Ch. 29- Structure and Function of Respiratory Function

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: A. Pulmonary congestion B. Destruction of alveoli C. Scar tissue D. Pulmonary fibrosis

A. Pulmonary congestion

The nurse is caring for a client who has a drop in oxygen saturation reading and the nurse suspects physiologic shunting of blood in the respiratory system is occurring. Which condition will the nurse associate as a potential cause of physiologic shunting? A. pulmonary edema B. diabetic coma due to low glucose levels C. hypertension D. tachypnea

A. pulmonary edema

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 region 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 area of the lung involved in gas exchange?

Alveoli

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 value with obstructive lung disease?

FEV1

Which physiologic forces from afferent input can exert their influence on respiration through the lower brain centers? Select all that apply.

Fever Pain Emotion

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? A. Aspiration B. Pertussis C. Ineffective cough reflex D. Recent exposure to TB

A. Aspiration

The nurse is caring for a postoperative client in traction. Which activity would be most beneficial for preventing atelectasis in this client? A. Encourage the client to cough and breathe deeply several times per hour. B. Have client remain on bed rest with the head of bed kept flat. C. Offer the client an incentive spirometer every shift. D. Administer oxygen via nasal cannula at 4 L/min.

A. Encourage the client to cough and breathe deeply several times per hour.

The nurse is caring for a client admitted with carbon monoxide (CO) poisoning who is extremely agitated, dyspneic, and confused. The nurse understands that treatment with a hyperbaric chamber with 100% oxygen administration would result in which physiologic response? A. Increase the amount of oxygen that can be carried in the dissolved state. B. Encourage the uptake of oxygen by the cells. C. Decrease the amount of carbon monoxide on the hemoglobin. D. Enable oxygen to bind to hemoglobin.

A. Increase the amount of oxygen that can be carried in the dissolved state. Hemoglobin carries most of the oxygen in the blood (98% to 99%) and is essential in the transport and release of oxygen at the tissue level. Dissolved oxygen in the blood accounts for approximately 1% to 2%

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 reason? A. Loss of diaphragmatic function B. Positive intrathoracic pressures C. Negative intrapleural pressures D. Dysfunction of the accessory muscles

A. Loss of diaphragmatic function The phrenic nerve, which exits the spinal cord between C3 and C5, stimulates the diaphragm to contract, increasing the space in the chest cavity and thus causing a decrease in the intrathoracic pressure, allowing air to flow into the lungs.

A client with pneumonia will experience a decrease in the diffusion of gases in the lung that leads to which compensatory response in the alveoli?

Increase in the thickness of the alveolar-capillary membrane

Ventilation is driven by which alteration in arterial blood?

Increased PCO2

In a client with emphysema, the nurse anticipates that the intrapleural pressure will become less negative, which results in which potential problem?

Increased trapping of air in the alveoli

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

The most common cause of pulmonary edema is left-sided heart failure. Which explanation best describes the pathophysiology causing the development of pulmonary edema?

Pulmonary pressures are increased

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

Pursed-lip breathing

A client has experienced a bout of coughing after aspirating some of his secretions. The client's coughing was triggered by which of the following?

Signals from receptors in the tracheobronchial wall

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

Spirometer

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

a nasogastric (NG) tube attached to suction

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

-A smoker who smokes two packs of cigarettes/day and is currently hospitalized with pneumonia -A mountain skier who spends several hours/day outside teaching ski lessons -A nursing home client diagnosed with H1N1 influenza with fever of 102°F (38.9°C)

Completion of a client's pulmonary function study has yielded the following data: tidal volume, 500 mL; inspiratory reserve, 3100 mL; expiratory reserve, 1200 mL; residual volume, 1200 mL; functional residual capacity, 2400 mL. What is this client's inspiratory capacity?

3600 mL

A client who is in a room at 1 atmosphere (760 mm Hg) is receiving supplemental oxygen therapy that is being delivered at a concentration of 50%. What is the consequent PO2? 15.2 mm Hg 38,000 mm Hg More data are needed 380 mm Hg

380 mm Hg Explanation: The law of partial pressures states that the total pressure of a mixture of gases, as in the atmosphere, is equal to the sum of the partial pressures of the different gases in the mixture. If the concentration of oxygen at 760 mm Hg (1 atmosphere) is 50%, its partial pressure is 380 mm Hg (50.54 kPa). The equation to calculate is 760 × 0.50 = 380.

