Adult Health I Chapter 8

The pressure exerted by each type of gas, such as oxygen or carbon dioxide, in a mixture of gases

Partial pressure

A patient exhibits cyanosis when how much hemoglobin is unoxygenated?

5.0 g/dL

The alveoli begin to lose elasticity about age ____ years, resulting in decreased gas diffusion.

50

A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation but allows no reserve for situations that threaten ventilation. A safe but low oxygen saturation level is:

40 mm Hg

Inspection of a patient's skin color is part of the assessment of the integumentary system. Cyanosis, which is a late indicator of hypoxia is present when the unoxygenated hemoglobin level is:

5 g/dL

External respiration requires the coordination of three processes: ______, ______, and ______.

Ventilation, perfusion, and diffusion

During inspiration, the pressure in the alveoli and airways must be less than atmospheric pressure. Therefore, atmospheric pressure should be ______ mm Hg; intrapulmonary pressure should be _____ mm Hg; and intrapleural pressure should be _____ mm Hg for inspiration to occur.

760 mm Hg; 757 mm Hg; 750 mm Hg

Describe the function of the epiglottis

A flap of cartilage that covers the opening of the larynx during swallowing.

Crepitus or subcutaneous emphysema refers to ______.

Air bubbles present in the subcutaneous tissues or underlying muscle. Upon palpation, the sensation of bubbles under the fingers can be felt and occasionally crackling can be heard.

What is the function of the Type II alveolar cells?

Alveolar cells that are metabolically active. These cells secrete surfactant.

The nurse inspects the thorax of a patient with advanced emphysema. The nurse expects chest configuration changes consistent with a deformity known as:

Barrel chest

Choose the initial part of the respiratory tract that is NOT CONSIDERED part of the gas-exchange airways.

Bronchioles

A patient diagnosed with a pulmonary embolism would be expected to have which type of ventilation-perfusion?

Dead space

Lung compliance (the ability of the lungs to stretch) is a physical factor that affects ventilation. A nurse is aware that a patient who has lost elasticity in the lung tissue has a condition known as:

Emphysema

Which of the following disease processes cause increased compliance?

Emphysema

Airflow into the lungs during inspiration depends on:

Enlargement of the thoracic cavity; lowered intrathoracic pressure; relaxation of the diaphragm

A patient with sinus congestion points to a location on the inside of his eye as the area of pain. The nurse documents that the patient is complaining of pain in which sinus?

Ethmoid

True or False. Blood from the lung is usually dark red and mixed with sputum.

False

True or False. Cyanosis is a early indicator of hypoxia.

False

True or False. Wheezing can only be heard with a stethoscope.

False

A patient is seen in the emergency room for a severe case of diabetic acidosis. The respiratory note indicates the presence of Kussmaul's respirations. The nurse knows that this diagnosis is associated with which of the following?

Hyperventilation

A pediatrician diagnosed a child with swollen and inflamed adenoids. The nurse practitioner confirmed the diagnosis by:

Inspecting the roof the nasopharynx

A patient diagnosed with diabetic ketoacidosis would be expected to have which type of respiratory pattern?

Kussmaul respirations

Minute ventilation, the volume of air expired per minute is measured by ______.

Multiplying the tidal volume in liters by the respiratory rate or frequency

Explain how oxygen is carried in the blood.

Oxygen is carried in the blood dissolved in plasma or combined with hemoglobin. The higher the PaO2, the greater the amount of dissolved oxygen.

The symbol used to identify the partial pressure of oxygen is:

PAO2

A patient describes his chest pain as knife-like on inspiration. Which of the following is the most likely diagnosis?

Pleurisy

During a preadmission assessment, the nurse finds increased tactile fremitus. She knows this sign is consistent with which of the following diagnoses?

Pneumonia

Percussion sounds are dull to flat in these three disorders: ______, ______, and ______.

