to result in an increased binding affinity of hemoglobin for oxygen?

Three of four binding sites on a client's hemoglobin molecule are occupied by oxygen.

A nurse is conducting a class on healthy living with COPD and presents potential complications with the disease. Many clients with COPD have bronchospasms, airway inflammation, and excess mucus production which contribute to obstruction to the alveoli. Which of the following physiologic conditions could result from the obstruction?

Ventilation perfusion mismatch

A 44-year-old woman has developed calf pain during a transatlantic flight. She is extremely short of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE) which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE?

Ventilation was occurring but perfusion was inadequate causing shortness of breath.

A nurse is caring for a client in the intensive care unit who has sustained severe trauma and now has developed disseminated intravascular coagulation (DIC). The nurse is aware that the client is experiencing:

Widespread coagulation and bleeding in the vascular compartment

A patient is admitted with pneumoconiosis. His history most likely reveals which of the following?

Work in a coal mine for 20 years

Which client most likely faces the highest risk of developing secondary pulmonary hypertension? a. A client who suffered a thermal injury to his lungs in a fire. b. An older adult client who has been hospitalized for the treatment of community-acquired pneumonia. c. A client with COPD and a 35 pack-year smoking history d. A client with asthma who uses her inhaled bronchodilator more often than prescribed.

c. A client with COPD and a 35 pack-year smoking history

You are taking a course in lung sounds. You are learning about the lungs of a child with asthma. You learn that the most common symptoms of asthma are what? Select one: a. Rhonchi in the lower bases. b. Increased A-P diameter c. Bilateral wheezes. d. Shallow respirations.

c. Bilateral wheezes.

A physician is providing care for a child who has a diagnosis of cystic fibrosis (CF). Which issue will occur first in the client? a. Recurrent pulmonary infections. b. Increased Na+ absorption c. Impaired Cl- transport d. Decreased water content of mucociliary blankey

c. Impaired Cl- transport

A patient is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering:

corticosteroid

A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that:

cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant.

The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education centre to learn more about her son's condition. Which teaching point is most accurate? a. "Steroids that your child can inhale will likely be the first line of defence." b. "Your son will likely need to limit or avoid exercise and sports."cross out c. "The most reliable indicator that your child is having an asthma attack is audible wheezing." d. "Research has shown that viruses may actually be a factor in many children's asthma

d. "Research has shown that viruses may actually be a factor in many children's asthma

Which resident of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? a. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells b. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke c. A 79-year-old lifetime smoker who is reporting shortness of breath and pain on deep inspiration d. An 81-year-old man who has a productive cough and recurrent respiratory infections.

d. An 81-year-old man who has a productive cough and recurrent respiratory infections

A child is brought to the emergency department struggling to breathe with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following is the most likely diagnosis?

severe asthma attack

Which client is exhibiting signs of advanced chronic obstructive pulmonary disease (COPD)? The client who is

sitting in bed resting elbows on overbed table, expiratory wheezes noted.

A 10-year-old male is experiencing an acute exacerbation of his asthma. The most appropriate treatment for this client would be:

β-adrenergic agonist

While lecturing on COPD, the instructor mentions emphysema. The instructor asks the students, "If the client is a smoker, explain the physiology behind cellular changes occurring in the lung which allow destruction of the alveoli." Which students have an accurate response? Select all that apply.

• "Antiprotease production and release is not adequate to neutralize the excess protease production." • "There is α1-antitrypsin deficiency, so this enzyme can't protect the lung from damage."

Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply.

• A school-aged child with severe asthma controlled by steroids admitted for an exacerbation • A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation • A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food

Which factors influence diffusion of gases in the lungs? Select all that apply.

• Administration of high concentrations of oxygen • Difference in the partial pressures of the gas on either side of the membrane • Diffusion characteristics of the gas • Surface area available for diffusion • Thickness of the alveolar-capillary membrane

A client has developed community-acquired pneumonia and is being treated at home. What does the nurse recognize are the methods in the diagnosis of community-acquired pneumonia? Select all that apply.

• Age • Severity of illness • Coexisting health problems

A physician is providing care for a child who has a diagnosis of cystic fibrosis (CF). Place the following events in the etiology of CF in ascending chronological order. Use all the options.

• Airway obstruction • Increased Na+ absorption • Impaired Cl- transport • Recurrent pulmonary infections • Decreased water content of mucociliary blanket

When CO2 levels in the blood rise, a state of hypercapnia occurs in the body. What factors contribute to hypercapnia? (Select all that apply.)

• Alteration in carbon dioxide production • Abnormalities in respiratory function • Disturbance in gas exchange function • Changes in neural control of respiration

A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply.

• Bluish discoloration of the skin and mucous membranes (central cyanosis) • Expiratory grunting • Substernal retractions with each breathe

A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply.

