Patho II Exam 2 Ch.19, Patho II Exam 2 Ch.20, Patho II Exam 2 Ch.21, Patho II Exam 2 Ch.22, Patho II Exam 2 Ch.23

18. Which assessment would support a diagnosis of type A COPD rather than type B COPD

Normal PaCO2, scant sputum, accessory muscle use, barrel chest

26. A patient has heart failure with a normal ejection fraction. Which findings are most likely found in this patient? (Select all that apply.)

Pulmonary congestion Edema Ejection fraction greater than 50%

15. Chronic pulmonary hypertension can eventually cause which complication?

Right heart failure

10. Croup is characterized by

a barking cough.

16. Sepsis has been recently redefined as

a systemic inflammatory response to infection.

14. A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum. This patient is most likely experiencing

acute cardiogenic pulmonary edema.

12. COPD leads to a barrel chest, because it causes

air trapping.

19. Tachycardia is an early sign of low cardiac output that occurs because of

baroreceptor activity.

2. Copious amounts of foul-smelling sputum are generally associated with

bronchiectasis.

29. Dysrhythmias are significant since they (Select all that apply.)

can indicate an underlying disorder. can impair cardiac output.

5. Hypoxic pulmonary vasoconstriction

can lead to secondary pulmonary hypertension.

17. Right-sided heart failure secondary to pulmonary hypertension is also called

cor pulmonale.

2. The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is

digitalis

25. Right-sided heart failure is usually a consequence of (Select all that apply.)

elevated right ventricular afterload. right ventricular infarction.

5. In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with

high cardiac output.

6. Lusitropic impairment refers to

impaired diastolic relaxation.

2. An increase in filtration of fluid from the pulmonary capillaries into the interstitium occurs with ________ pressure.

increased capillary hydrostatic

3. The central chemoreceptors for respiratory control are

responsive primarily to changes in pH and CO2.

5. Cor pulmonale refers to

right ventricular hypertrophy secondary to pulmonary hypertension.

17. A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock.

septic

1. The progressive stage of hypovolemic shock is characterized by

tachycardia

15. The effect of nitric oxide on systemic arterioles is

vasodilation.

28. A type of shock that includes brain trauma that results in depression of the vasomotor center is ____________.

neurogenic shock

18. Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of

nitric oxide.

17. A major cause of treatment failure in tuberculosis is

noncompliance.

6. Asthma is categorized as a(n)

obstructive pulmonary disorder.

31. Restrictive respiratory disorders include (Select all that apply.)

pneumothorax ARDS

11. An abnormally wide (more than 0.10 second) QRS complex is characteristic of

premature ventricular complexes.

28. Common characteristics of sarcoidosis include (Select all that apply.)

presence of CD4+ T cells. a non-productive cough. granulomas in multiple body systems. fatigue, weight loss, and fever.

19. Legionnaires disease is characterized by

presence of systemic illness.

7. First-degree heart block is characterized by

prolonged PR interval.

3. Hypertrophy of the right ventricle is a compensatory response to

pulmonary stenosis.

1. The amount of gas remaining in the lungs after a maximal expiration is called the

residual volume.

19. Structure(s) that engage in exchange of respiratory gases include(s) the (Select all that apply.)

trachea. bronchi. pulmonary capillaries. alveoli.

24. Which statement is true about the incidence of heart failure? (Select all that apply.)

Heart failure is the fastest-growing cardiac disorder. The increasing incidence and hospitalization rates of heart failure reflect the aging population in the United States. The incidence of heart failure is 10 per 1000 population after age 65.

9. Which disorder is caused by inhalation of organic substances?

Hypersensitivity pneumonitis

13. When exposed to inhaled allergens, a patient with asthma produces large quantities of

IgE

1. Allergic (extrinsic) asthma is associated with

IgE-mediated airway inflammation.

18. "My doctor said I have cor pul-something, which is a heart problem," says Mr. Garabedian. "I thought I just had these bad lungs that can't be fixed. How can that make my heart go bad?" Which mechanism leads to the development of cor pulmonale, which should serve as the basis for your response to Mr. Garabedian?

Increased resistance to pulmonary arterial flow leads to compensatory right ventricular hypertrophy.

14. In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiological event?

Inflammation, mucosal edema, and bronchoconstriction

32. First-degree block is identified by a prolonged ________.

PR interval

6. Most of the carbon dioxide in blood is transported

as bicarbonate.

8. After evaluation, a child's asthma is characterized as "extrinsic." This means that the asthma is

associated with specific allergic triggers.

9. Cystic fibrosis is associated with

bronchiectasis.

26. An acute asthma attack is associated with (Select all that apply.)

bronchoconstriction. bronchial mucosal edema. hypersecretion of mucus. hypoxemia

7. Shifts in the oxyhemoglobin dissociation curve represent the

changes in hemoglobin affinity for oxygen.