A client with a right-sided chest tube in place describes an increase in respiratory effort over the past day. The nurse suspects an increase in the size of the pneumothorax and anticipates that pulmonary function tests results would show which corroborating result? Select all that apply. A decrease in inspiratory capacity An increase in expiratory reserve volume An increase in dead space An increase in tidal volume A decrease in total lung capacity

A decrease in inspiratory capacity An increase in dead space A decrease in total lung capacity Explanation: Increased size of the pneumothorax would cause a collapse of lung tissue, increasing the dead space in the lung due to the fact that there will be the presence of alveolar tissue that cannot participate in gas exchange. Collapse of the lung tissue will decrease the amount of functional lung tissue and therefore decrease inspiratory capacity. Less functional lung tissue would also decrease the total lung capacity.

Clients who have been bedridden for a long time likely will experience: A. shallow, quiet breathing, which impairs the spreading of surfactant. B. an increase in depth of breathing, which increases lung volumes and causes more surfactant to spread out over the alveolar surfaces. C. an inability to produce sufficient amounts of surfactant and may require recombinant forms. D. a sharp increase in surfactant levels that will require frequent suctioning.

A. shallow, quiet breathing, which impairs the spreading of surfactant.

The nurse is caring for a group of clients. Which clients should the nurse identify as experiencing a shift to the right on the oxygen dissociation curve? Select all that apply.

Anemia Pulmonary edema Fever

A client is diagnosed with a stroke that affects the left hemisphere of the brain, and the health care provider has prescribed testing to assess for damage to the glottis. Which action should the nurse take prior to allowing the client to receive food/beverages from the cafeteria?

Assess ability to swallow and check breath sounds for signs aspiration pneumonia

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

Atelectasis

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 physiologic measurement?

Diffusion capacity

Select the clinical situation that would result in increased diffusion of gases from the arterial blood into the alveoli. A. A client who has a pulmonary disorder that increases the thickness of the alveolar-capillary membrane B. A client who is receiving 100% oxygen via oxygen mask C. A client who has an oxygen saturation measured at 95% D. A client who is diagnosed with pneumonia

B. A client who is receiving 100% oxygen via oxygen mask

A client diagnosed with asthma is scheduled for a pulmonary function test. During the test, the technician instructs the client to forcefully exhale air for 1 second to evaluate: A. Inspiratory capacity B. Forced expiratory volume C. Forced vital capacity D. Maximum voluntary ventilation

B. Forced expiratory volume

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 muscles to help air leave the lungs more effectively? A. Pulmonary and scalene muscles B. Intercostal and abdominal muscles C. Shoulder and diaphragmatic muscles D. Abdominal and pelvic muscles

B. Intercostal and abdominal muscles

A nursing student is studying the respiratory airways in the lungs, in particular the alveoli. A fellow student asks which cells are most instrumental in the destruction of foreign substances that may enter the alveoli with inspired air. The most accurate response would be: A. Brush cells B. Macrophages C. Killer T cells D. Pneumocytes

B. Macrophages

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. What should the nurse anticipate when observing her breathing? A. Pursed-lip breaths B. Short, shallow breaths C. Rapid, deep breaths D. Wheezing breaths

B. Short, shallow breaths

The nurse is calculating the minute volume of a client. Select the correct categories of measurement. A. inspiratory reserve × tidal volume B. tidal volume × respiratory rate C. total lung capacity × reserve volume D. respiratory rate × heart rate

B. Tidal volume × respiratory rate

What is the function of the mucociliary blanket that lines the conducting airways? A. To warm the moving gases B. To remove foreign materials C. To spread antibacterial enzymes D. To dehumidify inhaled air

B. To remove foreign materials

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 short of breath due to a: A. decreased residual volume. B. decreased tidal volume. C. increased vital capacity. D. increased total lung capacity.

B. decreased tidal volume.

The nurse is monitoring trends in the client's arterial blood gases and recognizes that changes in ventilation will result from which of the following? Select all that apply. A. Cerebrospinal fluid (CSF) B. pH C. Anion gap D. Carbon dioxide E. Oxygen

B. pH D. Carbon dioxide E. Oxygen

An expectant mother of twins has been told there is a strong chance that she will go into labor early and her babies will be premature. In order to increase the chances of having healthy infants, she is given a dose of steroids to stimulate the production of surfactant in the infants' lungs. Surfactant is important for survival of the babies because it reduces: A. surface viscosity for alveolar macrophage movement. B. surface tension of the respiratory membrane. C. carbon dioxide distribution in tissues. D. oxygen/carbon dioxide diffusion through the membrane.

