PATHOPHYSIOLOGY: RESPIRATORY PRACTICE QUESTIONS

The nurse caring for a male child with respiratory problems is concerned he may be developing respiratory failure. Upon assessment, the nurse knows that which of the following are clinical manifestations of respiratory failure? Select all that apply. A) Severe accessory muscle retractions B) Nasal flaring C) Grunting on expiration D) Inspiratory wheezes heard E) Swollen glottis

A, B, C

A nurse is providing care for a client who has been admitted to a medical unit with a diagnosis of bronchiectasis. Which of the following signs and symptoms should the nurse expect to find during physical assessment of the client and the review of the client's history? Select all that apply. A) Recurrent chest infections B) Production of purulent sputum C) A barrel chest D) Low hemoglobin levels E) Recent surgery

A, B, D Chest infections, copious production of purulent sputum, and anemia are all associated with bronchiectasis. A barrel chest is more commonly evident with emphysema, and recent surgery is not a noted factor.

A patient with pulmonary hypertension may display which of the following clinical manifestations? Select all that apply. A) Shortness of breath B) Decreased exercise tolerance C) Nasal flaring D) Grunting on expiration E) Swelling (edema) of the legs and feet

A, B, E

A patient who has been on a high-protein diet comes to the emergency department with respiratory symptoms. Upon analysis of arterial blood gases (ABGs), the patient is diagnosed with hypercapnia. The nurse will note the ABG results that confirm this diagnosis include: Select all that apply. A) pH 7.31 (normal 7.35 to 7.45). B) PO2 of 97%. C) PCO2 of 58 mm Hg (normal 38 to 42). D) Serum HCO3of -33 mEq/L (normal 22 to 28). E) Serum K+ (potassium)of 3.6 mmol/L (normal 3.5 to 5.0).

A, C, D

A 3-year-old boy has developed croup following a winter cold. His care provider would recognize that which of the following microorganisms and treatments is most likely to be effective? A) Respiratory syncytial virus treated with intubation B) Parainfluenza virus treated with a mist tent and oxygen therapy C) Haemophilus influenza treated with appropriate antibiotics D) Staphylococcus aureus treated with bronchodilators and mist tent

B

A 41-year-old male client has presented to the emergency department with an acute onset of increased respiratory rate and difficulty breathing. STAT chest x-ray indicates diffuse bilateral infiltrates of his lung tissue, and ECG displays no cardiac dysfunction. What is this client's most likely diagnosis? A) Cor pulmonale B) Acute lung injury C) Pulmonary hypertension D) Sarcoidosis

B

A midwife who is providing care for a woman during her first pregnancy is assessing for intrauterine growth retardation (IUGR) during an early prenatal checkup. Which of the following questions best addresses the risks for IUGR? A) "What does your typical diet look like over the course of a day?" B) "What is the highest level of education that you've finished?" C) "Are there many people in your life that you can count on for help and support?" D) "How would you describe your mood since you've been pregnant?"

A

A nurse is providing care for a patient who has been admitted with a newly diagnosed bilateral pleural effusion. Which of the following findings from the nurse's initial assessment of the patient is incongruent with the patient's diagnosis and would require further investigation? A) The client complains of sharp pain exacerbated by deep inspiration. B) The client's breath sounds are diminished on auscultation. C) Pulse oximetry indicates that the client is hypoxemic. D) The client complains of dyspnea and increased work of breathing.

A

A patient with small cell lung cancer (SCLC) has developed a paraneoplastic syndrome called Cushing syndrome. Based on this new complication, the nurse will likely assess which of the following clinical manifestations of Cushing syndrome? A) Weight gain, moon face, buffalo hump, and purple striae on the abdomen B) Bilateral edema in the arms, swollen face, and protruding eyes C) Severe bone/joint pain, nausea/vomiting, and polyuria D) Tetany, new-onset seizure activity, emotional lability, and extrapyramidal symptoms

A

A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress. Which of the following is the most likely contributor to the infant's present health problem? A) High-inspired oxygen concentration and injury from positive-pressure ventilation B) Failure to administer corticosteroids to the infant in utero C) Insufficient surfactant production and insufficient surfactant therapy D) Insufficient supplemental oxygen therapy

A

The first-time parents of an infant girl 2 days postpartum are distressed at the jaundiced appearance of her skin and are eager for both an explanation and treatment for the problem. Which of the following responses by their physician is most accurate? A) "Your daughter's young liver is unable to get rid of the waste products from old red blood cells." B) "Because your daughter's kidneys are so small, they have a hard time getting rid of the wastes that are always accumulating in her blood." C) "Nearly half of all infants have this problem, and while it is distressing to look at, it is largely harmless and will resolve in time." D) "This is a sign that your baby needs more milk than she is currently getting, and increased breast-feeding will act to flush these pigments out of her system."

