Week 8: Pulmonary Disorders (Patho)
A nurse is asked which function of the pulmonary system is carried out by the cardiovascular system. How should the nurse reply? 1. It is osmosis. 2. It is perfusion. 3. It is ventilation. 4. It is metabolism.
2. It is perfusion. Perfusion is carried out by the cardiovascular system. Ventilation and diffusion are carried out by the pulmonary system. Osmosis and metabolism are not functions of the pulmonary system.
The nurse plans to teach a client about oxygen and carbon dioxide. Which information would be appropriate for the nurse to include in the teaching plan? 1. Carbon dioxide is less soluble than oxygen. 2. Oxygen diffuses more quickly than carbon dioxide. 3. The capillary beds do not allow for the exchange of carbon dioxide. 4. Carbon dioxide is eliminated to maintain normal acid-base balance.
4. Carbon dioxide is eliminated to maintain normal acid-base balance. Carbon dioxide is eliminated to maintain normal acid-base balance. Carbon dioxide is more soluble and is diffused more quickly than oxygen. The capillary beds surround the alveoli and allow for easy exchange of oxygen and carbon dioxide.
What is the correct term the nurse should use to describe a client who has a positive tuberculin skin test but is asymptomatic? 1. Stage 1 2. Stage 3 3. Active tuberculosis infection 4. Latent tuberculosis infection
4. Latent tuberculosis infection Latent tuberculosis infection is exposure to a tuberculosis-causing Mycobacterium species with development of immune responsiveness to the organism but with no clinical signs and symptoms of the disease. Active tuberculosis infection would show chest radiograph evidence of infiltrates and clinical signs and symptoms of tuberculosis. Tuberculosis is not defined in stages.
Which information indicates the nurse has an accurate understanding about the major role of neutrophils in acute respiratory distress syndrome (ARDS)? 1. They phagocytize pathogens. 2. They phagocytize alveolar macrophages. 3. They release α1-antitrypsin that degrades alveolar septa. 4. They release inflammatory mediators that damage alveolar-capillary membranes.
4. They release inflammatory mediators that damage alveolar-capillary membranes. In ARDS, neutrophils release inflammatory mediators that damage alveolar-capillary membranes. In ARDS, the major role of neutrophils is not phagocytizing pathogens. In ARDS, neutrophils do not phagocytize alveolar macrophages. α1-antitrypsin is not a major part of the pathophysiology of ARDS, but a deficiency can be an inheritable form of emphysema.
Which clients will have a shift to the left in their oxyhemoglobin dissociation curve? Select all that apply. 1. A client with hypocapnia 2. A client with hypothermia 3. A client that has alkalosis 4. A client with increased Paco2 5. A client with increased levels of 2,3-diphosphoglycerate
1. A client with hypocapnia 2. A client with hypothermia 3. A client that has alkalosis A shift to the left is caused by alkalosis (high pH) and hypocapnia, hypothermia, and decreased levels of 2,3-diphosphoglycerate. A shift to the right is caused by acidosis (low pH) and hypercapnia (increased Paco2), hyperthermia, and increased levels of 2,3-diphosphoglycerate.
A nurse is teaching a client about the structures that compose the conducting airways. Which structures should the nurse include in the teaching session? Select all that apply. 1. Bronchi 2. Trachea 3. Oropharynx 4. Nasopharynx 5. Alveolar ducts
1. Bronchi 2. Trachea 3. Oropharynx 4. Nasopharynx Structures that compose the conducting airways include the trachea, bronchi, oropharynx, and nasopharynx. The alveolar ducts are not included as a structure of the conducting airways; they are a component of the acinus.
