Week 4 Check Your Understanding Assignment

A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for pneumonia. pneumothorax. pulmonary edema. pulmonary embolus.

pneumothorax. Pneumothorax leads to a tracheal shift to the side opposite the pneumothorax. Pneumonia, pulmonary edema, and pulmonary embolus do not lead to tracheal shift.

Which electrolyte imbalances cause increased neuromuscular excitability? Hypokalemia and hyperphosphatemia Hyperkalemia and hypophosphatemia Hypocalcemia and hypomagnesemia Hypercalcemia and hypermagnesemia

Hypocalcemia and hypomagnesemia Hypocalcemia and hypomagnesemia both cause increased neuromuscular excitability.Hypokalemia, hyperkalemia, hypophosphatemia, hypercalcemia, and hypermagnesemia do not cause increased neuromuscular excitability.

Which is indicative of a left tension pneumothorax? Course crackles throughout the left chest Tracheal deviation to the left Absent breath sounds on the left Respiratory acidosis

Absent breath sounds on the left A left pneumothorax results in absent breath sounds on the affected side. Crackles will not be heard because breath sounds are not present. Tracheal deviation occurs on the contralateral side. Pneumothorax results in acute respiratory alkalosis.

Which alterations can lead to edema? Decreased capillary hydrostatic pressure Increased capillary colloid osmotic pressure Decreased lymphatic flow Decreased capillary membrane permeability

Decreased lymphatic flow Lymphatic obstruction prevents the drainage of accumulated interstitial fluid and proteins, which can lead to severe edema. Decreased capillary hydrostatic pressure would push less fluid into the interstitial space. Increased capillary colloid osmotic pressure would remove fluid from the interstitial space. Decreased capillary membrane permeability would allow less fluid movement into the interstitial space.

What is likely to lead to hyponatremia? Insufficient ADH secretion Excess aldosterone secretion Administration of intravenous normal saline Frequent nasogastric tube irrigation with water

Frequent nasogastric tube irrigation with water Sodium is lost from gastric secretions when nasogastric tubes are irrigated with water. The sodium diffuses into the irrigating water and is then lost when the aspirate is withdrawn. Excessive ADH would lead to hyponatremia by the retention of water in the body, thus diluting the sodium. Excess aldosterone would increase serum sodium. Normal saline is an isotonic solution and will not alter the serum sodium.

Croup is characterized by a productive cough. a barking cough. an inability to cough. drooling, sore throat, and difficulty swallowing.

a barking cough. Croup is characterized by a barking cough with stridor. A productive cough is not characteristic of croup. Croup is associated with coughing. Drooling, sore throat, and difficulty swallowing are not characteristics of croup.

What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding? Too much sodium in the feedings Excess of feedings Inadequate water intake Kidney failure

Inadequate water intake Failure to provide adequate water when a patient is receiving tube feedings could result in hypernatremia. The feedings may have too much sodium, or the patient may be receiving too much feeding solution, but most likely the patient is not receiving enough water. Kidney failure is most likely not the cause of hypernatremia in this patient.

Which assessment would support a diagnosis of type A COPD rather than type B COPD Copious sputum, dyspnea, cor pulmonale Noisy breath sounds, fatigue, high PaCO2, overweight Normal PaCO2, scant sputum, accessory muscle use, barrel chest Barrel chest, productive cough, cyanosis, very decreased PaO2

Normal PaCO2, scant sputum, accessory muscle use, barrel chest Barrel chest and obvious respiratory effort that maintains near normal blood gases are consistent with type A COPD in the early stages. Copious sputum, dyspnea, and cor pulmonale are consistent with type B COPD. Noisy breath sounds, fatigue, high PaCO2, and overweight are consistent with type B COPD. Barrel chest, productive cough, cyanosis, and very decreased PaO2 are not consistent with type A COPD.

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. remove the telephone to reduce myocardial oxygen demand. add a box of surgical masks to the nursing supplies near the door. remove the water pitcher to comply with anticipated fluid restrictions.

People who have bronchiectasis have a productive cough, usually with foul-smelling sputum. Bronchiectasis is not contagious or a cardiac condition. Fluid restriction is not part of the treatment for bronchiectasis.

