PrepU CH. 21

The nurse teaches a patient scheduled for surgery about pulmonary function testing (PFT). Which statement, if made by the patient, indicates teaching was effective?

"These tests results will be used to assess any risk I could have due to the anesthesia."

What is the normal tidal volume for a person at rest?

500 mL

What is the normal range for an arterial blood gas pH?

7.35 - 7.45

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.

Select the clinical situation that would result in increased diffusion of gases from the arterial blood into the alveoli.

A client who is receiving 100% oxygen via oxygen mask

A client with a right-sided chest tube in place to remove air describes an increase in his respiratory effort over the past day. The nurse would suspect an increase in the size of the pneumothorax and would anticipate that the pulmonary function tests would show which of the following? Select all that apply

A decrease in inspiratory capacity An increase in dead space A decrease in total lung capacity

A nurse on an acute medical unit is providing care for a number of patients with a variety of diagnoses. Which of the following patients most likely exhibits risk factors for impaired coughing? A patient with:

A nasogastric (NG) tube attached to suction

Dyspnea can best be described by which of the following?

A subjective sensation felt when experiencing difficulty breathing

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

The physician mentions the patient has developed alveolar dead space. The nurse recognizes that this means:

Alveoli are ventilated but not perfused.

An infant with a ventricular septal defect (VSD) does not fully oxygenate his blood. Large quantities of deoxygenated blood enter the left ventricle from the right ventricle via the VSD. What type of disorder is this?

Anatomic shunt

A client is suffering from severe gastroesophageal reflux disease (GERD) and has been admitted to the hospital with a diagnosis of pneumonia. Which of the following would be the most likely cause for the development of pneumonia?

Aspiration

A nurse is evaluating patients at risk for developing dyspnea. Which diagnoses would place a patient at risk? Select all that apply.

Asthma Heart disease Emphysema Pneumonia

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

Atelectasis

The nurse has just completed a respiratory assessment on a postoperative patient who has undergone repair of a large abdominal aneurysm. Which conditions may impair the patient's cough reflex? Select all that apply.

Bed rest Muscle weakness Surgery Paralysis

The nurse is caring for a client suffering from multiple pulmonary embolisms who is concerned that her lungs will be permanently destroyed. The nurse reassures the client that collateral circulation is formed to protect the lung tissue until the embolisms resolve by means of:

Bronchial blood vessels.

The emergency department is awaiting the arrival of a spinal cord injured patient. Knowing the innervation of the diaphragm, a patient with which type of injury may be in need of immediate mechanical ventilation? Injury to the:

C4 area.

The nurse is monitoring trends in the patient's arterial blood gases and recognizes that changes in ventilation will result from which of the following? Select all that apply.

Carbon dioxide, Oxygen, pH

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 client's respiratory rate is being primarily influenced by carbon dioxide levels. What receptors are responding to the CO2?

Central receptors

During the admission interview the client, who is admitted with bacterial pneumonia, reveals a 20 pack per year smoking history. The nurse relates the possible cause of this pneumonia to the decreased defense of the pulmonary system caused by cigarette smoking. Smoking affects the pulmonary defense system by which of these?

Damage or destruction of cilia

A nurse educator is explaining a client's lung disease and describing how some of the air that he is moving with each breath is not actually participating in gas exchange. The nurse is describing what phenomenon?

Dead space

A client with asbestosis-induced pulmonary fibrosis asks the nurse why breathing is so difficult at times. The nurse explains that the scar tissue in the client's lung tissues causes which of these?

Decreased compliance of the lung tissue

The nurse caring for a client with bilateral rib fractures explains to the client that the pain causes him to take more shallow respirations which will contribute to feeling SOB due to a

Decreased tidal volume.

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

A client with lung cancer is scheduled for the removal of the right lung. The nurse should anticipate that after surgery the client will experience a significant decrease in which of the following?

