PATHO exam 3: 25, 26, 29, 30, 31
Left ventricle
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?
Nitric Oxide
Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?
Vasospasm causing excessive vasoconstriction
Which pathogenesis is primarily responsible for Raynaud phenomenon?
nasal congestion
Which problem in neonates can result in increased upper airway resistance and decreased airflow into the lungs?
Lymphedema in the affected arm
Which related circulatory complication can result from surgical treatment for metastatic breast cancer?
right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
Which sequence is the correct pathway for blood flow through the heart?
hypoxemia
The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen and other laboratory work reveals an increase in lactic levels. How will the nurse interpret these findings?
Aveoli
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?
Encourage the client to cough and breathe deeply several times per hour
The nurse is caring for a postoperative client in traction. Which activity would be most beneficial for preventing atelectasis in this client?
cyanosis secondary to an anatomic shunt.
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 62-year-old male who is postoperative for repair of a fractured femur
The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism.
stretch receptors
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?
500 mL
What is the normal tidal volume for a person at rest?
Tunica media
Which blood vessel layer is made primarily of muscle?
HDL
A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring
Systemic vasoconstriction maintained the diastolic pressure.
A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which reason accounts for this lack of change in the diastolic pressure?
House dust
A 9-year-old boy has been diagnosed with bronchial asthma. Which factor is most likely contributing to his condition?
Increased turbulence of air moving through the obstructed airways
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:
Short-acting beta 2-adrenergic agonists such as albuterol (SABA)
A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which drug will the nurse anticipate administering first?
beta-adrenergic agonists
A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client?
Severe asthma attack
A child struggling to breathe is brought to the emergency department with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. What is the most likely diagnosis?
- Respiratory rate 34. - Asymmetrical chest movements, especially on inspiration - Diminished breath sounds over painful chest area
A client arrives in the ED after an automobile accident. Which clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply.
Forced expiratory volume
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:
Bending forward or coughing
A client diagnosed with sinusitis will express concern that which physical maneuver increases the headache?
Signals from receptors in the tracheobronchial wall
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?
Right-sided heart failure
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
Administer a beta-2 agonist.
A client in the emergency department reports sudden onset of coughing with a feeling of chest tightness. Lung sounds are diminished with wheezing in all lung fields, skin is moist, and the client appears anxious. What is the first intervention the nurse should implement?
membranous sac that encloses the heart
A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching th client about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium?
Increase in PCO2
A client is brought into the emergency department with severe crushing injuries to the chest wall and signs of respiratory failure following a motor vehicle accident. Which laboratory value would be expected?
insertion of a large-bore needle or chest tube
A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:
-Maintain normal weight -Control hypertension -Control blood glucose levels
A client is concerned about his family history of atherosclerosis and asks the nurse if there is anything he can do to decrease his risk. The client has type 2 diabetes. Which responses by the nurse are most accurate? Select all that apply.
During the first 3 days after the onset of symptoms
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?
Prevention of the development of a deep vein thrombosis
A client recently had surgery for a hip fracture. Which nursing intervention would be mosteffective for preventing pulmonary emboli in this client?
Air is permitted to enter but not leave the pleural space, causing lung collapse.
A client sustained a puncture injury to the chest resulting in development of a tension pneumothorax. What is the pathogenesis behind a tension pneumothorax?
380 mm Hg
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?
"I'll ask you to breathe in as deeply as you can, and then blow out as much of that air as possible."
A client with a history of chronic obstructive pulmonary disease (COPD) is undergoing pulmonary function testing. Which instructions should the technician provide to determine the client's forced vital capacity (FVC)?
Bicuspid valve
A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:
Deviated trachea
A diagnosis of tension pneumothorax would be suspected in which physical assessment finding?
loss of intrapleural pressure
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:
Four (4)
A fully saturated hemoglobin molecule can hold how many oxygen molecules?
Cigarette smoke
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 factor mostlikely had the greatest impact on development of the lung cancer?
cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant.
