respiratory ch. 23
The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis. a. The client who is postoperative after a total knee replacement and receiving patient-controlled analgesia b. The client diagnosed with pneumonia who performs frequent coughing and deep-breathing exercises c. The client who is mobile within 24 hours after abdominal surgery d. The client with a lower leg cast who changes position every 2 hours
a The danger of obstructive atelectasis increases after surgery as anesthesia, pain, administration of narcotics, and immobility tend to promote retention of viscid bronchial secretions and hence airway obstruction. The encouragement of coughing and deep breathing, frequent change of position, adequate hydration, and early ambulation decrease the likelihood of atelectasis developing. Coughing and deep-breathing exercises are the most beneficial option to prevent atelectasis. Repositioning needs to occur more frequently (about every 2 hours), ambulating prior to 24 hours postoperatively, and increasing oral fluids will assist with the prevention of atelectasis.
A client is diagnosed with pulmonary embolism. Which symptom would most likely be present? a. Chest pain and dyspnea b. Shallow respirations and wheezing c. Left arm pain and diaphoresis d. Cough and crackles
a The manifestations of pulmonary embolism depend on the size and location of the obstruction. Chest pain, dyspnea, and increased respiratory rate are the most frequent signs and symptoms of pulmonary embolism.
Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response? a. Pulmonary vessels constrict b. Pulmonary vessels spasm c. Pulmonary vessels dilate d. Pulmonary vessels infarct
a 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 is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be: a. insertion of a large-bore needle or chest tube. b. chest x-ray. c. arterial blood gas analysis. d. administration of oxygen by face mask.
a 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.
A client is brought into the emergency department with severe crushing injuries to the chest wall and signs of respiratory failure following a motor vehicle accident. Which laboratory value would be expected? a. Increase in PCO2 b. Hyperventilation c. Metabolic alkalosis d. Cool moist skin
a Hypoventilation or ventilatory failure occurs when the volume of "fresh" air moving into and out of the lung is significantly reduced. It is commonly caused by conditions outside the lung such as depression of the respiratory center, diseases of the nerves supplying the respiratory muscles, or thoracic cage disorders such as a crushed chest. Hypoventilation almost always causes an increase in PCO2. The PCO2 level is a good diagnostic measure for hypoventilation. Additional indicators of hypercapnia are warm and flushed skin and hyperemic conjunctivae.
Atelectasis is the term used to designate an incomplete expansion of a portion of the lung. Depending on the size of the collapsed area and the type of atelectasis occurring, the nurse may see a shift of the mediastinum and trachea. Which way does the mediastinum and trachea shift in compression atelectasis? a. Away from the affected lung b. Away from the trachea c. Toward the affected lung d. Toward the mediastinum
a If the collapsed area is large, the mediastinum and trachea shift to the affected side. In compression atelectasis, the mediastinum shifts away from the affected lung.
Three days following surgical repair of a hip fracture a client becomes anxious and complains of sudden shortness of breath. What disorder is the client most likely experiencing? a. Pulmonary embolism b. Pneumonia c. Bronchiectasis d. Atelectasis
a Pulmonary embolism occurs when a blood-borne 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. Bronchiectasis does not have sudden onset.
A client with pulmonary arterial hypertension asks the health care provider, "Why are you giving me sildenafil? It is my lungs that are my problem, not erectile dysfunction." Which statement by the health care provider is the most appropriate response? a. "Sildenafil causes vasodilation, which will help treat the high pressure in your lung vessels." b. "People with pulmonary arterial hypertension also have similar problems in their penile vessels." c. "Xildenafil is a misrespresented drug and can be given for many other conditions that have constriction problems." d. "Since pulmonary arterial hypertension causes such fatigue, you will still be able to enjoy an intimate relationship with your spouse."
a Sildenafil acts in a manner similar to nitric oxide to produce vasodilation, and is another treatment for pulmonary arterial hypertension. It is not being prescribed for erectile dysfunction in this population of clients. Health care providers should not assume a client is experiencing erectile dysfunction, unless the client has verbalized this directly to them.