Diffusion capacity

Some nursing students are studying normal respiratory physiology in relation to stimulation of the sympathetic nervous system. As they reflect on the fight or flight syndrome, they determine that which of the following would happen? Select all that apply.

Dilation of the bronchioles • Blood vessel constriction

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

The parents of a premature infant ask how changing their baby's position can possibility help with the baby's ventilation. The nurse explains that changing the baby's position encourages which of these?

Distribution of ventilation

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

A patient is reporting difficulty breathing when walking to the bathroom. The nurse documents this as:

Dyspnea

Our ability to oxygenate the tissues and organs of our bodies depends on our ability to ventilate, or exchange, gases in our respiratory system. The resultant distribution of ventilation or the areas of the body open to the exchange of gases in our respiratory system depends on what?

Effects of gravity and body position

The pulmonary rehabilitation specialist is educating medical students on a respiratory disease process that causes a severe compromise in exhalation due to air trapping. Air trapping is caused by the loss of elastic recoil, especially in the alveoli, which occurs after overstretching in which of the following diseases?

Emphysema

A client is preparing for a hip replacement surgery and his physician orders pulmonary function tests (PFTs) to be done pre-surgical. Upon arrival to the lab for the PFTs, the client is anxious and asks the nurse why his physician would order these tests since he does not have any pulmonary diseases. The nurse responds that although the client should speak with his physician, the most likely reason is which of the following?

Evaluate anesthetic risk

A client admitted to the hospital with aspiration pneumonia subsequent to having a recent stroke is requesting an antitussive medication to stop her productive cough. The nurse explains to the client that the purpose of her cough is which of the following? Select all that apply.

Expel excess secretions Protect the lungs Remove foreign aspirate

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

A fully saturated hemoglobin molecule can hold how many oxygen molecules?

Four (4)

Aspiration pneumonia is a serious and sometimes life threatening inflammation in the lungs caused by inhaling food, fluids, stomach contents, or other foreign substances. Identify the structures that protect the lungs from aspiration. Select all that apply.

Glottis, Epiglottis

A female patient is requiring supplementary oxygen by face mask due to her reduced lung compliance. Which of the following pathophysiological processes is most likely to be a contributor to her low lung compliance?

Her thoracic cage is less flexible than when she was healthy.

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

The nurse is caring for a client who is 2 days postop following a total hip replacement. The client is refusing to participate in physical therapy, complaining of extreme fatigue and severe pain with any movement. The nurse administers pain medication and then encourages the client to sit up to more effectively cough and deep breathe to increase ventilation by:

Increasing the spread of surfactant

People with emphysema often have a difficult time with air trapping, which is air left in the lungs following expiration, often due to the destruction of the alveoli. Pulmonary rehabilitation educates people who suffer from this disease to use which of the following to help air leave the lungs more effectively?

Intercostal and abdominal muscles

While working in the newborn ICU, the nurses receive a call that an infant, gestational age of 23, is being air-flighted to their level three trauma nursery. The priority intervention for this infant would be:

Intubation and mechanical ventilation.

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

A male, lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team expect in the weeks prior to his death?

Large numbers of alveolar macrophages in septal connective tissue

The home care nurse is caring for a client who has sustained phrenic nerve damage from a skiing accident. The nurse understands that the client must be on a ventilator for which of the following reasons?

Loss of diaphragmatic function

A nursing student is studying the respiratory airways in the lungs, in particular the alveoli. A fellow student asks which of the following cells is most instrumental in the destruction of foreign substances that may enter the alveoli with inspired air. The most accurate response would be alveolar which of the following?

Macrophages

Dyspnea is defined as an uncomfortable sensation or difficulty in breathing that is subjectively defined by the client. Which of the following disease states is not characterized by dyspnea?

Multiple sclerosis

The nursing instructor is explaining pressure changes that occur during inspiration to a group of students. Which would be the most appropriate information to include? During inspiration, intrapleural pressure is:

Negative in relation to alveolar pressure

Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation?