24. A restrictive respiratory disorder is characterized by

decreased residual volume.

15. Lack of alpha1-antitrypsin in emphysema causes

destruction of alveolar tissue.

21. A common characteristic of viral pneumonia is

dry cough.

29. Clinical manifestations of pleural effusion include (Select all that apply.)

dyspnea diminished breath sounds. a tracheal shift, if large.

15. Pneumocystitis is a term that refers to a

fungal pneumonia secondary to HIV.

31. Chronic elevation of myocardial wall tension results in ________.

hypertrophy

13. Hypoventilation causes

hypoxemia.

3. Widespread atelectasis, non-cardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates on chest radiograph are characteristic of

acute respiratory distress syndrome.

6. A patient with a productive cough and parenchymal infiltrates on x-ray is demonstrating symptomology of

bacterial pneumonia.

3. Low cardiac output in association with high preload is characteristic of ________ shock.

cardiogenic

27. Lactated Ringer solution and normal saline are commonly used ________

crystalloid

2. Cardiogenic shock is characterized by

reduced cardiac output.

4. The peripheral chemoreceptors

respond to the arterial oxygen level.

20. Bacterial pneumonia leads to hypoxemia due to

accumulation of alveolar exudates.

30. Chronic occupational lung disease is characterized by (Select all that apply)

causation from long-term inhalation of inorganic material. a latent period before symptoms occur. a progressive cough and dyspnea with exercise. possible negative chest x-ray when symptom-free.

28. Characteristics of asthma include (select all that apply.)

chronic inflammatory disorder. airway hyperresponsiveness. genetic susceptibility. airway remodeling.

23. Positive inotropic drugs work by increasing (Select all that apply.)

contractility. cardiac output. tissue perfusion. myocardial oxygen demand.

16. Beta-blockers are advocated in the management of heart failure because they

reduce cardiac output.

4. The common denominator in all forms of heart failure is

reduced cardiac output.

20. The majority of tachydysrhythmias are believed to occur because of

reentry mechanisms.

3. Emphysema results from destruction of alveolar walls and capillaries, which is due to

release of proteolytic enzymes from immune cells.

18. Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells.

renin

5. All obstructive pulmonary disorders are characterized by

resistance to airflow.

26. A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of ____________.

respiratory alkalosis

13. After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence of

right-sided heart failure.

12. A laboratory test that should be routinely monitored in patients receiving digitalis therapy is

serum potassium.

16. The most definitive diagnostic method for active tuberculosis is acquired via

sputum culture.

11. Autonomic nervous system stimulation effects on the respiratory system include

sympathetic stimulation relaxes pulmonary blood vessels.

6. Improvement in a patient with septic shock is indicated by an increase in

systemic vascular resistance.

25. Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called

tension pneumothorax.

22. Airway obstruction in chronic bronchitis is due to

thick mucus, fibrosis, and smooth muscle hypertrophy.

27. When assessing an individual during an acute asthma episode, you should expect to find (Select all that apply.)

use of accessory breathing muscles. expiratory wheezing. coughing. feeling of chest tightness.

18. Neuromuscular disorders impair lung function primarily due to

weak muscles of respiration.

17. When preparing for the admission of a client diagnosed with bronchiectasis, the nurse will

put a sputum cup and a box of tissues on the bedside table.

12. Primary pulmonary hypertension is

rapidly progressive.

16. The hyper-secretion of mucus resulting for chronic bronchitis is the result

recurrent infection.

20. When a client diagnosed with COPD type A asks, "Why is my chest so big and round?", the nurse responds that

"Loss of elastic tissue in your lungs allows your airways to close and trap air, which makes your chest round."

23. Accumulation of fluid in the pleural space is called

pleural effusion.

14. Which person is at greatest risk for developing a pulmonary embolism?

A 67-year-old man with a deep vein thrombosis in the femoral vein

19. Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class?

Class I

23. Increased preload of the cardiac chambers may lead to which patient symptom?

Edema

15. A patient with pure left-sided heart failure is likely to exhibit

pulmonary congestion with dyspnea.

8. Second-degree heart block type I (Wenckebach) is characterized by

lengthening PR intervals and dropped P wave.

11. Obstructive disorders are associated with

low expiratory flow rates.

10. The pulmonary structure that has the least pulmonary blood flow is

lung apex.

26. When a parent of a toddler recently diagnosed with pneumococcal pneumonia asks why their child is so much sicker than a classmate was when they were diagnosed with pneumonia, the nurse replies

"It sounds like your child has a case of bacterial pneumonia, while the classmate had viral pneumonia."

8. Which clinical manifestation is not likely the result of a tuberculosis infection?

Cyanosis

9. In which stage of shock is a patient who has lost 1200 ml of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing?

Class II, Compensated Stage

4. Which is indicative of a left tension pneumothorax?

Absent breath sounds on the left

13. Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?