The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond? a. The sweat test measures the concentration of salt in the infant's sweat. b. The sweat test evaluates the infant's ability to sweat in response to heat. c. Abnormal pancreatic enzymes may cause the infant to sweat more. d. Cystic fibrosis decreases the amount of salt in the infant's sweat.
a cystic fibrosis is a genetic disorder that produces abnormal functioning in the epithelial cell chloride channels. The chloride is not reabsorbed, leaving high concentrations of sodium chloride in the sweat. The sweat test is the standard approach to diagnosis of CF. A gel is applied to the skin and a patch with electrodes is applied. Once enough sweat is collected, it is tested in the lab for sodium chloride concentration.
For which client condition will a pulse oximeter reading be inaccurate? a. Carbon monoxide poisoning b. Hyperlipidemia c. Bacterial pneumonia d. Dehydration
a he pulse oximeter is a noninvasive method to evaluate blood oxygen concentrations by passing red-wavelength light and infrared-wavelength light through capillaries in the finger, toe, or ear lobe. The sensors cannot distinguish between carbon monoxide-carrying hemoglobin and oxygenated hemoglobin.
A client with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which term should the nurse use to document this finding? a. Barrel chest b. Pink puffer c. Blue bloater d. Pneumothorax
a An increased anterior-posterior chest diameter is referred to as a barrel chest.
Which conditions increase client risk for developing pulmonary arterial hypertension (PAH)? Select all that apply. a. Scleroderma b.HIV infection c. Family history d. Diabetes mellitus e. Breast cancer
a, b, c Pulmonary arterial hypertension (PAH) is a disorder in which the pressure in the pulmonary arteries is elevated. It can lead to fibrosis in the arteries, progressive right heart failure, low cardiac output, and death. Conditions predisposing to PAH include an autosomal dominant family trait, human immunodeficiency virus (HIV), scleroderma, portal hypertension, and persistent pulmonary hypertension in a newborn.
A client arrives in the ED after an automobile accident. Which clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply. a. Asymmetrical chest movements, especially on inspiration b. Respiratory rate 34. c.Diminished breath sounds over painful chest area d. Pulse oximetry 98% e. ABG pH level of 7.38
a, b, c Manifestations of pneumothorax include increased respiratory rate, dyspnea, asymmetrical movements of chest wall (especially during inspiration), hyperresonant sound on percussion, and decreased or absent breath sounds over area of pneumothorax. The pulse oximetry reading is normal. ABG pH level of 7.38 is a normal finding.
Which is a criterion for diagnosing moderately persistent asthma? a. Nighttime symptoms occur less than two times a month. b. Symptoms occur daily. c. Symptoms occur more than two times a week but less than daily d. Physical activity is limited by symptoms.
b Mild intermittent asthma includes nighttime symptoms occurring less than or equal to two times a month. Mild persistent ashtma requires symptoms that occur more than two times a week but less than daily. Moderately persistent asthma is defined as having daily symptoms. Severe persistent asthma limits physical activity.
A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client? a. Anti-inflammatory agents b. beta-adrenergic agonists c. Antileukotrienes d.Leukotrienes
b A beta-adrenergic agonist would be the best option to use in an acute exacerbation of asthma. The quick-relief medications include the short-acting beta-adrenergic agonists, anticholinergic agents, and systemic corticosteroids. The short-acting beta-adrenergic agonists relax bronchial smooth muscle and provide prompt relief of symptoms, usually within 30 minutes. All of the other drugs would be used as maintenance treatment.
A client is diagnosed with pneumoconiosis. Which aspect of the client's history is mostlikely the cause of this diagnosis? a. Has congestive heart failure b. Worked in a coal mine for 20 years c. Exposed to tuberculosis recently d. Has 20 pack-years history of smoking
b People who work in a coal mine can develop coal worker's pneumoconiosis (CWP). Heart failue and tuberculosis exposure are not causes of this diagnosis. Smoking will likely cause chronic obstructive pulmonary disease (COPD) and not a cause of pneumoconiosis.