B. surface tension of the respiratory membrane.

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 that caused an interruption in: A. diffusion. B. ventilation. C. inhalation. D. exhalation.

B. ventilation.

Which form accounts for the greatest percentage of carbon dioxide transport?

Bicarbonate

A nurse caring for a client diagnosed with multiple pulmonary embolisms explains that permanent demage to lung tissue is prevented when which physiologic structure helps with the formation of collateral circulation to protect the lung tissue?

Bronchial blood vessels

What is the normal tidal volume for a person at rest? A. 1100 ml B. 4600 mL C. 500 mL D. 3000 mL

C. 500 mL

A client's respiratory rate is being primarily influenced by carbon dioxide levels. What receptors are responding to the CO2? A. Oxygen receptors B. Peripheral receptors C. Central receptors D. Irritant receptors

C. Central receptors central chemoreceptors are extremely sensitive to short-term changes in carbon dioxide. -Peripheral receptors monitor oxygen concentration, -irritant receptors respond to lung damage.

Above the glottis that opens and closes for speech, the epiglottis performs which physiologic function during swallowing? A. Opens the epiglottis B. Collapses the vocal cords C. Covers the larynx D. Constricts the airways

C. Covers the larynx

A client's recent history of emphysema has resulted in the functional loss of many alveoli. How will this impact the physiologic function of the type II alveoli? A. Improve bronchial circulation B. Decrease the production of macrophages C. Decrease the production of surfactant D. Increase gas exchange

C. Decrease the production of surfactant

A fully saturated hemoglobin molecule can hold how many oxygen molecules? A. Eight (8) B. Six (6) C. Four (4) D. Two (2)

C. Four (4)

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 pathophysiologic principle? A. Release of catecholamines causing blood vessel constriction B. Inhibition of glandular secretions, which causes build up of mucus in the lungs C. Parasympathetic nervous system stimulation resulting in airway constriction D. Influx of macrophages to wall of the pollen, thereby stopping the attack

C. Parasympathetic nervous system stimulation resulting in airway constriction

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

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 that may have infiltrated which regulator of respiratory function responsible for detecting changes in carbon dioxide levels?

Central chemoreceptors

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: A. "For unknown reasons, you lost intrapleural negative pressure. You must have coughed too forcibly and your air sacs burst." B. "For unknown reasons, you lost intrapleural negative pressure. This means your lungs collapsed and expelled its air when you lose negative pressure." C. "For unknown reasons, you lost intrapleural negative pressure. You must have experienced a forced expiration against a closed glottis to cause the lung to deflate." D. "For unknown reasons, you lost intrapleural negative pressure. You must have a genetic anomaly causing weakened alveolar sacs to rupture."

D. "For unknown reasons, you lose intrapleural negative pressure. This means your lungs collapsed and expelled its air when you lose negative pressure."

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: A. a physiologic shunt and chest pain. B. jaundice related to an anatomic shunt. C. a physiologic shunt and pallor. D. cyanosis secondary to an anatomic shunt.

D. cyanosis secondary to an anatomic shunt.

A distressed, confused client is admitted to the hospital ER with a penetrating right chest stab wound. The nurse assesses the client and notes a lack of breath sounds in the right lung. The nurse knows this is likely the result of: A. increase in negative intrapleural pressure. B. decreased intra-alveolar pressure. C. hyperinflation of the lung. D. loss of intrapleural negative pressure.

D. loss of intrapleural pressure. Intrapleural pressure is always negative in comparison to atmospheric pressure, and this is essential to maintain inflation of the lungs and alveoli.

An individual has sensitivity to perfumes and experiences shortness of breath when exposed to them. This occurs because: A. certain chemicals in artificial scents disrupt gas diffusion B. a type III hypersensitivity reaction is caused. C. toxins can compete with oxygen for hemoglobin-binding sites. D. stimulation of irritant receptors causes bronchoconstriction.

D. stimulation of irritant receptors causes bronchoconstriction.

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 physiologic 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 in what way?

Damage or destruction of cilia

A nurse educator is explaining a client's lung disease and describing how some of the air that he is moving with each breath is not actually participating in gas exchange. The nurse is describing what phenomenon?

