Pathophysiology - Respiratory

A 10-year-old female develops pneumonia. Physical exam reveals subcostal and intercostal retractions. She reports that breathing is difficult and she feels she cannot get enough air. What term should the nurse use to document this condition?

a. Cyanosis
b. Dyspnea
c. Hyperpnea
d. Orthopnea

A 10-year-old female develops pneumonia. Physical exam reveals subcostal and intercostal retractions. She reports that breathing is difficult and she feels she cannot get enough air. What term should the nurse use to document this condition?

a. Cyanosis
b. Dyspnea
c. Hyperpnea
d. Orthopnea

b. Dyspnea

Rationale: Dyspnea is defined as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity."

Cyanosis is a bluish discoloration to the skin.

Hyperpnea is an increased ventilatory rate.

Orthopnea is dyspnea that occurs when an individual lies flat.

A 20-year-old male presents to his primary care provider reporting difficulty breathing when lying down. What term should the nurse use to document this condition?

a. Dyspnea
b. Orthopnea
c. Apnea
d. Tachypnea

b. Orthopnea

Rationale: Orthopnea is dyspnea that occurs when an individual lies flat.

Dyspnea is shortness of breath that occurs with activity.

Apnea is cessation of breathing.

Tachypnea is rapid breathing.

A 50-year-old diabetic male did not take his medication and is now in metabolic acidosis. He is experiencing Kussmaul respirations. What type of breathing will the nurse observe upon assessment?

a. Audible wheezing or stridor
b. A slightly increased ventilatory rate, large tidal volumes, and no expiratory pause
c. Rapid respirations with periods of apnea
d. Very slow inhalations and rapid expirations

b. A slightly increased ventilatory rate, large tidal volumes, and no expiratory pause

Rationale: Kussmaul respirations are characterized by a slightly increased ventilatory rate, very large tidal volumes, and no expiratory pause.

Audible wheezing is usually associated with conditions such as asthma, and stridor indicates a narrowed airway.

Cheyne-Stokes respirations are characterized by alternating periods of deep and shallow breathing, with periods of apnea lasting from 15 to 60 seconds.

Kussmaul respirations do not have slow inhalations; bronchiolar disorders have these characteristics.

A 30-year-old female received a severe head injury in a motor vehicle accident. She is now experiencing respiratory abnormalities characterized by alternating periods of deep and shallow breathing with periods of apnea. What term should the nurse use when charting this condition?

a. Cheyne-Stokes
b. Frank-Starling
c. Apnea
d. Orthopnea

a. Cheyne-Stokes

Rationale: Cheyne-Stokes respirations are characterized by alternating periods of deep and shallow breathing, with periods of apnea lasting from 15 to 60 seconds.

Frank-Starling is related to the stretch of fibers.

Apnea is cessation of respirations.

Orthopnea is dyspnea that occurs when an individual lies flat.

Which patient would the nurse assess for paroxysmal nocturnal dyspnea (PND)? A patient with:

a. Pulmonary fibrosis
b. Asthma
c. Left ventricular failure
d. Hypotension

c. Left ventricular failure

Rationale: Some individuals with cardiac disease awake at night gasping for air and have to sit up or stand to relieve the dyspnea (PND).

PND occurs primarily with cardiac disease, not pulmonary fibrosis.

Individuals with asthma experience orthopnea, rather than PND.

A 20-year-old male is in acute pain. An arterial blood gas reveals decreased carbon dioxide (CO2) levels. Which of the following does the nurse suspect is the most likely cause?

a. Hyperventilation
b. Hypoventilation
c. Apnea
d. Cyanosis

a. Hyperventilation

Rationale: Individuals with hyperventilation blow off CO2.

Individuals with hypoventilation retain CO2.

Apnea is cessation of breathing.

Cyanosis is a blue color to the skin.

A 65-year-old female with emphysema presents to the ER for difficulty breathing. Physical exam reveals bluish skin and mucous membranes. How should the nurse chart this condition? Patient has:

a. Cyanosis
b. Hemoptysis
c. Hematemesis
d. Ischemia

a. Cyanosis

Rationale: Cyanosis is a blue color to the skin.

Hemoptysis is the coughing up of blood or bloody secretions.

Hematemesis is blood in the vomitus.

Ischemia is a lack of blood supply to tissues.

A 28-year-old male reports to his primary care provider that he has had a cold for a week and is coughing up bloody secretions. When giving report, what term should the nurse use to describe this condition?

a. Hematemesis
b. Cyanosis
c. Rhinitis
d. Hemoptysis

d. Hemoptysis

Rationale: Hemoptysis is the coughing up of bloody secretions.