Anaphylactic

10. In which dysrhythmias should treatment be instituted immediately?

Atrial fibrillation with a ventricular rate of 220 beats/min

29. _________________ is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body.

Disseminated intravascular coagulation

20. Which causes of shock are considered to be obstructive? (Select all that apply)

Pulmonary embolus, Cardiac tamponade, Tension pneumothorax

21. A patient experiencing shock may exhibit which signs and symptoms? (Select all that apply.)

Pulse of more than 100 beats/minute, Fast and deep respirations

7. Which pulmonary function test result is consistent with a diagnosis of asthma?

Reduced forced expiratory volume in 1 second (FEV1)

20. Which is true about lung compliance? (Select all that apply.)

Represents lung expandability Decreases in the elderly Can be decreased by obesity, abdominal distention, pregnancy Is affected by body position

12. Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock?

Septic

8. A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock?

Septic

1. Viral pneumonia is characterized by

a dry cough.

4. Administration of which therapy is most appropriate for hypovolemic shock?

Crystalloids

28. A patient with forward effects of heart failure may present with which symptoms? (Select all that apply.)

Impaired memory Mental fatigue Confusion

2. The characteristic x-ray findings in tuberculosis include

Ghon tubercles.

24. A patient experiences anaphylactic shock. The nurse expects to observe which signs and symptoms in the patient? (Select all that apply.)

Hypotension Urticaria Angioedema Wheezing

21. Which complication of asthma is life threatening?

Status asthmaticus

25. The assessment findings of a 5 year old with a history of asthma include extreme shortness of breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles. There is no wheezing and the chest is silent in many areas. How should you interpret your assessment?

The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the doctor immediately.

21. A patient who reports dizziness and who has absent P waves, wide QRS complexes, and a heart rate of 38 beats/min on an ECG is most likely in which rhythm?

Ventricular escape rhythm

5. A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for

pneumothorax

1. Left-sided heart failure is characterized by

pulmonary congestion.

29. Which is true about epiglottitis? (Select all that apply.)

Is usually caused by H. influenzae type B Can be caused by bacterial infection Usually occurs in children Is characterized by pain with swallowing

16. Virchow's triad can result in

pulmonary embolus.

30. A patient's ECG lacks recognizable waveforms and is deemed to be in sinus arrest.. The patient's sinus arrest may be a result of (Select all that apply.)

MI. electrical shock. electrolyte disturbance. acidosis.

7. The organism that causes pulmonary tuberculosis is

Mycobacterium tuberculosis.

14. Obstructive sleep apnea would most likely be found in a patient diagnosed with

Pickwickian syndrome.

9. Which dysrhythmia is thought to be associated with reentrant mechanisms?

Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

23. Individuals who have chronic bronchitis most often have

a productive cough.

8. Surfactant is a phospholipid that reduces

alveolar surface tension.

11. The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with

antibiotics.

7. Hypotension associated with neurogenic and anaphylactic shock is due to

peripheral pooling of blood.

14. Administration of a vasodilator to a patient in shock would be expected to

decrease left ventricular afterload.

22. A patient is diagnosed with heart failure with normal ejection fraction. This patient is most likely characterized by a(n)

elderly woman without a previous history of MI.

25. Septic shock is commonly associated with Gram-negative infections and Gram-positive organisms that enter the body through the (Select all that apply.)

genitourinary tract. gastrointestinal tract. respiratory tract. skin.

10. The hallmark manifestation of acute respiratory distress syndrome is

hypoxemia

22. A major risk factor for the development of active pulmonary tuberculosis (TB) disease is

immunosuppression

19. To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke

impairs alpha1-antitrypsin, allowing elastase to predominate.

4. Chronic bronchitis often leads to cor pulmonale because of

increased pulmonary vascular resistance.

9. Secondary pulmonary hypertension is most often caused by

increased pulmonary vascular resistance.

24. The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by

increased residual lung volumes.

12. Empyema is defined as an

infection in the pleural space.

11. The primary cause of infant respiratory distress syndrome is

lack of surfactant.

27. It is true that diffuse interstitial lung disease (Select all that apply.)

leads to loss of alveolar walls. may be immunologic in nature. shows on x-ray as a "honeycomb lung."

27. The most common causes of heart failure are (Select all that apply.)

myocardial ischemia. hypertension.

10. A patient who was involved in a fall from a tree becomes short of breath. The lung sounds are absent on one side. This patient is experiencing ________ shock.

obstructive

22. The urinary signs and symptoms of acute renal failure associated with the progressive stage of shock are (Select all that apply.)

oliguria, increased serum creatinine.

13. A patient with flail chest will demonstrate

outward chest movement on expiration.

17. A patient with heart failure who reports intermittent shortness of breath during the night is experiencing

paroxysmal nocturnal dyspnea.