Chapter 53: Introduction to the Respiratory System
The pediatric nurse practitioner is caring for a child who is diagnosed with cystic fibrosis (CF). The parents ask what the treatment is for because CF is considered a terminal illness. What would be the nurse's best response? A) "Treatment is aimed at maintaining airway patency as much as possible." B) "Treatment is aimed at lowering high levels of carbon dioxide in the blood." C) "Treatment is aimed at raising oxygen levels to the extremities." D) "Treatment is aimed at maintaining the child until lung transplantation can occur."
A) "Treatment is aimed at maintaining airway patency as much as possible." Feedback: Treatment is aimed at keeping the secretions fluid and moving and maintaining airway patency as much as possible. Treatment for CF is not aimed at lowering hypercapnia or raising oxygen levels to the extremities. Treatment for CF is not aimed at maintaining the child until lung transplantation can occur.
The nurse is caring for a 6-year-old patient with cystic fibrosis. The parents ask how the cystic fibrosis started. The nurse explains that the key feature in the presentation of cystic fibrosis includes what? A) Airway obstruction B) Obstructed bowel C) Sweet-tasting sweat D) Clubbing of the extremities
A) Airway obstruction Feedback: CF results in the accumulation of copious amounts of very thick secretions in the lungs. Eventually, the secretions obstruct the airways, leading to destruction of the lung tissue. Parents will often comment that their child tastes salty, not sweet. Newborns with CF often present with meconium ileus but not a bowel obstruction. Clubbing of the extremities occurs after many years of inadequate oxygenation.
A nurse is caring for a 73-year-old woman who just arrived on the medical surgical floor following a radical mastectomy for breast cancer. The nurse will encourage the patient to cough and breathe deeply to help prevent what? A) Atelectasis B) Asthma C) Bronchiectasis D) Sinusitis
A) Atelectasis Feedback: Atelectasis most commonly occurs as a result of airway blockage, which prevents air from entering the alveoli, keeping the lung expanded. This occurs when a mucous plug, edema of the bronchioles, or a collection of pus or secretions occludes the airway and prevents the movement of air. Patients may experience atelectasis after surgery, when the effects of anesthesia, pain, and decreased coughing reflexes can lead to a decreased tidal volume and accumulation of secretions in the lower airways. Asthma, bronchiectasis, and sinusitis are not directly related to surgery but instead result from other conditions.
The nurse is caring for a patient who has just been admitted with atelectasis and anticipates which possible treatments for this patient? (Select all that apply.) A) Chest tube B) Surgical removal of the affected lung C) Oxygen delivery D) Assisted ventilation E) Antianxiety medication
A) Chest tube B) Surgical removal of the affected lung D) Assisted ventilation Feedback: Treatments for atelectasis include airway clearance (e.g., postural drainage and suctioning), oxygen delivery, and assisting ventilation. Patients with atelectasis may feel some anxiety if the patients oxygen level has lowered, but it is not a treatment for atelectasis. Removal of the portion of the lung that is affected is not an effective treatment.
A nursing instructor is discussing ways that the respiratory tract protects itself from bacteria and shares with the students that it is done in which ways? (Select all that apply.) A) Cough and sneeze reflex B) Surfactant in the alveoli C) Goblet cells D) Gas exchange in the alveoli E) Nasal cilia
A) Cough and sneeze reflex C) Goblet cells E) Nasal cilia Feedback: Nasal hairs, mucus-producing goblet cells, cilia, the superficial blood supply of the upper respiratory tract, and the cough and sneeze reflexes all work to keep foreign substances from entering the lower respiratory tract. Surfactant and gas exchange in the alveoli are involved in the oxygenation process but are not involved in protecting the respiratory tract.
The nurse is caring for a patient with pneumonia. The nurse would expect to see which symptoms? (Select all that apply.) A) Difficulty breathing B) Urinary retention C) Rash D) Fever E) Oxygen saturation of 88%
A) Difficulty breathing D) Fever E) Oxygen saturation of 88% Feedback: Symptoms of patients with pneumonia include fever, difficulty breathing, fatigue, noisy breath sounds, and poor oxygenation. Urinary retention and rash are not usual symptoms of pneumonia.
