Unit 9 Respiratory Prep U Questions

An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis?

"Do you tend to have a cough even when you don't feel sick?" A clinical diagnosis of chronic bronchitis requires the history of a chronic productive cough for at least 3 consecutive months over 2 consecutive years. This is not noted to be a strong genetic component of the disease, and childhood RSV is not a risk factor. Immunization status is normally linked to the development of bronchitis.

A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states:

"For unknown reasons, you lost intrapleural negative pressure. This means your lungs collapsed and expelled its air when you lose negative pressure." The intrapleural pressure is always negative in relation to alveolar pressure in the normally inflated lung: approximately 4 mm Hg between breaths when the glottis is open and the alveolar spaces are open to the atmosphere. Although the intrapleural pressure of the inflated lung is always negative in relation to alveolar pressure, it may become positive in relation to atmospheric pressure (e.g., as during forced expiration and coughing). A spontaneous pneumothorax is a collapsed lung with loss of negative pressures.

An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement 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?" The causes of emphysema are smoking, which incites lung injury, and an inherited deficiency of alpha 1-antitrypsin, an antiprotease enzyme that protects the lung from injury.

A client newly diagnosed with lung cancer asks the nurse why the health care provider has ordered a positron emission tomography (PET) scan. Which response by the nurse is best?

"This diagnostic procedure will let the doctor know if you have any metastatic lesions in your body." Positron emission tomography (PET) is a noninvasive alternative for identifying metastatic lesions in the mediastinum or distant sites. Persons with SCLC should also have a CT scan or MRI of the brain for detection of metastasis.

A client diagnosed with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. What is the best response?

"You can take drug therapy for as long as 24 months or until all tubercle bacilli are eliminated." The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period.

A client lives in Calgary, where the high elevation results in an atmospheric pressure of 672 mm Hg. What is the partial pressure of oxygen where this client lives?

141 mm Hg PO2 = atmospheric pressure × 0.21. Thus, 672 × 0.21 = 141 mm Hg. This does not vary according to temperature, unlike the partial pressure of water vapor.

A client who is in a room at 1 atmosphere (760 mm Hg) is receiving supplemental oxygen therapy that is being delivered at a concentration of 50%. What is the consequent PO2?

380 mm Hg The law of partial pressures states that the total pressure of a mixture of gases, as in the atmosphere, is equal to the sum of the partial pressures of the different gases in the mixture. If the concentration of oxygen at 760 mm Hg (1 atmosphere) is 50%, its partial pressure is 380 mm Hg (50.54 kPa). The equation to calculate is 760 × 0.50 = 380.

Which client most likely faces the highest risk of developing secondary pulmonary hypertension?

A client with COPD and a 35 pack-year smoking history. COPD is a major risk factor for secondary pulmonary hypertension. Pneumonia, bronchodilator use, and thermal injury are not noted to be among the more common causes of the disease.

A client recovered from influenza 2 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 People in whom secondary bacterial pneumonia develops usually report that they were beginning to feel better when they experienced a return of fever, shaking chills, pleuritic chest pain, and productive cough. Reye syndrome is a complication, though rare, of influenza, particularly in young children who have been given aspirin as an antipyretic agent. Tuberculosis is not a complication of influenza.

A client sustained a puncture injury to the chest resulting in development of a tension pneumothorax. What is the pathogenesis behind a tension pneumothorax?

Air is permitted to enter but not leave the pleural space, causing lung collapse. Tension pneumothorax occurs when the intrapleural pressure exceeds atmospheric pressure. It is a life-threatening condition and occurs when injury to the chest or respiratory structures permits air to enter but not leave the pleural space. Spontaneous pneumothorax occurs when an air-filled bleb, or blister, on the lung surface ruptures. Rupture of these blebs allows atmospheric air from the airways to enter the pleural cavity. This results in a rapid increase in pressure in the chest with a compression atelectasis of the unaffected lung.

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 The common cold virus does not respond to antibiotics and should be treated with antipyretic medications and rest. Bed rest is recommended, but complete isolation is not required.

