Chapter 8 - Respiratory Function

The nurse is providing care for a number of patients who are receiving treatment for health problems that have a respiratory etiology. Which of the following patients is most likely to benefit from the administration of a PO or IV diuretic? A patient who presents with a barrel chest A patient who has crackles on auscultation A patient who has a sibilant wheeze A patient who has recently complained of chest pain

A patient who has crackles on auscultation Crackles are generally secondary to fluid in the airways or alveoli. Consequently, diuretic may be of benefit in the treatment of some of the health problems associated with the development of crackles. A barrel chest is associated with emphysema, which is treated with diuretics. As well, wheezes and chest pain are not assessment findings that normally suggest a need for diuresis.

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: Posterior surface of the left side of the chest, near the sixth rib. Anterior surface of the right side of the chest, between the fourth and fifth rib. Posterior surface of the right side of the chest, near T3. Anterior surface of the left side of the chest, near the sixth rib.

Anterior surface of the right side of the chest, between the fourth and fifth rib. The middle lobe of the lung is only found on the right side of the thorax and can only be assessed anteriorly. It is located at the fourth rib, at the right sternal border and extends to the fifth rib, in the midaxillary line.

Which of the following disease processes cause increased compliance? Emphysema Pulmonary fibrosis Pulmonary edema Acute respiratory distress syndrome

Emphysema High or increased compliance occurs if the lungs have lost their elasticity (cannot return to normal state) and the thorax is overdistended, as in emphysema. Low or decreased compliance occurs if the lungs and thorax are "stiff" (difficult to stretch). Conditions associated with decreased compliance include pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS).

A nurse is obtaining a health history from a client who reports hemoptysis for the past 2 months. The client reports occasional dyspnea. Which imaging study, ordered by the physician, will view the thoracic cavity while in motion? Fluoroscopy Chest x-ray Magnetic resonance imaging (MRI) Computed tomography (CT) scan

Fluoroscopy Fluoroscopy enables the physician to view the thoracic cavity with all of its contents in motion. A fluoroscopy more precisely diagnoses the location of a tumor or lesion. An x-ray shows the size, shape, and position of the lungs. An MRI and CT produce axial views of the lungs.

A client is seen in the emergency room for a case of diabetic acidosis with the presence of Kussmaul respirations. What client condition is associated with the presence of Kussmaul respirations? Bradypnea Tachypnea Hypoventilation Hyperventilation

Hyperventilation Hyperventilation is an increased rate and depth of breathing that results in decreased PaCO2 levels and inspiration and expiration nearly equal in duration This is associated with exertion, anxiety, and metabolic acidosis. This hyperventilation is called Kussmaul respiration if associated with diabetic ketoacidosis or renal origin. Bradypnea is breaths slower than 10 per minute. Tachypnea is rapid, shallow breathing exceeding 24 breaths per minute. Hypoventilation is shallow, irregular breathing.

The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation? PaO2 PaCO2 pH SaO2

PaCO2 When the minute ventilation falls, alveolar ventilation in the lungs also decreases, and the PaCO2 increases.

High or increased compliance occurs in which condition? Emphysema Pneumothorax Pleural effusion ARDS

Pneumothorax High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended, as in emphysema. Conditions associated with decreased compliance include pneumothorax, pleural effusion, and acute respiratory distress syndrome (ARDS).

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: One Two Three Four

Three

The nurse is caring for a client with a decrease in airway diameter causing airway resistance. The client experiences coughing and mucus production. Upon lung assessment, which adventitious breath sounds are anticipated? Crackles Rhonchi Rubs Wheezes

Wheezes A decrease in airway diameter, such as in asthma, produces breath sounds of wheezes. Wheezes are a whistling type of sound relating to the narrowing on the airway. A wheeze can have a high-pitched or low-pitched quality. Crackles, also noted as rales, are crackling or rattling sounds signifying fluid or exudate in the lung fields. Rhonchi are a course rattling sound similar to snoring usually caused by secretion in the bronchial tree. Rubs are secretions that can be heard in the large airway.

During assessment of the respiratory system, the nurse inspects and palpates the trachea in order to assess: trachea? deviation from the midline. evidence of exudate. color of the mucous membranes. evidence of muscle weakness.

deviation from the midline.

A Black client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the: lips. mucous membranes. nail beds. earlobes.

mucous membranes.

