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?

Accepted Answer

The primary role of the mucociliary blanket is to trap foreign particles and bacteria and thus prevent their entry into the lungs. Impaired ciliary function may result in an inadequate mucociliary blanket, but the opposite relationship is unlikely. Decreased oxygen and increased carbon dioxide levels may eventually result, but not as a direct or immediate consequence.

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?

Accepted Answer

The vocal folds contribute to blocking of the airways during swallowing; compromise to this function is likely to allow food to enter the lungs. The epiglottis is performing its normal, protective role against aspiration when it covers the larynx, and the vocal folds contribute to sound enunciation, not swallowing or protection against aspiration.
Tracheobronchial obstruction would not contribute to aspiration.

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?

Accepted Answer

Smokers often retain large numbers of carbon-filled macrophages in their septal connective tissue. NK cell proliferation is not a noted phenomenon in the alveoli, and tubercles are associated specifically with tuberculosis infection. Type I alveoli are incapable of regeneration.

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?

Accepted Answer

Deoxygenated blood leaves the right heart through the pulmonary artery. Return of oxygenated blood to the heart occurs by way of the pulmonary vein, which empties into the left atrium.

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

Accepted Answer

Pleural effusion is used to describe an abnormal collection of fluid or exudates in the pleural cavity. Pleurisy is an inflammation in the pleural space, and pneumothorax is an abnormal collection of air in the pleural space.

Question 6

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

Accepted Answer

Negative intrapleural pressure holds the lungs in place against the chest wall and prevents their natural elastic properties from causing them to collapse. Intrapleural pressure is negative in relation to the inflated lung, and the chest wall exerts negative pressure on the lungs that keeps them from contracting and contributes to inspiration. Intrapulmonary pressure oscillates between positive and negative relative to atmospheric pressure with expiration and inspiration.

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

Accepted Answer

The diaphragm is the principal muscle of inspiration. It is innervated by the phrenic nerve roots, which arise from the cervical level of the spinal cord, mainly from C4 but also C3 and C5.

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?

Accepted Answer

Scarring diminishes the elasticity of the lung tissue, resulting in noncompliant lungs that are more difficult to inflate. In order to maintain a sufficient tidal volume and oxygen level with the lungs that require extra work to expand, the individual must take shallower, more rapid breaths. The effort and time required for him to breathe deeply would detract from his ability to bring in enough air.

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?

Accepted Answer

Impaired thoracic cage flexibility can be a contributor to reduced lung compliance. Increased recoil and a modest excess of surfactant would increase lung compliance, and turbulent flow in the airways is a normal, not pathological, finding.

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

Accepted Answer

The type II alveolar cells that produce surfactant do not begin to mature until 26th to 27th week of gestation; consequently, many premature infants have difficulty in producing sufficient amounts of surfactant. This can lead to alveolar collapse and severe respiratory distress. The only answer (B) to facilitate respiratory is mechanical ventilation. IV fluids and nutrition are important but not a priority of airway/breathing problems. There is no indication that the infant has increased ICP and would need 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?

Accepted Answer

Vital capacity is determined by combining inspiratory reserve, expiratory reserve, and tidal volume. Total lung capacity always exceeds vital capacity, given that it is not possible to completely empty the lungs. Tidal volume becomes wider during exercise, and expiratory reserve is neither equal to nor synonymous with residual 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.

Accepted Answer

In lung pathology such as emphysema, large amounts of air are trapped at the end of a given breath, a situation that corresponds to increased residual volume and decreased vital capacity. Elastic recoil would tend to suffer, and both alveolar and anatomical dead space consequently increase.

Question 13

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

Accepted Answer

Alveolar dead space results from alveoli that 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?

Accepted Answer

Regional hypoxia, such as with a diagnosis of atelectasis, is associated with vasoconstriction and redirection of blood away from, not toward, the affected area of the lung. This also contributes to an increased workload for the right side of the heart.

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?

Accepted Answer

Impaired blood flow to a portion of the lung, such as with a PE, is associated with ventilation without perfusion, rather than perfusion without ventilation. The situation is not related to an anatomic shunt or impaired diffusion across alveolar membranes.

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?

Accepted Answer

^{While increased alveolar PO}2 ^{improves the oxygen saturation of hemoglobin, carbon}monoxide occupies the hemoglobin sites usually available for oxygen. With much of the blood composed, temporarily, of carboxyhemoglobin, it is necessary to rely upon alternate means to deliver oxygen to the tissues. Plasma's normally low carrying capacity for dissolved oxygen can be increased by administration of 100% oxygen in the high atmospheric pressure of a hyperbaric chamber.

Question 17

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

Accepted Answer

As each binding site on a hemoglobin molecule is occupied, the affinity of the remaining sites for oxygen binding is increased. Increased affinity is associated with alkalosis, not acidosis, and fever causes reduced affinity. Exercise increases the unloading of oxygen, a situation characterized by low affinity.

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^incr^{eased PCO}2^{. Which of the following associated consequences would the nurse} anticipate?

Accepted Answer

As a result of the combination of water and carbon dioxide, hydrogen ions are produced along with bicarbonate. This would be associated with a shift to the right of the oxygen-hemoglobin dissociation curve, increased bicarbonate output, and higher than normal levels of carbaminohemoglobin.

Question 19

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

Accepted Answer

The respiratory center is located in the pons. Damage to the temporal lobe, frontal lobe, or spinal cord at C7 is less likely to affect respiration.

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

Accepted Answer

An NG tube can inhibit the closing of the upper airways that is required for normal coughing. Pneumonia, obesity, diabetes, and injury to the cerebellum are unlikely to affect the ability to cough.

Quiz 34: Acute Kidney Injury and Chronic Kidney Disease