A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that:
Inspiratory stridor and barking cough
A nurse is assessing a 1-year-old child diagnosed with croup. Which manifestation would mostlikely be present?
Grunting during expiration
A nurse is assessing a 2-week-old infant with pulmonary edema. Which symptom indicates the infant is experiencing respiratory distress?
Lymphedema
A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy 1 year ago. What does the nurse suspect is the problem?
Systemic vascular resistance (SVR)
A nurse is evaluating a client to determine the effectiveness of medications given to reduce left ventricular afterload. Which hemodynamic parameter is most appropriate for the nurse to monitor?
Family History Race
A nurse is evaluating hypertension risk factors with a black male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 lb (6.8 kg) in the past year. Which risk factors or hypertension are nonmodifiable? Select all that apply.
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?
Black and South Asian People
A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?
Accumulate and encase the M. tuberculosis.
A nurse is speaking to a client who tested positive for the presence of M. tuberculosis but has a normal chest x-ray. The nurse explains that the client does not have the active disease because of which function of the alveolar macrophages?
a nasogastric (NG) tube attached to suction.
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:
Anticoagulation therapy and elevation of the leg
A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which has lead to a diagnosis of deep vein thrombosis (DVT). What treatment option will be of greatest benefit to prevent further thrombus formation?
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.
Which of the following is true regarding pulmonary circulation?
It is a low-pressure system that allows for improved gas exchange.
Surgical treatment may have the consequence of weakening the client.
A social worker is counseling the family of an 85-year-old woman who has just been diagnosed with non-small cell lung cancer. What concerns should she convey to the family regarding the unintended effects of treating the disease?
Pancreatic
A teenaged client with cystic fibrosis presents to the clinic. The health care provider (HCP) knows that cystic fibrosis (CF) causes severe chronic respiratory disease in children. In addition, the HCP should also focus his or her assessment on which of the other body systems affected by CF?
Ventilation
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:
Airway inflammation
Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following?
Local vasoconstriction
Adverse effects of emboli on pulmonary circulation and airways include:
The client who is postoperative after a total knee replacement and receiving patient-controlled analgesia
Air is permitted to enter but not leave the pleural space, causing lung collapse.
Elevate the head of the bed.
An adult client recently had a cerebrovascular accident that resulted in dysphagia. What is the nurse's priority action to prevent the aspiration of gastric contents?
"Do you tend to have a cough even when you don't feel sick?"
An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis?
surface tension of the respiratory membrane.
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:
Staphylococcus aureus
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?
stimulation of irritant receptors causes bronchoconstriction.
An individual has sensitivity to perfumes and experiences shortness of breath when exposed to them. This occurs because:
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?
Hypotension
An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?
"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"
An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement is the best response?
organ damage and hypovolemic shock
At 4 AM the hemodynamic monitoring for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure (MAP) is at the low end of the normal range; at 5 AM the client's MAP has fallen definitively below normal. The nurses should prioritize assessments for:
Organ damage and hypovolemic shock
At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for:
70 to 75 mL/kg
Blood flow in the circulatory system depends on a blood volume that is sufficient to fill the blood vessels and a pressure difference across the system that provides the force to move blood forward. What is the total blood volume in an adult?
Chickenpox
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?
shallow, quiet breathing, which impairs the spreading of surfactant.
Clients who have been bedridden for a long time likely will experience:
Radiologic findings Age Presence of coexisting disease
Community-acquired pneumonia can be categorized according to which indexes? Select all that apply.
3600 mL
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?
Pseudomonas aeruginosa and Staphylococcus aureus
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?
"Have you ever been a smoker?"
Diagnostic testing has resulted in a diagnosis of small cell lung cancer (SCLC) in an older adult client. When exploring the etiology of the client's disease, what assessment question is mostrelevant?
The pulse decreases, rather than increases, in amplitude.
Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease?
The client has increased pressure related to right-sided heart failure.
During an assessment of a client with ankle swelling, the nurse observes jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. What is the correct interpretation of this finding?
Carbon monoxide poisoning
For which client condition will a pulse oximeter reading be inaccurate?
