Unit 6: Ch 21 - 23

A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be:

"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques."

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?

"Actually, people who have the latent form of the disease won't be sick and can't spread it either."

The nurse is performing a health history for a male client who is having a series of diagnostic test to determine the presence of squamous cell carcinoma. What question would be most beneficial for the nurse to ask that would correlate with this suspicion?

"Do you have a history of smoking, and if so, how much?"

A client from Texas is suspected of being infected with coccidioidomycosis and has been admitted to the hospital with fever, cough, pleuritic chest pain, and skin lesions. When performing a health history, which question would be most valuable to assist with diagnosis?

"Do you work in construction and dig soil?"

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?

"I could come down with viral or bacterial pneumonia as a result of a bad flu bug."

An elderly patient who was recently diagnosed with emphysema asks the nurse what caused the disease. Which of the following statements is the best response?

"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"

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?

"Research has shown that viruses may actually be a factor in many children's asthma."

While administering a tuberculin (TB) skin test, a client who is HIV positive asks, "I heard from my friends, this test may not work on me since I have HIV." The health care provider's best response would be:

"Sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction."

While educating a smoking cessation class, a client asks the nurse, "If I can still get lung cancer, what should I be looking for?" Which response by the nurse is best?

"The earliest symptoms relate to a chronic cough and shortness of breath."

A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, "Is our baby's kidneys not working right? Why is he so swollen?" The nurse bases his or her reply on which of the following physiological principles?

"The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen."

The nurse teaches a patient scheduled for surgery about pulmonary function testing (PFT). Which statement, if made by the patient, indicates teaching was effective?

"These tests results will be used to assess any risk I could have due to the anesthesia."

A client tells the nurse he was diagnosed with a sinus infection about 7 days ago. He is now experiencing facial swelling and has also had periods of confusion. His family told him he is not remembering things. The best response by the nurse would be:

"This can be a complication of the infection; we need to let the health care provider know."

A client, newly diagnosed with lung cancer, asks the nurse why the health care provider has ordered a positron emission tomography (PET) scan. Which response by the nurse is best?

"This diagnostic procedure will let the doctor know if you have any mestastatic lesions in your body."

A pregnant client at 26 weeks of gestation states that she is "not really short of breath" but feels aware of the need to breathe. What is the nurse's best reply?

"This may be a normal response to pregnancy. What are you usually doing when you experience this feeling?"

When educating a student who lives in a crowded apartment and diagnosed with tuberculosis, the college school nurse will emphasize:

"To destroy this bacterium, you must strictly adhere to a long-term drug regimen."

A client diagnosis with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. Which of the following is the best response?

"You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated."

A 51 year-old female client who is two days post-operative 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?

"You should breath deeply and cough to help your lungs expand as much as possible while you're in bed."

A client with a history of hypertension and diabetes mellitus has developed a cold and tells the nurse he purchased an OTC (over-the-counter) nasal decongestant. The most important information for the nurse to provide would be:

"You should not take this medication; it can cause problems."

Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Select the most appropriate treatment for the client.

1 to 2 L/min via nasal cannula

The neonatal ICU nurse is aware that Type II alveolar cells produce surfactant and they usually develop at how many weeks gestation?

24-28 weeks.

What is the normal tidal volume for a person at rest?

500 mL

What is the normal range for an arterial blood gas pH?

7.35 - 7.45

At an influenza vaccination clinic, a nurse is screening clients who are requesting the vaccine. The nurse determines that which of the following clients is unable to receive the vaccine?

A 20-year-old healthy female reporting an allergy to eggs

Which of the following neurological patient's is most likely to have abnormalities in breathing regulation?

A 34-year-old male with damage to his upper and lower pons following a blow to the back of the head.

The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism.

A 62-year-old male postop repair of a fractured femur

The nurse is assigned to care for four clients on a medical floor. Which client is most at risk for viral pneumonia after influenza?

A 76-year-old client with cardiopulmonary disease

Select the clinical situation that would result in increased diffusion of gases from the arterial blood into the alveoli.

A client who is receiving 100% oxygen via oxygen mask

A patient is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering:

A corticosteroid.

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 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.

Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?

A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F

Which of the following clients is at risk for developing acute respiratory failure?

A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation

Which of the following situations would be most deserving of a pediatrician's attention?

A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting.

A nurse on an acute medical unit is providing care for a number of patients with a variety of diagnoses. Which of the following patients most likely exhibits risk factors for impaired coughing? A patient with:

A nasogastric (NG) tube attached to suction

Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?

A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking"

A client recovered from influenza two days ago and informs the nurse that she is feeling better but now has a fever, chills, pain when breathing, and a productive cough. What complication does the nurse anticipate the client will be treated for?

A secondary bacterial pneumonia

Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development?

A single-capillary network exists and the lungs are capable of respiration.

Dyspnea can best be described by which of the following?

A subjective sensation felt when experiencing difficulty breathing

Tuberculosis is an infectious respiratory disease caused by the insoluble Myobacterium tuberculosis (M. tuberculosis). The nurse explains to the client, who has tested positive for the presence of M. tuberculosis but has a normal chest x-ray, that he does not have the active disease because his alveolar macrophages have:

Accumulated and encased the M. tuberculosis.

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?

Acute lung injury

An adult comes to the urgent care clinic reporting facial pain, headache, and copious amounts of thick purulent nasal discharge. Based on these symptoms, the nurse practitioner suspects the client is experiencing which condition?

Acute viral rhinosinusitis

A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercule scarring site, located in a peripheral area of his bronchiolar tissue. What is this client's most likely diagnosis?

Adenocarcinoma

Which client with a diagnosis of asthma is at greatest risk for developing an asthma attack?

Adult with a respiratory virus and reflux

A prison inmate contracted tuberculosis during a recent outbreak. The nurse caring for these inmates correctly identifies which of the following as the mode of transmit for this disease?

Airborne droplets

What description is characteristic of the pathology of interstitial lung disease?

Airways become stiff and resist expansion, leading to hypoxemia.

Which of the following is the most common cause of hypercapnia?

Alterations in respiratory rate

Nursing students in an anatomy class are observing lung tissue under the microscope in order to identify regions of the lung. The slide shows a basement membrane, capillary lumen, macrophages, and brush cells. This tissue is identified as which of the following regions of the lung?

Alveoli

The nurse is caring for a client who is now 2 days post near-drowning. The focused assessment would involve which of the following areas of the lung involved in gas exchange?

Alveoli

The physician mentions the patient has developed alveolar dead space. The nurse recognizes that this means:

Alveoli are ventilated but not perfused.

Many pharmaceutical agents may cause pulmonary damage. The nurse knows the following cardiac medication has been associated with toxic effects in the lungs:

Amiodarone

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)?