• Chemotherapy • Surgery to remove tumor • Radiation therapy

While administering influenza vaccines for the general public, the nurse will advise which clients to avoid taking the flu shot? Select all that apply.

• Client with allergy to eggs • Client with Guillain-Barre syndrome

A 25-year-old cystic fibrosis client presents to the clinic in obvious respiratory distress. Following physical exam, the health care provider suspects bronchiectasis based on which of the following findings? Select all that apply.

• Copious amounts of foul-smelling purulent sputum • Blood-tinged sputum • Wheezing throughout the lung fields

There can be many reasons for a client to present with hypoxemia. For a client's PO2 to fall, a respiratory disease is usually involved. Often, clients have involvement from more than one mechanism. Which of the following will result in hypoxemia? (Select all that apply.)

• Decreased oxygen in air • Disease in respiratory system • Dysfunction of neurologic system

Following a dust storm in Arizona, several clients have presented to the clinic complaining of productive cough, fever, and night sweats. The health care provider suspects a fungal infection related to breathing dust. One particular client is critical. They suspect the infection has progressed outside the lung when they observe the client has: Select all that apply.

• Generalized lymph node enlargement • An enlarged liver via palpation • Copious bleeding at the site where the lab technician drew some blood

Which conditions increase client risk for developing pulmonary arterial hypertension (PAH)? Select all that apply.

• HIV infection • Scleroderma • Family history

A client presents with atypical pneumonia signs/symptoms and is diagnosed with Mycoplasma pneumoniae. For which characteristics of the cough should the nurse assess this client? Select all that apply.

• Hacking • Nonproductive • Dry

Which symptoms accompanying shortness of breath indicate a client has cor pulmonale? Select all that apply.

• Jugular vein distention • 2+ pitting edema in feet • Warm moist skin

A nurse is assessing a client for cyanosis. The most appropriate areas for the nurse to assess would be: Select all that apply.

• Lips • Nails • Ears • Cheeks

Soon after delivery, the mother grabs the nurses arm and states, "Something's wrong...I can't get my breath." Which of the following assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply.

• Productive cough with blood-streaked sputum. • BP 90/65; pulse 130, irregular; respiratory rate 35, shallow.

Community-acquired pneumonia can be categorized according to several indexes. What are these indexes? (Select all that apply.)

• Radiologic findings • Presence of coexisting disease • Age

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is distinguishable between the two by the extent of hypoxemia involved. What is the clinical presentation of ARDS? (Select all that apply.)

• Rapid onset • Increase in respiratory rate • Hypoxemia refractory to treatment

The neonatal ICU nurse is assessing a client with severe bronchopulmonary dysplasia (BPD). The nurse knows that this client will likely exhibit which clinical manifestations? Select all that apply.

• Rapid, shallow breathing • Chest retractions with accessory muscle use • Clubbing of the fingers

A patient with sepsis secondary to pneumonia develops acute respiratory distress syndrome (ARDS) and a low ventilation-perfusion ratio. Which of the following alterations in the lungs occurs as the disease progresses? Select all that apply.

• Surfactant inactivation • Intrapulmonary shunting • lung stiffens • Alveolar collapse

A client is admitted to hospital to rule out Legionnaire disease following a canoe trip where he was sprayed in the face with a lot of "creek" water. Which of the following manifestations are characteristic of Legionnaire pneumonia? Select all that apply.

• Temperature of 103.5°, pulse 80 • "Talking but not making a lot of sense" (confusion) • Chest x-ray that reveals areas of consolidation suggestive of pneumonia

A COPD patient asks the nurse which of the following medications is prescribed to help their breathing. The nurse, looking at the list of medications, will educate the patient about which of the following medications to help their COPD in the long-term. Select all that apply.

• Tiotropium (Spiriva), anticholinergic. • Salmeterol (Serevent), a bronchodilator.

The nurse is caring for an adult client diagnosed with acute rhinosinusitis. The nurse anticipates that the client will more than likely receive prescriptions for which medications? Select all that apply.

• Topical alpha-adrenergic decongestant • Guaifenesin • Intranasal corticosteroid

A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic with the following complaints: auscultation of breath sounds reveal absent/diminished breath sounds in the right lower lobe. Which other manifestations lead the health care provider to suspect the client may have developed atelectasis? Select all that apply.

• Using accessory muscles to help him breathe. • "Having a hard time catching my breath." • Respiratory rate—32; pulse rate—122 beats/minute.

An 82-year-old man with chronic obstructive pulmonary disease (COPD) is at the clinic for a regular checkup. Because of his diagnosis, the nurse would expect his respiratory rate under normal circumstances to be what?

≥18 to 20 breaths/minute