Warm, standing water becomes aerosolized and inhaled
How is the organism causing Legionnaire disease, a form of bronchopneumonia, usually transmitted?
Histamine
Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability.
Volume
In the circulatory system, pressure is inversely related to which factor?
Lung compliance
Most respiratory disorders in infants make it difficult to get air into their lungs. This is due to a decrease in which factor?
Alveoli
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?
1 to 2 L/min
Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Which amount of oxygen is considered most appropriate for the COPD client?
Pleuritis
Pain is an expected assessment finding in clients who have which lung disease?
Intercostal and abdominal muscles
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?
Venous Blood Return
Preload, the stetch on the heart before contraction, is largely determined by which factor?
Rapid and shallow breathing and chest retractions
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?
Atelectasis and pulmonary embolism
Prolonged immobility is implicated in the development of which disorder?
Pulmonary vessels constrict
Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?
Histamine
Release of which humoral factors will result in vasodilation?
A client who is receiving 100% oxygen via oxygen mask
Select the clinical situation that would result in increased diffusion of gases from the arterial blood into the alveoli.
Capillaries, venules, veins, right atrium
Select the correct sequence of blood return to the heart.
Delivers the blood supply for the conducting airways and supporting structures
Select the primary function of bronchial circulation.
Ventricles contract and blood is ejected from the heart.
The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?
Right Heart, Pulmonary artery, Pulmonary veins
The circulatory system is divided into two parts. What does the pulmonary circulation include? Select all that apply.
Pulmonary Embolism
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent:
"I should avoid fats that are manufactured from vegetable oils and used to extend the shelf life of fast foods."
The dietitian is teaching a client about cholesterol reduction strategies. Which comment by the client indicates that he understands the teaching?
Stroke Volume
The difference between the end-diastolic and end-systolic volumes is called what?
Tricuspid, Mitral
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.
Pulmonary, Aortic
The heart consists of four valves. Which are the semilunar valves? Select all that apply.
Controls the direction of blood flow from the left side of the heart to the systemic circulation
The heart controls the direction of blood flow. What is the role of the aortic valve?
Pumps blood to the lungs
The heart is a four-chambered pump. What is the function of the right ventricle?
Respiratory distress syndrome
The neonatologist explains to the parents of a neonate born at 35 weeks' gestation that their premature infant will be monitored for complications. Which respiratory complication is the mostcommon?
Bed Rest Muscle Weakness Surgery Paralysis
The nurse has just completed a respiratory assessment on a postoperative client who has undergone repair of a large abdominal aneurysm. Which conditions may impair the client's cough reflex? Select all that apply.
Tunica media
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as:
Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed.
The nurse in the emergency department is assessing a toddler suspected of epiglottitis. Which intervention is considered the priority when working with this client?
Tidal volume × respiratory rate
The nurse is calculating the minute volume of a client. Select the correct categories of measurement.
Elevated total cholesterol
The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?
Receives blood returning to the heart from the systemic circulation
The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?
You have a 25% chance that your next child will have CF.
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?
The sweat test measures the concentration of salt in the infant's sweat.
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?
"Capillaries permit the exchange of material between the blood and interstitial fluid."
The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states:
Emphysema
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?
Troponin T and troponin I
The troponin complex is one of a number of important proteins that regulate actin-myosin binding. Troponin works in striated muscle to help regulate calcium-mediated contraction of the muscle. Which of the troponin complexes is diagnostic of a myocardial infarction?
chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%.
The use of oxygen at a rate above 2 L/minute is inappropriate for a client with:
Stasis of blood, hyper coagulability, vessel wall injury
Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include:
Increased PCO2
Ventilation is driven by which alteration in arterial blood?
Lung compliance
What does the equation C = ΔV/ΔP stand for?
Corticosteroids
What intervention is appropriate for a client with sarcoidosis?
To remove foreign materials
What is the function of the mucociliary blanket that lines the conducting airways?
An ejection fraction of 40%
When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?
Left Ventricle
When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart?
Pulmonary insufficiency or heart failure
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?