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 it more appropriate to measure the blood in the arteries rather than in the veins?

Arterial blood most adequately measures the gas exchange function of the lungs. In the clinical setting, blood gas measurements are used to determine the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) in the blood. Arterial blood commonly is used for measuring blood gases. Venous blood is not used because venous levels of oxygen and carbon dioxide reflect the metabolic demands of the tissues rather than the gas exchange function of the lungs.

A client has presented to a clinic reporting a persistent headache. What assessment should the clinician conduct to differentiate between rhinosinusitis and other health problems?

Ask the client if bending forward exacerbates the headache. Sinusitis headache usually is exaggerated by bending forward, coughing, or sneezing. The other cited assessments do not differentiate between rhinosinusitis and other health problems.

A moderate hemothorax diagnosis would be confirmed by the presence of which of the following?

Blood filling approximately one-third of the pleural space A minimal hemothorax involves the presence of at least 250 mL of blood in the pleural space. Small amounts of blood usually are absorbed from the pleural space, and the hemothorax usually clears in 10 to 14 days without complication. A moderate hemothorax fills approximately one-third of the pleural space and may produce signs of lung compression and loss of intravascular volume. It requires immediate drainage and replacement of intravascular fluids. A large hemothorax fills one half or more of one side of the chest and is usually caused by bleeding from a high-pressure vessel such as an intercostal or mammary artery. It requires immediate drainage and, if the bleeding continues, surgery to control the bleeding.

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 manifestations are characteristic of Legionnaire pneumonia? Select all that apply.

Chest x-ray that reveals areas of consolidation suggestive of pneumonia "Talking but not making a lot of sense" (confusion) Temperature of 103.5°F (39.7°C), pulse 80 Legionella pneumonia typically presents acutely with malaise, weakness, lethargy, fever, and dry cough. Other manifestations include disturbances of central nervous system function and elevation in body temperature, sometimes to more than 104°F (40°C). The presence of pneumonia along with diarrhea, hyponatremia, and confusion is characteristic of Legionella pneumonia. The disease causes consolidation of lung tissues and impairs gas exchange. Another characteristic of the disease is a lack of a normal pulse-temperature relationship in which a fever is not accompanied by an appropriate rise in heart rate. For example, a temperature of 102°F (38.9°C) is normally accompanied by a heart rate of 110 beats/minute; in Legionella pneumonia it is often less than 100 beats/minute.

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 factor most likely had the greatest impact on development of the lung cancer?

Cigarette smoke Cigarette smoking causes more than 80% of cases of lung cancer. The risk for lung cancer among cigarette smokers increases with duration of smoking and the number of cigarettes smoked per day. Cigarette smokers can benefit at any age from smoking cessation. Industrial hazards also contribute to the incidence of lung cancer. A commonly recognized hazard is exposure to asbestos. The mean risk for lung cancer is significantly greater in asbestos workers compared to the general population. In addition, tobacco smoke contributes heavily to the development of lung cancer in people exposed to asbestos.

Which client is exhibiting manifestations of drug-induced interstitial lung disease?

Client taking amiodarone for dysrhythmias who develops a dry cough. Drug-induced interstitial lung diseases are caused by drugs such as cancer treatment chemotherapeutics methotrexate, bleomycin, busulfan, and cyclophosphamide; the antidysrhythmic agent amiodarone, and radiation therapy. Clients receiving immunosuppressive agents may develop infections. Angiotensin converting enzyme (ACE) inhibitors, such as lisinopril, cause dry cough because of the inhibiting action in the lung. Beta adrenergic blockers are known to cause bronchospasm and wheezing in susceptible clients.

The nurse is assessing a client whose recent health history is suggestive of sarcoidosis. What assessment should the nurse prioritize?

Constructing a genogram from the client's report of her family history Sarcoidosis has a strong genetic component and a detailed family history is appropriate. The disease does not have an allergic etiology so there is not an exceptional need to focus on the client's allergy status. Sarcoidosis is noninfectious, so sputum testing is not directly indicated unless there are indications of a concurrent infection. Sarcoidosis is not linked to occupational risks.