Dead Space

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

Dyspnea

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:

Dyspnea

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 disease?

Emphysema

The nurse is caring for a postoperative client in traction. Which activity would be mostbeneficial for preventing atelectasis in this client?

Encourage the client to cough and breathe deeply several times per hour.

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 findings, the nurse determines which 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 lifestyle 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

What does the equation C = ΔV/ΔP stand for?

Lung compliance

The nurse is caring for a client with mediastinal carcinoma. Which body structures located in this area are responsible for filtering foreign particles from the interstitial spaces of the lungs to prevent the spread of this cancer?

Lymph nodes

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

Multiple sclerosis

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

When there is a mismatching of ventilation and perfusion within the lung itself, insufficient ventilation occurs. What causes a physiologic right-to-left shunting of blood in the respiratory system?

Pulmonary insufficiency or heart failure

An unconscious client admitted to the ICU with severe head injuries following a motorcycle accident is experiencing very irregular respiration with long inspiratory gasps interrupted by expiratory effort. The nurse explains to the family that the reason for the client's respiration abnormality is a result to injury in which part of the brain?

Pneumotaxic and apneustic connection

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

Pneumotaxic center

A nurse caring for a client on complete bed rest will focus her assessment on which area of this client's lungs most affected by immobility?

Posterior portions of the lungs

Alveolar oxygen levels directly impact the blood vessels in the pulmonary circulation. In a person with lung disease, there is vasoconstriction throughout the lung, causing a generalized hypoxia. What can prolonged hypoxia lead to?

Pulmonary hypertension and increased workload on the right heart.

Which type of lung receptor monitors for lung inflation?

Stretch

The nurse is assessing a client's respiratory status for lung expansion and airway resistance. Which type of lung receptors respond to changes in pressure occurring in the walls of the airways? A. Juxtacapillary receptors B. Peripheral chemoreceptors C. Irritant receptors D. Stretch receptors

Stretch receptors

A neonate delivered at 36 weeks' gestation is in respiratory distress and requires ventilation. Tests reveal prematurity of the lungs and an underdevelopment of type II alveolar cells. Based on these results, the nurse will anticipate the administration of which of the following to improve respiratory function?

Surfactant

In addition to being the site of gas exchange, the lungs also perform which function?

Synthesize pulmonary surfactant

A client asks the nurse what anatomic airway dead space is. What 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 principle accurately describes FVC

The volume of air exhaled vigorously and quickly after maximum inspiration

A postoperative client asks, "Why do I have to take all these deep breathing and coughing exercises every hour?" What response by the nurse is the most accurate rationale for this client?

These exercises enhance the spread of surfactant and prevent atelectasis.

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

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

Type II alveolar cells

Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop below 60 mm Hg, causes what response in the pulmonary circulation?

Vasoconstriction

A nurse is conducting a class on healthy living with COPD and presents potential complications with the disease. Many clients with COPD have bronchospasms, airway inflammation, and excess mucus production, which contribute to obstruction to the alveoli. Which physiologic condition could result from the obstruction?

Ventilation/perfusion mismatch

A client has inhaled, drawing air into the oropharynx. From this location, air will:

proceed through the trachea, bronchi, and then bronchioles.

The nurse is caring for a postoperative client who is ordered to have oxygen saturation monitored. The method used to monitor the saturation of oxygen in the blood is:

pulse oximetry.

Clients who have been bedridden for a long time likely will experience: an inability to produce sufficient amounts of surfactant and may require recombinant forms. shallow, quiet breathing, which impairs the spreading of surfactant. a sharp increase in surfactant levels that will require frequent suctioning. an increase in depth of breathing, which increases lung volumes and causes more surfactant to spread out over the alveolar surfaces.

shallow, quiet breathing, which impairs the spreading of surfactant. Explanation: At low lung volumes, the molecules of surfactant become tightly packed, and at higher lung volumes, they spread out to cover the alveolar surface. In surgical clients and bedridden persons, shallow and quiet breathing often impairs the spreading of surfactant. Premature infants may require recombinant forms of surfactant to treat infant respiratory distress syndrome. Suctioning cannot be done at the alveolar level. One of the treatments for bedrest clients is cough and deep breathing exercises to enhance the spread of surfactant to prevent atelectasis.

Clients with chronic obstructive lung disease (COPD) may experience airway closure at the end of normal lung volumes instead of low lung volumes. This results in:

trapping of large amounts of air that cannot participate in gas exchange.