An 81 year-old male who has a productive cough and recurrent respiratory infections.

The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be:

Antipyretic medications and rest

A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:

Apply a Vaseline gauze (airtight) dressing over the insertion site

A client is suffering from severe gastroesophageal reflux disease (GERD) and has been admitted to the hospital with a diagnosis of pneumonia. Which of the following would be the most likely cause for the development of pneumonia?

Aspiration

An elderly client recently had a cerebrovascular accident that resulted in dysphagia. Which of the following is the nurse's greatest concern while feeding this client?

Aspiration

A client has sudden severe dyspnea, fear, asymmetrical chest movement and decreased lung sounds on the right side. Which intervention is most appropriate?

Assist to high-Fowler's position and prepare for chest tube insertion.

A patient arrives in the ED after an automobile accident. Which of the following clinical manifestations leads the nurse to suspect a pneumothorax? Select all that apply.

Asymmetrical chest movements, esp. on inspiration. Diminished breath sounds over painful chest area. Respiratory rate 34.

The patient with airway obstruction may experience perfusion of the lungs without ventilation due to what disorder?

Atelectasis

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?

Away from the affected lung

A patient with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms should the nurse use to document this finding?

Barrel chest

A client has been diagnosed with sinusitis. The nurses anticipate that the client may present with head pain that increases with:

Bending forward, coughing, or sneezing

A moderate hemothorax diagnosis would be confirmed by the presence of which of the following?

Blood filling approximately one third of the pleural space

The nurse is caring for a client suffering from multiple pulmonary embolisms who is concerned that her lungs will be permanently destroyed. The nurse reassures the client that collateral circulation is formed to protect the lung tissue until the embolisms resolve by means of:

Bronchial blood vessels.

A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication?

Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract.

An infant born 10 weeks premature was placed on mechanical ventilation. Eight weeks later a nursing assessment reveals a barrel chest, tachycardia, rapid and shallow breathing, hypoxemia, hypercapnia, and poor weight gain. Based on this assessment which of the following is the most likely diagnosis?

Bronchopulmonary dysplasia

An infant who was born prematurely and developed respiratory distress syndrome was placed on mechanical ventilation for several weeks. What condition should the nurse monitor the infant for related to the long-term ventilatory support?

Bronchopulmonary dysplasia

The emergency department is awaiting the arrival of a spinal cord injured patient. Knowing the innervation of the diaphragm, a patient with which type of injury may be in need of immediate mechanical ventilation? Injury to the:

C4 area.

For which client condition will a pulse oximeter reading be inaccurate?

Carbon monoxide poisoning

While discussing carbon dioxide transport within the body, the instructor asks, "What enzyme helps carbon dioxide with water to form bicarbonate?" Which student response is correct?

Carbonic anhydrase

Tuberculosis is a highly destructive disease because the tubercle bacillus activates a tissue hypersensitivity to the tubercular antigens. What does the destructive nature of tuberculosis cause in a previously unexposed immunocompetent person?

Caseating necrosis and cavitation

A client is brought into the ER with rapid, deep respirations at a rate of 25 breaths per minute and decreased level of consciousness. A stat MRI shows a lesion in the brain stem which may have infiltrated which of the following regulators of respiratory function responsible for detecting changes in carbon dioxide levels?

Central chemoreceptors

The nurse determines that the client has clubbing of the fingertips. Which is the best intervention?

Check the patient's O2 saturation level.

A patient is diagnosed with pulmonary embolism. Which of the following symptoms would most likely be present?

Chest pain and dyspnea

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?

Chickenpox

Which condition places the client at risk for hypercapnia if given high-flow oxygen as treatment for a ventilation perfusion mismatch?

Chronic bronchitis from smoking

Chronic obstructive pulmonary disease (COPD) is a combination of disease processes. What disease processes have been identified as being part of COPD?

Chronic obstructive bronchitis and emphysema

A client has undergone pulmonary diagnostic studies. The health care provider reviews the results and notes a mismatching of ventilation and perfusion. The client most likely has developed:

Chronic obstructive pulmonary disease

For a client with which of the following is the use of oxygen at a rate above 2 L/minute inappropriate?

Chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%

A middle-aged client with a 30-year history of smoking was diagnosed with lung cancer. A health history revealed previous exposure to air pollution, asbestos, and radiation. Which of the following most likely had the greatest impact on development of the lung cancer?

Cigarette smoke

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:

Constriction of the pulmonary vessels in response to hypoxemia

A 3-year-old boy has been diagnosed with croup (acute laryngotracheobronchitis). The nurse anticipates the plan of care to include:

Cool, humidified air to relieve airway spasms

A client with primary lung disease has developed right heart failure. The health care provider would document this as:

Cor pulmonale

What intervention is appropriate for a client with sarcoidosis?

Corticosteroids

A patient with chronic obstructive pulmonary disease presents to the emergency department with difficulty breathing. Physical examination reveals bluish skin, nail beds, and mucous membranes. Which of the following terms correctly describes this condition?

Cyanosis

A client arrives in the emergency department suffering a traumatic brain injury as a result of a car accident. While assessing this client, the nurse notices the client has an irregular breathing pattern consisting of prolonged inspiratory gasps interrupted by expiratory efforts. The underlying physiological principle for these signs would include:

Damage has occurred at the connection between the pneumotaxic and apneustic centers.

During the admission interview the client, who is admitted with bacterial pneumonia, reveals a 20 pack per year smoking history. The nurse relates the possible cause of this pneumonia to the decreased defense of the pulmonary system caused by cigarette smoking. Smoking affects the pulmonary defense system by which of these?

Damage or destruction of cilia

Which classification of medications used to self treat the common cold should be avoided by those with a history of hypertension?

Decongestants

A client with asbestosis-induced pulmonary fibrosis asks the nurse why breathing is so difficult at times. The nurse explains that the scar tissue in the client's lung tissues causes which of these?

Decreased compliance of the lung tissue

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)?

Decreased tidal volume

The nurse caring for a client with bilateral rib fractures explains to the client that the pain causes him to take more shallow respirations which will contribute to feeling SOB due to a

Decreased tidal volume.

The nurse is explaining to the parents of a 23-week premature infant the reason their baby needs to be on mechanical ventilation. The education is successful when the parents state that they understand their baby was born before the type II alveolar cells could mature which has caused a

Deficiency in surfactant

When there is a mismatching of ventilation and perfusion within the lung itself, insufficient ventilation occurs. There is a lack of enough oxygen to adequately oxygenate the blood flowing through the alveolar capillaries, creating a physiologic shunt. What causes a physiologic right-to-left shunting of blood in the respiratory system?

Destructive lung disease or heart failure

A diagnosis of tension pneumothorax would be suspected in which of the following physical assessment findings?

