Respiratory - Chapter 20

Tidal volume which may not significantly change with disease has a normal value of approximately _______.

1000mL

The alveoli begin to lose elasticity at about _______ years old resulting in decreased gas diffusion

50 years

The nurse is interviewing a patient who says he has a dry, irritating cough that is not "bringing anything up." What medication should the nurse question the patient about taking? a) Angiotensin convering enzyme inhibitors b) Aspirin c) Bronchodilators d) cardiac glycosides

A

The nurse inspects the thorax of a patient with advanced emphysema. What does the nurse expect the chest configuration to be for this patient? a) barrell chest b) funnel chest c) kyphoscoliosis d) pigeon chest

A - a barrel chest occurs as a result of overinflation of the lunch which increases the ateroposterior diameter of the thorax, a hallmark sign of COPD and emphysema a funnel chest occurs when there is a depression in the lower portion of the sternum, usually occuring with rickets or Marfan's syndrome. Kyphoscoliosis is an elevation of the scapula and a corresponding S shaped spine, limits lung expansion, may occur with osteoporosis and other skeletal disorders that affect the thorax. Pigeon chest occurs as a result of the anterior displacement of the sternum, also results in the anteroposterior diameter increasing and occurs with rickets, Marfan or sever kyphoscoliosis.

The nurse is caring for a patients with a pulmonary disorder. What observation by the nurse is indicative of a very late symptom of hypoxia? a) cyanosis b) dyspnea c) restlessness d) confusion

A - cyanosis is a very late sign of hypoxia

The nurse is instructing a patient who is scheduled for a perfusion lung scan. What should be included in the information about the procedure? Select all that apply. a) A mask will be placed over the nose and mouth during the test b) The patient will be expected to lie under the camera c) The imaging time will be around 20-40 minutes d) The patient will be expected to be NPO for 12 hours prior to the procedure e) An injection will be placed into the lung during the procedure

A, B, C A V/Q lung scan is performed by injecting a radioactive agent into a peripheral vein and then obtaining a scan of the chest to detect radiation. Is used to measure the integrity of the pulmonary vessesls relative to blood flow and to evaluate blood flow abnormalities as seen in pulmonary emboli. The imaging time takes 20-40 minutes, the pt lays under a camera with a mask fitted over the nose and mouth, the pt takes a deep breath where oxygen and radioactive gas diffuse throughout the lungs and a scan is done to detect ventilation abnormalities. The patient normally can eat and/or drink before the procedure, pt should avoid caffeine, alcohol and tobacco for 24hrs prior to a PET scan and a foley cath may be placed to ensure an empty bladder exists.

The nurse is instructing a patient on the collection of a sputum specimen. What should be included in the instructions? Select all that apply. a) Initially, clear the nose and throat b) Spit surface mucus and saliva into a sterile specimen container c) Take a few deep breaths before coughing d) use diaphragmatic contractions to aid in the expulsion of sputum e) rinse with mouthwash prior to providing the specimen

A, C, E Sputum samples are collected to identify pathogenic organisms and to determin whether malignant cells are present. Periodic sputum examinations may be needed for pts taking antibiotics, corticosteroids and immunosuppressive meds for prolonged periods of time. Sputum samples are usually obtained in the morning before the patient has had anything to eat or drink. The patient should clear the nose and throat and rinse the mouth to decrease contamination of the sputum and not spit into a container. Rather, after taking a few deep breaths the patient coughs deeply and expectorates sputum from the lungs into a sterile container.