The anatomy and physiology teacher is discussing ventilation with the nursing students. What would the instructor say causes an increased respiratory rate? A) Increased stimulation of the respiratory center B) Decreased stimulation of the respiratory center C) Increased O2 D) Decreased pH
A) Increased stimulation of the respiratory center Feedback: Respiration, or the act of breathing to allow gas exchange, is controlled by the central nervous system. The inspiratory musclesdiaphragm, external intercostal muscles, and abdominal musclesare stimulated to contract by the respiratory center in the medulla. The medulla receives input from chemoreceptors (neuroreceptors sensitive to carbon dioxide and acid levels) to increase the rate and/or depth of respiration to maintain homeostasis in the body.
The nursing instructor is discussing the oxygenation process and explains unoxygenated blood is received from the right ventricle by the alveoli. The delivery of this blood is referred to as what? A) Perfusion B) Oxygenation C) Expiration D) Inhalation
A) Perfusion Feedback: The lung tissue receives its blood supply from the bronchial artery, which branches directly off the aorta. The alveoli receive unoxygenated blood from the right ventricle via the pulmonary artery. The delivery of this blood to the alveoli is referred to as pulmonary perfusion. Oxygenation is the process where unoxygenated blood receives oxygen in the lungs. Expiration is the act of exhaling to rid the body of excess carbon dioxide. Inhalation is the act of inhaling or taking in air to replace oxygen from the air.
A nurse is caring for a patient with chronic bronchiectasis. The nurse should assess the patient for what clinical manifestations? A) Purulent cough B) Angina C) Pigeon chest D) Pulmonary hypertension
A) Purulent cough Feedback: Patients present with the signs and symptoms of acute infection, including fever, malaise, myalgia, arthralgia, and a purulent, productive cough. A patient with bronchiectasis would not present with pulmonary hypertension, chest deformity, or chest pain related to lack of oxygen to the heart.
The nurse is aware that patients with bronchiectasis often have an underlying medical condition that increases the chance for infection. What are some of these medical conditions? (Select all that apply.) A) Rheumatoid arthritis B) AIDS C) Diabetes mellitus D) Hydrocephalus E) Organ transplant patient
A) Rheumatoid arthritis B) AIDS E) Organ transplant patient Feedback: Patients with bronchiectasis often have an underlying medical condition that makes them more susceptible to infections. These underlying medical conditions include immune suppression, which would include patients who have had organ transplants and are receiving antirejection medication. Other conditions include acquired immune deficiency syndrome (AIDS) and chronic inflammatory conditions, such as rheumatoid arthritis. Diabetes mellitus and hydrocephalus do not fit into these categories.
The nurse in the clinic is caring for a patient who has seasonal rhinitis and the patient wants to know what causes this to occur. What is the nurse's best response? A) "You are experiencing symptoms because bacteria have entered the nose and caused an infection." B) "Your upper airways are experiencing an inflammatory response to an inhaled antigen that is causing you to have sneezing and watery eyes." C) "Your sympathetic nervous system is responding to an acute amount of stress in your life causing you to have nasal congestion." D) "Your runny nose and sneezing have occurred because a portion of your lung has collapsed."
B) "Your upper airways are experiencing an inflammatory response to an inhaled antigen that is causing you to have sneezing and watery eyes." Feedback: Seasonal rhinitis usually occurs when the upper airways become inflamed because of the bodys response to an inhaled antigen. The lungs do not collapse and the sympathetic systems response to stress usually opens the airways and does not cause inflammation. Bacteria entering the nose do not cause inflammation of the rest of the upper airways.
A nurse in the postanesthesia care unit is caring for a 77-year-old male patient after hip replacement surgery. While assessing the patient, the nurse notes crackles, dyspnea, cough, and changes in movement of the chest wall. The nurse would suspect the patient has developed what? A) Pneumonia B) Atelectasis C) Bronchitis D) Emphysema
B) Atelectasis Feedback: Patients may present with crackles, dyspnea, fever, cough, hypoxia, and changes in chest wall movement. Treatment may involve clearing the airways, delivering oxygen, and assisting ventilation. In the case of pneumothorax, treatment would also involve insertion of a chest tube to restore the negative pressure to the space between the pleura. These signs and symptoms are not the presentation of pneumonia, bronchitis, or emphysema.