What intervention is appropriate for a client with sarcoidosis?

Corticosteroids Sarcoidosis treatment is directed at interrupting the inflammatory process with corticosteroid medications. Sarcoidosis is overgrowth of granulomas and does not have a fungal or allergy component.

Above the glottis that opens and closes for speech, the epiglottis performs which physiologic function during swallowing?

Covers the larynx During swallowing, the free edges of the epiglottis move downward to cover the larynx, thereby preventing liquids and foods from entering. When substances other than air manage to enter the airway, the vocal folds serve as a sphincter, causing the larynx muscles to constrict and close and/or collapse the airway as a protective measure.

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 physiologic principle for these signs would include:

Damage has occurred at the connection between the pneumotaxic and apneustic centers. Brain injury, which damages the connections between the pneumotaxic and apneustic centers, results in an irregular breathing pattern that consists of prolonged inspiratory gasps interrupted by expiratory efforts. If the occipital lobe was not functioning, the client would have no respiratory effort and require mechanical ventilation. Leaking of spinal fluid would not cause these respiratory signs. If nerves were severed to the lungs, the client would not be able in inflate/deflate the lungs with mechanical ventilation.

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 in what way?

Damage or destruction of cilia There are over 4,000 chemicals in cigarette smoke; these chemicals and tar stick to the cilia that line the conducting airway, causing decreased movement and eventual destruction of this vital pulmonary defense system. With the destruction of the cilia, which are essential in keeping foreign particles out of the lungs, dust, particles, pathogens and other harmful substances enter the lungs where they can cause damage or disease. Nicotine increases the release of neurotransmitters in the brain and is extremely addictive; it has no known effect on the cilia.

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 physiologic measurement?

Diffusion capacity In the lungs, gases move from the inspired air to the vascular system and from the vascular system to the expired air by a process known as diffusion over the alveolar-capillary membrane. A decrease in the pulmonary membrane by the removal of one of the lungs would directly affect diffusion capacity because there is less surface area for diffusion.

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:

Dyspnea Dyspnea is defined as a subjective feeling of shortness of breath, labored breathing, or the feeling of not being able to get enough air. There are many reasons dyspnea may occur; however, in this case the most likely cause is a reactive airway disorder triggered by exercise.

The nurse is caring for a postoperative client in traction. Which activity would be most beneficial for preventing atelectasis in this client?

Encourage the client to cough and breathe deeply several times per hour. The best technique to prevent atelectasis is coughing and deep breathing exercises. The client should not remain immobile and the head of the bead should be elevated. The other measures are more invasive.

The emergency room provider diagnoses a client with a hemothorax. Which could be possible causes of this condition?

Fractured ribs following car accident Hemothorax is a collection of blood in the thoracic cavity. Bleeding may arise from chest injury (like a car accident), a complication of chest surgery, malignancies, or rupture of a great vessel such as an aortic aneurysm. Fractured and dislocated ribs alert the nurse to the presence of a possible chest injury. Pleural effusion refers to an abnormal collection of fluid in the pleural cavity and is associated with diagnoses of congestive heart failure, pneumonia, and renal failure.

Which manifestation typically accompanies an asthmatic attack?

Hyperinflation of the lungs During a prolonged attack, air becomes trapped behind the occluded and narrowed airways, causing hyperinflation of the lungs. This produces an increase in the residual volume of the lungs. Pulmonary arterial pressure tends to increase and expiration becomes prolonged.

Ventilation is driven by which alteration in arterial blood?

Increased PCO2 Ventilatory drive is exquisitely sensitive to PCO2 of the blood perfusing the central chemoreceptors. These receptors are located in chemosensitive regions near the respiratory center in the medulla and are bathed in cerebrospinal fluid (CSF).