The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism. a. An 80-year-old female client with diabetes b. A 62-year-old male who is postoperative for repair of a fractured femur c. A 32-year-old male with viral pneumonia d. A 36-year-old female smoker with an intrauterine device (IUD)
b A client with surgery to the lower extremities is at higher risk for the development of deep vein thrombosis that could lead to a pulmonary embolism. There is increased risk for pulmonary embolism among users of oral contraceptives, particularly in women who smoke, but not with the use of IUD.
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? a. "Do you have a family history of lung disease?" b. "Do you tend to have a cough even when you don't feel sick?" c. "Do you know if you had respiratory syncytial virus as a child?" d. "Have you ever been immunized against pneumococcal pneumonia?"
b 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 client reports chest pain to the nurse. Which characteristics of the pain indicate bronchial irritation? a. Sudden sharp pain in one side made worse by deep breathing b. Dull pain in mid-chest that is worse when coughing c. Sharp bilateral pain in the inferior chest that is worse when lifting or stretching d. Crushing pain in mid-chest that is not changed by breathing or coughing
b Bronchitis pain usually is described as dull, located in the substernal region, and made worse by coughing but not by deep breathing. The pain of pleuritis is usually abrupt onset with a sharp pain that increases with deep breathing. The pain of musculoskeletal strain from frequent forceful coughing is usually bilateral and located in the inferior portion of the rib cage. Contracting the abdominal muscles makes the pain worse. A myocardial infarction (MI) commonly produces substernal chest pain that is crushing, but not affected by respiratory activity.
A pulmonary embolism occurs when there is an obstruction in the pulmonary artery blood flow. Classic signs and symptoms of a pulmonary embolism include dyspnea, chest pain, and increased respiratory rate. What is a classic sign of pulmonary infarction? a. Tracheal shift to the right b. Pleuritic pain c. Pericardial pain d. Mediastinal shift to the left
b Chest pain, dyspnea, and increased respiratory rate are the most frequent signs and symptoms of pulmonary embolism. Pulmonary infarction often causes pleuritic pain that changes with respiration; it is more severe on inspiration and less severe on expiration. Mediastinal and tracheal shifts are not signs of a pulmonary infarction, and neither is pericardial pain.
The use of oxygen at a rate above 2 L/minute is inappropriate for a client with: a. pneumonia, walking in the hall with pursed lip breathing, pulse oximeter reading 89%. b. chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%. c. atelectasis, using incentive spirometer, pulse oximeter reading 90%. d. pneumonectomy, incisional pain with breathing, pulse oximeter reading 92%.
b Clients with end-stage chronic obstructive pulmonary disease may experience significant hypoxemia. Low-flow oxygen at a rate between 1 and 2 L/min may assist oxygenation. These clients should not receive higher rates of oxygen because the ventilatory drive from hypoxemia generally does not occur when the PO2 is above 60 mm Hg (7.98 kPa). The client will develop hypoventilation and CO2 retention. Pulse oximeter readings indicate the amount of hemoglobin that is oxygenated. A normal range is above 92%.
A 9-year-old boy has been diagnosed with bronchial asthma. Which factor is most likely contributing to his condition? a. Playing sports b. House dust c. Stress d. Flowering plants around his house
b Environmental allergens such as pet dander, dust mite antigens, and cockroach allergens have been shown to contribute to the development of asthma, with the strongest response occurring in response to house dust. Active participation in physical activities, exercise, and sports should be encouraged.
A farmer is admitted with hypersensitivity pneumonitis. Which factor could have caused his condition? a. Organic pesticides b. Moldy grain dust c. Herbicides d. Exposure to pigeon feathers
b Farmer's lung results from exposure to moldy hay or grain dust. Pigeon breeder's lung is provoked by exposure to the serum, excreta, or feathers of birds. Pesticides and herbicides are health risks but do not cause pneumonitis.