Deviated trachea

A client with lung cancer is scheduled for the removal of the right lung. The nurse should anticipate that after surgery the client will experience a significant decrease in which of the following?

Diffusion capacity

Due to complications, a male postoperative patient has been unable to mobilize secretions for several days following surgery and develops atelectasis. Which of the following processes would his care team anticipate with relation to his health problem?

Directing blood flow away from the lung regions that are hypoxic

Which of the following diagnoses will present the highest risk for hypercapnic/hypoxemic respiratory failure?

Drug overdose

A client is preparing to travel for business and has developed the common cold. The client informs the nurse that she will be flying and does not want to give it to anyone else. When should the nurse inform the client is the most highly contagious period?

During the first 3 days after the onset of symptoms

A client who has no previous history of respiratory disease describes a sensation of shortness of breath and the feeling of not being able to pass enough air during exercise that has just developed over the past month. The client would be documented as having which of these?

Dyspnea

A patient is reporting difficulty breathing when walking to the bathroom. The nurse documents this as:

Dyspnea

The school nurse is providing education to parents of school-age children during flu season. What should the nurse teach about the importance of early diagnosis of influenza?

Early diagnosis can reduce the inappropriate use of antibiotics.

When developing the plan of care for a child with respiratory distress, what nursing intervention can the nurse provide that will facilitate respiratory movements and avoid airway compression?

Elevate the head of the bed.

The pulmonary rehabilitation specialist is educating medical students on a respiratory disease process that causes a severe compromise in exhalation due to air trapping. Air trapping is caused by the loss of elastic recoil, especially in the alveoli, which occurs after overstretching in which of the following diseases?

Emphysema

A mother rushes her toddler into the emergency department stating, "My baby can't breathe." Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breath. The nurse suspects the child has which of the following acute respiratory infections?

Epiglottitis

A parent calls 911 and states her child is having trouble breathing. The child is rushed to the emergency department. Upon assessment, the child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward. The parent states that the child just developed a sore throat and fever today. The health care provider determines that the child is experiencing:

Epiglottitis

Which diagnosis places a child at the greatest risk for airway obstruction?

Epiglottitis

A client is preparing for a hip replacement surgery and his physician orders pulmonary function tests (PFTs) to be done pre-surgical. Upon arrival to the lab for the PFTs, the client is anxious and asks the nurse why his physician would order these tests since he does not have any pulmonary diseases. The nurse responds that although the client should speak with his physician, the most likely reason is which of the following?

Evaluate anesthetic risk

A client has been admitted to the hospital for new-onset dyspnea and is undergoing testing for obstructive lung disease. In reviewing the results of the pulmonary function studies, the nurse would expect to note a decrease in which of the following values with obstructive lung disease?

FEV1

A patient diagnosed with asthma is scheduled for a pulmonary function test. During the test, the technician instructs the patient to forcefully exhale air for 1 second to evaluate:

Forced expiratory volume

A fully saturated hemoglobin molecule can hold how many oxygen molecules?

Four (4)

The health care provider suspects a newly admitted client may have a hemothorax. The client most likely experienced:

Fractured or dislocated ribs

A client's chest x-ray and pathology report identify a granulomatous lesion that contains the tubercle bacilli. The health care provider would interpret this as:

Ghon focus

A nurse is assessing a 2-week-old infant with pulmonary edema. Which of the following symptoms indicates the infant is experiencing respiratory distress?

Grunting during expiration

A female patient is requiring supplementary oxygen by face mask due to her reduced lung compliance. Which of the following pathophysiological processes is most likely to be a contributor to her low lung compliance?

Her thoracic cage is less flexible than when she was healthy.

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?

High inspired oxygen concentration and injury from positive-pressure ventilation

A 21-year-old male client has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately captures an aspect of his condition?

His vocal folds are likely not performing their normal function.

A client has been diagnosed with an advanced tumor that has invaded the mediastinum. The client would most likely manifest:

Hoarseness and difficulty swallowing

A pneumonia that occurs 48 hours or more after admission to the hospital is considered:

Hospital-acquired pneumonia.

An asthmatic patient comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. Which of the following is the most likely cause?

Hyperventilation

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?

Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.

A patient diagnosed with congestive heart failure has an arterial blood oxygen level (PaO2) of 89%. Which of the following terms should the nurse use to document a reduced oxygenation of arterial blood?

Hypoxemia

The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen in the arterial blood and a decreased in the partial pressure of oxygen. The nurse would interpret this as:

Hypoxemia

What is the underlying cause of respiratory failure in a child with bronchiolitis?

Impaired gas exchange

A patient 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 of the following laboratory values would be expected?

Increase in PCO2

Ventilation is driven by which alteration in arterial blood?

Increased PCO2

Which alteration in acid-base balance could be expected as a compensatory response for a client with severe chronic respiratory impairment?

Increased arterial blood bicarbonate

Acute respiratory failure is commonly signaled by varying degrees of hypoxemia and hypercapnia. Respiratory acidosis develops, manifested by:

Increased cerebral blood flow

A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be:

Increased turbulence of air moving through the obstructed airways

The nurse is caring for a client who is 2 days postop following a total hip replacement. The client is refusing to participate in physical therapy, complaining of extreme fatigue and severe pain with any movement. The nurse administers pain medication and then encourages the client to sit up to more effectively cough and deep breathe to increase ventilation by:

Increasing the spread of surfactant

The nurse is assessing a client who states he felt fine all day and then within five minutes, began to feel extremely weak and tired and began having a fever. What do these symptoms indicate that the client may be experiencing?

Influenza

A client asks the nurse if it is possible to contract influenza by being exposed to wound secretions. On what knowledge should the nurse base her response to the client?

Influenza transmission occurs by inhalation of droplet nuclei.

Influenza A subtype H5N1 (avian flu) has been documented in poultry in both East and Southeast Asian Countries. This form of avian flu is highly contagious from bird to bird but rarely is passed from human to human. There is a large amount of concern that the H5N1 strain might mutate, making it easier to be passed from human to human, carrying with it a high mortality rate. What is the main concern if the H5N1 strain does mutate?

Initiation of a pandemic

A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:

Insertion of a large-bore needle or chest tube

People with emphysema often have a difficult time with air trapping, which is air left in the lungs following expiration, often due to the destruction of the alveoli. Pulmonary rehabilitation educates people who suffer from this disease to use which of the following to help air leave the lungs more effectively?

Intercostal and abdominal muscles

Talc lung can occur from injected or inhaled talc powder that has been mixed with heroin, methamphetamine, or codeine as a filler. What are people with talc lung very susceptible to?

Interstitial lung disease

While working in the newborn ICU, the nurses receive a call that an infant, gestational age of 23, is being air-flighted to their level three trauma nursery. The priority intervention for this infant would be:

Intubation and mechanical ventilation.