Hematemesis is bloody vomiting.

Cyanosis is a bluish color to the skin.

Rhinitis is a runny nose.

A nurse is reviewing the results of an ABG and finds reduced oxygenation of arterial blood. What term should the nurse use to describe this condition?

a. Ischemia
b. Hypoxia
c. Hypoxemia
d. Hypocapnia

c. Hypoxemia

Rationale: Hypoxemia is a reduction of oxygen in arterial blood.

Ischemia is a lack of blood supply to tissues.

Hypoxia is reduced oxygen in tissues.

Hypocapnia is decreased CO2.

A group of mountain climbers experience confusion, tachycardia, edema, and decreased renal output after climbing Mount Rainier. A nurse recalls this condition is caused by:

a. Bronchoconstriction
b. Hypoventilation
c. Decreased inspired oxygen
d. Diffusion abnormalities

c. Decreased inspired oxygen

Rationale: The mountain climbers are experiencing decreased inspired oxygen.

Bronchoconstriction would result in wheezing.

Hypoventilation would result in retained CO2.

A nurse remembers a low ventilation-perfusion ratio results in:

a. Increased dead space
b. Shunting
c. Alveolar collapse
d. Bronchoconstriction

b. Shunting

Rationale: Hypoxemia caused by inadequate ventilation of well-perfused areas of the lung is a form of mismatching called shunting.

When the pulmonologist discusses the condition in which a series of alveoli in the left lower lobe receive adequate ventilation but do not have adequate perfusion, which statement indicates the nurse understands this condition? When this occurs in a patient it is called:

a. A right-to-left shunt
b. Alveolar dead space
c. A low ventilation-perfusion ratio
d. Pulmonary hypotension

b. Alveolar dead space

Rationale: When certain areas of the alveoli experience inadequate perfusion, it is referred to as dead space.

A 30-year-old male is involved in a motor vehicle accident and sustains trauma to the lungs and chest wall. He experiences respiratory failure. Which of the following lab values would the nurse expect?

a. Electrolyte imbalances
b. Elevated PaCO2
c. Low hematocrit
d. Elevated pH

b. Elevated PaCO2

Rationale: In respiratory failure, inadequate gas exchange occurs such that PaO2 = 50 mm Hg or PaCO2 = 50 mm Hg with pH = 7.25.

Electrolyte imbalances do not occur, but changes in blood gas values do.

Hematocrit may be unaffected.

pH will be decreased.

A nurse is teaching staff about pulmonary edema. Which information should the nurse include? The most common cause of pulmonary edema is:

a. Right heart failure
b. Left heart failure
c. Asthma
d. Lung cancer

b. Left heart failure

A 47-year-old male is diagnosed with pulmonary edema. Which assessment findings will the nurse observe?

a. Thick mucus secretions
b. Pink, frothy sputum
c. Hypocapnia
d. Wheezing

b. Pink, frothy sputum

A 65-year-old male recently had a cerebrovascular accident that resulted in dysphagia. He now has aspiration of gastric contents. The nurse assesses the patient for which complication?

a. Pneumonia
b. Bronchiectasis
c. Pneumothorax
d. Emphysema

a. Pneumonia

A 26-year-old female recently underwent surgery and is now experiencing dyspnea, cough, fever, and leukocytosis. Tests reveal that she has a collapsed lung caused by removal of air from obstructed alveoli. What condition will the nurse observe on the chart?

a. Compression atelectasis
b. Bronchiectasis
c. Absorption atelectasis
d. Hypoventilation

c. Absorption atelectasis

Rationale: Absorption atelectasis results from removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated oxygen or anesthetic agents.

Compression atelectasis is caused by external pressure exerted by tumor, fluid, or air in pleural space or by abdominal distention pressing on a portion of lung.

Bronchiectasis is dilation of the bronchi, not atelectasis.

Hypoventilation is inadequate alveolar ventilation of the lungs; it is not due to removal of air.

A 45-year-old male undergoes lung transplantation. He now suffers from airway occlusion secondary to fibrosis. Which diagnosis will the nurse see on the chart?

a. Compression atelectasis
b. Bronchiectasis
c. Bronchiolitis
d. Bronchiolitis obliterans

d. Bronchiolitis obliterans

Rationale: Bronchiolitis is a serious complication of stem cell and lung transplantation and can progress to bronchiolitis obliterans, a fibrotic process that occludes airways and causes permanent scarring of the lungs.