Which pulmonary function test result is consistent with a diagnosis of asthma? Reduced forced expiratory volume in 1 second (FEV1) Decreased functional residual capacity Increased FEV1 Reduced total lung volume

Reduced forced expiratory volume in 1 second (FEV1) Forced expiratory volumes (FEV1) decrease during asthma attacks. Functional residual capacity is not used to diagnose asthma. Reduced (not increased) FEV1 is found in asthma. Total lung volume is not used to diagnose asthma.

What form of oral rehydration, bottled water or salty broth, is best suited for a patient who is demonstrating signs of clinical dehydration? Bottled water, because he is so weak that he might choke on the fluid when he swallows, and water would be less damaging to the lungs than salty soup Bottled water, because it will rehydrate his cells Salty soup, because he needs nutrition as well as fluid Salty soup, because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid

Salty soup, because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid This man has indicators of clinical dehydration and he needs salt to hold the water in his extracellular compartment. Replacing fluids and electrolytes is more important than meeting his nutritional needs now.

How is a patient hospitalized with a malignant tumor that secretes parathyroid hormone-related peptide monitored for the resulting electrolyte imbalance? Serum calcium, Chvostek and Trousseau signs Serum calcium, bowel function, level of consciousness Serum potassium, Chvostek and Trousseau signs Serum potassium, bowel function, level of consciousness

Serum calcium, bowel function, level of consciousness Parathyroid hormone increases the plasma calcium concentration, and constipation and lethargy are manifestations of hypercalcemia. Parathyroid hormone increases the plasma calcium concentration, but these are signs of increased neuromuscular excitability, which occurs with hypocalcemia. Parathyroid hormone affects plasma concentration of calcium, not potassium.

Which complication of asthma is life threatening? Exercise-induced asthma Late phase response Status asthmaticus Mast cell degranulation

Status asthmaticus Status asthmaticus is a severe attack unresponsive to routine therapy and can be life threatening if not reversed. Exercise-induced asthma is a form of asthma, rather than a complication of it. The late phase response is part of the pathophysiology of asthma and is not always life threatening. Mast cell degranulation is part of the pathophysiology of asthma and in itself is not life threatening.

If an individual has a fully compensated metabolic acidosis, the blood pH is high. low. in the normal range. either high or low, depending on the type of compensation.

in the normal range. The blood pH is in the normal range if an individual has fully compensated for an acid-base imbalance. High blood pH indicates alkalosis. Low blood pH indicates uncompensated or partially compensated acidosis.

Chronic bronchitis often leads to cor pulmonale because of ventricular hypoxia. increased pulmonary vascular resistance. left ventricular strain. hypervolemia.

increased pulmonary vascular resistance. Chronic bronchitis often leads to cor pulmonale as a result of increased pulmonary vascular resistance when right ventricular end-diastolic pressure increases. Ventricular hypoxia, left ventricular strain, and hypervolemia do not lead to cor pulmonale.

Viral pneumonia is characterized by a productive cough. a dry cough. exudative consolidation. significant ventilation-perfusion imbalance.

a dry cough. No exudative fluids are produced. Viral pneumonia does not produce exudates, so the cough is non-productive. Ventilation-perfusion imbalance does not usually occur in viral pneumonia.

Individuals who have chronic bronchitis most often have a productive cough. normal lung sounds. a barrel chest. substantial weight loss.

a productive cough. A productive cough for at least 3 months is the classic sign of chronic bronchitis. People who have chronic bronchitis commonly have abnormal lung sounds resulting from mucus in their airways. Barrel chest is a classic sign of emphysema. Substantial weight loss is characteristic of emphysema, but not of chronic bronchitis.

Vomiting of stomach contents or continuous nasogastric suctioning may predispose to development of carbonic acid deficit. metabolic acid deficit. metabolic acidosis. carbonic acid excess.

metabolic acid deficit. Gastric contents are rich in hydrochloric acid; loss of this through suctioning or vomiting leads to a metabolic acid deficit and alkalosis. Carbonic acid is related to the respiratory system. Vomiting produces metabolic alkalosis as a result of loss of acid-rich gastric contents, it does not increase carbonic acid.

Signs and symptoms of extracellular fluid volume excess include tachycardia. increased serum sodium concentration. bounding pulse. increased hematocrit.

bounding pulse. Bounding pulse is one of the signs of extracellular fluid volume excess. Tachycardia is one of the signs of extracellular fluid volume deficit. Increased serum sodium concentration is found in hypernatremia. Hematocrit can be decreased with extracellular fluid volume excess.