A client is admitted with tachypnea, absent breath sounds on the affected side, hyperresonance on the affected side, tracheal deviation, and sudden chest pain. Which primary piece of equipment should the nurse obtain to assist the primary healthcare provider in management of this condition? 1. Chest tube 2. Thermometer 3. Electrocardiograph 4. Blood pressure cuff
1. Chest tube Pneumothorax is treated with insertion of a chest tube that is attached to a water-seal drainage system with suction. Clinical features of a pneumothorax include tachypnea, decreased or absent breath sounds on the affected side, hyperresonance on the affected side, tracheal deviation, and sudden chest pain. A thermometer and blood pressure cuff would not be as helpful in resolving the pneumothorax as a chest tube. An electrocardiograph would help determine heart problems, not lung problems.
A nurse is teaching a client about the functions of the pulmonary circulation. Which functions should the nurse include in the teaching session? Select all that apply. 1. Facilitates gas exchange 2. Delivers nutrients to lung tissue 3. Provides nutrients to the pleurae 4. Acts as a reservoir for the right ventricle 5. Filters and removes clots from the circulation
1. Facilitates gas exchange 2. Delivers nutrients to lung tissue 5. Filters and removes clots from the circulation The pulmonary circulation facilitates gas exchange, delivers nutrients to lung tissue, and filters/removes clots from the circulation. The pulmonary circulation is a reservoir for the left ventricle, not the right ventricle. The bronchial circulation, not the pulmonary circulation, provides nutrients to the pleurae.
Which information by the client indicates teaching was successful about the purposes of the upper airway? Select all that apply. 1. Filters inspired gas 2. Warms inspired gas 3. Humidifies inspired gas 4. Exchanges inspired gas 5. Removes foreign particles
1. Filters inspired gas 2. Warms inspired gas 3. Humidifies inspired gas 5. Removes foreign particles These upper airway structures are lined with a ciliated mucosa that warms, filters, and humidifies inspired air and removes foreign particles from it. Gas exchange occurs in the alveoli, not in the upper respiratory system.
A nurse is asked how tuberculosis is spread from person to person. What is the nurse's best response? 1. From airborne droplets 2. From undercooked food 3. From contaminated water 4. From lack of handwashing
1. From airborne droplets Tuberculosis is highly contagious and is transmitted from person to person in airborne droplets. Contaminated water can lead to hepatitis, not tuberculosis. Lack of handwashing can lead to infection, but not from tuberculosis. Undercooked food can lead to food poisoning, not tuberculosis.
A nurse is teaching the staff about lung receptors that send impulses from the lungs to the dorsal respiratory group. Which examples should the nurse include in the teaching session? Select all that apply. 1. J-receptors 2. Baroreceptors 3. Chemoreceptors 4. Stretch receptors 5. Irritant receptors
1. J-receptors 4. Stretch receptors 5. Irritant receptors The lung receptors that send impulses from the lungs to the dorsal respiratory group include the J-receptors, stretch receptors, and irritant receptors. Baroreceptors help the cardiovascular system. Chemoreceptors monitor the pH, pressure of carbon dioxide (PaCO2), and pressure of oxygen (PaO2) in the arterial blood, not in the lungs themselves.
If a client's bronchial circulation is damaged, which areas will have a lack of nutrients? Select all that apply. 1. Pleural membrane 2. Conducting airways 3. Gas exchange units 4. Pulmonary capillaries 5. Large pulmonary vessels
1. Pleural membrane 2. Conducting airways 5. Large pulmonary vessels The bronchial circulation is part of the systemic circulation and supplies nutrients to the conducting airways, the pleural membrane, and the large pulmonary vessels. The bronchial circulation does not provide nutrients to the pulmonary capillaries or gas exchange units; these are the functions of the pulmonary circulation.
A nurse is teaching the staff about cellular structures that are present in a client's alveoli. Which information should the nurse include in the teaching session? Select all that apply. 1. Surfactant 2. Ciliated cell 3. Mucous layer 4. Type I alveolar cell 5. Type II alveolar cell 6. Alveolar macrophage
1. Surfactant 4. Type I alveolar cell 5. Type II alveolar cell 6. Alveolar macrophage The alveoli contain both Type I and Type II alveolar cells, surfactant, alveolar macrophages, and a basement membrane. Cilia and a mucous layer are located in the trachea, bronchus, and bronchioles, not in the alveoli.