The nurse is assessing a client who states he felt fine all day and then, within 5 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 One distinguishing feature of an influenza viral infection is the rapid onset, sometimes in as little as 1 to 2 minutes, of profound malaise. Viral pneumonia is a complication of influenza. Reye syndrome is a complication of influenza that is extremely rare and is found mostly in children after being give aspirin as an antipyretic. The common cold has more of a slow onset.

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. As with many viral respiratory tract infections, influenza is more contagious than bacterial respiratory tract infections. In contrast to the rhinoviruses, transmission occurs by inhalation of droplet nuclei rather than touching contaminated objects.

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 muscles to help air leave the lungs more effectively?

Intercostal and abdominal muscles Air trapping in clients with emphysema occurs due to the loss of elasticity of the alveoli and interferes with the intake of air and gas exchange. The goal of pulmonary rehabilitation in relation to air trapping is to increase a client's ability to exhale. The use of the internal intercostal muscles constrict the rib cage, causing a decrease in the thoracic volume, and the abdominal muscles force the abdomen to push up against the diaphragm moving it upward toward the thorax.

A nurse is instructing a class for people with newly diagnosed asthma to encourage healthy lifestyle 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 It is believed that the irritant receptors protect the lower airways and respiratory tissues from damage. The receptors cause airway constriction and rapid, shallow breathing. It would be beneficial for people living with asthma to avoid these triggers.

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 reason?

Loss of diaphragmatic function The diaphragm is the primary muscle of respiration and is essential to ventilation. The phrenic nerve, which exits the spinal cord between C3 and C5, stimulates the diaphragm to contract, increasing the space in the chest cavity and thus causing a decrease in the intrathoracic pressure, allowing air to flow into the lungs.

The nurse is caring for a client with mediastinal carcinoma. Which body structures located in this area are responsible for filtering foreign particles from the interstitial spaces of the lungs to prevent the spread of this cancer?

Lymph nodes These are all structures found is the mediastinum; however, only the lymph nodes are responsible for filtering and removing foreign particles from the lymph fluid that travels throughout the entire body. If cancer cells from the mediastinal cancer break off and enter the lymph circulation it would be the responsibility of the lymph nodes in this area to filter and destroy these cells so they cannot carry cancer to other parts of the body.

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

Macrophages Macrophages develop from monocytes and are phagocytic cells that not only destroy foreign substances but also initiate the inflammatory response and release cytokines that alert other cells in the immune system.

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

Marked elevation in temperature Pleuritic pain, a sharp pain that is more severe with respiratory movements, is common. With antibiotic therapy, fever usually subsides in approximately 48 to 72 hours, and recovery is uneventful. Older adults are less likely to experience marked elevations in temperature; in these persons, the only sign of pneumonia may be a loss of appetite and deterioration in mental status.

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 the most likely cause of this infection is:

Nosocomial hospital-acquired infection (HAI) Hospital-acquired pneumonia is defined as a lower respiratory tract infection that was not present or incubating on admission to the hospital. Hospital-acquired pneumonia is the second most common cause of hospital-acquired infection and has a mortality rate of 20% to 50%. Most hospital-acquired infections are bacterial. The organisms are those present in the hospital environment and include P. aeruginosa, S. aureus, Enterobacter species, Klebsiella species, Escherichia coli, and Serratia species. The organisms that are responsible for hospital-acquired pneumonias are different from those responsible for community-acquired pneumonias, and many of them have acquired antibiotic resistance and are more difficult to treat.

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

Nosocomial pneumonia Pneumonia can be classified according to the type of organism causing the infection (typical or atypical), location of the infection—lobar pneumonia or bronchopneumonia—and setting in which it occurs—community- or nosocomial/hospital-acquired pneumonia. Community-acquired pneumonia involves infections from organisms that are present more often in the community than in the hospital or nursing home. Hospital-acquired (nosocomial) pneumonia is defined as a lower respiratory tract infection occurring 48 hours or more after admission.