Which is a true statement regarding air pressure variances? Air is drawn through the trachea and bronchi into the alveoli during inspiration. Air flows from a region of lower pressure to a region of higher pressure during inspiration. The diaphragm relaxes during inspiration. The thoracic cavity becomes smaller during inspiration.

Air is drawn through the trachea and bronchi into the alveoli during inspiration. Air flows from a region of higher pressure to a region of lower pressure. During inspiration, movement of the diaphragm and other muscles of respiration enlarge the thoracic cavity, thereby lowering the pressure inside the thorax to a level below that of atmospheric pressure.

After remaining in bed for 48 hours after surgery and dismissing nurses' encouragements to mobilize, a patient has begun to display the characteristic signs and symptoms of atelectasis. Because atelectasis is a health problem associated with decreased lung compliance, the nurse should understand that this patient is experiencing what pathophysiological phenomenon? Decreased expandability of the patient's lung tissue Decreased blood flow to the capillaries in the patient's alveoli Increased airway resistance A cessation of ventilation

Decreased expandability of the patient's lung tissue

The nurse knows that what condition is associated with increased compliance of the lungs? Atelectasis Pulmonary edema Emphysema Pleural effusion

Emphysema Compliance is normal if the lungs and the thorax easily stretch and distend. Increased compliance occurs if the lungs have lost their elastic recoil and become overdistended as in emphysema. Decreased compliance occurs if the lungs and the thorax are "stiff." Conditions associated with decreased compliance include morbid obesity, pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS). This causes airway collapse during expiration, dyspnea, and eventually cyanosis.

As a component of a patient's comprehensive respiratory assessment, the nurse is preparing to assess for the presence of tactile fremitus. How should the nurse direct the patient prior to this assessment? "Please say 'toy boat' after I put my stethoscope on your back." "Take few deep breaths after I put my hands on your ribs." "Take a deep breath while I tap your back in a few places with my fingers." "I'd like you to say 'one, two, three' for me a few times while I feel your chest and back."

"I'd like you to say 'one, two, three' for me a few times while I feel your chest and back." To assess tactile fremitus, the patient is asked to repeat "ninety-nine" or "one, two, three," or "epee, eee, eee" as the nurse's hands move down the patient's thorax comparing vibrations from similar areas. A stethoscope is not used and the ribs are not normally palpated. The assessment of tactile fremitus does not involve tapping or striking the patient's thorax.

High or increased compliance occurs in which disease process? Emphysema Pneumothorax Pleural effusion ARDS

Emphysema High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended, as in emphysema. Conditions associated with decreased compliance include pneumothorax, pleural effusion, and acute respiratory distress syndrome (ARDS).

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

Emphysema High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended, in conditions such as emphysema. Conditions associated with decreased compliance include pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and acute respiratory distress syndrome.

While assessing for tactile fremitus, the nurse palpates almost no vibration. Which of the following conditions in this client's history will account for this finding? Pneumonia Funnel chest Emphysema Pigeon chest

Emphysema Tactile fremitus is assessed through vibrations of sound on the chest wall by palpation. Normally, fremitus is felt most over the large bronchi and least over the distant lung fields. Clients with emphysema exhibit almost no fremitus, because of the rupture of alveoli and the trapping of air. Air does not conduct sound well.

The nurse has assessed a patient's pulse, temperature, blood pressure, and respiratory rate and is now measuring the patient's oxygenation by pulse oximetry. The nurse understands that this assessment finding is based on: The ratio of oxygen to carbon dioxide in arterial blood The amount of oxygen dissolved in blood plasma The saturation of hemoglobin by oxygen molecules The quantity of free oxygen in arterial blood

The saturation of hemoglobin by oxygen molecules

An client is described as having pectus carinatum. What would be the physical manifestation of this condition? The sternum protrudes and the ribs are sloped backward. The sternum is depressed from the second intercostal space. The thoracic and lumbar spine have a lateral S-shaped curvature. The chest is rounded, ribs are horizontal, and sternum is pulled forward.

The sternum protrudes and the ribs are sloped backward. Also known as pigeon chest, in this congenital anomaly, the sternum abnormally protrudes and the ribs are sloped backward. A depressed sternum would be considered funnel chest, or pectus excavatum. S-shaped spinal curvature would be considered scoliosis. A rounded chest would be considered barrel chest in which the anteroposterior diameter increases to equal the transverse diameter.