Which age-related changes to the pulmonary system does the nurse consider when planning care for an older adult? Select all that apply. 1. Ventilatory capacity declines. 2. Lung compliance decreases. 3. Pulmonary capillary network decreases. 4. Early airway closure inhibits expiratory flow. 5. Respiratory muscle strength and endurance irreversibly decrease. 6. Sensitivity of respiratory centers to hypoxia or hypercapnia decreases.
1. Ventilatory capacity declines. 3. Pulmonary capillary network decreases. 4. Early airway closure inhibits expiratory flow. 6. Sensitivity of respiratory centers to hypoxia or hypercapnia decreases. Several age-related changes occur in the older adult, including decreases in ventilatory capacity, pulmonary capillary networks, and sensitivity of respiratory centers to hypoxia or hypercapnia. Early airway closure inhibits expiratory flow. Lung compliance increases, not decreases. Although respiratory muscle strength and endurance tend to decrease with age, they can be strengthened by exercise.
A nurse is teaching about examples of chronic obstructive pulmonary disease (COPD). Which diseases should the nurse include? Select all that apply. 1. Asthma 2. Emphysema 3. Pneumonia 4. Pulmonary fibrosis 5. Chronic bronchitis
2. Emphysema 5. Chronic bronchitis Together, emphysema and chronic bronchitis are referred to as COPD because they often occur together.
A client is experiencing hypoventilation. The nurse expects which laboratory result? 1. Hypocapnia 2. Hypercapnia 3. Respiratory alkalosis 4. Elevated D-dimer levels
2. Hypercapnia With hypoventilation, CO2 removal is slower than CO2 production, and the level of CO2 in the arterial blood (Paco2) increases, causing hypercapnia (Paco2 greater than 44 mm Hg), not hypocapnia. This results in respiratory acidosis, not alkalosis, which can affect the function of many tissues throughout the body. Elevated D-dimer levels occur with pulmonary embolism, which leads to hyperventilation, not hypoventilation; arterial blood gases are used to detect hypocapnia and hypercapnia.
A client has a reduced Pao2. Which term should the nurse use to describe this finding? 1. Hypoxia 2. Hypoxemia 3. Hemoptysis 4. Hematemesis
2. Hypoxemia Hypoxemia, or reduced oxygenation of arterial blood (reduced Pao2), is caused by respiratory alterations, whereas hypoxia is reduced oxygenation of cells in tissues. Hemoptysis is the expectoration of blood or bloody secretions; this is sometimes confused with hematemesis, which is the vomiting of blood.
The nurse teaches a student nurse about the pathogenesis of bronchitis. Which information by the student indicates teaching was successful? 1. It causes decreased secretion of mucus. 2. It is characterized by airway inflammation. 3. Presents with occasional nonproductive cough. 4. There is decreased responsiveness to environmental stimuli.
2. It is characterized by airway inflammation. Bronchitis is characterized by airway inflammation as a result of inspired irritants. Hypersecretion of mucous along with a productive cough are seen for at least 3 months of the year for two consecutive years. There is a hyperresponsiveness to stimuli, not decreased.
The nurse is teaching a client about the functions of surfactant. Which information should the nurse include in the teaching session? 1. It increases surface tension. 2. It keeps the alveoli free of fluid. 3. It allows the muscles to move freely. 4. It functions to inhibit normal gas exchange.
2. It keeps the alveoli free of fluid. The decrease in surface tension caused by surfactant also is responsible for keeping the alveoli free of fluid. Surfactant lines the alveoli and reduces surface tension. It is critical for maintaining alveolar expansion and allows for normal gas exchange. Surfactant prevents alveolar collapse at the end of each exhalation. It does not affect muscles, but it does affect alveoli.