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 Asthma can be rated at four levels: mild intermittent, mild persistent, moderate persistent, and severe persistent. In mild intermittent asthma the symptoms occur 2 or fewer times per week and the client is asymptomatic between attacks with a normal peak expiratory flow (PEF). In mild persistent asthma the symptoms occur more than 2 times per week, but not daily. Exacerbations may affect activity. The PEF has 20-30 percent variability. Moderate persistent asthma has daily symptoms, exacerbations affect activity, and the PEF variability is greater than 30 percent. In severe persistent asthma the symptoms are continual with frequent exacerbations and the PEF is less than 60 percent of what is predicted, with variability more than 30 percent.

Pain is an expected assessment finding in clients who have which lung disease?

Pleuritis The effects of asthma, PAH, and pleural effusion may be profound, but none is typically accompanied by acute pain. Pleuritis, in contrast, is associated with characteristic pleural pain.

A client recently had surgery for a hip fracture. Which nursing intervention would be most effective for preventing pulmonary emboli in this client?

Prevention of the development of a deep vein thrombosis Almost all pulmonary emboli are thrombi that arise from deep vein thrombosis in the lower and upper extremities. The presence of thrombosis in the deep veins of the legs or pelvis often is unsuspected until an embolism occurs.

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 organism most commonly creates chronic infection in a child with cystic fibrosis?

Pseudomonas aeruginosa In addition to airway obstruction, the basic genetic defect that occurs with cystic fibrosis (CF) predisposes to chronic infection with a surprisingly small number of organisms, the most common being Pseudomonas aeruginosa. This organism has a propensity to undergo pathogenesis and early colonization can cause recurring pulmonary infections.

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 Continued exposure of the pulmonary vessels to hypoxemia is a common cause of pulmonary hypertension. Unlike blood vessels in the systemic circulation, most of which dilate in response to hypoxemia and hypercapnia, the pulmonary vessels constrict.

A client diagnosed with the common cold has been taking an over-the-counter antihistamine for the control of symptoms. What should the client be aware may occur if the drugs are used too frequently over too many days?

Rebound symptoms Antihistamines are popular OTC drugs because of their action in drying nasal secretions. However, they may dry up bronchial secretions and worsen the cough, and they may cause dizziness, drowsiness, and impaired judgement. If these drugs are used too frequently over too many days, they can cause rebound symptoms.

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

Reduction of nasal swelling Decongestant drugs are available in OTC nasal sprays, drops, and oral cold medications. These drugs constrict the blood vessels in the swollen nasal mucosa and reduce nasal swelling. They will not reduce the excess lacrimation that often accompanies a cold. Coughing is not affected by the use of these drugs. Fever reduction occurs with acetaminophen.

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 Scarring diminishes the elasticity of lung tissue, resulting in noncompliant lungs that are more difficult to inflate. In order to maintain a sufficient tidal volume and oxygen level with lungs that require extra work to expand, the individual must take shallower, more rapid breaths. The effort and time required for her to breathe deeply would detract from her ability to bring in enough air.

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 Sarcoidosis is a systemic disorder that primarily affects the lungs and lymphatic systems. Granulomas develop in the absence of infection or environmental agents known to cause them. Common manifestations can be identified by body system affected. Respiratory symptoms include shortness of breath, non-productive cough, and chest pain. Constitutional manifestations include fever, sweating, anorexia, weight loss, fatigue, and myalgia. Clients also develop skin papules and plaques, and uveitis. There may be cardiac, neuromuscular, hematologic, hepatic, endocrine, and lymph node findings.

Which breathing-related actions are affected by voluntary respiratory control? Select all that apply.

Singing Blowing Speaking Voluntary respiratory control is needed for integrating breathing and actions such as speaking, blowing, and singing. Neither hiccupping nor swallowing is related to voluntary respiratory control.

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 possible diagnosis?

Small cell lung cancer due to smoking history Small cell lung cancer has the strongest association with cigarette smoking and is rarely observed in someone who has not smoked; brain metastasis is common. The earliest symptoms (of lung cancer) usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels. There is no indication the client has risk factors for TB. Pulmonary emboli result from blood clots traveling to the lungs. Pneumothorax would cause different symptoms and be an acute, abrupt onset.