Epiglottitis
Which diagnosis places a child at the greatest risk for airway obstruction?
Histamine
Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability?
Venous thrombosis
Which of the following is associated with stasis of blood, increased blood coagulability, and vessel wall injury?
Abdominal aortic
Which type of aortic aneurysm is the most common?
Vascular smooth muscle cells (SMCs)
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?
the stiffening of the lung, making it more difficult to inflate.
With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiologic principle behind this respiratory distress is related to:
Bronchial dilation
With bronchiectasis, persistent airway obstruction and chronic infection results in which physiologic response?
The volume of air contained in the nose, pharynx, trachea, and bronchi
A client asks the nurse what anatomic airway dead space is. What would be the nurse's bestresponse?
Rebound symptoms
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?
Damage has occurred at the connection between the pneumotaxic and apneustic centers.
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:
The client will need education about the administration of isoniazid and the importance of taking it as prescribed.
A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. What education about medications will the nurse provide to the client?
Periodic severe headache and marked variability in blood pressure
A 37-year-old woman is admitted to the unit with a differential diagnosis of rule out pheochromocytoma. What are the most common symptoms the nurse would expect this client to exhibit?
Sclerotherapy or surgery
A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which intervention?
The use of antibiotics
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?
Influenza transmission occurs by inhalation of droplet nuclei.
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?
"This means your heart is not pumping as much blood out of the heart with each beat."
A client with heart failure has an echocardiogram performed, revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client:
Surgery to remove tumor Radiation therapy Chemotherapy
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.
The infant is using nasal flaring to take in more air.
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?
A 20-year-old healthy female reporting an allergy to eggs
At an influenza vaccination clinic, a nurse is screening clients who are requesting the vaccine. The nurse determines that which client is unable to receive the vaccine?
Away from the affected lung
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?
Damage or destruction of cilia
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?
-Generalized lymph node enlargement -An enlarged liver via palpation -A headache and reports of stiff neck with movement
Following a dust storm, the health care provider suspects coccidioidomycosis, a fungal infection, when several clients present to the clinic reporting productive cough, fever, and night sweats. Which manifestations lead the provider to suspect the infection has progressed outside the lung? Select all that apply.
LDL
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which lipoprotein is the main carrier of cholesterol?
The client must protect the entire body from cold, not just the extremities.
The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?
"Do you have a history of smoking, and if so, how much?"
The nurse is performing a health history for a male client who is having a series of diagnostic tests 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?
Antipyretic medications and rest
The nurse is providing instructions to a client for the treatment of a common cold. The mostappropriate information would be:
The venous system collects deoxygenated blood from the tissues.
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
Preload represents the volume work of the heart.
The nurse is teaching a client diagnosed with heart failure about preload. Which principle would be most appropriate to provide to the client?
Impaired gas exchange
What is the underlying cause of respiratory failure in a child with bronchiolitis?
The man's blood pressure is 178/102 and he has abnormal liver function tests.
Which assessment finding of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa?
Tunica media
Which blood vessel layer is composed primarily of smooth muscle cells?
Capillaries
Which blood vessels function without the benefit of having walls comprised of three muscular layers?
Smaller airways create a susceptibility to changes in airway resistance and airflow.
Which characteristic of the lungs of infants and small children creates an increased risk of respiratory disorders?
"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked."
A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:
"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques."
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:
"Do you work in construction and dig soil?"
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?
Pulmonary congestion
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:
Tearing or ripping-type pain in the chest or back
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:
Elevation of triglycerides
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?
O2
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:
As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture.
A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to "watch" for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which physiologic principle?
Worked in a coal mine for 20 years
A client is diagnosed with pneumoconiosis. Which aspect of the client's history is most likely the cause of this diagnosis?
Chest pain and dyspnea
A client is diagnosed with pulmonary embolism. Which symptom would most likely be present?
Sustained systolic pressure ≥160 mm Hg
A client is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?
Aspiration
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?
"This diagnostic procedure will let the doctor know if you have any metastatic lesions in your body."
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?