A client presents to his physician complaining of severe fatigue and intermittent shortness of breath. The physician is concerned that the client has developed anemia, a decreased oxygen carrying capacity of the blood, and has ordered blood work. A deficiency in which of the following would support the diagnosis of anemia secondary to a decrease in oxygen's ability to bind with hemoglobin?

Iron

A client with a history of asthma comes to the clinic complaining of wheezing and difficulty in breathing when harvesting the field. The assessment findings include use of accessory neck muscles, prolonged expiration, intercostal retractions, decreased breath sounds, and expiratory wheezes. Based on these finding the nurse determines which of the following anatomical receptors in the lungs have been stimulated?

Irritant receptors

A nurse is instructing a class for people with newly diagnosed asthma to encourage healthy life style choices. The nurse explains that stimulation of certain lung receptors with things such as smoke, cigarette smoke, inhaled dust, or cold air can lead to constriction of the conducting airways resulting in rapid, shallow breathing. How does the nurse identify these receptors?

Irritant receptors

A parent brings his child to the emergency department stating that the child became sick very quickly. The nurse observes the child having to sit upright with the mouth open, drooling, lethargic, with inspiratory and expiratory stridor. What action should the nurse perform at this time?

Keep the child calm and decrease anxiety.

A 66-year-old male presents 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 135-145 mEq/L). Based on this assessment, the nurse suspects the patient has:

Legionella pneumonia

A nurse is assessing a client for cyanosis. The most appropriate areas for the nurse to assess would be: Select all that apply.

Lips Nails Ears Cheeks

The home care nurse is caring for a client who has sustained phrenic nerve damage from a skiing accident. The nurse understands that the client must be on a ventilator for which of the following reasons?

Loss of diaphragmatic function

A nursing student is studying the respiratory airways in the lungs, in particular the alveoli. A fellow student asks which of the following cells is most instrumental in the destruction of foreign substances that may enter the alveoli with inspired air. The most accurate response would be alveolar which of the following?

Macrophages

Around three 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?

Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them.

Elderly people are very susceptible to pneumonia in all its varieties. The symptoms the elderly exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are elderly people with pneumonia less likely to experience than people with pneumonia in other age groups?

Marked elevation in temperature

Dyspnea is defined as an uncomfortable sensation or difficulty in breathing that is subjectively defined by the client. Which of the following disease states is not characterized by dyspnea?

Multiple sclerosis

The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on?

Mycobacterium tuberculosis

The nursing instructor is explaining pressure changes that occur during inspiration to a group of students. Which would be the most appropriate information to include? During inspiration, intrapleural pressure is:

Negative in relation to alveolar pressure

Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation?

Negative intrapleural pressure holds the lungs against the chest wall

A client hospitalized for 72 hours has developed symptoms of a lower respiratory tract infection. Sputum cultures reveal S. aureus as the infectious organism. The nurse explains to the client that which of the following is the most likely cause of this infection?

Nosocomial hospital-acquired infection

A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis.

Nosocomial pneumonia

A client is admitted to the hospital following smoke inhalation. The nurse would anticipate the need for cellular metabolism and that the client would need supplemental:

O2

Question: Put these steps in order to describe the process of oxygen transport from the alveolar to the cellular level.

Oxygen moves from inspired air in the alveoli to the pulmonary capillaries through the process of diffusion. Oxygen moves quickly to the red blood cells where it binds reversibly to hemoglobin. Oxygen is released from the hemoglobin in the tissues capillaries. Oxygen separates from the hemoglobin and moves into the tissues where the PO2 level is lower.

A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has severe persistent asthma?

PEF 350 ml in AM, 200 ml at noon, symptoms occur continuously

A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has mild intermittent asthma?

PEF 400 ml in AM, 390 ml at noon, symptoms occur twice a week

A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has moderate persistent asthma?

PEF 450 ml in AM, 300 ml at noon, symptoms occur daily

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 are most likely to be related and effective, respectively?

Parainfluenza virus, treated with a mist tent and oxygen therapy.

When a client with a history of asthma takes a walk outside on a windy day with high pollen counts, she may experience an asthma attack, resulting in an increase in respiration rate and wheezing. The body's response is likely related to which pathophysiological principle?

Parasympathetic nervous system stimulation resulting in airway constriction

A patient admitted to the hospital with heart failure tells the nurse he has developed a condition that interferes with movement of blood through sections of the lungs. The nurse recognizes this as which of the following?

Physiologic shunting

A child is brought to the emergency department with a respiratory infection. The child is struggling to breath and is very anxious. The health care providers suspect epiglottitis. Which of the following interventions would be a priority?

Place the child upright in bed and begin preparing for a tracheostomy placement.

The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is:

Pleural effusion.

A diagnosis of exudative pleural effusion would be based on which of the following?

Pleural fluid protein/serum protein ratio >0.5

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?

Pleuritic pain

A young adult is brought to the urgent care by a parent. The client states that he just does not feel good. Upon further assessment, the health care provider notes the following: • Unilateral chest pain when the client is asked to cough or move • Rapid respiratory rate • Splinting of the chest • Decreased tidal volume The provider would interpret these manifestations as:

Pleuritis

A short, nonsmoking 44 year old male presents to the emergency room with left-sided chest pain and a cough. He states 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, no cyanosis. Which condition is most likely causing his symptoms?

Pleuritis related to infection

Select the group of respiratory neuron that turns off inspiration and assists in the control of the respiratory rate.

Pneumotaxic center

The respiratory neurons that turn off inspiration and assist with regulation of the respiratory rate are located where?

Pneumotaxic center

A 40-year-old male presents to the emergency department reporting chest pain and shortness of breath. The health care provider suspects a pulmonary embolism and orders several diagnostic tests. Select the test that would require further follow-up.

Positive D-dimer

A nurse is caring for a patient who has been ordered complete bed rest. The nurse determines the area of this client's lungs that experience the most ventilation as which of the following?

Posterior portions of the lungs

A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client's respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support?

Prepare for mechanical ventilation.

Which of the following best describes the pressure that drives breathing?

Pressure in the pleural cavity

A patient recently had surgery for a hip fracture. Which of the following nursing interventions would be most effective for preventing pulmonary emboli in this patient?

Prevention of the development of a deep vein thrombosis

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?

Pseudomonas aeruginosa and Staphylococcus aureus

Reviewing pathology for an exam on pulmonary vasculature, the nursing student states that blood enters the right side of the heart via vena cava's, then to the right atrium, right ventricle, and then which vessel carries the deoxygenated blood into the pulmonary system?

Pulmonary artery.

A client has been admitted with bacterial pneumonia and is complaining of difficulty breathing. The nurse would explain the most likely reason for the dyspnea is that pneumonia interferes with lung compliance due to which of the following?