Conditions that can cause low compliance or distensibility of the lungs

ARDS, morbid obesity, atelectasis, pneumothorax, hemothorax, pulmonary fibrosis, pulmonary edema, pleural effusion

The nurse is assessing a patient in respiratory failure. What finding is a late indicator of hypoxia? a) clubbing of fingers b) cyanosis c) crackles d) restlessness

B

The nurse is performing an assessment for a patient with congestive heart failure. The nurse asks if the patient has difficulty breathing in any position other than upright. What is the nurse referring to? a) Dyspnea b) Orthopnea c) Tachypnea d) Bradypnea

B

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

B

During a preadmission assessment, for what diagnosis would the nurse expect to find decreased tactile fremitus and hyperresonant percussion sounds? a) bronchitis b) emphysema c) atelectasis d) pulmonary edema

B - Tactile fremitus may be decreased or absent when vibrations from the larynx to the chest surface are impeded by chronic obstructive pulmonary disease, obstruction, pleural effusion, or pneumothorax. It is increased in pneumonia. Hyperresonant sounds that are louder and lower pitched than resonant sounds are normally heard when percussing the chests of children and very thin adults.

What finding by the nurse may indicate that the patient has chronic hypoxia? a) crackles b) peripheral edema c) clubbing of fingers d) cyanosis

C

A physician wants a study of diaphragmatic motion because of suspected pathology. What does the nurse anticipate that the physician will most likely order? a) Barium Swallow b) Bronchogram c) Fluoroscopy d) Tomogram

C - Fluoroscopy - shows a continuous X-ray image on a monitor, much like an X-ray movie. During a fluoroscopy procedure, an X-ray beam is passed through the body. The image is transmitted to a monitor so the movement of a body part or of an instrument or contrast agent ("X-ray dye") through the body can be seen in detail. A barium swallow is a test that may be used to determine the cause of painful swallowing, difficulty with swallowing, abdominal pain, bloodstained vomit, or unexplained weight loss. An air bronchogram is a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates.

The nurse auscultated crackles in a patient with a respiratory disorder. With what disorder would crackles be commonly heard? a) asthma b) bronchospasm c) collapsed alveoli d) pulmonary fibrosis

C - crackles are associated with delayed or collapsed opening of the alveoli seen in pts with heart failure, pulmonary fibrosis, obstructive pulmonary disease, pneumonia or bronchitis asthma and bronchospam produce wheezing

The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard? a) rales b) crackles c) wheezes d) rhonchi

C - wheezes are usually heard on expiration, associated with bronchial wall oscillation and changes in airway diameter Rales are characterized by discontinuous clicking or rattling sounds, sound like salt dropped onto a hot pan or like cellophane being crumpled. Crackles are soft, high-pitched, discontinuous popping sounds that occur during inspiration. Rhonchi are deep, low pitched rumbling sounds heard primarily during expiration.

alternating episodes of apnea & deep breathing usually associated with Heart Failure and/or damage to the respiratory center

Cheyne-Stokes Respirations

The nurse is performing an assessment of a patient who arrived in the ED with a barbiturate overdose. The respirations are normal for 3-4 breaths followed by a 60 second period of apnea. How does the nurse document the respirations? a) Cheyne-Stokes b) Tachypnea c) Bradypnea d) Biot's respirations

D - Biot's respiration is an abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea

A patient comes to the emergency department complaining of a knifelike pain when taking a deep breath. What does this type of pain likely indicate to the nurse? a) bacterial pneumonia b) bronchogenic carcinoma c) lung infarction d) pleurisy

D - pleurisy causes chest pain that worsens during breathing, patient may have fast/shallow breathing, SOB, dry cough or fever

What interventions should be provided post bronchoschopy?

Ice chips and fluids once the gag reflex has returned

What interventions should the nurse provide to a patient prior to a thoracentesis?

Inform the patient about pressure sensations that may be felt during the procedure inform patient of importance of remaining totally still during procedure inform patient minimal discomfort is expected post procedure make sure that chest roentgenagrams (xrays or ultrasound) have been completed make sure informed consent was signed obtain baseline vitals, oxygen sat, pain level and respiratory staus

The symbol used to identify the partial pressure of oxygen is ____.

PaO2

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

Respiration

Which position should the nurse place the patient in for a thoracentesis?