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 Streptococcus pneumoniae (pneumococcus) remains the most common cause of bacterial pneumonia.S. pneumoniae is a gram-positive diplococcus, possessing a capsule of polysaccharide. The virulence of the pneumococcus is a function of its capsule, which prevents or delays digestion by phagocytes.

Which type of lung receptor monitors for lung inflation?

Stretch There are three types of lung receptors: stretch receptors, which monitor lung inflation; irritant receptors, which protect against the damaging effects of toxic inhalants; and J receptors, which are thought to sense lung congestion. There are two groups of chemoreceptors: central and peripheral. The central chemoreceptors are the most important in sensing changes in carbon dioxide levels, and the peripheral chemoreceptors function in sensing arterial blood oxygen levels.

The nurse is assessing a client's respiratory status for lung expansion and airway resistance. Which type of lung receptors respond to changes in pressure occurring in the walls of the airways?

Stretch receptors Stretch receptors are located in the smooth muscle layers of the conducting airways. They respond to changes in pressure in the walls of the airways. When the lungs are inflated, these receptors inhibit inspiration and promote expiration. They are important in establishing breathing patterns and minimizing the work of breathing by adjusting respiratory rate and tidal volume to accommodate changes in lung compliance and airway resistance. Stimulation of the irritant receptors leads to airway constriction and a pattern of rapid, shallow breathing. The juxtacapillary or J receptors are located in the alveolar wall, close to the pulmonary capillaries. It is thought that these receptors sense lung congestion. Chemoreceptors monitor blood levels of oxygen, carbon dioxide, and pH and adjust ventilation to meet the changing metabolic needs of the body.

A client had a tuberculin skin test (TST) performed as part of the immigration process and is surprised that the results are positive. How should the nurse best interpret this result?

The client was exposed to the tubercle bacillus at an indefinite point in the past. A positive reaction to the TST does not mean that a person has active tuberculosis, only that there has been exposure to the bacillus and that cell-mediated immunity to the organism has developed. Tuberculosis has no genetic component to its etiology and a positive TST does not guarantee an active future infection.

A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. Which education will the nurse provide based on the most likely treatment course for this client?

The client will need education about the administration of isoniazid and the importance of taking it as prescribed. People who are 35 years of age or younger with a positive reaction of unknown duration are considered to harbor a small number of microorganisms and usually are treated with isoniazid. It is important to inform the client that they should take the medication as directed and not skip doses or stop the medication without discussing it with the physician. The client will not be required to take a short course (10 days) of antibiotics. The urine and tears turn orange when taking rifampin. This does not occur when taking isoniazid. Ethambutol and pyrazinamide are not the typical treatments for the client scenario provided.

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 anticipates which of the following has occurred?

The lesion has eroded blood vessels in the lungs. The earliest symptoms of lung cancer are usually chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes blood vessels.

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse?

The nurse is likely asymptomatic. Latent TB infection is not an active form of TB, and affected individuals are asymptomatic and cannot pass on the disease to others. It does not confer immunity. However, small numbers of organisms may remain viable for years. Later, if immune mechanisms decline or fail, latent TB infection has the potential to develop into secondary TB.

A client seen in the emergency department after a motor vehicle accident complains of increasing shortness of breath. Which manifestations support the diagnosis of a possible left tension pneumothorax? Select all that apply.

Tracheal deviation to the right Hyperresonance on the left Diminished breath sounds on the left Subcutaneous emphysema Tension pneumothorax allows air to compress the lung on the affected side. This pushes the mediastinal organs and trachea to the opposite side. The affected side has hyperresonance and the breath sounds are decreased. The peripheral pulses are not affected by pneumothorax. Subcutaneous emphysema is air under the skin of the chest and neck.

How is the organism causing Legionnaire disease, a form of bronchopneumonia, usually transmitted?

Warm, standing water becomes aerosolized and inhaled The organism frequently is found in water, particularly in warm, standing water. Infection typically occurs when water that contains the pathogen is aerosolized into appropriately sized droplets and is inhaled or aspirated by a susceptible host. E. coli is commonly found in restrooms; fermenting yogurt contains Lactobacillus, which is important for normal digestion; potted plant soil may contain a usually harmless strain of Clostridium bacteria.