A 50-year-old male presents with hypotension, hypoxemia, and tracheal deviation to the left. Tests reveal that the air pressure in the pleural cavity exceeds barometric pressure in the atmosphere. Based upon these assessment findings, what does the nurse suspect the patient is experiencing?

a. Pleural effusion
b. Tension pneumothorax
c. Open pneumothorax
d. Transudative pneumothorax

b. Tension pneumothorax

Rationale: Tracheal deviation suggests tension pneumothorax.

A 60-year-old female with a history of cirrhosis presents with dyspnea, impaired ventilation, and pleural pain. A diagnosis of pleural effusion is made, and a watery fluid is drained. When giving report, the nurse will refer to this fluid as:

a. Exudative
b. Purulent
c. Infected
d. Transudative

d. Transudative

Rationale: Pleural effusions that enter the pleural space from intact blood vessels can be transudative (watery).

An 80-year-old female develops pneumonia in the hospital. She becomes cyanotic, tachycardic, and develops a fever and cough. Chest x-ray reveals pus in the pleural space. Which of the following is the most likely diagnosis documented on the chart?

a. Empyema
b. Emphysema
c. Pleurisy
d. Chyle

a. Empyema

Rationale: The presence of microorganisms in the pleural space is termed empyema.

A 54-year-old male is diagnosed with empyema. Upon receiving and reviewing the culture result, which organism does the nurse suspect is the most likely cause?

a. Virus
b. Staphylococcus aureus
c. Klebsiella pneumonia
d. Moraxella catarrhalis

b. Staphylococcus aureus

A 15-year-old female is diagnosed with restrictive lung disease caused by fibrosis. The patient had a pulmonary functions test. Which of the following findings is expected?

a. Increased compliance
b. Increased tidal volume
c. Decreased respiratory rate
d. Decreased functional residual capacity

d. Decreased functional residual capacity

Rationale: Fibrosis progressively obliterates the alveoli, respiratory bronchioles, and interstitium (fibrosing alveolitis), which can result in chronic pulmonary insufficiency, and functional residual capacity declines.

A 57-year-old male presents with cough, sputum production, dyspnea, and decreased lung volume. He is diagnosed with pneumoconiosis. When taking the patient's history, which finding is the most probable cause of his illness?

a. Inhalation of silica, asbestos, mica
b. Autoimmune disease
c. Allergic reactions
d. Flail chest

a. Inhalation of silica, asbestos, mica

A 42-year-old female presents with dyspnea; rapid, shallow breathing; inspiratory crackles; decreased lung compliance; and hypoxemia. Tests reveal a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury. Which of the following is the most likely diagnosis the nurse will observe on the chart?

a. Acute respiratory distress syndrome (ARDS)
b. Sarcoidosis
c. Postoperative respiratory failure
d. Malignant respiratory failure

a. Acute respiratory distress syndrome (ARDS)

Which of the following shows a correct cause and effect sequence in the development of acute respiratory distress syndrome (ARDS)?

a. Impaired alveolar compliance causing decreased surfactant production
b. Alveolocapillary membrane injury causing a massive inflammatory response
c. Hyaline membrane formation and fibrosis causing pulmonary edema
d. Increased alveolocapillary membrane permeability causing metabolic alkalosis

b. Alveolocapillary membrane injury causing a massive inflammatory response

Rationale: All disorders causing ARDS cause massive pulmonary inflammation that injures the alveolocapillary membrane and produces severe pulmonary edema and inflammation.

A 60-year-old female with emphysema is having difficulty expiring a given volume of air. When giving report, the nurse will relay that the patient is most likely experiencing _____ pulmonary disease.

a. Restrictive
b. Obstructive
c. Atelectatic
d. Pleuritic

b. Obstructive

Rationale: Emphysema is a form of obstructive pulmonary disease.

When the nurse is asked what causes asthma, how should the nurse respond? Asthma is thought to be caused by:

a. An autosomal recessive trait
b. Autoimmunity
c. Excessive use of antibiotics as a young child
d. Interactions between genetic and environmental factors

d. Interactions between genetic and environmental factors

A nurse recalls asthma is classified by:

a. Pathophysiologic differences
b. Clinical severity
c. Genetic traits
d. Treatment outcomes

b. Clinical severity

Rationale: The National Asthma Education and Prevention Program offers stepwise guidelines for the diagnosis and management of chronic asthma based on clinical severity.