A

The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which of the following teaching points is most justifiable? A) "Research has shown that viruses may actually be a factor in many children's asthma." B) "The most reliable indicator that your child is having an asthma attack is audible wheezing." C) "Steroids that your child can inhale will likely be the first line of defense." D) "Your son will likely need to limit or avoid exercise and sports."

A

Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with rhinosinusitis rather than a common cold? A) A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F B) A woman presenting with malaise, lethargy, and copious nasal secretions C) A man with a dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F D) A woman complaining of generalized aches and who has a hoarse voice and reddened, painful upper airways

A Fever and facial pain are more commonly associated with rhinosinusitis rather than the common cold. The other noted symptoms are indicative of the common cold rather than rhinosinusitis.

A family physician is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year's vaccine. Which of the following statements by the patient best reflects an accurate understanding of the flu virus? A) "I could come down with viral or bacterial pneumonia as a result of a bad flu bug." B) "I know my vaccination is especially important since there aren't any drugs that can treat the flu once I get sick with it." C) "The emphasis on bundling up, staying warm, and drinking lots of fluids is outdated and actually ineffective." D) "Like all vaccines, it is ideal if everyone in a population gets immunized against the flu."

A Viral and bacterial pneumonia are known sequelae of influenza. Antiviral drugs do exist for the flu, and the efficacy of staying warm and increasing fluid consumption have been demonstrated. The flu vaccine is recommended for higher risk individuals, and guidelines do not indicate the need for all individuals to be vaccinated.

A patient arrives in the ED after an automobile accident. Which of the following clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply. A) Respiratory rate 34 B) Asymmetrical chest movements, especially on inspiration C) Diminished breath sounds over the painful chest area D) Pulse oximetry 98% E) ABG pH level of 7.38

A, B, C

A COPD patient asks the nurse what medications are prescribed to help his breathing. The nurse, looking at the list of medications, will educate the patient about which of the following medications to help his COPD in the long term? Select all that apply. A) Salmeterol (Serevent), a bronchodilator B) Tiotropium (Spiriva), anticholinergic C) Alprazolam (Xanax), a benzodiazepine D) Sildenafil (Viagra), a vasodilator E) Ketorolac (Toradol), an NSAID

A, B

Which of the following clients are displaying known risk factors for the development of pulmonary emboli? Select all that apply. A client who is: A) immobilized following orthopedic surgery. B) experiencing impaired Cl- and Na+ regulation. C) taking amiodarone for the treatment of premature ventricular contractions. D) a smoker and who takes oral contraceptives. E) undergoing radiation therapy for the treatment of breast cancer.

A, D Postsurgical immobility, smoking, and the use of oral contraceptives are all identified risk factors for the development of pulmonary emboli. Impaired Cl- and Na+ regulation are associated with cystic fibrosis, while amiodarone and radiation therapy are linked to interstitial lung diseases.

A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse is most appropriate? A) "Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it's important for you to change positions often." B) "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." C) "Make sure that you stay hydrated and walk as soon as possible to avoid us having to insert a chest tube." D) "I'll proscribe bronchodilator medications that will help open up your airways and allow more oxygen in."

B

A nurse who works in a neonatal intensive care unit is providing care for an infant born at 26 weeks' gestation. Which of the following assessments would lead the nurse to suspect that the infant has developed respiratory distress syndrome (RDS)? A) The infant's blood pressure and temperature are normal measurements as expected. B) Infant is grunting and has notable intercostal retractions with respirations. C) Infant has poor motor skills and limited limb range of motion. D) Infant has apnea lasting 5 to 10 seconds with a decrease in heart rate, which reverses with tactile stimulation.

B

A patient is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering A) a bronchodilator. B) a corticosteroid. C) aspirin. D) an albuterol inhaler.

B

Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development? A) Terminal alveolar sacs are developing, and surfactant production is beginning. B) A single capillary network exists, and the lungs are capable of respiration. C) The conducting airways are formed, but respiration is not yet possible. D) Primitive alveoli are formed, and the bronchi and bronchioles become much larger.

B

A pneumonia that occurs 48 hours or more after admission to the hospital is considered A) community-acquired pneumonia. B) hospital-acquired pneumonia. C) viral pneumonia. D) immunocompromised pneumonia.