Sitting on edge of the bed with the feet supported and arm on a padded over-the-bed table straddling a chair with arm and head resting on the back of the chair OR lying on the unaffected side with the head of the bed elevated 30-45 degrees if unable to assume a sitting position

_____________________ are the alveolar cells that secrete surfactant

Type II cells

A patient with sinus congestion complains of discomfort when the nurse is palpating the supraorbital ridges. The nurse knows that the patient is referring to which sinus? a) frontal b) ethmoidal c) maxillary d) sphenoidal

a) The frontal sinus

What are the two centers in the brain that are responsible for neurologic control of ventilation?

apneustic center in the lower pons & the pneumotaxic center in the upper pons

What complications should the nurse be aware of during a bronchoscopy?

aspiration infection pneumothorax

Conditions influenced by genetic factors that affect respiratory function

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

When the nurse is assessing the older adult client patient what gerontologic changes in the respiratory system should the nurse be aware of? Select all that apply. a) decreased alveolar duct diameter b) increased presence of mucous c) decreased gag reflex d) increased presence of collagen in alvoelar walls e) decreased presence of mucus

c, d, e elderly patient will have an Incresed alveolar duct diameter and a decreased presence of mucus

The nurse is taking a respiratory history for a patient who has come to the clinic with a chronic cough. What information should the nurse obtain from this patient? Select all that apply. a) financial ability to pay the bill b) social support c) previous history of lung disease in the patient or family d) occupational and environmental influences e) previous history of smoking

c, d, e financial ability to pay the bill and social support are not factors that would contribute to the reason the patient is seeking care

Major S/S of respiratory disease

chest pain, wheezing, hemoptysis, tachypnea, hypoxia, dyspnea, cough, sputum production

A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient? a) 40 mmHg b) 75 mmHg c) 80 mmHg d) 95 mmHg

d

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

diffusion

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

diffusion

covers the opening of the larynx during swallowing

epiglottis

The pulmonary circulation is considered a _______, _______ system.

high pressure, high resistance

A patient is scheduled to undergo a bronchoscopy, the nurse knows that the suspected lesion may be located where?

in the bronchus, larynx or trachea - a bronchoscopy is the direct inspection and examination of the larynx, trachea and bronchi through either a flexible fiberoptic bronchoscope or a rigid bronchoscope

what should the nurse assess for after a thoracentesis?

increasing respiratory rate asymmetry in respiratory movement dyspnea diminished breath sounds anxiety/restlessness tightness in chest uncontrollable cough blood-tinged/frothy mucus rapid pulse signs of hypoxemia (changes in mental status, dyspnes, HTN, changes in HR, dysrhythmias, central cyanosis, diaphoresis and cool extremeties)

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

lobar bronchi segmented bronchi subsegmented bronchi bronchioles

What is the purpose of cilia?

moves mucous back to the larynx

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

one less lobe. The right lung has 3 lobes and the left lung has 2 lobes.

pressure exerted by each type of gas (O2 & CO2) in a mixture of gasses

partial pressure

After a bronchoscopy what should the nurse assess for?

patients respiratory status hypoxia hypotension tachycardia dysrhythmias hemoptysis dyspnea older patients should be assessed for LOC

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

pleura

When preparing a patient for a bronchoscopy what interventions by the nurse are required prior to the procedure?

provide information on the procedure maintain NPO status for 4-8 hours (to reduce risk of aspiration) administer preop medications (usually atropine and a sedative or opoid to inhibit vagal stimulation reducing the risk of bradycardia, dysrhythmias, and hypotension) remove or have patient remove dentures or other oral protheses ensure informed consent has been obtained

actual flow of blood through the pulmonary circulation

pulmonary perfusion

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

respiration

The four common phenomena that can alter bronchial diameter

streptococcus pneumoniae, haemophilus influenzae, staphylococcus aureus, moraxella catarrhalis

What anatomic site does the nurse anticipate the physician will use for a thoracentesis?

the second and third intercostal space

movement of air in and out of airways

ventilation