A nurse is preparing to teach the staff about asthma. Which information should the nurse include? Airway hyper-responsiveness in asthma is related to:

a. Increased sympathetic nervous system response
b. The release of stress hormones
c. Exposure to an allergen causing mast cell degranulation
d. Hereditary decrease in IgE responsiveness

c. Exposure to an allergen causing mast cell degranulation

A nurse is preparing to teach the staff about asthma. Which information should the nurse include? Airway obstruction contributing to increased airflow resistance and hypoventilation in asthma is caused by:

a. Type II alveolar cell injury and decreased surfactant
b. Alveolar fibrosis and pulmonary edema
c. Mucus secretion, bronchoconstriction, and airway edema
d. Collapse of the cartilaginous rings in the bronchi

c. Mucus secretion, bronchoconstriction, and airway edema

Rationale: The mediators of asthma cause vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchospasm), and mucus secretion from mucosal goblet cells with narrowing of the airways and obstruction to airflow.

A 10-year-old male is brought to the ER with prolonged bronchospasm and severe hypoxemia. The most likely diagnosis on the chart is:

a. Exercise-induced asthma
b. Chronic obstructive pulmonary disease (COPD)
c. Status asthmaticus
d. Bronchiectasis

c. Status asthmaticus

Rationale: When bronchospasm is not reversed by usual measures, the individual is considered to have severe bronchospasm or status asthmaticus.

A 22-year-old female presents with chronic bronchitis. Tests reveal closure of the airway during expiration. While planning care, a nurse recalls this condition is most likely caused by:

a. Thick mucus from hypertrophied glands
b. Ventilation-perfusion mismatch
c. Hyperventilation
d. Thinning smooth muscle in the bronchioles

a. Thick mucus from hypertrophied glands

Rationale: Chronic bronchitis is defined by hypersecretion of thick mucus.

A 25-year-old male presents with chronic bronchitis of 5 months' duration. When obtaining the patient's history, which of the following findings is most likely to cause this condition?

a. Chronic asthma
b. Air pollution
c. Cigarette smoke
d. Recurrent pneumonias

c. Cigarette smoke

A 25-year-old male presents with chronic bronchitis of 5 months' duration. Which of the following is the most significant concern for the nurse to monitor in this patient?

a. Left heart failure
b. Pulmonary embolus
c. Immunosuppression
d. Recurrent pulmonary infections

d. Recurrent pulmonary infections

A 53-year-old male with a 20-year history of smoking is diagnosed with emphysema. When a staff member asks why the patient's airways are obstructed, how should the nurse respond? The airways are obstructed because of:

a. Excessive mucus production
b. Loss of elastic recoil
c. Infection and inflammation
d. Airway edema

b. Loss of elastic recoil

A 53-year-old male with a 20-year history of smoking is diagnosed with emphysema. When the nurse is asked what causes this, what is the nurse's best response? Changes in his lungs are caused by:

a. Viral infections
b. Destruction of alveolar macrophages
c. Alpha-1-antitrypsin deficiency
d. Fibrotic lung disease

c. Alpha-1-antitrypsin deficiency

Individuals with a recent diagnosis of emphysema should be assessed for which most common presenting factor?

a. A productive cough
b. Cyanosis
c. Dyspnea
d. Cor pulmonale

c. Dyspnea

A 60-year-old female with a 25-year history of smoking is diagnosed with emphysema. She has an increased anterior-posterior chest diameter. The nurse attributes this finding to:

a. Air trapping
b. Decreased inspiratory reserve volumes
c. Increased flow rates
d. Alveolar destruction

a. Air trapping

Rationale: Air trapping expands the thorax, putting the respiratory muscles at a mechanical disadvantage.

A patient asks what causes pneumonia. How should the nurse reply? Pneumonia is caused by:

a. Use of anesthetic agents in surgery
b. Atelectasis
c. Chronic lung changes seen with aging
d. Viral or bacterial infections

d. Viral or bacterial infections

When the nurse observes a diagnosis of nosocomial pneumonia, the patient generally acquires this pneumonia:

a. At day care centers
b. On airplanes
c. During hospitalization
d. In the winter season

c. During hospitalization

A 30-year-old male prison inmate contracted tuberculosis during an outbreak. When the nurse reviews the lab results, the organism that caused this condition is a:

a. Bacterium
b. Fungus
c. Virus
d. Parasite

a. Bacterium

A 30-year-old male prison inmate contracted tuberculosis during an outbreak. While planning interactions, the nurse realizes the patient can transmit this disease through:

a. Skin contact
b. Fecal-oral contact
c. Airborne droplets
d. Blood transfusions

c. Airborne droplets

A 70-year-old female is in the hospital for pelvic fracture. She develops pulmonary thromboembolism. The nurse realizes this embolus is composed of:

a. Fat
b. Air
c. Tissue fragment
d. Blood clot

d. Blood clot

Which of the following patients is at highest risk for developing pulmonary embolism (PE)?

a. 21-year-old male with a hemophilia bleeding disorder
b. 28-year-old woman who had a baby 6 months earlier
c. 36-year-old woman with a history of alcohol abuse who is recovering from a gastric ulcer
d. 72-year-old male who is recovering from hip replacement surgery in the hospital

d. 72-year-old male who is recovering from hip replacement surgery in the hospital

Rationale: The 72-year-old is at risk for immobility and at increased risk for PE.