Pulmonary congestion

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?

Pulmonary embolism

Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?

Pulmonary vessels constrict

The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement techniques would be:

Pulse oximetry

The nurse is educating a client suffering from advanced emphysema on how to improve expiratory flow rates. Which of the following breathing techniques would the nurse describe as most effective?

Pursed-lip breathing

Premature infants who are treated with mechanical ventilation, mostly for respiratory distress syndrome, are at risk for developing bronchopulmonary dysplasia (BPD), a chronic lung disease. What are the signs and symptoms of BPD?

Rapid and shallow breathing and chest retractions

The early stages of influenza pass by as if the infection were any other viral infection. What is the distinguishing feature of an influenza viral infection that makes it different from other viral infections?

Rapid onset of profound malaise

A client diagnosed with the common cold has been taking an over-the-counter antihistamine for the control of symptoms. What should the client be aware may occur if the drugs are used too frequently over too many days?

Rebound symptoms

The nurse is educating the client with a cold about the use of over-the-counter decongestants. What expected outcome does the nurse anticipate with the use of this medication?

Reduction of nasal swelling

A nurse is assessing a 1-year-old child diagnosed with croup. Which of the following manifestations would most likely be present?

Respiratory stridor and barking cough

Which of the following diagnoses puts a patient at risk for developing an immunologic form of interstitial lung disease?

Rheumatoid arthritis

Which conditions increase client risk for developing pulmonary arterial hypertension (PAH)? Select all that apply.

Scleroderma HIV infection Family history

A child is brought to the emergency department struggling to breathe with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following is the most likely diagnosis?

Severe asthma attack

Patients with chronic diseases such as chronic obstructive pulmonary disease (COPD), when given oxygen at a level that increases PO2 above 60 mmHg would experience which of the following?

Severely depressed ventilation

Clients who have been bed-ridden for a long time likely will experience:

Shallow, quiet breathing, which impairs the spreading of surfactant

A client who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. Upon assessment of the lungs, what clinical manifestations should the nurse expect?

Short, shallow breaths.

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 of the following drugs will the nurse anticipate administering first?

Short-acting beta 2-adrenergic agonists such as albuterol (SABA)

Which description of symptoms would the nurse expect to obtain from a client with exacerbation of sarcoidosis?

Shortness of breath, non-productive cough, and chest pain

A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which of the following possible diagnoses?

Small cell lung cancer due to smoking history

Which would be the most appropriate measurement tool to determine lung volume and lung capacity of a patient?

Spirometer

When talking to a group of homeless women living in a shelter, the nurse should educate about risk for developing tuberculosis. The nurse should emphasize which lab/diagnostic test as considered to be the "gold" standard for diagnosing tuberculosis?

Sputum or bronchial cultures

An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organism is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function?

Staphylococcus aureus

A client has developed bacterial pneumonia and is admitted to the hospital. The nurse obtains sputum cultures upon admission. What bacteria does the nurse anticipate finding when the results are complete?

Streptococcus pneumoniae

Which type of lung receptor monitors for lung inflation?

Stretch

The nurse is assessing a patient's respiratory status for lung expansion and airway resistance. The nurse is aware that changes in the pressure occurring in the walls of the airways will be adjusted by which of the following?

Stretch receptors

Which description of the onset of symptoms is most characteristic of epiglottitis?

Suddenly onset

The nurse develops a plan to prevent atelectasis in a postsurgical client. Which intervention will be effective?

Supervision of hourly deep breathing exercises

Select the primary function of bronchial circulation.

Supplies the blood supply for the conducting airways and supporting structures

Which of the following is a criterion for diagnosing moderately persistent asthma?

Symptoms occur daily.

Non-small cell lung cancers (NSCLCs) mimic small cell lung cancers (SCLCs) through their abilities to do what?

Synthesize bioactive products and produce paraneoplastic syndromes

Which of the following medications helps treat the inflammatory reaction of asthma clients diagnosed with late-phase asthma response?

Systemic corticosteroids

A patient's oxygen-hemoglobin dissociation curve is represented by a shift to the right. The nurse recognizes this as:

The affinity of hemoglobin for oxygen is decreased.

When thinking in terms of airway radius with regard to resistance, the lung structure responsible for the most airway resistance to airflow would be:

The bronchioles near the trachea

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?

The client complains of sharp pain exacerbated by deep inspiration.

A 23-year-old woman goes to the drugstore to buy a medication to ease the symptoms of her cold. Her friends have told her to buy a medication with an antihistamine in it to help dry up her runny nose and make it easier to breathe. The woman talks with the pharmacist, who has known her many years. The pharmacist recommends that this young woman not buy a cold medication with a decongestant in it. Why would he do that?

The client has a history of hyperthyroidism.

The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis.

The client who is postop total knee replacement and receiving client-controlled analgesia

A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. What medication education will the nurse provide to the client?

The client will need education about the administration of INH and the importance of taking it as prescribed.

An infant born prematurely is in the neonatal intensive care unit (NICU) for observation and to ensure hemodynamic stability when the nurse observes the infant beginning to have nasal flaring. What does the nurse understand that this may indicate?

The infant is using nasal flaring to take in more air.

A client presents to the physician's office with a chronic cough, shortness of breath, and wheezing that has gotten progressively worse, with recent episodes of hemoptysis. Diagnostic tests reveal a lung mass. Based on these symptoms, the nurse is anticipates which of the following has occurred?

The lesion has eroded blood vessels in the lungs.

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?

The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.

A 76-year-old male client is admitted to the emergency department after a fall. His assessment reveals a bruised left hip, shortness of breath, and shallow respirations with a respiratory rate of 30. What additional physical assessment finding would lead to a possible diagnosis of tension pneumothorax?

The presence of a deviated trachea

The nurse is teaching a group of nursing students about exudative pleural effusion. The nurse determines that teaching was effective when the students' state:

The specific gravity of the pleural exudate is greater than 1.020.

Select the statement that best describes pneumococcal infection.

The spread of some strains of pneumococci is through healthy colonized individuals.

A client has been diagnosed with pneumococcal infection. The nurse shares with the client which statement about the spread of the disease?

The spread of this bacteria, especially the antibiotic-resistant strain, is largely by healthy, colonized individuals.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to:

The stiffening of the lung, making it more difficult to inflate

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?

The sweat test measures the concentration of salt in the infant's sweat.

A client arrives in the clinic with a cough, fever, and chest discomfort and is diagnosed with community-acquired pneumonia. What education does the nurse anticipate providing prior to discharging the client from the clinic?

The use of antibiotics

A client asks the nurse what anatomic airway dead space is. Which of the following would be the nurse's best response?