The nursing instructor is discussing cystic fibrosis (CF) with his clinical group. What would the instructor cite as the hallmark pathology of CF? A) Alveolar mucous plugging, infection, and eventual bronchiectasis B) Bronchial mucous plugging, inflammation, and tissue damage C) Atelectasis, infection, and eventual chronic obstructive pulmonary disease (COPD) D) Bronchial mucous plugging, infection, and eventual chronic obstructive pulmonary disease (COPD)
B) Bronchial mucous plugging, inflammation, and tissue damage Feedback: CF results in the accumulation of copious amounts of very thick secretions in the lungs. Eventually, the secretions obstruct the airways, leading to destruction of the lung tissue. Mucous plugs occur in CF, but it is at the bronchial level, not the alveolar level. COPD is not an eventual outcome in this disease.
The nurse is developing the teaching portion of a care plan for a patient with asthma. What would be an important component for the nurse to emphasize? A) Smoking a half a pack of cigarettes weekly is allowable. B) Chronic inhalation of nonallergic inhaled irritants can trigger an attack. C) Minor respiratory infections are not treated. D) Activities of daily living (ADLs) should be completed in the waking hours.
B) Chronic inhalation of nonallergic inhaled irritants can trigger an attack. Feedback: Asthma is characterized by reversible bronchospasm, inflammation, and hyperactive airways. The hyperactivity is triggered by allergens or nonallergic inhaled irritants or by factors such as exercise and emotions. The trigger causes an immediate release of histamine, which results in bronchospasm in about 10 minutes. The later response (i.e., 3 to 5 hours) is cytokine-mediated inflammation, mucus production, and edema contributing to obstruction. Patients with asthma should not smoke at all and even minor respiratory infections should be treated to prevent an exacerbation of asthma and ADLs should be completed whenever the patient feels able.
A nurse is discussing ways the body protects itself against infection. What are the microscopic, hair-like projections of the cell membrane found in the nasal cavity, which transport foreign substances toward the throat where it can be swallowed and kept away from the respiratory system? A) Goblet cells B) Cilia C) Alveolar sacs D) Sinuses
B) Cilia Feedback: Cilia are found in the epithelial cells of the lining of the nasal cavity and are constantly in motion directing mucus and trapped substances down toward the throat. Goblet cells are found in the epithelial lining and produce mucus, which traps foreign substances. Alveolar sacs are located in the lower respiratory tract and are considered the functional units of the lung. Sinuses are air-filled passages through the skull, which open into the nasal cavity.
The nurse is admitting a patient with an obstructive respiratory disorder. The nurse knows this includes which disorders? (Select all that apply.) A) Atelectasis B) Cystic fibrosis C) Asthma D) Pneumonia E) Bronchiectasis
B) Cystic fibrosis C) Asthma Feedback: Obstructive disorders of the lower respiratory tract include asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and respiratory distress syndrome (RDS). Atelectasis is a collapse of once-expanded alveoli. Pneumonia is an infection of the lower respiratory tract. Bronchiectasis is a disorder of chronic infection and inflammation of the bronchial passages.
While discussing gas exchange, the instructor would tell the students that oxygen and carbon dioxide enter and leave the body by what method? A) Osmosis B) Diffusion C) Passive transport D) Active transport
B) Diffusion Feedback: The alveolar sac holds the gas, allowing needed oxygen to diffuse across the respiratory membrane into the the capillary, whereas carbon dioxide, which is more abundant in the capillary blood, diffuses across the membrane and enters the alveolar sac to be expired.
A patient is admitted with an asthma attack caused by an allergic reaction to a medication. The nurse is aware that this severe allergic response is triggered by the immediate release of what? A) Antihistamine B) Histamine C) Epinephrine D) Surfactant
B) Histamine Feedback: Asthma is characterized by reversible bronchospasm, inflammation, and hyperactive airways. The hyperactivity is triggered by allergens or nonallergic inhaled irritants or by factors such as exercise and emotions. The trigger causes an immediate release of histamine, which results in bronchospasm in about 10 minutes. An antihistamine is used to treat allergic responses because it counteracts the effects of histamine. Surfactant is a lubricating substance that is necessary to keep the alveoli open. Epinephrine is a medication used to treat acute allergic responses.