Pneumonia, pleural effusion, and atelectasis

Gas exchange between the lungs and blood and between the blood and tissues is called:

Respiration

Refers to gas exchange between atmospheric air and blood and between the blood and the cells of the body.

Respiration

In which positions should the patient be placed for a thoracentesis?

Sitting on the edge of the bed

Deep, low-pitched rumbling sounds heard primarily during expiration.

Sonorous wheezes (rhonchi)

Name two centers in the brain that are responsible for the neurologic control of ventilation.

The apneustic center in the lower pons, and the pneumotaxic center in the upper pons.

Explain what the nurse should do with the collected fluid of a thoracentesis.

The nurse should record the total amount of fluid withdrawn from the procedure and document the nature of the fluid, its color, and its viscosity. If indicated, prepare samples of fluid for laboratory evaluation. A specimen container with formalin may be needed for a pleural biopsy.

Explain how to assess for tactile fremitus.

The patient is asked to repeat "ninety-nine" or "one, two, three", or "eee, eee, eeee" as the nurse's hands move down the patient's thorax, comparing vibrations from similar areas. The vibrations are detected with the palmar surfaces of the fingers and hands, or the ulnar aspect of the extended hands, on the thorax. Bony areas are not tested.

Choose the alveolar cells that secrete surfactant.

Type II cells

A patient's lung volumes and capacities were assessed to help determine the cause of a respiratory problem. Which of the following findings are indicative of chronic obstructive pulmonary disease (COPD)?

Vital capacity of 3,000 mL

Hemoptysis, a symptom of cardiopulmonary disorders, is characterized by:

a coffee ground appearance

The nurse is aware that possible complications of bronchoscopy include:

aspiration, infection, and pneumothorax

List four conditions that are influenced by genetic factors that affect respiratory function.

asthma, COPD, cystic fibrosis, and alpha-1 antitrypsin deficiency

Nursing assessment for a patient with chest pain includes:

determining whether there is a relationship between the pain and the patient's posture; evaluating the effect of the phases of respiration on the pain; looking for factors that precipitate the pain

The nurse inspects the thorax of a patient with advanced emphysema. The nurse expects chest configuration change consistent with a deformity known as:

barrel chest

Nursing observations after the thoracentesis include assessment for:

blood-tinged mucus; signs of hypoxemia; tachycardia

On auscultation, the nurse would expect to find wheezes for these three disorders: ______, ______, and ______.

bronchitis, asthma, and pulmonary edema

direct examination of larynx, trachea, and bronchi using an endoscope

bronchoscopy

The exchange of oxygen and carbon dioxide at the alveolar-capillary membrane.

diffusion

The exchange of oxygen and carbon dioxide from the alveoli into the blood occurs by:

diffusion

Lung function is viewed in terms of lung volumes and lung __________.

capacities

A term to describe the fine hairs in the nose.

cilia

short hairs that provide a constant whipping motion that serves to propel mucus and foreign substances away from the lung and toward the larynx

cilia

Discontinuous popping sounds heard in early inspiration.

coarse crackles

Crackles, noncontinguous breath sounds, would be assessed for a patient with:

collapsed alveoli

A term to describe the elasticity and distensibility of the lungs and the thoracic structures.

compliance

__________ is a measure of the elasticity, expandability, and distensibility of the lungs and thoracic structures.

compliance

Noncontinuous breath sounds that are called rales.

crackles

soft, high-pitched, discontinuous popping sounds during inspiration caused by delayed reopening of the airways

crackles

Soft, high-pitched, discontinuous popping sounds that occur during inspiration.

crackles in general

Gerontologic changes in the respiratory system are:

decreased gag reflex, increased presence of collagen in alveolar walls, decreased presence of mucus

labored breathing or shortness of breath

dyspnea

List six major signs and symptoms of respiratory disease.

dyspnea, cough, sputum production, chest pain, wheezing, and hemoptysis

blood spit up from the respiratory tract

hemoptysis

For the thoracentesis, the patient is assisted to any of the following positions:

lying on the unaffected side with the bed elevated 30 to 40 degrees; sitting on the edge of the bed with the feet supported and the arms and head on a padded overbed table; straddling a chair with the arms and head resting on the back of the chair

The respiratory system is composed of the: _____, _____, _____, and _____.

upper and lower respiratory tracts, blood vessels, thoracic cage (spine, ribs, and sternum), and the respiratory muscles, chiefly the diaphragm.