A child struggling to breathe is brought to the emergency department with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. What is the most likely diagnosis? a. Pulmonary embolism b. Severe asthma attack c. Chronic obstructive pulmonary disease d. Cystic fibrosis
b Severe asthma attacks are accompanied by use of the accessory muscles, distant breath sounds due to air trapping, and loud wheezing. As the condition progresses, fatigue develops, the skin becomes moist, and anxiety and apprehension are obvious. Sensations of shortness of breath may be severe, and often the person is able to speak only one or two words before taking a breath. At the point at which airflow is markedly decreased, breath sounds become inaudible with diminished wheezing, and the cough becomes ineffective despite being repetitive and hacking. This point often marks the onset of respiratory failure.
A client has sudden severe dyspnea, fear, asymmetrical chest movement and decreased lung sounds on the right side. Which intervention is most appropriate? a. Administer morphine sulfate (morphine) to reduce pain and increase contractility. b. Assist to high-Fowler's position and prepare for chest tube insertion. c. Position head of bed at 45 degrees and prepare for intubation to improve respiratory status. d. Position limbs above heart for venous return and give dobutamine IV.
b Spontaneous pneumothorax can occur in healthy people and tends to occur most often in tall boys and young men between the ages of 10 and 30 years. It is treated with insertion of chest tubes to reinflate the affected lung.
A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which drug will the nurse anticipate administering first? a. Anticholinergic medications such as ipratropium b. Short-acting beta 2-adrenergic agonists such as albuterol (SABA) c. Anti-inflammatory agents such as sodium cromolyn d. Oral corticosteroids
b The quick-relief medications such as SABA (e.g., albuterol, levalbuterol, pirbuterol) relax bronchial smooth muscle and provide prompt relief of symptoms, usually within 30 minutes. They are administered by inhalation (i.e., metered-dose inhaler or nebulizer), and their recommended use is in alleviating acute attacks of asthma.
A client 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 Treatment is directed at interrupting the granulomatous inflammatory process that is characteristic of the disease and managing the associated complications. When treatment is indicated, corticosteroid drugs are used. Bronchodilators may be used if there is wheezing, but this is not a normal medication for this disease. Aspirin is a blood thinner. Albuterol is a short-term bronchodilator for acute asthma.
The term chronic obstructive pulmonary disease (COPD) can be a combination of two types of obstructive airway diseases. What disease processes have been identified as being part of COPD? a. Emphysema and asthma b. Chronic obstructive bronchitis and emphysema c. Chronic obstructive bronchitis and asthma d. Chronic bronchitis and emphysema
b he term chronic obstructive pulmonary disease 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.
Bronchiectasis is considered a secondary COPD, and with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow? a. Complicated measles b. Chickenpox c. Influenza d. Necrotizing bacterial pneumonia
b in the past, bronchiectasis often followed a necrotizing bacterial pneumonia that frequently complicated measles, pertussis, or influenza. Chickenpox has never been linked to bronchiectasis.
The nurse determines that the client has clubbing of the fingertips. Which is the bestintervention? a. Call the health care provider. b. Assess peripheral capillary refill. c. Check the client's O2 saturation level. d. Monitor the client's heart rate.
c Clubbing of the nails indicates long-term hypoxia and should be evaluated.
A moderate hemothorax diagnosis would be confirmed by the presence of which of the following? a. Blood in at least half of one side of the chest b. <250 mL of blood in the pleural space c. Blood filling approximately one-third of the pleural space d. Blood in half of both sides of the chest
c 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 recently had surgery for a hip fracture. Which nursing intervention would be most effective for preventing pulmonary emboli in this client? a. Encourage increase fluid intake b. Monitor hematocrit and hemoglobin levels c. Prevention of the development of a deep vein thrombosis d. Use of oxygen and incentive spirometer following surgery
c 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.
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 teaching point by her nurse is most appropriate? a. "I'll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in." b. "Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube." c."You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." d. "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."
c Atelectasis is characterized by incomplete lung expansion, and can often be prevented by deep breathing and coughing. Pleural effusion, not atelectasis, is associated with fluid accumulation between the lungs and their lining . Neither chest tube insertion nor bronchodilators are common treatments for atelectasis.