A nurse is caring for an 80-year-old patient with pneumonia. The most appropriate nursing diagnosis for this patient would be what? A) Dysfunctional ventilatory weaning response B) Impaired gas exchange C) Ineffective health maintenance D) Risk for delayed development
B) Impaired gas exchange Feedback: Pneumonia causes swelling, engorgement, and exudation of protective sera in the lower respiratory tract. The respiratory membrane is affected, resulting in decreased gas exchange. There is no indication that the patient has been on a ventilator so a diagnosis that concerns weaning is not appropriate. There is also no indication that this patient has pneumonia because of ineffective health maintenance and because the patient is 80 years old, a diagnosis of risk for delayed development is also inappropriate.
A patient is complaining of an inability to breathe nasally because of severe rhinitis. The nurse is aware that the nose plays what important role in breathing that is disrupted when the nasal passages are blocked? A) It decreases the number of pathogens inhaled. B) Inspired air is warmed and humidified. C) Carbon dioxide will not be inhaled. D) It simulates surfactant release from the alveoli.
B) Inspired air is warmed and humidified. Feedback: Air usually moves into the body through the nose and into the nasal cavity. The nasal hairs catch and filter foreign substances that may be present in the inhaled air. The air is warmed and humidified as it passes by blood vessels close to the surface of the epithelial lining in the nasal cavity. The epithelial lining contains goblet cells that produce mucus. This mucus traps dust, microorganisms, pollen, and any other foreign substances. The epithelial cells of the lining also contain ciliamicroscopic, hair-like projections of the cell membranewhich are constantly moving and directing the mucus and any trapped substances down toward the throat (Figure 53.2). The action of the goblet cells and cilia is commonly called the mucociliary escalator. It does not affect carbon dioxide or pathogen inhalation and does not stimulate surfactant release.
A 39-year-old teacher with bronchitis has been up all night with intense coughing spasms and asks the nurse "How is all this coughing related to my bronchitis?" The nurse tells the patient that a cough is initiated by what? A) Irritation to receptors in the nasal cavity B) Irritation to receptors in the bronchi C) Irritation to receptors in the pharynx D) Irritation to receptors in the sinus cavities
B) Irritation to receptors in the bronchi Feedback: Irritation to bronchial receptors will initiate a cough, which causes air to be pushed through the bronchial tree. Irritation to receptors in the nasal cavity, pharynx, and sinuses are more likely to initiate the sneeze reflex.
A student asks the pharmacy instructor where air exchange takes place in the human body. What would be the instructor's best response? A) "Air exchange in the human body takes place in the trachea." B) "Air exchange in the human body takes place in the bronchioles." C) "Air exchange in the human body takes place in the alveoli." D) "Air exchange in the human body takes place in the nares."
C) "Air exchange in the human body takes place in the alveoli." Feedback: Gas exchange occurs across the respiratory membrane in the alveolar sac. It does not occur in the bronchioles, the trachea, or the nares.
A patient arrives in the emergency room with an attack of acute bronchiectasis. The nurse knows that the principal pathologic finding in the diagnosis of bronchiectasis includes what? A) Increase in the red blood cell concentration in the blood B) Leakage of fluid into the alveolar interstitial spaces C) Chronic, irreversible dilation of the bronchi and bronchioles D) Obstruction of the pulmonary vasculature by a clot
C) Chronic, irreversible dilation of the bronchi and bronchioles Feedback: Bronchiectasis is a chronic disease that involves the bronchi and bronchioles. It is characterized by dilation of the bronchial tree, chronic infection, and inflammation of the bronchial passages. It is not caused by increased red blood cell concentration in the blood, leakage of fluid into the alveolar interstitial spaces, or the obstruction of the pulmonary vasculature by a clot.
A nurse is discussing cystic fibrosis (CF) with a couple who have just given birth to an infant with this disorder. The nurse explains that the respiratory component of this disease is caused by what? A) Bronchospasm B) Infection C) Excessive respiratory tract secretions D) Chemical irritation of the respiratory tract
C) Excessive respiratory tract secretions Feedback: CF is a hereditary disease involving the exocrine glands of the respiratory, gastrointestinal, and reproductive tracts. CF results in the accumulation of copious amounts of very thick secretions in the lungs. CF is not caused by bronchospasm or chemical irritation. Patients with cystic fibrosis develop many lung infections but that is secondary to the disease, not the underlying disease process itself.