This term describes the movement of air from the atmosphere to the alveoli.

ventilation

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. This means that:

ventilation exceeds perfusion

continuous musical sounds associated with airway narrowing or partial obstruction

wheeze

Breath sounds that are continuous and musical sounding.

wheezes

Breath sounds that originate in the smaller bronchi and bronchioles and are high-pitched, sibilant, and musical are called:

wheezes

Nursing instructions for a patient who is scheduled for a perfusion lung scan should include informing the patient that:

a mask will be placed over his or her nose and mouth during the test; he or she will be expected to lie under the camera; the imaging time will amount to 20 to 40 minutes

During a preadmission assessment, the nurse would expect to find decreased tactile fremitus and hyperresonant percussion sounds with a diagnosis of:

emphysema

The maximum volume of air that can be inhaled after a normal inhalation is known as:

expiratory reserve volume

Discontinuous popping sounds heard late in inspiration.

fine crackles

A physician wants a study of diaphragmatic motion because of suspected pathology. The physician would most likely order a:

fluoroscopy

The nurse should advise the patient who is scheduled for bronchoscopy that he or she will:

have his or her nose sprayed with a topical anesthetic; be required to fast before the procedure; receive preoperative medication

The pulmonary circulation is considered a:

high-pressure, high-resistance system

Low oxygen saturation

hypoxemia

decrease in arterial oxygen tension in the blood

hypoxemia

decrease in oxygen supply to the tissues and cells

hypoxia

Nursing responsibilities before a thoracentesis should include:

informing the patient about pressure sensations that will be experienced during the procedure; making sure that chest roentgenograms ordered in advance have been completed; seeing that the consent form has been explained and signed

Nursing directions to a patient from whom a sputum specimen is to be obtained should include:

initially clear his or her nose and throat; take a few deep breaths before coughing; use diaphragmatic contractions to aid in the expulsion of sputum

This term is frequently used to describe the "voice box".

larynx

List five risk factors for hypoventilation: ______, _______, ______, _______, and ______.

limited neurologic impulses transmitted from the brain, depressed respiratory centers, limited thoracic movement, limited lung movement, and reduced functional lung tissue.

The __________ is the middle of the thorax between the pleural sacs.

mediastinum

__________ ventilation is the volume of air expired per minute.

minute

The purpose of the cilia is to:

move the mucus back to the larynx

Nursing measures before the bronchoscopy include:

obtaining an informed consent; supplying information about the procedure; withholding food and fluids for 6 hours before the test

The left lung, in contrast to the right lung has:

one less lobe

The inability to breathe unless sitting or standing.

orthopnea

shortness of breath when lying flat

orthopnea

Because a bronchoscopy was ordered, the nurse knows that the suspected lesion WAS NOT in the:

pharynx

The lungs are enclosed in a serous membrane called the _____.

pleura

blood flow through the pulmonary vasculature

pulmonary perfusion

gas exchange between atmospheric air and the blood, and between the blood and the cells of the body

respiration

Nursing intervention includes exposing the entire chest even though the thoracentesis site is normally in the midclavicular line between the:

second and third intercostal spaces

Continuous, musical, high-pitched, whistle-like sounds heard during inspiration and expiration.

sibilant wheezes

When taking a respiratory history, the nurse should assess:

the previous history of lung disease in the patient or family; occupational and environmental influences; smoking and exposure to allergies

Bacterial pneumonia can be indicated by the presence of:

thin, mucoid sputum

aspiration of fluid or air from the pleural space

thoracentesis

Tidal volume, which may not significantly change with disease, has a normal value of approximately:

1,000 mL

A nurse is aware that crackles, noncontiguous breath sounds, are assessed for a patient with:

Pulmonary fibrosis

Normally, approximately what percentage of the blood pumped by the right ventricle does not peruse the alveolar capillaries?