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. Emergency treatment of tension pneumothorax involves the prompt insertion of a large-bore needle or chest tube into the affected side of the chest along with one-way valve drainage or continuous chest suction to aid in lung reexpansion. Other listed options may be implemented after the emergency measure.

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. Cystic fibrosis is autosomal recessive, meaning that two defective genes are needed for a child to be born with the disorder. Both parents must either be carriers (having one defective gene, but no symptoms) or have the disease (two defective genes). If both parents are carriers, each child has 1 in 4 chance of receiving two normal genes, a 50 percent chance of inheriting at least one gene, and a 1 in 4 chance of receiving two abnormal genes and having CF.

The term chronic obstructive pulmonary disease (COPD) can be a combination of two types of obstructive airway diseases. Which disease processes have been identified as being part of COPD?

chronic bronchitis and emphysema The term chronic obstructive pulmonary disease (COPD) encompasses two types of obstructive airway disease: emphysema, with enlargement of air spaces and destruction of lung tissue, and chronic obstructive bronchitis, with increased mucus production, obstruction of small airways, and a chronic productive cough. Persons with COPD often have overlapping features of both disorders. Asthma and chronic bronchitis have not been identified as components of COPD. Alpha1-antitrypsin deficiency is a genetic risk factor for COPD (emphysema specifically).

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

client sitting in bed resting elbows on the overbed table, expiratory wheezes noted The client sitting in a tripod position with expiratory wheezes is the most typical presentation for a client with COPD. COPD progresses from relatively mild manifestations in the early stages to severe respiratory impairment where breathing is labored, even at rest. In addition, the expiratory phase is prolonged, and expiratory wheezes and crackles can be auscultated. Use of accessory muscles such as the sternocleidomastoid, scalene, and intercostal muscles is common and the respiratory rate is elevated with activity due to dyspnea on exertion. The client will also use pursed-lip breathing to increase expiratory volume.

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 short of breath due to a:

decreased tidal volume Tidal volume is the amount of air that a person brings in the lungs with one inhalation and exhalation. The pain caused by the fractured ribs will cause a decrease in the tidal volume, due to more shallow respirations, causing the feeling of shortness of breath because less air is entering and leaving the lungs.

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

four (4) The hemoglobin molecule is composed of four polypeptide chains with an iron-containing heme group. Because oxygen binds to the iron atom, each hemoglobin molecule can bind four molecules of oxygen when it is fully saturated.

A client with asthma comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. What is the most likely cause of the decreased carbon dioxide levels?

hyperventilation Nonpharmacologic management of asthma includes relaxation techniques and controlled breathing, which often help to allay the panic and anxiety that aggravate breathing difficulties. The hyperventilation that often accompanies anxiety and panic is known to act as an asthmatic trigger. Hyperventilation by definition results in the excess exhalation of carbon dioxide, leading to respiratory alkalosis. Cyanosis develops if there is a high level of deoxygenated hemoglobin in the arterial circulation but does not cause changes in carbon dioxide levels. Apnea is a lack of respirations which would lead to an elevation of carbon dioxide levels. Heart rate does not influence carbon dioxide levels.

Which is an adverse effect of emboli on pulmonary circulation and airways?

local vasoconstriction The effects of emboli on the pulmonary circulation are related to mechanical obstruction of the pulmonary circulation by the blood clot and associated reflex vasoconstriction. Obstruction of pulmonary blood flow also causes reflex bronchoconstriction (not bronchodilation) in the affected area of the lung, wasted ventilation, impaired gas exchange, and loss of alveolar surfactant. Lower lobe consolidation is associated with pneumonia.

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

loss of intrapleural negative pressure. Intrapleural pressure is always negative in comparison to atmospheric pressure, and this is essential to maintain inflation of the lungs and alveoli. The loss of the negative pressure due to air, blood, fluids, or pus in the pleural space causes the lungs to collapse. The collapse of the right lung would result in decreased or absent breath sounds in that lung.