The volume of air contained in the nose, pharynx, trachea, and bronchi

The nurse is reviewing the near-drowning client's pulmonary function tests and is concerned that the forced vital capacity (FVC) is decreased. Which of the following accurately describes FVC?

The volume of air exhaled vigorously and quickly after maximum inspiration

The nurse is interviewing a client who has come in for the first round of radiation treatment of a large, right upper lobe lung tumor. The client asks how the tumor could get so large without causing any pain. The most accurate explanation would be which of these?

There are no pain receptors in the lung tissue.

Bronchial blood vessels have several functions. They warm and humidify incoming air as well as distribute blood to the conducting airways and the supporting structures of the lung. What is it that makes bronchial blood vessels unique in the body?

They can undergo angiogenesis.

A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states, "For unknown reasons, you lose intrapleural negative pressure.

This means your lungs collapsed and expelled its air when you lose negative pressure."

Which of the following situations is most likely to result in an increased binding affinity of hemoglobin for oxygen?

Three of four binding sites on a client's hemoglobin molecule are occupied by oxygen.

The nurse is calculating the minute volume of a patient. Select the correct categories of measurement.

Tidal volume × respiratory rate

Following a winter power outage, a client who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning?

To increase the amount of oxygen carried in the dissolved state

A nurse experiences a person having seizure activity in the grocery store. Once the seizure activity has subsided the nurse places the person in a side lying position to avoid occlusion of the airway, which could cause cessation of ventilation due to which of the following?

Tongue falling back and blocking the airway

Clients with chronic obstructive lung disease (COPD) may experience airway closure at the end of normal instead of low lung volumes, which result in:

Trapping of large amounts of air that cannot participate in gas exchange

A patient has sustained a lung injury while hospitalized for the treatment of acute pancreatitis. The nurse anticipates that proliferation of cells will result from which of the following?

Type II alveolar cells

The nurse is caring for a patient with adult respiratory distress syndrome. The nurse knows that the pathophysiology of this disorder is related to what type of pulmonary alveolar cells?

Type II alveolar cells

A client is admitted to the hospital suspected to have Legionnaire disease after a cruise. What type of specimen should the nurse collect that is a rapid test to detect the antigens of L. pneumophila?

Urine specimen

A nurse is caring for a child with an airway obstruction. It is most important for the nurse to avoid:

Using a tongue depressor to assess the child's tonsils

Blood transports both oxygen and carbon dioxide in a physically dissolved form to the tissues and organs of the body. It is the measurements of the components of the gases in the blood that are used as indicators of the body's status by health care workers. Why is common to measure the blood in the arteries rather than the blood in the veins?

Venous blood measures the metabolic demands of the tissues rather than the gas exchange function of the lungs.

A 44-year-old woman has developed calf pain during a transatlantic flight. She is extremely short of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE) which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE?

Ventilation was occurring but perfusion was inadequate causing shortness of breath.

A 60-year-old male hospital patient with a diagnosis of chronic obstructive pulmonary disease (COPD) is undergoing lung function tests to gauge the progression of his disease. Which of the following aspects of the lung volumes will the respiratory therapist be most justified in using to guide interpretation of the test results?

Vital capacity will equal the patient's combined inspiratory reserve, expiratory reserve, and tidal volume.

Which of the following is a function of the bronchial circulation?

Warms and humidifies incoming air

The nurse is educating a group of school-age students about the prevention of cold viruses and staying healthy during the school year. What should the nurse inform the students is one of the most important ways for them to avoid spreading a cold?

Wash your hands after touching surfaces prior to touching your nose or eyes.

A patient is admitted with pneumoconiosis. His history most likely reveals which of the following?

Work in a coal mine for 20 years

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?

You have a 25% chance that your next child will have CF.

A client with chronic asthma is experiencing a severe asthma attack and is becoming increasingly agitated. The nurse supports the client's ability to move more air in and out of the lungs by instructing the client to stabilize his accessory muscles. The nurse understands that by stabilizing the accessory muscles the:

accessory muscles can assist in ventilation.

Which client is exhibiting manifestations of drug-induced interstitial lung disease? A client taking

amiodarone for dysrhythmias who develops a dry cough.

A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that:

cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant.

The nurse is caring for an infant with a large ventricular septal defect, also called a hole in the heart, which is a congenital heart defect causing a right to left shunt. The nurse illustrates for the parents how this compromises their child's ability to deliver oxygenated blood to the tissues causing

cyanosis secondary to an anatomic shunt.

A client reports chest pain to the nurse. Which characteristics of the pain indicate bronchial irritation?

dull pain in mid-chest that is worse when coughing

The client ask the nurse how influenza is spread from person-to-person. The nurse educates her client that influenza is transmitted by:

inhalation of droplet nuclei.

A client comes to an urgent care center. The nurse notes that the client has a fever of 103.2 F (39.5 C), pleuritic pain with each breath, and enlarged lymph nodes in the neck and axilla area. The client also has a productive cough. The nurse should consider tuberculosis if the client's history includes:

intravenous drug abuse and living on the streets.

A distressed, confused client is admitted to the hospital ER with a penetrating right chest stab wound. The nurse assesses the patient and notes a lack of breath sounds in the right lung due. The nurse knows this is likely the result of:

loss of intrapleural pressure.

Which client will the nurse see first? The client with

refractory asthma, PEF 210 ml out of best PEF 450 ml, diminished wheezing.

Which client is showing signs of chronic hypoxemia? A client who is

restless, has clubbed fingers, and frequently drops items.

Which client is exhibiting signs of advanced chronic obstructive pulmonary disease (COPD)? The client who is

sitting in bed resting elbows on overbed table, expiratory wheezes noted.

A young child is brought to the ER with CPR in progress. The parent found the child lying on the kitchen floor without respirations, although a heartbeat was initially detected. The triage nurse anticipates the most likely cause of the situation is an obstruction of the conducting airways which caused an interruption in

ventilation

A 10-year-old male is experiencing an acute exacerbation of his asthma. The most appropriate treatment for this client would be:

β-adrenergic agonist

While lecturing on COPD, the instructor mentions emphysema. The instructor asks the students, "If the client is a smoker, explain the physiology behind cellular changes occurring in the lung which allow destruction of the alveoli." Which students have an accurate response? Select all that apply.

• "Antiprotease production and release is not adequate to neutralize the excess protease production." • "There is α1-antitrypsin deficiency, so this enzyme can't protect the lung from damage."

A nurse runs into an old high school friend after 20 years. She notes her friend continues to smoke after all these years. The friend asks, "Do you think I sound hoarse?" Upon further assessment, the nurse/friend notes her friend has several warning signs of cancer. Which manifestations would lead to this conclusion? Select all that apply.

• "I seem to have some difficulty swallowing food... this is new for me." • "Can you feel how large my lymph nodes are on my neck and armpits (axillae)?"