Nosocomial pneumonia
A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis.
short, shallow breaths
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?
Barrel chest
A client with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which term should the nurse use to document this finding?
Activation of the renin-angiotensin-aldosterone mechanism
A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure?
Perfusion without ventilation
A client with a diagnosis of community-acquired pneumonia is producing copious secretions that are physically obstructing the airway. Which pathophysiologic process will result from this condition?
Irritant receptors
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?
-Respiratory rate—32; pulse rate—122 beats/min. -"Having a hard time catching my breath." -Using accessory muscles to help him breathe.
A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic reporting difficulty breathing. 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.
50%
A client with a history of heart failure has the following echocardiogram results: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction (EF)
"I will skip church during flu season and wear a scarf when out in the cold."
A client with advanced chronic obstructive pulmonary disease (COPD) has been taught methods to maintain maximum functioning. Which client statement indicates accurate understanding of the instructions?
Small cell lung cancer due to smoking history
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 possible diagnosis?
Hyperventilation
A client with asthma 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. What is the most likely cause?
Cyanosis
A client with chronic obstructive pulmonary disease presents to the emergency department with difficulty breathing. Physical examination reveals bluish skin, nail beds, and mucous membranes. Which term correctly describes this condition?
Activation of the renin-angiotensin-aldosterone mechanism
A client with chronic renal failure secondary to diabetes has just been diagnosed with secondary hypertension. This increase in blood pressure is likely caused by which physiologic factor?
The client might have meningitis, which is the most common cause of death.
A client with coccidioidomycosis has developed a severe headache with neck stiffness, has a fever, and states he feels very ill. What does the nurse recognize these symptoms may indicate?
The presence of skin and joint manifestations indicates strong host defenses.
A client with coccidioidomycosis has developed skin and joint manifestations to accompany the disease process. What does the nurse recognize that this indicates for the client?
Decrease the production of surfactant
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?
"For unknown reasons, you lose intrapleural negative pressure. This means your lungs collapsed and expelled its air when you lose negative pressure."
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:
Increase sympathetic stimulation of the heart and blood vessels
A grandmother who works as a cook at a nearby school was recently hospitalized when she lost an extensive amount of blood in a work-related accident. The grandmother tells the nurse that she heard that she would keep feeling faint until the brain made more blood. The nurse knows that when the blood pressure dropped, the pressure in the carotid arteries decreased. This was detected by baroreceptors in the carotid arteries. What did the baroreceptors do?
Prepare for mechanical ventilation.
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?
PEF 450 mL in AM, 300 mL at noon, symptoms occur daily
A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has moderate persistent asthma?
dead space
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?
Black and South Asian people
A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?
Reduce Dietary Sodium Stop Smoking Limit Alcohol Consumption Consume a diet rich in fruits, vegetables, and low fat dairy products
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply.
Measuring the pulse of a client taking an ACE inhibitor
A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which assessment would the nurse be most justified in eliminating during a busy morning on the unit?
Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves.
A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which assessment should the nurse complete?
The nurse is likely asymptomatic.
A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse?
the relationship between venous return and stroke volume.
A nurse working with a client in heart failure is explaining why the symptoms of the heart failure were not evident for a long period of time. When describing the Frank-Starling mechanism, the nurse will explain:
Macrophages
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:
Watery, clear nasal secretions Coughing Mild fever
A parent brings a child into the urgent care clinic. The health care provider suspects the child has a "common cold" based on which clinical manifestations? Select all that apply.
Epiglottis
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:
The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine.
A parent of a toddler is concerned about possible side effects of influenza immunizations. What will the nurse teach the parent regarding the flu vaccine?
increased heart rate and increased contractility
If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations?
Slowing of heart rate to below 60 beats/minute
If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern?
influenza
The nurse is assessing a client who states he felt fine all day and then, within 5 minutes, began to feel extremely weak and tired and began having a fever. What do these symptoms indicate that the client may be experiencing?
Rapid onset of profound malaise
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?
Repolarization of the ventricles
The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?