B Hospital-acquired pneumonia is defined as a lower respiratory tract infection that was not present or incubating on admission to the hospital. Usually, infections occurring Test Bank - Porth's Essentials of Pathophysiology (5th Edition by Norris) 297 48 hours or more after admission are considered hospital-acquired. Community-acquired pneumonia is diagnosed within 48 hours after admission. Most hospital-acquired pneumonia is bacterial.

A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her physician most appropriately respond to her? A) "I'm sure this is very hard news to hear, but be aware that with aggressive treatment, your chances of beating this are quite good." B) "This is very difficult to hear, I'm sure, and we have to observe to see if it spreads because that often happens." C) "I'm very sorry to have to give you this news; I'd like to talk to you about surgical options, however." D) "This is a difficult diagnosis to receive, but there is a chance that the cancer may go into remission."

B Metastases are common with SCLC. Survival rates are very low; surgical options do not exist; and remission is very unlikely.

A client with a newborn infant is also the caregiver for her 75-year-old mother, who lives with them and who has diabetes. The client requests pneumonia vaccinations for her entire household. Which vaccine is most likely to be effective for the baby? A) Since the baby's immune system is mature at birth, regular vaccine is appropriate. B) There is no effective vaccine for newborn infants. C) The 23-valent vaccine will be effective. D) No vaccine is necessary for the baby if the nursing mother is immunized.

B S. pneumoniae capsular polysaccharides would be especially appropriate for the client and her diabetic, elderly mother but is not effective in the immune system of anyone younger than 2 years old. Fortunately, a newer, 7-valent vaccine was designed to protect infants as young as 7 months. However, because their immune system is immature, the antibody response to most flu shots is poor or inconsistent in children younger than 2 years of age.

A nurse is providing care for an older, previously healthy adult male who has been diagnosed today with pneumococcal pneumonia. Which of the following signs and symptoms is the nurse most likely to encounter? A) The man will be hypotensive and febrile and may manifest cognitive changes. B) The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles. C) The patient will have copious bloody sputum and diffuse chest pain and may lose his cough reflex. D) The patient will lack lung consolidation and will have little, if any, sputum production.

B The typical onset of pneumococcal pneumonia involves production of clear sputum, along with faint breath sounds and fine crackles. The patient is less likely to be hypotensive, have copious bloody sputum, or have chest pain. A lack of lung consolidation or sputum production is more closely associated with atypical pneumonias.

The nursery has just admitted a new infant born 1 hour ago. While performing an assessment, the nurse suspects the infant may have hypoglycemia based on which of the following assessment data? Select all that apply. A) Heel stick glucose value of 50 mg/dL B) Infant having periods of apnea requiring physical stimulation C) Muscle twitching noted while lying in crib undisturbed by nurses D) Hyperactive reflexes noted especially when crying E) Poor suck reflex resulting in an inability to feed properly

B, C, E In neonates, glucose levels stabilize to a value of 50 mg/dL or higher within the first 3 hours of life. Concentrations below 45 mg/dL should be considered abnormal. Signs and symptoms of neonatal hypoglycemia include cyanosis, apnea, hypothermia, hypotonia, poor feeding, lethargy, and seizures.

As a consequence of a long-standing lung disease, a client is in a chronic state of hypoxia. Which of the following phenomena would the client's care team be most justified in anticipating? Select all that apply. A) Metabolic alkalosis B) Increased erythropoietin production C) Pulmonary vasodilation D) Hyperventilation E) Personality changes

B, D, E

Upon admission to the ICU, a patient with a history of cor pulmonale will likely be exhibiting which of the following clinical manifestations of right heart failure? Select all that apply. A) Fine crackles throughout both lung fields B) +4 pitting edema in lower extremities C) Expectorating copious amounts of frothy, pink sputum D) Jugular vein distension E) Altered level of consciousness

B, D, E

A nurse is performing a 5-minute Apgar score on a newborn female. Which of the following characteristics of the infant's current condition would not be reflected in the child's Apgar score? A) The baby's heart rate is 122 beats/minute. B) The infant displays a startle reflex when the crib is accidentally kicked. C) The child's temperature is 35.0°C (95°F) by axilla. D) The infant's skin is pink in color.