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.

• +4 pitting edema in lower extremities. • Jugular vein distension. • Altered level of consciousness.

Which of the following clients are likely experiencing a shift to the right in the dissociation curve? Select all that apply.

• A client with respiratory influenza with a temperature of 102.6°F • A COPD client with pneumonia with blood gas pH level of 7.31 • A renal failure client with admitting hemoglobin level of 8.0 mg/dL

A client with a right-sided chest tube in place to remove air describes an increase in his respiratory effort over the past day. The nurse would suspect an increase in the size of the pneumothorax and would anticipate that the pulmonary function tests would show which of the following? Select all that apply.

• A decrease in inspiratory capacity • An increase in dead space • A decrease in total lung capacity

Which of the following clients are more than likely experiencing impairment of the mucociliary blank with cilia dysfunction? Select all that apply.

• A smoker who smokes 2 packs of cigarettes/day and currently hospitalized with pneumonia • A mountain skier who spends all day outside teaching ski lessons • A nursing home client diagnosed with H1N1 influenza with fever of 102°F

Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply.

• A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation • A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food • A school-aged child with severe asthma controlled by steroids admitted for an exacerbation

Which assessment findings may indicate that the acute rhinosinusitis is experiencing a complication? Select all that apply.

• Abnormal extraocular movements • Changes in mental status

Which of the following is/are a lower airway disease? (Select all that apply.)

• Acute bronchiolitis • Asthma

Which factors influence diffusion of gases in the lungs? Select all that apply.

• Administration of high concentrations of oxygen • Difference in the partial pressures of the gas on either side of the membrane • Diffusion characteristics of the gas • Surface area available for diffusion • Thickness of the alveolar-capillary membrane

When CO2 levels in the blood rise, a state of hypercapnia occurs in the body. What factors contribute to hypercapnia? (Select all that apply.)

• Alteration in carbon dioxide production • Abnormalities in respiratory function • Disturbance in gas exchange function • Changes in neural control of respiration

The nurse caring for a premature infant explains to the parents that the lack of type II alveolar cells in their baby's lungs will contribute to which of the following? Select all that apply.

• An interference in alveolar ventilation • An interference in pulmonary ventilation • An increase in alveolar collapse

A client with cystic fibrosis reports sinus congestion and coughing up thick greenish mucus. What interventions will the nurse implement? Select all that apply.

• Antibiotic therapy • Chest physiotherapy

A nurse is evaluating patients at risk for developing dyspnea. Which diagnoses would place a patient at risk? Select all that apply.

• Asthma • Heart disease • Emphysema • Pneumonia

A client with a history of chronic obstructive pulmonary disease (COPD) has developed influenza. Which statements about possible treatments is accurate for this client. Select all that apply.

• At the onset of influenza-like symptoms, the client is eligible to begin antiviral medications within the first 36 hours. • The antiviral drug of choice is oral oseltamivir.

A toddler seems to have a little "cold" and runny nose. At bedtime, he appears to be OK. A few hours later, parents awaken hearing a "tight" coughing sound. They recognize the child is not breathing well, so they rush to the emergency department. On arrival, the nurses suspect bronchial asthma based on which of the following assessment data? Select all that apply.

• Audible wheezing • Respiratory rate—44 with prolonged exhalation • Sitting upright, leaning forward, and using accessory muscles to breathe

A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply.

• Bluish discoloration of the skin and mucous membranes (central cyanosis) • Substernal retractions with each breathe • Expiratory grunting

While administering influenza vaccines for the general public, the nurse will advise which clients to avoid taking the flu shot? Select all that apply.

• Client with allergy to eggs • Client with Guillain-Barre syndrome

A client has developed community-acquired pneumonia and is being treated at home. What does the nurse recognize are the methods in the diagnosis of community-acquired pneumonia? Select all that apply.

• Coexisting health problems • Age • Severity of illness

A 25-year-old cystic fibrosis client presents to the clinic in obvious respiratory distress. Following physical exam, the health care provider suspects bronchiectasis based on which of the following findings? Select all that apply.

• Copious amounts of foul-smelling purulent sputum • Blood-tinged sputum • Wheezing throughout the lung fields

A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following pathological processes occur as a result of her emphysema? Select all that apply.

• Decreased elastic recoil due to alveolar damage. • Increased anatomical dead space due to reduced tidal volume. • Increased alveolar dead space due to incorrect intrapleural pressure.

There can be many reasons for a client to present with hypoxemia. For a client's PO2 to fall, a respiratory disease is usually involved. Often, clients have involvement from more than one mechanism. Which of the following will result in hypoxemia? (Select all that apply.)

• Decreased oxygen in air • Disease in respiratory system • Dysfunction of neurologic system

Some nursing students are studying normal respiratory physiology in relation to stimulation of the sympathetic nervous system. As they reflect on the fight or flight syndrome, they determine that which of the following would happen? Select all that apply.

• Dilation of the bronchioles • Blood vessel constriction

A client presents with atypical pneumonia signs/symptoms and is diagnosed with Mycoplasma pneumoniae. For which characteristics of the cough should the nurse assess this client? Select all that apply.

• Dry • Nonproductive • Hacking

What manifestations would the nurse expect to find when assessing a client with a right pleural effusion? Select all that apply.

• Dyspnea on exertion • Diminished right breath sounds • Hypoxemia

A client admitted to the hospital with aspiration pneumonia subsequent to having a recent stroke is requesting an antitussive medication to stop her productive cough. The nurse explains to the client that the purpose of her cough is which of the following? Select all that apply.

• Expel excess secretions • Protect the lungs • Remove foreign aspirate

Respiration has both automatic and voluntary components that are sent to the respiratory center of the brain from a number of sources. What physiologic forces can exert their influence on respiration through the lower brain centers? (Select all that apply.)

• Fever • Pain • Emotion

Which assessment findings concern the presence of respiratory distress in an infant? Select all that apply.

• Grunting • Respiratory rate of 95 breaths/minute • Sternal retraction • Central cyanosis

The community health nurse is developing a program to decrease the amount of pulmonary tuberculosis that has recently risen in her area. Which populations at risk will the nurse target? Select all that apply.

• HIV-infected people • Foreign-born people from countries with a high incidence of tuberculosis • Residents of high-risk congregate settings

Which factors increase the risk that a client will develop chronic obstructive pulmonary disease (COPD)? Select all that apply.

• History of asthma • History of tobacco use

All of the following clients are exhibiting manifestations of a common cold. At the pharmacy, the pharmacist should advise which clients to avoid decongestant drugs from over-the-counter? Client with a history of: Select all that apply.