The major buffer in the extracellular fluid is hemoglobin. albumin. bicarbonate. phosphate.

bicarbonate. Bicarbonate is the major buffer in the extracellular fluid. Hemoglobin is in erythrocytes, which are in the vascular compartment, but not in the interstitial portion of extracellular fluid. Albumin is in the vascular compartment, but not in the interstitial portion of extracellular fluid. Phosphate is an important buffer in urine and intracellular fluid.

Manifestations from sodium imbalances occur primarily as a result of cellular fluid shifts. vascular collapse. hyperosmolarity. hypervolemia.

cellular fluid shifts. Sodium imbalances alter osmolality of fluid compartment leading to osmosis of water from the hypo-osmolar compartment to the hyperosmolar compartment. In brain cells, this leads to swelling or shrinkage of cells, and associated manifestations.

Total body water in older adults is increased because of decreased adipose tissue and decreased bone mass. increased because of decreased renal function and hormonal fluctuations. decreased because of increased adipose tissue and decreased muscle mass. decreased because of renal changes that cause diuresis with sodium excretion.

decreased because of increased adipose tissue and decreased muscle mass. Older adults have decreased total body water because of increased adipose tissue and decreased muscle mass. Older adults have increased adipose tissue. Hormonal fluctuations and diuresis with sodium excretion are not characteristic of older adults.

Lack of α-antitrypsin in emphysema causes chronic mucous secretion and airway fibrosis. destruction of alveolar tissue. pulmonary edema and increased alveolar compliance. bronchoconstriction and airway edema.

destruction of alveolar tissue. Lack of α1-antitrypsin in emphysema causes destruction of alveolar tissue, as it is a protective enzyme that prohibits proteolytic breakdown of alveolar tissue. Lack of alpha1-antitrypsin does not cause chronic mucous secretion and airway fibrosis, pulmonary edema and increased alveolar compliance, or bronchoconstriction and airway edema.

A person who has hyperparathyroidism is likely to develop hypokalemia. hyperkalemia. hypocalcemia. hypercalcemia.

hypercalcemia. A person who has hyperparathyroidism is likely to develop hypercalcemia, because parathyroid hormone causes calcium to come out of the bones and go to the ECF. Hypokalemia, hyperkalemia, and hypocalcemia are not the result of hyperparathyroidism.

Empyema is defined as an exudative bronchitis. infection in the pleural space. infection localized in the lung. infection in the blood.

infection in the pleural space. Empyema is infection in the pleural space. Empyema is not exudative bronchitis, localized infection in the lung, or an infection in the blood.

A known cause of hypokalemia is oliguric renal failure. pancreatitis. insulin overdose. hyperparathyroidism.

insulin overdose. Insulin overdose causes hypokalemia by shifting potassium into cells. Oliguric renal failure decreases electrolyte excretion. Pancreatitis causes fat malabsorption, which binds calcium and magnesium, but not potassium, in the gastrointestinal tract. Hyperparathyroidism regulates calcium, not potassium.

Obstructive disorders are associated with low residual volumes. low expiratory flow rates. increased expiratory reserve volume. decreased total lung capacity.

low expiratory flow rates. Obstructive disorders are associated with low expiratory flow rates. Obstructive disorders are associated with high residual volume. Increased expiratory reserve volume and decreased total lung capacity are not characteristic of obstructive disorders.

Diarrhea and other lower intestinal fluid losses will contribute to metabolic alkalosis. metabolic acidosis. respiratory acidosis. mixed acid-base disorders.

metabolic acidosis. Diarrhea results in loss of bicarbonate and leads to metabolic acidosis. Loss of bicarbonate (a base) would not lead to metabolic alkalosis. Respiratory conditions lead to respiratory acid and base disturbances; diarrhea is not a respiratory condition. Bicarbonate loss through diarrhea would not lead to any respiratory acid/base disturbance.

Clinical manifestations of moderate to severe hypokalemia include muscle spasms and rapid respirations. muscle weakness and cardiac dysrhythmias. confusion and irritability. vomiting and diarrhea.

muscle weakness and cardiac dysrhythmias. Hypokalemia causes muscle weakness (or paralysis) and cardiac dysrhythmias. Hypokalemia does not cause muscle spasms and rapid respirations or confusion and irritability. Vomiting and diarrhea can cause hypokalemia, but they are not signs and symptoms of it.