C

A short, nonsmoking 44-year-old male presents to the emergency room with left-sided chest pain and a cough. He states that the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, and no cyanosis. Which condition is most likely causing his symptoms? A) Myocardial infarction B) Spontaneous pneumothorax C) Pleuritis related to infection D) Obstructive atelectasis

C

In the early morning, an African American woman brings her 5-year-old son to the emergency room. The boy is wheezing, is short of breath, and has a dry cough. The mother states that he has always been very healthy. He went to bed with only a slight cold and a runny nose but woke her with his coughing shortly after 4 AM. His symptoms worsened so dramatically that she brought him to the hospital. The care team would most likely suspect that he has A) respiratory syncytial virus. B) influenza. C) asthma. D) pneumonia.

C

New parents were just told by their physician that their son is two standard deviations above the mean. The parents later asked the nurse what that means. The nurse will explain by stating, A) "If your child is one standard deviation from the norm that translates to mean, he will be taller than 50% of his peers." B) "This is great news since it means you will have a larger baby than most." C) "Being two standard deviations above the mean translates into that your child will likely be taller than 95% of children in the population." D) "With the mean being average at 50%, two standard deviations means that your child will be at least 99.7% taller than his brother."

C

The neonatal ICU nurse is aware that type II alveolar cells produce surfactant, and they usually develop at how many weeks of gestation? A) 17 to 18 weeks B) 19 to 20 weeks C) 24 to 28 weeks D) 34 to 38 weeks

C

Which of the following assessment findings of a male infant 14 hours postpartum would be considered abnormal and would require further assessment and possible intervention? A) The baby's first stool appears to contain blood. B) The child is unable to breathe through his mouth. C) The baby's skin has a yellowish orange hue. D) The child's suck is weak when placed at his mother's breast.

C

While assessing a premature infant born at 25 weeks' gestation, the neonatal intensive care unit (NICU) nurse would suspect which diagnosis when the infant displays poor muscle tone, apnea, and a new onset of somnolence? A) Hydrocephalus B) Airway obstruction C) Intraventricular hemorrhage D) Sepsis

C

Which of the following clinical findings would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)? A) Audible wheezing on expiration B) Reduced expiratory flow rates C) Decreased tidal volume D) Normal forced expiratory volume

C Because it takes less work to move air through the airways at an increased rate than it does to stretch a stiff lung to accommodate a larger tidal volume, interstitial lung disease is commonly associated with an increased respiratory rate but decreased tidal volume. Wheezing and decreased expiratory flow rate are more closely associated with COPD.

A 66-year-old male presents to the emergency room accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F, and his blood work indicates his sodium level at 126 mEq/L (normal 135 to 145 mEq/L). Based on this assessment, the nurse suspects the patient has A) bronchopneumonia. B) Mycoplasma pneumonia. C) Legionella pneumonia. D) pneumococcal pneumonia.

C Confusion, dry cough, diarrhea, and hyponatremia are associated with Legionnaire disease and less so with bronchopneumonia, Mycoplasma pneumonia, or pneumococcal pneumonia.

A health educator is performing a health promotion workshop with the staff of a large, urban homeless shelter, and a component of the teaching centers around tuberculosis. One of the staff members comments, "Anyone who's had contact with tuberculosis in the past can give it to any of the other residents of the shelter, even if they didn't get sick themselves." How could the educator best respond to this comment? A) "Many people do manage to fight off the infection, but you're right: they can still spread it by coughing or sneezing." B) "If someone has been previously exposed to tuberculosis, they are particularly infectious because they are often unaware of the disease." C) "Actually, people who have the latent form of the disease won't be sick and can't spread it either." D) "There isn't any real risk of them spreading it, but we would like to vaccinate everyone who's had any contact with it in the past."

C Contact with M. tuberculosis without the development of progressive primary tuberculosis results in a latent infection that is not communicable. Vaccination is not a common intervention in the United States.

A child with rhinosinusitis should be monitored for complications. Which of the following assessment findings would alert the nurse that a complication is developing? A) Purulent nasal discharge B) Temperature of 100.8°F C) Periorbital edema D) Complaints of headache

C Expected s/s of acute viral rhinosinusitis include facial pain, headache, purulent nasal discharge, decreased sense of smell, and fever. Complications can lead to intracranial and orbital wall problems. Facial swelling over the involved sinus, abnormal extraocular movements, protrusion of the eyeball, periorbital edema, or changes in mental status may indicate intracranial complications.

Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? A) A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration B) An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells C) An 81-year-old male who has a productive cough and recurrent respiratory infections D) An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke

C Productive cough and recurrent respiratory infections are associated with COPD, while pain, fever, and increased white cells are not common signs and symptoms of COPD. Acute shortness of breath and bronchoconstriction are associated with asthma.