Which structure in the pulmonary system protects a client against bacterial invasion of the alveoli? 1. Cilia 2. Mucous blanket 3. Alveolar macrophages 4. Upper respiratory tract mucosa
3. Alveolar macrophages The alveolar macrophages phagocytize (ingest and destroy) bacteria and other foreign materials from the alveoli. The cilia propel the mucous blanket and foreign particles trapped in the mucous to the oropharynx, where they are swallowed or expectorated. The mucous blanket protects the trachea and bronchi from injury and traps most foreign particles and bacteria that reach the lower airways. The upper respiratory tract mucosa maintains a constant temperature and humidification of gas entering the lungs and traps and removes foreign particles, some bacteria, and noxious gases from inspired air.
A client reports breathlessness when exercising. Which term should the nurse use to describe this finding? 1. Orthopnea 2. Retractions 3. Dyspnea on exertion 4. Paroxysmal nocturnal dyspnea
3. Dyspnea on exertion Often the first episode of dyspnea (breathlessness) occurs with exercise and is called dyspnea on exertion. This type of dyspnea is common to many pulmonary disorders. Orthopnea is dyspnea that occurs when an individual lies flat. Some individuals with pulmonary or cardiac disease awake at night gasping for air and have to sit or stand to relieve the dyspnea (paroxysmal nocturnal dyspnea). Although the client may experience retractions, a pulling back of the intercostal spaces, retraction is not the term used to describe breathlessness when exercising.
A nurse is discussing the tendency of the lungs to return to the resting state after inspiration. Which term should the nurse use to describe this process? 1. Collectins 2. Compliance 3. Elastic recoil 4. Surface tension
3. Elastic recoil Elastic recoil is the tendency of the lungs to return to their resting state after inspiration. A group of surfactant proteins consists of large hydrophilic molecules called collectins, but these are not the source of elasticity. Compliance represents the relative ease with which the lungs and chest wall can be stretched and is therefore the opposite of elasticity. Surface tension occurs at any gas-liquid interface and refers to the tendency for liquid molecules that are exposed to air to adhere to one another.
A nurse is asked how air moves into the lung during quiet inspiration. How should the nurse respond? 1. From dilation of the primary bronchi 2. From an increased pressure in the alveoli 3. From muscular contraction of the diaphragm 4. From lowering of the ribs by the accessory muscles
3. From muscular contraction of the diaphragm Contraction of the diaphragm is the primary driving force for inhalation during quiet breathing. When it contracts and flattens downward, it increases the volume of the thoracic cavity, creating a negative pressure that draws gas into the lungs through the upper airways and trachea. Bronchodilation decreases airway resistance and increases airflow into the lung, but it does not draw air into the lung. The accessory muscles of inspiration lift the ribs rather than lower them. Their role is more important during vigorous inspiration than quiet inspiration. Diffusion occurs in the alveoli.
What information will the nurse include when educating a client regarding the diagnosis of pneumothorax? 1. It is the presence of liquid in the pleural space. 2. It is the presence of pus in the pleural space. 3. It is the presence of air in the pleural space. 4. It is the presence of blood in the pleural space.
3. It is the presence of air in the pleural space. Pneumothorax is the presence of air or gas in the pleural space. Empyema is the presence of pus in the pleural space. Pleural effusion is the presence of liquid (such as blood) in the pleural space.
Which client condition most commonly results in pulmonary edema? 1. Dehydration 2. Adequate surfactant 3. Left-sided heart disease 4. Permanent enlargement of acini
3. Left-sided heart disease The most common cause of pulmonary edema is left-sided heart disease. When the left ventricle fails, filling pressures on the left side of the heart increase. Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis. Adequate surfactant would help prevent pulmonary edema. Dehydration would lead to a lack of fluids, not an excess.