Asthma is categorized as a(n) restrictive pulmonary disorder. infective pulmonary disorder. obstructive pulmonary disorder. type of acute tracheobronchial obstruction.

obstructive pulmonary disorder. Asthma is an obstructive pulmonary disorder. Asthma is not a restrictive pulmonary disorder or a type of tracheobronchial obstruction. Although asthma can be associated with infection, it is not an infective pulmonary disorder.

The process responsible for distribution of fluid between the interstitial and intracellular compartments is filtration. osmosis. active transport. diffusion.

osmosis Distribution of fluid between the interstitial and intracellular compartments occurs by the process of osmosis. Filtration is responsible for the distribution of fluid between the vascular and interstitial compartments. Active transport moves ions across membranes, but does not move water. Diffusion involves movement of particles, not movement of water.

The hypersecretion of mucus resulting for chronic bronchitis is the result of recurrent infection. destruction of alveolar septa. reduced inflammation. barrel chest.

recurrent infection. Mucus provides a hospitable environment for bacterial colonization and recurrent infection. Destruction of alveolar septa and reduced inflammation are not complications of chronic bronchitis. Hypersecretion of mucus does not contribute to barrel chest.

All obstructive pulmonary disorders are characterized by resistance to airflow. hyperresponsiveness. decreased residual volumes. decreased lung compliance.

resistance to airflow. Obstructive lung diseases are characterized by increased resistance to airflow. Only asthma is characterized by hyperresponsiveness. Increased residual volume is common in obstructive pulmonary disorders. Emphysema is characterized by increased lung compliance caused by a loss of alveoli and elastic tissue.

The ________ system compensates for metabolic acidosis and alkalosis. gastrointestinal renal cardiovascular respiratory

respiratory When metabolic acids are out of balance, the respiratory system compensates for the altered pH by adjusting the amount of carbon dioxide in the blood. The gastrointestinal system is not a major compensatory mechanism in acid-base imbalances. The kidneys are overwhelmed or dysfunctional in a metabolic acid-base imbalance. The cardiovascular system is not a major compensatory mechanism in acid-base imbalances.

A person with acute hypoxemia may hyperventilate and develop respiratory acidosis. respiratory alkalosis. metabolic alkalosis. metabolic acidosis.

respiratory alkalosis. Hyperventilation causes much carbonic acid to be blown off, resulting in respiratory alkalosis. Respiratory acidosis is caused by hypoventilation and retention of carbonic acid. Hyperventilation does not cause metabolic acid or base disturbances.

The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3- = 24 mEq/L demonstrates metabolic acidosis. respiratory acidosis. respiratory alkalosis. mixed alkalosis.

respiratory alkalosis. The high pH, low PaCO2, and normal HCO3 indicate respiratory alkalosis. Metabolic and respiratory acidosis would decrease the pH. The HCO3- is normal, so no metabolic imbalance is indicated.

Causes of metabolic acidosis include hyperventilation. massive blood transfusion. tissue anoxia. hypoventilation.

tissue anoxia. Tissue anoxia can cause metabolic acidosis resulting from lactic acid production during anaerobic metabolism. Hyperventilation causes excretion of too much carbonic acid and respiratory alkalosis. The liver metabolizes the citrate in transfused blood into bicarbonate. Hypoventilation causes CO2 retention and respiratory acidosis.

The fraction of total body water (TBW) volume contained in the intracellular space in adults is three fourths. two thirds. one half. one third.

two thirds. Approximately two thirds of TBW is contained inside the cells. Two thirds, not three fourths, of TBW is contained inside the cells. Two thirds, not one-half, of TBW is contained inside the cells. One-third of the TBW is extracellular in adults.

Osmoreceptors located in the hypothalamus control the release of angiotensin. atrial natriuretic peptide. aldosterone. vasopressin (antidiuretic hormone, ADH).

vasopressin (antidiuretic hormone, ADH). Factors that increase secretion of ADH into the blood include increased osmolality of the blood, which is sensed by osmoreceptors in the hypothalamus. Release of angiotensin, atrial natriuretic peptide, and aldosterone is not controlled by osmoreceptors in the hypothalamus.

Neuromuscular disorders impair lung function primarily because of inflammatory events in the lung. secondary pneumonia. weak muscles of respiration. inactivity secondary to the disorder.

weak muscles of respiration. Neuromuscular disorders weaken respiratory muscle function resulting in poor ventilation. Inflammatory events in the lung, secondary pneumonia, and inactivity secondary to the disorder are not the primary reasons neuromuscular disorders impair lung function.