2

What is the function of the Type III alveolar cells?

Alveolar cell macrophages are large phagocytic cells that ingest foreign matter, such as mucus and bacteria, and act as an important defense mechanism.

What is the function of the Type I alveolar cells?

Alveolar epithelial cells that form the alveolar walls.

A patient visited a health care clinic for treatment of upper respiratory tract congestion, fatigue, and sputum production that was rust-colored. Which of the following diagnoses is likely based on this history and inspection of the sputum?

An infection with pneumococcal pneumonia

Describe four common phenomena that may alter bronchial diameter and cause increased airway resistance.

Contraction of bronchial smooth muscle (asthma), thickening of the bronchial mucosa (chronic bronchitis), obstruction of the airway (mucus, a tumor, or a foreign body), and loss of lung elasticity (emphysema).

Exchange of oxygen and carbon dioxide at the air-blood interface

Diffusion

A patient with sinus congestion points to the area on the inside of the eye as a point of pain. The nurse knows that the patient is referring to which sinus?

Ethmoidal

List seven conditions that cause low compliance or distensibility of the lungs.

Morbid obesity, atelectasis, pneumothorax, hemothorax, pulmonary fibrosis or edema, pleural effusion, and acute respiratory distress syndrome

The arterial blood gas measurement that best reflects the adequacy of alveolar ventilation is the:

PaCO2

A young adult visited a clinic because he was injured during a softball game. He told the nurse that the ball struck him in his "Adam's apple". To assess the initial impact of injury, the nurse should:

Palpates the thyroid cartilage

List four of the six risk factors for respiratory disease: ______, ______, ______, and ______.

Smoking (the single most important contributor to lung disease); exposure to secondhand smoke; personal or family history of lung disease; genetic make-up; allergens and environmental pollutants; recreational and occupational exposure

A hospitalized patient is asked to describe his dyspnea as objectively as possible. He states that he has to stop to breathe after walking about 100 yards on a level path. On a grade of 0 to 4, the nurse documents his symptoms as a grade:

Three

True or False. A productive cough is considered more than 30 mL/day of sputum.

True

True or False. Clubbing of the fingers is found in patient with chronic hypoxic conditions.

True

List the order of the division of the lung lobe, beginning at the mainstem bronchi.

lobar bronchi, segmented bronchi, subsegmented bronchi, and bronchioles

Harsh, crackling sounds, like two pieces of leather being rubbed together.

pleural friction rub

Chest pain described as knifelike on inspiration would most likely be diagnostic of:

pleurisy

movement of air in and out of the airways

Ventilation

A nurse practitioner diagnosed a patient with an infection in the maxillary sinuses. Select the area that the nurse palpated to make that diagnosis.

Above the eyebrows

The nurse auscultated a patient's middle lobe of the lungs for abnormal breath sounds. To do this, the nurse placed the stethoscope on the:

Anterior surface of the right side of the chest, between the fourth and fifth rib.

Compare the appearance of blood from a pulmonary hemorrhage to blood that is vomited.

Blood from the lungs is usually bright red, frothy, and mixed with sputum. This blood has an alkaline pH, greater than 7.0. Whereas, if the hemorrhage is in the stomach, the blood is vomited (hematemesis) rather than coughed up. Blood that has been in contact with gastric juice is sometimes so dark that it is referred to as "coffee grounds". This blood has an acid pH, less than 7.0.

Explain why the hypoxic drive is less sensitive in those with COPD.