How will the nurse describe unilateral chest pain associated with respiratory movements?

pleuritic Pleuritis is usually unilateral and tends to be localized to the lower and lateral part of the chest; pain worsens with chest movements, such as deep breathing and coughing that accentuate pressure changes in the pleural cavity and increase movement of the inflamed or injured pleural surfaces. Musculoskeletal pain usually is bilateral and may occur as the result of frequent, forceful coughing. The pain associated with irritation of the bronchi usually is substernal and dull. Myocardial pain usually is located in the substernal area and is not affected by respiratory movements.

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

proceed through the trachea, bronchi, and then bronchioles. Air moves sequentially through the conducting airway, proceeding through the nasal passages, mouth and pharynx, larynx, trachea, bronchi, and bronchioles. The trachea does not contain alveoli. Similarly, gas exchange does not take place in the bronchi. Oxygen does not move from type I alveolar cells then to type II cells; each alveolus contains both types of cells.

The nurse is caring for a client who has a drop in oxygen saturation reading and the nurse suspects physiologic shunting of blood in the respiratory system is occurring. Which condition will the nurse associate as a potential cause of physiologic shunting?

pulmonary edema Physiologic shunting is a term describing conditions that result in a mismatching of ventilation and perfusion within the lung. It is a condition whereby blood from the right side of the heart enters the left side without taking part in any gas exchange. Conditions that impair the ability to pick up oxygen from alveoli contribute to physiologic shunting such as pulmonary edema, which is fluid inside the alveoli. Tachypnea may result from conditions that result in shunt and hypoxemia as a compensatory mechanism but cannot cause shunt. Hypertension does not alter how the oxygen moves from alveoli to the pulmonary capillaries and low blood glucose levels do not directly affect ventilation.

Three days following surgical repair of a hip fracture a client becomes anxious and reports sudden shortness of breath and chest pain that worsens with a deep breath. Which disorder is the client likely experiencing?

pulmonary embolism Pulmonary embolism occurs when a bloodborne substance blocks blood flow through a branch of the pulmonary artery. Substances that can cause this obstruction include air, clots, fat, and amniotic fluid. Manifestations include sudden onset of chest pain, dyspnea, and often includes a feeling of impending doom. Symptoms of pneumonia would include signs of infection. Atelectasis does not typically produce chest pain or anxiety. Bronchiectasis does not have sudden onset.

Clients who have been bedridden for a long time likely will experience:

shallow, quiet breathing, which impairs the spreading of surfactant. At low lung volumes, the molecules of surfactant become tightly packed, and at higher lung volumes, they spread out to cover the alveolar surface. In surgical clients and bedridden persons, shallow and quiet breathing often impairs the spreading of surfactant. Premature infants may require recombinant forms of surfactant to treat infant respiratory distress syndrome. Suctioning cannot be done at the alveolar level. One of the treatments for bedrest clients is cough and deep breathing exercises to enhance the spread of surfactant to prevent atelectasis.

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

stimulation of irritant receptors causes bronchoconstriction. It is possible that irritant receptors are involved in the bronchoconstriction response that occurs in some persons with bronchial asthma when exposed to irritants such as tobacco, smoke, or perfume. A type III hypersensitivity reaction is an immune complex response, which does not exist in this case. Toxins do not normally compete with oxygen for binding sites. Artificial scents do not directly disrupt gas diffusion.

The nurse is calculating the minute volume of a client. Which shows the correct categories of measurement for this calculation?

tidal volume × respiratory rate The minute volume, or total ventilation, is the amount of air that is exchanged in 1 minute (tidal volume multiplied by the respiratory rate). It is determined by the metabolic needs of the body, which during normal activity are about 6000 ml (500 ml TV × respiratory rate of 12 breaths/min). Inspiratory reserve × tidal volume, respiratory rate × heart rate, and total lung capacity × reserve volume are not correct parameters to measure.