When educating a student who lives in a crowded apartment and diagnosed with tuberculosis, the college school nurse will emphasize, A) "Once your fever goes away, you can stop taking the streptomycin injection." B) "If isoniazid makes you nauseous, we can substitute something milder." C) "To destroy this bacterium, you must strictly adhere to a long-term drug regimen." D) "You will have to wear an N95 mask while on campus at all times."

C Success of chemotherapy for prophylaxis and treatment of tuberculosis depends on strict adherence to a lengthy drug regimen that includes isoniazid (INH), rifampin, ethambutol, pyrazinamide, and streptomycin (or some combination of these).

A physician is providing care for a child who has a diagnosis of cystic fibrosis (CF). Place the following events in the etiology of CF in ascending chronological order. Use all the options. A) Airway obstruction B) Recurrent pulmonary infections C) Impaired Cl- transport D) Decreased water content of mucociliary blanket E) Increased Na+ absorption

C, E, D, A, B

A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar. tissue. What is this client's most likely diagnosis? A) Squamous cell carcinoma B) Small cell lung cancer C) Large cell carcinoma D) Adenocarcinoma

D

A woman has recently determined that she is pregnant, and her clinician believes that the conception occurred around 8 weeks prior. Since the embryo is in the third stage of embryonic development, which of the following events and processes in growth and development would be expected to be taking place? A) Transition from a morula to a blastocyst B) Ossification of the skeleton and acceleration of body length growth C) Rapid eye movement and early support of respiration D) Formation of upper limbs and opening of the eyes

D

Which of the following infants most likely requires medical intervention? A) A 2-day-old baby boy who has caput succedaneum B) An infant 4 hours postpartum who has visible coning of his head following vaginal delivery C) A girl 3 days postpartum with noticeable unilateral cephalhematoma D) A male infant whose vertex delivery resulted in a brachial plexus injury

D

Which of the following situations would be most deserving of a pediatrician's attention? A) The mother of an infant 2 days postpartum notes that her baby has intermittent periods of hyperventilation followed by slow respirations or even brief periods of apnea. B) A volunteer in the nursery notes that one of the infants, aged 2 weeks, appears unable to breathe through his mouth, even when his nose is congested. C) A neonate is visibly flaring her nostrils on inspiration. D) A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting.

D

Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma? A) IgG production is heightened as a consequence of exposure to an allergen. B) Airway remodeling results in airflow limitations. C) Epithelial injury and edema occur along with changes in mucociliary function. D) Chemical mediators are released from presensitized mast cells.

D

While rock climbing, a 22-year-old male has endured a severe head injury. Which of the following statements best captures expected clinical manifestations and treatments for his immediate condition? A) Oxygen therapy is likely to decrease his respiratory drive and produce an increase in PCO2. B) Cheyne-Stokes breathing is likely but will respond to bronchodilators. C) The client is unlikely to respond to supplementary oxygen therapy due to impaired diffusion. D) Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation

D

Around 3 weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea, and vomiting. After ruling out more common health problems, his care provider eventually made a diagnosis of histoplasmosis. Which of the following processes is most likely taking place? A) Toxin production by Histoplasma capsulatum is triggering an immune response. B) Antibody production against the offending fungi is delayed by the patient's age and the virulence of the organism. C) Spore inhalation initiates an autoimmune response that produces the associated symptoms. D) Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them.

D Disseminated histoplasmosis results from the inability of macrophages of the reticuloendothelial system to destroy the fungi. Fungi do not produce toxins, and antibody production and autoimmune responses are not involved in the pathophysiology of this fungal infection.

As part of a public health initiative, a nurse is teaching a group of older adults about ways to promote and maintain their health. Recognizing that the common cold is a frequent source of ailment, the nurse is addressing this health problem. Which of the following teaching points about the common cold is most accurate? A) "You shouldn't be taking antibiotics for a cold until your doctor has confirmed exactly which bug is causing your cold." B) "It's important to both cover your mouth when you cough or sneeze and encourage others to do so, since most colds are spread by inhaling the germs." C) "Scientists don't yet know exactly what virus causes the cold, and there is not likely to be a vaccine until this is known." D) "Use caution when choosing over-the-counter drugs for your cold; most people do best with rest and antifever medications."

D The efficacy of over-the-counter cold remedies is minimal, and all have a risk of unwanted side effects; rest and antipyretics are normally sufficient since cold viruses are normally self-limiting. No cold-causing virus will respond to antibiotics, and most colds are spread by the fingers. There is no one specific virus that causes the common cold, and numerous different viruses cause similar symptoms.