The nursing instructor is discussing acute respiratory distress syndrome (ARDS) with her clinical group. What signs and symptoms would the instructor present to the students as characteristic of ARDS? A) Anoxia B) Hypocapnia C) Hypoxia D) Hypercapnia
C) Hypoxia Feedback: Acute respiratory distress syndrome (ARDS) is characterized by progressive loss of lung compliance and increasing hypoxia. Anoxia is a lack of oxygen to the body. ARDS will cause decreased oxygen (hypoxia). ARDS does not cause hypocapnia or hypercapnia, which is too little or too much carbon dioxide, respectively.
The nurse is teaching a class about common upper respiratory infections to parents of preschoolers. The parents correctly respond that which are examples of upper respiratory infections? (Select all that apply.) A) Bronchitis B) Asthma C) Pharyngitis D) Sinusitis E) Laryngitis
C) Pharyngitis D) Sinusitis E) Laryngitis Feedback: Upper respiratory infections include pharyngitis, sinusitis, and laryngitis. Asthma and bronchitis are examples of lower respiratory disorders.
A nurse is caring for a 45-year-old patient with acute respiratory distress syndrome (ARDS). The nurse is aware that this disease is characterized by what? A) Accumulation of copious amounts of very thick secretions in the lungs B) Loss of elastic tissue of the lungs and destruction of alveolar walls C) Progressive loss of lung compliance and increasing hypoxia D) Reversible bronchospasm, inflammation, and hyperactive airways
C) Progressive loss of lung compliance and increasing hypoxia Feedback: ARDS is characterized by progressive loss of lung compliance and increasing hypoxia and occurs as a result of a severe insult to the body. Accumulation of copious amounts of thick secretions in the lungs is associated with cystic fibrosis. Chronic obstructive pulmonary disease (COPD) is characterized by loss of the elastic tissue of the lung, destruction of alveolar walls, and hyperinflation with tendency to collapse with expiration. Reversible bronchospasm, inflammation, and hyperactive airways are characteristics of asthma.
The nursing instructor is discussing the need for lubrication of the alveoli for effective gas exchange and is produced by type II cells of the alveoli. The students know that what substance is produced by type II cells of the alveoli? A) Erythrocytes B) Lymphatic fluid C) Surfactant D) Pleural fluid
C) Surfactant Feedback: Type II cells produce surfactant. Erythrocytes are made in the bone marrow. Lymphatic fluid is produced by lymph glands; pleural fluid is secreted by cells in the pleural cavity.
A patient asks the nurse what causes a cold. The nurse would tell the patient that the common cold is most often caused by which type of microorganism? A) Gram-positive bacteria B) Gram-negative bacteria C) Virus D) Fungus
C) Virus Feedback: Various viruses cause the common cold. These viruses invade the tissues of the upper respiratory tract, initiating the release of histamine and prostaglandins and causing an inflammatory response. Bacteria and fungi can cause a respiratory infection but the disorder commonly known as a cold is caused by a virus.
The clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what they could have done to minimize the risk of contracting this disease. What would be the nurse's best answer? A) "The most important risk factor for COPD is inadequate nutrition." B) "The most important risk factor for COPD is regular exercise." C) "The most important risk factor for COPD is exposure to dust and pollen." D) "The most important risk factor for COPD is cigarette smoking."
D) "The most important risk factor for COPD is cigarette smoking." Feedback: COPD is a permanent, chronic obstruction of airways, often related to cigarette smoking. Inadequate nutrition, regular exercise, and exposure to dust and pollen are not risk factors for COPD.