Negative intrapleural pressure holds the lungs against the chest wall

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

The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is:

Pleural effusion.

The respiratory neurons that turn off inspiration and assist with regulation of the respiratory rate are located where?

Pneumotaxic center

An unconscious client has been admitted to the ICU with severe head injuries following a motorcycle accident. The client's respirations are very irregular with long inspiratory gasps interrupted by expiratory effort. The nurse explains to the family that the reason is injury to which of the following?

Posterior area of the brain

A nurse is caring for a patient who has been ordered complete bed rest. The nurse determines the area of this client's lungs that experience the most ventilation as which of the following?

Posterior portions of the lungs

Which of the following best describes the pressure that drives breathing?

Pressure in the pleural cavity

Reviewing pathology for an exam on pulmonary vasculature, the nursing student states that blood enters the right side of the heart via vena cava's, then to the right atrium, right ventricle, and then which vessel carries the deoxygenated blood into the pulmonary system?

Pulmonary artery.

A client has been admitted with bacterial pneumonia and is complaining of difficulty breathing. The nurse would explain the most likely reason for the dyspnea is that pneumonia interferes with lung compliance due to which of the following?

Pulmonary congestion

The nurse is educating a client suffering from advanced emphysema on how to improve expiratory flow rates. Which of the following breathing techniques would the nurse describe as most effective?

Pursed-lip breathing

The nurse is caring for a client who is in the hospital with adult respiratory distress syndrome (ARDS) caused by a near drowning and the client wants to know why he is having such difficulty breathing. The most accurate explanation would be that the dyspnea is caused by a lack of alveolar surfactant which is essential to:

Reduce surface tension in the alveoli. Increase lung compliance. Prevent end-expiratory alveolar collapse. Regulate the immune system in the lungs.

The lungs are the working structures of the respiratory system, and they have several functions. What are the functions of the lungs? (Select all that apply.)

Serve as reservoir for blood storage Convert angiotensin I to angiotensin II

A client who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. What should the nurse anticipate when observing her breathing?

Short, shallow breaths

A client who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. Upon assessment of the lungs, what clinical manifestations should the nurse expect?

Short, shallow breaths.

Which would be the most appropriate measurement tool to determine lung volume and lung capacity of a patient?

Spirometer

What mechanism has been proposed to explain the sensation of dyspnea? Select all that apply.

Stimulation of lung receptors Stimulation of muscle fibers in the intercostals and diaphragm Decreased breathing reserve Increased CNS sensitivity to changes in ventilation

Which type of lung receptor monitors for lung inflation?

Stretch

The nurse is assessing a patient's respiratory status for lung expansion and airway resistance. The nurse is aware that changes in the pressure occurring in the walls of the airways will be adjusted by which of the following?

Stretch receptors

Select the primary function of bronchial circulation.

Supplies the blood supply for the conducting airways and supporting structures

A patient's oxygen-hemoglobin dissociation curve is represented by a shift to the right. The nurse recognizes this as:

The affinity of hemoglobin for oxygen is decreased.

A client occasionally experiences hypoxia and dyspnea because of a reduction in gas diffusion. What physiologic change is most likely to cause this?

The client had a lung lobe removed for the treatment of cancer

A client asks the nurse what anatomic airway dead space is. Which of the following would be the nurse's best response?

The volume of air contained in the nose, pharynx, trachea, and bronchi

The nurse is reviewing the near-drowning client's pulmonary function tests and is concerned that the forced vital capacity (FVC) is decreased. Which of the following accurately describes FVC?

The volume of air exhaled vigorously and quickly after maximum inspiration

The nurse is interviewing a client who has come in for the first round of radiation treatment of a large, right upper lobe lung tumor. The client asks how the tumor could get so large without causing any pain. The most accurate explanation would be which of these?

There are no pain receptors in the lung tissue.