While rock climbing, a 22-year-old male has endured a severe head injury. Which statement bestcaptures expected clinical manifestations and treatments for his immediate condition? a. Cheyne-Stokes breathing is likely but will respond to bronchodilators. b. Oxygen therapy is likely to decrease his respiratory drive and produce an increase in PCO2. c. Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation. d. The client is unlikely to respond to supplementary oxygen therapy due to impaired diffusion.
c Brain injuries and accompanying hypoventilation are often associated with increased PCO2 and by hypoxemia that responds to oxygen therapy. Persons with COPD are more vulnerable to diminished respiratory drive secondary to oxygen therapy, while Cheyne-Stokes breathing is not identified as a likely consequence of brain injury. Impaired alveolar diffusion is not an aspect of the client's injury.
Which client most likely faces the highest risk of developing secondary pulmonary hypertension? a. An older adult client who has been hospitalized for the treatment of community-acquired pneumonia b. A client with asthma who uses her inhaled bronchodilator more often than prescribed c. A client with COPD and a 35 pack-year smoking history d.A client who suffered a thermal injury to his lungs in a fire
c 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.
The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen and other laboratory work reveals an increase in lactic levels. How will the nurse interpret these findings? a. Hypoxia b. Respiratory alkalosis c. Hypoxemia d. Hypercapnia
c Hypoxemia refers to a reduction in PO2 of the arterial blood. Hypoxemia produces its effects through tissue hypoxia and compensatory mechanisms. If the PO2 of the tissues falls below a critical level, aerobic metabolism ceases and anaerobic metabolism takes over, with formation and release of lactic acid. This results in increased serum lactate levels and metabolic acidosis. Hypoxemia can result from an inadequate amount of O2 in the air, disease of the respiratory system, dysfunction of the neurologic system, or alterations in circulatory function. Hypercapnia is an increase in the carbon dioxide content of the arterial blood. Atelectasis is collapse of a segment of the lung due to airway obstruction.
A diagnosis of tension pneumothorax would be suspected in which physical assessment finding? a. Hypoxia b. Symmetry of chest during inspiration c. Deviated trachea d. Increased respiratory rate
c Physical assessment findings of a deviated trachea and neck vein distention would indicate a tension pneumothorax. Asymmetry of the chest during inspiration would suggest a spontaneous pneumothorax. Both would need to be confirmed by radiology. The remaining options are nonspecific and occur in many conditions.
A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be: a. Constant dilation of the pulmonary vessels in response to hypoxia b. Hardening of the pulmonary vessels due to increased fat deposits c. Constriction of the pulmonary vessels in response to hypoxemia d. Decreased vascular resistance in the pulmonary vessels
c Pulmonary HTN occurs as a result of chronic hypoxia. In response to hypoxia, the pulmonary vessels constrict. The pulmonary vessels differ from the systemic circulation vessels, which dilate in response to hypoxia and hypercapnia. Smooth muscle hypertrophy and proliferation of the vessel intima occur in pulmonary HTN.
The nurse is assessing a client whose recent health history is suggestive of sarcoidosis. What assessment should the nurse prioritize? a. Obtaining a sputum sample for culture and sensitivity b. Assessment of the client's occupational history and possible recurrent infections c. Constructing a genogram from the client's report of her family history d. Obtaining the client's allergy status
c 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.
Which client is showing signs of chronic hypoxemia? A client who is: a. sitting up in bed with blue lips expressing sudden feelings of doom. b. diaphoretic and breathless after walking in the hall. c. restless, has clubbed fingers, and frequently drops items. d. lying in bed talking on the phone using complete sentences.
c signs of chronic hypoxemia include clubbing of the fingers, polycythemia, pulmonary vasoconstriction, restless or agitated behavior, incoordination, and reduced mental function with impaired judgment. Cyanosis indicates an excessive concentration of deoxygenated hemoglobin. A sudden feeling of doom is a characteristic sign of pulmonary embolus.