An 80-year-old female is in the hospital for a bone fracture. While there she develops a large, nonlethal pulmonary embolus. Which of the following is a direct result of the obstruction to pulmonary blood flow?

a. Pulmonary hypertension
b. Systemic hypertension
c. Pulmonary edema
d. Risk of cerebral emboli

a. Pulmonary hypertension

Rationale: Significant obstruction of the pulmonary vasculature leads to increased pulmonary artery pressures (pulmonary hypertension).

The pressure is in the pulmonary bed; it is not systemic.

Pulmonary edema occurs secondary to heart failure.

Pulmonary emboli obstruct blood flow in the pulmonary vasculature, they do not increase the risk of cerebral emboli.

When a patient has a massive pulmonary embolism (PE), what complications will the nurse monitor for?

a. Damage to the lung microcapillaries
b. Chronic obstructive pulmonary disease (COPD)
c. Disseminated intravascular coagulation (DIC)
d. Shock and death

d. Shock and death

A 50-year-old male is diagnosed with pulmonary embolism (PE). Which of the following symptoms most likely occurred before treatment?

a. Dry cough and inspiratory crackles
b. Shallow respirations and wheezing
c. Chest pain and shortness of breath
d. Kussmaul respirations and back pain

c. Chest pain and shortness of breath

Rationale: An individual with PE usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety.

A 60-year-old male undergoes surgery for a bone fracture. Which of the following nursing measures would be most effective for preventing pulmonary embolism (PE) in this patient?

a. Ensure that patient uses supplemental oxygen.
b. Prevent deep vein thrombosis formation.
c. Check hematocrit and hemoglobin levels frequently during the postoperative period.
d. Promote aggressive fluid intake.

b. Prevent deep vein thrombosis formation.

Rationale: PE most commonly results from embolization of a clot from deep venous thrombosis (DVT) involving the lower leg; thus preventing these will help prevent pulmonary emboli.

A 50-year-old male with a 30-year history of smoking was diagnosed with lung cancer. He was previously exposed to air pollution, asbestos, and radiation at his job. Which of the following should the nurse realize had the greatest impact on the development of his cancer?

a. Radiation
b. Cigarette smoke
c. Asbestos
d. Air pollution

b. Cigarette smoke

A 60-year-old male with a 40-year history of smoking presents with chest pain, cough, sputum production, and pneumonia. Tests reveal widespread metastatic cancer, and the primary care provider plans radiation therapy. Which of following is the most likely type of cancer to be documented on the chart?

a. Adenoma
b. Non-small cell carcinoma
c. Small cell carcinoma
d. Basal cell carcinoma

b. Non-small cell carcinoma

Rationale: For individuals with non-small cell carcinoma, adjunctive radiation and chemotherapy may improve outcomes.

Which of the following assessment findings would be expected in pulmonary embolism (PE)? (Select all that apply.)

a. Chest pain
b. Tachycardia
c. Tachypnea
d. Fever
e. Hemoptysis

A, B, C, D, E

Rationale: An individual with PE usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety. Occasionally syncope (fainting) or hemoptysis occurs. With large emboli, a pleural friction rub, pleural effusion, fever, and leukocytosis may be noted. Recurrent small emboli may not be detected until progressive incapacitation, precordial pain, anxiety, dyspnea, and right ventricular enlargement are exhibited. Massive occlusion causes severe pulmonary hypertension and shock.

Which of the following are characteristic of idiopathic pulmonary arterial hypertension (IPAH)? (Select all that apply.)

a. Male gender
b. Fatigue
c. Dyspnea
d. Jugular vein distention
e. Weight gain

B, C, D

Rationale: IPAH is a rare condition and usually occurs in women between the ages of 20 and 40. Manifestations of fatigue, chest discomfort, tachypnea, and dyspnea (particularly with exercise) are common. Examination may reveal peripheral edema, jugular venous distension, a precordial heave, and accentuation of the pulmonary component of the second heart sound.