Which person is most at risk for developing a pulmonary embolism? 1. A 25-year-old man with asthma 2. A 42-year-old woman with a broken arm 3. A 28-year-old woman who is immobilized for 1 week 4. A 67-year-old man with a deep vein thrombosis in the femoral vein
4. A 67-year-old man with a deep vein thrombosis in the femoral vein The presence of deep vein thrombosis in the lower limbs is the most important risk factor for pulmonary embolism. Asthma is not a specific risk factor for pulmonary embolism. Although bone fracture and limb immobilization are risk factors for pulmonary embolism, most pulmonary emboli originate from the veins in the lower limbs. The risk of developing blood clots and pulmonary emboli after being immobilized for 1 week is not as high a risk factor as a deep vein thrombosis in the leg
Which clinical finding will allow the nurse to determine that the client is experiencing acute bronchitis rather than pneumonia? 1. Malaise 2. Coughing 3. Fever with chills 4. No infiltrates on the chest radiographs
4. No infiltrates on the chest radiographs Although many of the clinical manifestations of acute bronchitis are similar to those of pneumonia (i.e., fever, cough, chills, malaise), chest radiographs show no infiltrates. Pneumonia will have infiltrates visible on the chest radiographs.
A client is born with an α1-antitrypsin deficiency. Which condition will most likely manifest? 1. Pneumonia 2. Lung abscess 3. Pulmonary fibrosis 4. Primary emphysema
4. Primary emphysema Primary emphysema, which accounts for 1% to 3% of all cases of emphysema, is commonly linked to an inherited deficiency of α1-antitrypsin. Pneumonia is infection of the lower respiratory tract and is not associated with a deficiency of α1-antitrypsin. An abscess is a circumscribed area of suppuration and destruction of lung parenchyma and is caused by inflammation and infection. Pulmonary fibrosis is an excessive amount of fibrous or connective tissue in the lung.
A nurse is teaching the staff about pulmonary circulation. Which information should the nurse include in the teaching session? Select all that apply. 1. Both pulmonary arteries and veins enter the lung at the hila. 2. Both pulmonary arteries and veins branch to accompany individual alveoli. 3. Both pulmonary arteries and veins are dispersed regularly throughout the lungs. 4. Pulmonary veins are much more randomly dispersed in the lung than the pulmonary arteries. 5. The pulmonary arteries enter the lungs at the hila; the pulmonary veins leave the lungs at the hila. 6. Pulmonary arteries branch to accompany individual alveoli; pulmonary veins drain several capillaries.
4. Pulmonary veins are much more randomly dispersed in the lung than the pulmonary arteries. 5. The pulmonary arteries enter the lungs at the hila; the pulmonary veins leave the lungs at the hila. 6. Pulmonary arteries branch to accompany individual alveoli; pulmonary veins drain several capillaries. The pulmonary arteries enter the lungs at the hila; the pulmonary veins leave the lung at the hila. Both do not enter at the hila. The pulmonary artery branches with each main bronchus and with all bronchi at every division; every bronchus and bronchiole has an accompanying artery or arteriole while each pulmonary vein drains several pulmonary capillaries. Both do not accompany individual alveoli. Unlike the pulmonary arteries, pulmonary veins are dispersed randomly throughout the lung; both are not regularly dispersed throughout the lungs.
Which clinical manifestations will the nurse typically find in a client with an infected parietal pleura? 1. Hematemesis and eupnea 2. Bloody sputum and clubbing 3. Enlarged finger tips and cyanosis 4. Stabbing pain and pleural friction rub
4. Stabbing pain and pleural friction rub Infection and inflammation of the parietal pleura (pleurodynia) cause sharp or stabbing pain usually localized to a portion of the chest wall, where a unique breath sound called a pleural friction rub may be heard over the painful area. Hemoptysis (bloody sputum) is the coughing up of blood or bloody secretions, usually as a result of infection or inflammation that damages the bronchi (bronchitis, bronchiectasis) or the lung parenchyma (pneumonia, tuberculosis, lung abscess). Clubbing is the selective bulbous enlargement of the end (distal segment) of a digit (finger or toe). Clubbing is commonly associated with diseases that cause chronic hypoxemia, such as bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and congenital heart disease. Hematemesis is vomiting blood, and eupnea is normal breathing.