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 organisms create chronic infection in a child with cystic fibrosis? a. Pseudomonas aeruginosa and Escherichia coli b.Staphylococcus aureus and hepatitis C c.Haemophilus influenzae and influenza A d.Pseudomonas aeruginosa and Staphylococcus aureus
d In addition to airway obstruction, the basic genetic defect that occurs with CF predisposes to chronic infection with a surprisingly small number of organisms, the most common being Pseudomonas aeruginosa, Burkholderia cepacia, Staphylococcus aureus, and Haemophilus influenzae. The other disease causing organisms are not linked to CF.
A client tells the nurse that he is concerned he may be developing chronic bronchitis and asks how the diagnosis is made. The most appropriate information for the nurse to provide would be: a. A diagnosis of chronic bronchitis requires you to have been hospitalized at least one time in at least 2 consecutive years with shortness of breath. b. A diagnosis of chronic bronchitis requires a history of a respiratory infection that occurs every 3 consecutive months in at least 2 consecutive years. c. A diagnosis of chronic bronchitis requires a chest x-ray that shows a tubercle bacillus that has been present for at least 2 consecutive years. d. A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years.
d A clinical diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years. Typically, the cough has been present for many years, with a gradual increase in acute exacerbations that produce frankly purulent sputum. The other options do not meet the criteria.
Which clinical finding 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. Normal forced expiratory volume d. Decreased tidal volume
d 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.
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? a. CF is autosomal dominant, so you have a 50% risk in another child. b. Now that you have one child with CF, the rest will also have it. c. Since the male carries the CF gene, you might consider a sperm donor. d. You have a 25% chance that your next child will have CF.
d 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 emergency room provider diagnoses a client with a hemothorax. Which could be possible causes of this condition? a. Fluid imbalances from renal failure b. Congestive heart failure resulting with edema around the heart c. Excessive coughing from pneumonia d. Fractured ribs following car accident
d 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.
An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement is the best response? a. "This disease is seen most commonly in middle-aged men and is associated with chronic irritation from smoking and recurrent infections." b. "There is no known cause for emphysema; however, it does seem to run in families. Has anyone in your family been diagnosed with this disease?" c. "Emphysema is a permanent dilation of the bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue as the result of infection and inflammation." d. "One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"
d 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.
Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Which amount of oxygen is considered most appropriate for the COPD client? a. 5 L/min b. 4 to 6 L/min c. 10 L/min d. 1 to 2 L/min
d The goal of oxygen delivery for a client with COPD is to keep the PO2 at about 60 mm Hg or less, which can be accomplished with delivery of 1 to 2 L/min of oxygen (this will result in a PO2 at 55 to 65 mm Hg). All the other options would increase the PO2 above 60 mm Hg, which tends to depress the hypoxic stimulus for ventilation and often leads to hypoventilation and carbon dioxide retention
A client with primary lung disease has developed right heart failure. The health care provider would document this as: a . Adult respiratory distress syndrome b. Cardiac tamponade c. Primary hypertension d. Cor pulmonale
d The term cor pulmonale refers to right-sided heart failure resulting from primary lung disease or pulmonary hypertension. The increased pressures and work result in hypertrophy and eventual failure of the right ventricle. The manifestations of cor pulmonale include the signs and symptoms of the primary lung disease and the signs of right-sided heart failure. Primary hypertension is elevated blood pressure of unknown cause. Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space.
Which description of symptoms would the nurse expect to obtain from a client with exacerbation of sarcoidosis? a. Crushing pain in mid-chest that is not changed by breathing or coughing b. Sharp bilateral pain in the inferior chest that is worse when lifting or stretching c. Fever, sharp pain in mid-chest that is worse when coughing d. Shortness of breath, non-productive cough, and chest pain
d 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 manifestations are most common in clients with COPD that is predominantly emphysema? Select all that apply. a. Cyanosis b. Peripheral edema c. Increased mucus secretion d. Increased A-P diameter e. Hyperresonance
d, e Emphysema is noted for its loss of lung elasticity and enlargement of the distal air spaces. This leads to hyperresonance, decreased breath sounds, and an increase in the A-P chest diameter, commonly called barrel chest. Clients with emphysema tend to take short frequent breaths and exhale through pursed lips. In chronic bronchitis, there is an increase in mucus production, cyanosis, and often fluid retention associated with right-sided heart failure.