Fractured ribs following car accident
The emergency room provider diagnoses a client with a hemothorax. Which could be possible causes of this condition?
Controls the direction of blood flow from the right side of the heart to the lungs
The heart valves control the direction of blood flow. What is the function of the pulmonic valve?
Loss of diaphragmatic function
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?
decreased urine output
The nurse and nursing student are assessing a client experiencing shock. The nurse teaches the student that which finding reflects compensatory sympathetic stimulation in a shock state?
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 short of breath due to a:
apply sequential pneumatic compression devices to lower extremities
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement?
Pursed-lip breathing
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?
Carbon dioxide Oxygen pH
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.
Glomerular hypoperfusion
The nurse knows that hypertension can lead to nephrosclerotic damage. Which of the following occurs first in nephrosclerosis?
-Mean arterial pressure is determined by cardiac output and peripheral vascular resistance. -Peripheral resistance is influenced by blood viscosity. -Blood pressure can be maintained despite changes in cardiac output and resistance. -Peripheral resistance is influenced by arteriolar constriction.
The nurse knows that peripheral vascular resistance is an important factor in blood pressure regulation. Which statements regarding peripheral vascular resistance are correct? Select all that apply.
140/90
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:
Diuretics
The nurse knows that which group of antihypertensive drugs is usually the least expensive and are well tolerated?
pulse oximetry
The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement technique would be:
Arterioles
The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?
-A client who is HIV positive and has not been exposed to the infection -A client with active tuberculosis -A client who has had contact with a family member with active tuberculosis
The nurse working in the health department recognizes which clients in her group meet the criteria for beginning antimycobacterial therapy for tuberculosis? Select all that apply.
Kawasaki disease
The pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following?
Long-term compensatory regulation of blood flow
The physician states that a client has adequate collateral circulation. The nurse interprets this as:
A client with familial hypercholesterolemia
The physician understands that which client is at risk for developing primary hyperlipoproteinemia?
C-reactive protein
The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?
Exchange gases, nutrients, and wastes
The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?
Input from lung receptors that monitor bronchial constriction.
The sensation of chest tightness due to an impending asthmatic attack appears to be related to which physiologic cause?
Sympathetic
The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system?
Pulmonary embolism
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?
Exercise can increase blood vessel growth and help to decrease symptoms.
What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise?
Elevate the head of the bed.
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?
A client who has hypercapnia
Which client does the nurse determine will have the most difficulty in instituting an exercise plan?
A 66-year-old postoperative client on bed rest
Which client is at greater risk for orthostatic hypotension?
A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation
Which client is at risk for developing acute respiratory failure?
A client with COPD and a 35 pack-year smoking history.
Which client most likely faces the highest risk of developing secondary pulmonary hypertension?
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension
-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 clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply.
Increased velocity
Which factor can cause turbulent blood flow?
Pet dander
Which factor is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?
Administration of sodium nitroprusside and beta-adrenergic blocking medications (beta-blockers)
Which intervention is the priority for the medical management of a client with a dissecting aortic aneurysm?
Low-density lipoproteins (LDL)
Which lipoprotein is the main carrier of cholesterol?
Repeated blood pressure determinations
Which measure is the best modality to diagnose hypertension?
Laminar
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?
-The condition depends on the body's ability to adapt to lowered oxygen levels. -The brain is vulnerable to hypoxia. -When hypoxemia occurs, metabolic acidosis is a possible outcome. -Normally, serum lactate levels are between 0.5-1 mmol/L (4.5-9.0 mg/dL)
Which statements concerning hypoxemia are true? Select all that apply.
Decreased elasticity in arterial connective tissue
Which vascular changes can occur in older adults because of during the aging process?
-Client who has a fever with possible strep throat -Client with anaphylactic hypersensitivity to eggs -Client with Guillain-Barré syndrome
While administering influenza vaccines for the general public, the nurse will advise which clients to avoid taking the influenza shot? Select all that apply.
Carbon anhydrase
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?
"The earliest symptoms relate to a chronic cough and shortness of breath."
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?
