Deck 34: Acute Kidney Injury and Chronic Kidney Disease

Question 1

As a result of dehydration, a client's epithelial cells are producing insufficient amounts of mucus. Consequently, the client's mucociliary blanket is compromised. Which of the following changes would the care provider anticipate as a direct result of this change?

A) Impaired function of the client's cilia
B) Decreased levels of oxygen saturation
C) Increased amounts of bacteria in the lungs
D) Increased carbon dioxide levels

Answer 1

Increased amounts of bacteria in the lungs

Question 2

A 21-year-old male client has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately captures an aspect of his condition?

A) His vocal folds are likely not performing their normal function.
B) His epiglottis is covering his larynx.
C) His vocal folds have been compromised.
D) His tracheobronchial tree is intermittently obstructed.

Answer 2

His vocal folds are likely not performing their normal function.

Question 3

A male, lifetime smoker has died because of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team expect in the weeks prior to his death?

A) Proliferation of natural killer (NK) cells in the alveolar lumen
B) Large numbers of alveolar macrophages in septal connective tissue
C) The presence of tubercles in the interalveolar spaces
D) Compensatory regeneration of type I alveolar cells

Answer 3

Large numbers of alveolar macrophages in septal connective tissue

Question 4

Reviewing pathology for an exam on pulmonary vasculature, the nursing student states that blood enters the right side of the heart via the vena cavae, then to the right atrium, right ventricle, and then which vessel carries the deoxygenated blood into the pulmonary system?

A) Pulmonary capillaries
B) Pulmonary artery
C) Pulmonary vein
D) Ductus arteriosus

Question 5

The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is

A) pleurisy.
B) pleural effusion.
C) pneumothorax.
D) poor lung compliance.

Question 6

Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation?

A) Intrapleural pressure slightly exceeds that of the inflated lung.
B) The chest wall exerts positive pressure on the lungs that contributes to expiration.
C) The lungs are prevented from collapsing by constant positive intrapulmonary pressure.
D) Negative intrapleural pressure holds the lungs against the chest wall.

Question 7

The emergency department is awaiting the arrival of a spinal cord-injured patient. Knowing the innervation of the diaphragm, a patient with which type of injury may be in need of immediate mechanical ventilation? Injury to the

A) C4 area.
B) C7 area.
C) T1 area.
D) T4 area.

Question 8

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. Upon assessment of the lungs, what clinical manifestations should the nurse expect?

A) Rapid, deep breaths
B) Wheezing throughout lung fields
C) Short, shallow breaths
D) Pursed-lip breaths with slow, steady breaths

Question 9

A female patient is requiring supplementary oxygen by face mask due to her reduced lung compliance. Which of the following pathophysiological processes is most likely a contributor to her low lung compliance?

A) The woman's lungs have more recoil than a healthy person's.
B) Her type II alveolar cells are producing a slight excess of surfactant.
C) Turbulent airflow is taking place in the patient's large airways.
D) Her thoracic cage is less flexible than when she was healthy.

Question 10

While working in the newborn ICU, the nurses receive a call that an infant, gestational age of 23 weeks, is being air flighted to the level 3 trauma nursery. The priority intervention for this infant would be

A) insertion of an umbilical line for fluids.
B) intubation and mechanical ventilation.
C) insertion of a feeding tube.
D) insertion of an intraventricular catheter.

Question 11

A 60-year-old male hospital patient with a diagnosis of chronic obstructive pulmonary disease (COPD) is undergoing lung function tests to gauge the progression of his disease. Which of the following aspects of the lung volumes will the respiratory therapist be most justified in using to guide interpretation of the test results?

A) Vital capacity will equal the patient's combined inspiratory reserve, expiratory reserve, and tidal volume.
B) Vital capacity will equal the total lung capacity.
C) Resting tidal volume will exceed that of tidal volume during activity.
D) Expiratory reserve will equal residual lung volume.

Question 12

A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following pathological processes occur as a result of her emphysema? Select all that apply.

A) Decreased elastic recoil due to alveolar damage
B) Decreased residual lung volume due to impaired alveolar ventilation
C) Increased anatomical dead space due to reduced tidal volume
D) Increased alveolar dead space due to incorrect intrapleural pressure

Question 13

The physician mentions the patient has developed alveolar dead space. The nurse recognizes that this means

A) air that is moved in and out of the lungs with each breath.
B) air that cannot participate in gas exchange and remains in the main bronchus.
C) air is trapped in the conducting airways.
D) alveoli are ventilated but not perfused.

Question 14

Due to complications, a male postoperative patient has been unable to mobilize secretions for several days following surgery and develops atelectasis. Which of the following processes would his care team anticipate with relation to his health problem?

A) Vasodilation in the alveolar vessels in the affected region of his lung
B) Increased workload for the left side of the patient's heart
C) Increased blood flow to the area of atelectasis
D) Directing blood flow away from the lung regions that are hypoxic

Question 15

A 44-year-old woman has developed calf pain during a transatlantic flight. She is extremely short of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE) that resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE?

A) Ventilation was occurring, but perfusion was inadequate causing shortness of breath.
B) The combination of normal perfusion but compromised ventilation caused hypoxia.
C) She developed a transient anatomic shunt resulting in impaired oxygenation.
D) Impaired gas diffusion across alveolar membranes resulted in dyspnea and hypoxia.

Question 16

Following a winter power outage, a client who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning?

A) To increase the amount of oxygen carried in the dissolved state
B) To increase the production of unbound hemoglobin
C) To stimulate the release of oxygen at the capillaries
D) To remove bound CO from hemoglobin

Question 17

Which of the following situations is most likely to result in an increased binding affinity of hemoglobin for oxygen?

A) A client is in respiratory acidosis, with a low pH.
B) Three of four binding sites on a client's hemoglobin molecule are occupied by oxygen.
C) A client's body temperature is elevated as a result of an infectious process.
D) An increase in 2,3-diphosphoglycerate enhances the loading of oxygen.

Question 18

A nurse in a respiratory unit of a hospital is providing care for a client with end-stage lung disease. Consequently, measurement of the client's arterial blood gases indicates ^{increased PCO}2^{. Which of the following associated consequences would the nurse} anticipate?

A) A shift to the left of the oxygen-hemoglobin dissociation curve
B) ^{Lower than normal production of HCO}3
C) Higher than normal production of H⁺
D) An absence of carbaminohemoglobin

Question 19

Which of the following neurological patients is most likely to have abnormalities in breathing regulation?

A) A 23-year-old male who has an injury to his frontal lobe following a sports injury
B) A 45-year-old female with a spinal cord injury at C7 following a motor vehicle accident
C) A 34-year-old male with damage to his upper and lower pons following a blow to the back of the head
D) A 66-year-old male with temporal lobe infracts secondary to a stroke

Question 20

A nurse in an acute medical unit is providing care for a number of patients with a variety of diagnoses. Which of the following patients most likely exhibits risk factors for impaired coughing? A patient with

A) an injury to her cerebellum.
B) a nasogastric (NG) tube attached to suction.
C) a diagnosis of viral pneumonia.
D) diagnosis of diabetes mellitus and morbid obese.