• Hypertension • Cardiac disease

Which of the following clients are displaying known risk factors for the development of pulmonary emboli? A client who is: (Select all that apply)

• Immobilized following orthopedic surgery • A smoker and who takes oral contraceptives

A client with cystic fibrosis reports recent weight loss without fever or cough. What interventions will the nurse implement to promote health for the client? Select all that apply.

• Increase protein intake • Increase pancreatic enzymes

As a consequence of 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:

• Increased erythropoietin production • Hyperventilation • Personality changes

A 2-year-old child is admitted to pediatric unit with bronchiolitis. The nurse calls the physician fearing the child is going into respiratory failure based on which of the following assessment findings? Select all that apply.

• Increased respiratory rate to 44 breaths/minute • Substernal retractions becoming more pronounced • New-onset expiratory grunting

Which symptoms accompanying shortness of breath indicate a client has cor pulmonale? Select all that apply.

• Jugular vein distention • 2+ pitting edema in feet • Warm moist skin

The nurse teaches a client with a new diagnosis of asthma about measures to prevent asthma attacks. What should the nurse include? Select all that apply.

• Limit exposure to dust. • Schedule the influenza vaccine. • Use an inhaled corticosteroid.

The client with emphysema should be educated about changes in lung tissue that may include which of the following changes? Select all that apply.

• Loss of elastic recoil • Difficulty exhaling due to inability to recoil • Increased lung compliance

A client diagnosed with rhinosinusitis asks the nurse what type of nonpharmacologic measures can be used to reduce the nasal stuffiness that occurs with the disorder. What suggestion can the nurse give to the client? Select all that apply.

• Mist humidification • Nasal irrigation • Saline nasal spray

A child with asthma is walking outside and develops a bronchospasm. The school nurse knows this bronchospasm has what effects on bronchioles with airflow? Select all that apply.

• Narrowing of bronchioles • Impairs airflow

Which manifestations are most common in clients with COPD that is predominantly chronic bronchitis? Select all that apply.

• Peripheral edema • Increased mucus secretion • Cyanosis

The nurse is performing an assessment for a client who is suspected of having chronic histoplasmosis. What clinical manifestations reported by the client are consistent with this diagnosis? Select all that apply.

• Productive cough • Night sweats • Weight loss

Community-acquired pneumonia can be categorized according to several indexes. What are these indexes? (Select all that apply.)

• Radiologic findings • Age • Presence of coexisting disease

The nurse is caring for a client who is in the hospital with adult respiratory distress syndrome (ARDS) caused by a near drowning and the client wants to know why he is having such difficulty breathing. The most accurate explanation would be that the dyspnea is caused by a lack of alveolar surfactant which is essential to:

• Reduce surface tension in the alveoli. • Increase lung compliance. • Prevent end-expiratory alveolar collapse. • Regulate the immune system in the lungs.

A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic with the following complaints: auscultation of breath sounds reveal absent/diminished breath sounds in the right lower lobe. Which other manifestations lead the health care provider to suspect the client may have developed atelectasis? Select all that apply.

• Respiratory rate—32; pulse rate—122 beats/minute. • "Having a hard time catching my breath." • Using accessory muscles to help him breathe.

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.

• Severe accessory muscle retractions. • Nasal flaring. • Grunting on expiration.

A patient with pulmonary hypertension may display which of the following clinical manifestations? Select all that apply.

• Shortness of breath. • Decreased exercise tolerance. • Swell [edema] in their legs and feet.

Which breathing-related actions are affected by voluntary respiratory control? Select all that apply.

• Singing • Speaking • Blowing

What mechanism has been proposed to explain the sensation of dyspnea? Select all that apply.

• Stimulation of lung receptors • Stimulation of muscle fibers in the intercostals and diaphragm • Decreased breathing reserve • Increased CNS sensitivity to changes in ventilation

A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply.

• Surgery to remove tumor • Radiation therapy • Chemotherapy

A client is admitted to hospital to rule out Legionnaire disease following a canoe trip where he was sprayed in the face with a lot of "creek" water. Which of the following manifestations are characteristic of Legionnaire pneumonia? Select all that apply.

• Temperature of 103.5°, pulse 80 • "Talking but not making a lot of sense" (confusion) • Chest x-ray that reveals areas of consolidation suggestive of pneumonia

A child is having symptoms of spasmodic croup again after a previous admission to the hospital for the same diagnosis. What care does the parent provide at home that demonstrates understanding of the education received by the nurse at the hospital? Select all that apply.

• The parent brings the child into the bathroom where a warm shower is running to provide humidification. • The parent takes a child outside in the cool air. • The parent turns on the cold water room humidifier in the child's room.

Which statements regarding childhood respiratory tract infection are true? Select all that apply.

• The size of the child has an impact on the seriousness of the symptoms. • Impaired airflow and obstructions are common outcomes of these infections. • Each exposure to a new pathogen results in an infection. • An immature immune system is the usual trigger for such infections.

Pulmonary function studies are an essential tool in the diagnosis of pulmonary disorders. A spirometer is used in these studies and through direct measurement provides valuable information on which of the following? Select all that apply.

• Tidal volume • Inspiratory reserve volume • Expiratory reserve volume

A client seen in the emergency department after a motor vehicle accident complains of increasing shortness of breath. A left tension pneumothorax is suspected. What manifestations support the diagnosis? Select all that apply.

• Tracheal deviation to the right • Hyperresonance on the left • Diminished breath sounds on the left • Subcutaneous emphysema

A nurse has been exposed to a client who has been diagnosed with pulmonary tuberculosis. What frequently used screening method does the nurse prepare for? Select all that apply.

• Tuberculin skin test • Chest x-ray

A parent brings a child into the urgent care clinic. The practitioner suspects the child has a "cold" based on which clinical manifestations? Select all that apply.

• Watery, clear nasal secretions • Coughing • Mild fever

A client was involved in a motor vehicle accident and suffered a severe head injury and blunt abdominal trauma requiring immediate surgery. During the recovery period the client developed pneumonia due to an impaired cough reflex. Which of the following can interfere with the cough reflex? Select all that apply.

• Weak abdominal muscles following abdominal surgery • Prolonged bed rest • Presence of a nasogastric tube • Increase in intracranial pressure on the medulla

The nurse is monitoring trends in the patient's arterial blood gases and recognizes that changes in ventilation will result from which of the following? Select all that apply.

• pH • Oxygen • Carbon dioxide

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.

• pH 7.31 (Normal 7.35-7.45) • PCO2-58 mm Hg (Normal 38-42) • Serum HCO3-33 mEq/L (Normal 22-28)

An 82-year-old man with chronic obstructive pulmonary disease (COPD) is at the clinic for a regular checkup. Because of his diagnosis, the nurse would expect his respiratory rate under normal circumstances to be what?

≥18 to 20 breaths/minute