Chemoreceptors no longer respond to PaCO2 or pH in patients with COPD because of the persistent high levels of PaCO2 that exist with this disorder. Therefore, the primary drive to breathe comes from a low oxygen level rather than a high level of carbon dioxide. If oxygen is administered at a high enough rate to raise the PaO2 to normal, there is a risk of obliterating the hypoxic drive. Therefore, low-flow oxygen is administered to a patient with COPD, while the nurse carefully assesses for complications.

Characterized by alternating episodes of apnea, or cessation of breathing, and periods of deep breathing. It is usually associated with heart failure and damage to the respiratory center.

Cheyne-Stokes respirations

For air to enter the lungs (process of ventilation), the intrapulmonary pressure must be less than atmospheric pressure so air can be pulled inward. Select the movement of respiratory muscles that make this happen during inspiration.

Diaphragm contracts and elongate the chest cavity

an exchange of gas molecules from areas of high concentration to areas of low concentration

Diffusion

A patient presented to a clinic with a cough suggestive of pneumonia. Which of the following describes the expected characteristic of the cough?

Hacking with sputum production

The actual flow of blood through the pulmonary circulation

Pulmonary perfusoin

What is the sequence of the mechanics of ventilation?

The diaphragm contracts during inspiration; the lungs are pulled in a downward and forward direction; the diaphragmatic pull elongates the chest cavity; the external intercostal muscles contract to raise the ribs; intrapulmonary pressure is decreased to less than atmospheric pressure; air rushes into the lungs

Describe how a patient would be positioned for a thoracentesis.

The nurse should position the patient comfortable with adequate supports. If possible, place the patient upright or in one of the following positions: 1) Sitting on the edge of the bed with the feet supported and arms and head on a padded over-the-bed table; 2) Straddling a chair with arms and head resting on the back of the chair; 3) Lying on the unaffected side with the head of the bed elevated 30 to 45 degrees if unable to assume a sitting position.

Refers to the movement of air in and out of the airways

Ventilation

Explain what is meant by a ventilation-perfusion ratio.

Ventilation is the flow of gas in and out of the lungs normally at a rate of 4 liters per minute and perfusion is the filing of the pulmonary capillaries with blood normally at a rate of 5 liters per minute. Therefore, the alveolar ventilation to capillary perfusion ratio is 4:5 or 0.8. Adequate gas exchange depends on adequate ventilation-perfusion ratio.

Explain why an ultrasound is obtained prior to a thoracentesis.

When performed under an ultrasound, it has a lower rate of complications than when it is performed without ultrasound guidance, including a decrease in postprocedure pneumothorax from 18% to 3%. If fluid is isolated in a pocket of pleural fluid, ultrasound scans are performed to help select the best site for needle aspiration.

The divisions of the lung lobe proceed in the following order, beginning at the mainstem bronchi:

lobar bronchi, segmented bronchi, subsegmented bronchi, bronchioles

A chest x-ray film is usually ordered after the thoracentesis to rule out:

pneumothorax

The rhythm of breathing is controlled by the medulla oblongata and __________.

pons

Uneven perfusion of the lung is primarily due to:

pulmonary artery pressure; gravity; alveolar pressure

Which of the following are age-related structural and functional changes that occur in the respiratory system?

Decreased elasticity of the alveolar sacs, increased residual volume, increased diameter of the alveolar ducts, increased thickness of alveolar sacs

A patient exhibited signs of an altered ventilation-perfusion ratio. The nurse is aware that adequate ventilation but impaired perfusion exists when the patient has which of the following conditions?

Pulmonary embolism

The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months' duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely?

Asthma

Describe immediate, post-procedure nursing assessments for a thoracentesis.

Immediate postprocedure nursing assessments include monitoring the patient at intervals for increasing respiratory rate; increased dyspnea; asymmetry in respiratory movement; faintness; vertigo; tightness in the chest; uncontrollable cough; blood-tinged, frothy mucus; a rapid pulse; and signs of hypoxemia.