Bronchial blood vessels have several functions. They warm and humidify incoming air as well as distribute blood to the conducting airways and the supporting structures of the lung. What is it that makes bronchial blood vessels unique in the body?

They can undergo angiogenesis.

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.

Pulmonary function studies are an essential tool in the diagnosis of pulmonary disorders. A spirometer is used in these studies and through direct measurement provides valuable information on which of the following? Select all that apply.

Tidal volume Inspiratory reserve volume Expiratory reserve volume

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

Tidal volume × respiratory rate

Following a winter power outage, a client who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning?

To increase the amount of oxygen carried in the dissolved state

A nurse experiences a person having seizure activity in the grocery store. Once the seizure activity has subsided the nurse places the person in a side lying position to avoid occlusion of the airway, which could cause cessation of ventilation due to which of the following?

Tongue falling back and blocking the airway

Blood transports both oxygen and carbon dioxide in a physically dissolved form to the tissues and organs of the body. It is the measurements of the components of the gases in the blood that are used as indicators of the body's status by health care workers. Why is common to measure the blood in the arteries rather than the blood in the veins?

Venous blood measures the metabolic demands of the tissues rather than the gas exchange function of the lungs.

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 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.

Which of the following is a function of the bronchial circulation?

Warms and humidifies incoming air

A client with chronic asthma is experiencing a severe asthma attack and is becoming increasingly agitated. The nurse supports the client's ability to move more air in and out of the lungs by instructing the client to stabilize his accessory muscles. The nurse understands that by stabilizing the accessory muscles the:

accessory muscles can assist in ventilation.

The nurse is caring for an infant with a large ventricular septal defect, also called a hole in the heart, which is a congenital heart defect causing a right to left shunt. The nurse illustrates for the parents how this compromises their child's ability to deliver oxygenated blood to the tissues causing

cyanosis secondary to an anatomic shunt.

The nurse is explaining to the parents of a 23-week premature infant the reason their baby needs to be on mechanical ventilation. The education is successful when the parents state that they understand their baby was born before the type II alveolar cells could mature which has caused a

deficiency of surfactant

The nurse is caring for a client admitted with carbon monoxide (CO) poisoning. The client is extremely agitated, dyspneic, and confused. The nurse understands that the treatment of choice would be a hyperbaric chamber with 100% oxygen administration which will:

increase the amount of oxygen in the dissolved state.

A client admitted to the hospital with an exacerbation of chronic obstructive pulmonary disease (COPD) asks the nurse what can be done to decrease the dyspnea. The nurse instructs the client to use pursed-lip breathing (PLB) to help keep airways open by:

increasing intrapulmonary pressures.

A distressed, confused client is admitted to the hospital ER with a penetrating right chest stab wound. The nurse assesses the patient and notes a lack of breath sounds in the right lung due. The nurse knows this is likely the result of:

loss of intrapleural pressure

A client has inhaled, drawing air into the oropharynx. From this location, air will:

proceed through the trachea, bronchi, and then bronchioles.

The nurse is caring for a client with end stage chronic obstructive pulmonary disease (COPD). The client is extremely agitated and dyspneic, demanding that the oxygen be turned all the way up. The nurse states that this situation must be very frustrating for the client and then explains that the consequence of increasing the oxygen could cause:

serious depression of respirations.

An individual has sensitivity to perfumes and experiences shortness of breath when exposed to them. This occurs because:

stimulation of irritant receptors causes bronchoconstriction

An expectant mother of twins has been told there is a strong chance that she will go into labour early and her babies will be premature. In order to increase the chances of having healthy infants, she is given a dose of steroids to stimulate the production of surfactant in the infants' lungs. Surfactant is important for survival of the babies because it reduces:

surface tension of the respiratory membrane.

A young child is brought to the ER with CPR in progress. The parent found the child lying on the kitchen floor without respirations, although a heartbeat was initially detected. The triage nurse anticipates the most likely cause of the situation is an obstruction of the conducting airways which caused an interruption in

ventilation.