A patient presents to the clinic with a temperature of 101.5°F; malaise, myalgia, arthralgia, and a purulent, productive cough. The patient states "The fever just started today but I have had this cough for many, many months." What would the nurse suspect the patient has? A) Acute pneumonia B) Bronchitis C) Chronic obstructive pulmonary disease (COPD) D) Bronchiectasis
D) Bronchiectasis Feedback: Bronchiectasis is a chronic disease that involves the bronchi and bronchioles. It is characterized by dilation of the bronchial tree and chronic infection and inflammation of the bronchial passages. With chronic inflammation, the bronchial epithelial cells are replaced by a fibrous scar tissue. The loss of the protective mucus and ciliary movement of the epithelial cell membranes, combined with the dilation of the bronchial tree, leads to chronic infections in the now unprotected lower areas of lung tissue. Patients with bronchiectasis often have an underlying medical condition that makes them more susceptible to infections (e.g., immune suppression, acquired immune deficiency syndrome, chronic inflammatory conditions). Patients present with the signs and symptoms of acute infection, including fever, malaise, myalgia, arthralgia, and a purulent, productive cough. Patients who have pneumonia and bronchitis may present with the above symptoms, but it is not a chronic disorder. COPD is a chronic disorder but the patient with this disorder has more symptoms related to shortness of breath.
While assessing a new patient on the unit, the nurse notes the following: productive cough, respiratory rate of 22, oxygen saturation of 90%, and increased secretions. The patient has a 20-year history of smoking 1.5 packs of cigarettes daily. What chronic condition might this patient have? A) Pneumonia B) Cystic fibrosis C) Pleural effusion D) Chronic obstructive pulmonary disease (COPD)
D) Chronic obstructive pulmonary disease (COPD) Feedback: Chronic obstructive pulmonary disease (COPD) is a permanent, chronic obstruction of airways, often related to cigarette smoking. It is caused by two related disorders, emphysema and chronic bronchitis, both of which result in airflow obstruction on expiration, as well as overinflation of the lungs and poor gas exchange. Emphysema is characterized by loss of the elastic tissue of the lungs, destruction of alveolar walls, and a resultant alveolar hyperinflation with a tendency to collapse with expiration. Chronic bronchitis is a permanent inflammation of the airways with mucus secretion, edema, and poor inflammatory defenses. Characteristics of both disorders often are present in the person with COPD. Pneumonia and pleural effusion are not chronic conditions. Cystic fibrosis is a genetic disease of excessive pulmonary tract secretions and GI tract involvement.
The nurse is caring for a patient who suffered a head injury and is now having difficulty breathing. The nurse knows that this patient may have injured what part of the central nervous system? A) Cerebral cortex B) Cerebellum C) Hypothalamus D) Medulla oblongata
D) Medulla oblongata Feedback: The act of breathing is controlled by the medulla, which depends on a functioning muscular system and a balance between the sympathetic and parasympathetic systems. The cerebral cortex, cerebellum, and hypothalamus are not involved with this process.
A patient returns to the unit after thoracic surgery with a water-sealed chest drainage system. What should the nurse instruct the patient and the family that this drainage system is used for? A) Maintaining positive chest wall pressure B) Monitoring pleural fluid C) Providing positive intrathoracic pressure D) Re-expanding the lung and restoring the negative pressure to the space between the pleura
D) Re-expanding the lung and restoring the negative pressure to the space between the pleura Feedback: In the case of a pneumothorax, treatment would involve insertion of a chest tube to restore the negative pressure to the space between the pleura. A water-sealed chest drainage system does not maintain positive chest wall pressure, monitor pleural fluid, or provide positive intrathoracic pressure.
The nursing instructor is teaching a class on respiratory disorders and asks the students "What condition is a result of the upper airways response to pollen, mold, or dust?" A) Cystic fibrosis B) Adult respiratory distress syndrome (ARDS) C) Atelectasis D) Seasonal rhinitis
D) Seasonal rhinitis Feedback: Seasonal rhinitis is an inflammation of the nasal cavity; it occurs when the upper airways respond to a specific antigen such as pollen, mold, or dust. Cystic fibrosis, atelectasis, and ARDS are not associated with an allergic response.
A woman has just given birth to a premature infant. The mother asks why the infant is having such a hard time breathing. The nurse explains that the infant's alveoli are unable to stay open. What is the infant lacking that is necessary for correct functioning of the alveoli? A) Adenosine triphosphate (ATP) B) Histamine C) Serotonin D) Surfactant
D) Surfactant Feedback: Surfactant is a lipoprotein that decreases the surface tension in the sac and prevents alveolar collapse. ATP, histamine, and serotonin are released from mast cells throughout the airway to ensure a quick and intense inflammatory reaction to any cell injury, which may lead to a respiratory infection.
