Chapter 27: Alterations of Pulmonary Function Huether & McCance: Understanding Pathophysiology, 6th Edition

A 10-year-old develops pneumonia. Physical exam reveals subcostal and intercostal retractions. The child reports that breathing is difficult with feelings that, "I cannot get enough air." What term should the nurse use to document this condition?

a.

Cyanosis

b.

Dyspnea

c.

Hyperpnea

d.

Orthopnea

B. Dyspnea

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 and orthopnea is dyspnea that occurs when an individual lies flat.

A 20-year-old presents 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

Orthopnea is dyspnea that occurs when an individual lies flat. Dyspnea is shortness of breath that occurs with activity. Apnea is cessation of breathing, and tachypnea is rapid breathing.

What type of breathing will the nurse observe while assessing a patient experiencing both metabolic acidosis and Kussmaul respirations?

a.

Audible wheezing or stridor

b.

Increased rate, large tidal volumes, and no expiratory pause

c.

Rapid respirations with periods of apnea

d.

Very slow inhalations and rapid expirations

B. Increased rate, large tidal volumes, and no expiratory pause

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.

As a result of a severe head injury, a patient 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

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.

A patient's arterial blood gas reveals decreased carbon dioxide (CO2) levels. What is the most likely cause of this situation?

a.

Hyperventilation

b.

Hypoventilation

c.

Apnea

d.

Cyanosis

A. Hyperventilation

Individuals with hyperventilation blow off CO2 while individuals with hypoventilation retain CO2. Apnea is cessation of breathing. Cyanosis is a blue color to the skin.

When giving report, what term should the nurse use to describe the coughing up of bloody secretions?

a.

Hematemesis

b.

Cyanosis

c.

Rhinitis

d.

Hemoptysis

D. Hemoptysis

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 65-year-old diagnosed with emphysema presents to the ER for difficulty breathing. Physical exam reveals both bluish skin and mucous membranes. What term will the nurse use to document these observations?

a.

Cyanosis

b.

Hemoptysis

c.

Hematemesis

d.

Ischemia

A. Cyanosis

Cyanosis is a blue color to the skin. Hemoptysis is the coughing up of blood or bloody secretions, and hematemesis is blood in the vomitus. Ischemia is a lack of blood supply to tissues.

A nurse is reviewing the results of an arterial blood gas (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

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 low ventilation-perfusion ratio of the lung will result in:

a.

increased dead space.

b.

shunting.

c.

alveolar collapse.

d.

bronchoconstriction.

B. shunting.

Hypoxemia caused by inadequate ventilation of well-perfused areas of the lung is a form of mismatching called shunting, not bronchoconstriction. Inadequate ventilation of well-perfused areas of the lung is not referred to as dead space. Alveolar collapse is called atelectasis.

What phrase describes the condition in which a series of alveoli in the left lower lobe receive adequate ventilation but lack adequate perfusion?

a.

A right-to-left shunt

b.

Alveolar dead space

c.

A low ventilation-perfusion ratio

d.

Pulmonary hypotension

B. Alveolar dead space

When certain areas of the alveoli experience inadequate perfusion, it is referred to as dead space. The situation is not referred to as either a right-to-left shunt or as pulmonary hypotension. Shunting is due to a low ventilation-perfusion ratio.

Which of the following lab values would the nurse expect in a patient who has sustained trauma to the lungs and chest wall and is experiencing respiratory failure?

a.

Electrolyte imbalances

b.

Elevated PaCO2

c.

Low hematocrit

d.

Elevated pH

B. Elevated PaCO2

In respiratory failure, inadequate gas exchange occurs such that PaO2 ≤ 60 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 50-year-old 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

Tracheal deviation suggests tension pneumothorax, not pleural effusion. With an open pneumothorax, a sucking sound would be heard without tracheal deviation. Tracheal deviation suggests a tension, not transudative pneumothorax.

A 60-year-old 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

Pleural effusions that enter the pleural space from intact blood vessels can be transudative (watery). The fluid is watery; thus, it is not exudative, which is composed of white cells. Effusion is not purulent or infected.

An 80-year-old develops pneumonia in the hospital. An assessment identifies that the patient is cyanotic and tachycardic and has developed a fever and a cough. Chest x-ray reveals pus in the pleural space. This symptomology supports which medical diagnosis?

a.

Empyema

b.

Emphysema

c.

Pleurisy

d.

Chyle

A. Empyema

The presence of pus in the pleural space is termed empyema; emphysema is a total lung disorder. Pleurisy causes pain with inspiration. Chyle is milky fluid with lymph and fat.

Which organism does the nurse suspect is the most likely cause of empyema?

a.

Virus

b.

Staphylococcus aureus

c.

Fungus

d.

Moraxella catarrhalis

B. Staphylococcus aureus

The most likely cause of empyema is Staphylococcus aureus; it is not due to a virus.

Empyema is not due to Moraxella catarrhalis or to a fungal infection.

A 26-year-old recently underwent surgery and is now experiencing dyspnea, cough, fever, and leukocytosis. Tests reveal a collapsed lung caused by the removal of air from obstructed alveoli. Which term is used to document this condition?

a.

Compression atelectasis

b.

Bronchiectasis

c.

Absorption atelectasis

d.

Hypoventilation

C. Absorption atelectasis

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 the pleural space or by abdominal distention pressing on a portion of lung. Bronchiectasis is a dilation of the bronchi, not atelectasis. Hypoventilation is inadequate alveolar ventilation of the lungs; it is not due to removal of air.

A 15-year-old is diagnosed with restrictive lung disease caused by fibrosis. Which pulmonary function test finding is expected?

a.

Increased compliance

b.

Increased tidal volume

c.

Decreased respiratory rate

d.

Decreased functional residual capacity

D. Decreased functional residual capacity

Fibrosis progressively obliterates the alveoli, respiratory bronchioles, and interstitium (fibrosing alveolitis), which can result in chronic pulmonary insufficiency, and functional residual capacity declines. Compliance decreases in restrictive disease. In restrictive disease, tidal volume decreases. Respirations may increase with restrictive disease.

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

a.

Inhalation of silica

b.

Autoimmune disease

c.

Allergic reactions

d.

Flail chest

A. Inhalation of silica

The dusts of silica, asbestos, and coal are the most common causes of pneumoconiosis.

Pneumoconiosis is neither an autoimmune nor an allergic disorder; it is not due to flail chest.

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.

The most common cause of pulmonary edema is left-sided heart disease, not right-sided.

Pulmonary edema is not commonly caused by asthma or lung cancer.

Which assessment findings will the nurse observe in a patient diagnosed with severe pulmonary edema?

a.

Thick mucous secretions

b.

Pink, frothy sputum

c.

Hypocapnia

d.

Wheezing

B. Pink, frothy sputum

In severe edema, pink frothy sputum is expectorated, not thick mucous secretions.

Neither hypocapnia nor wheezing is an expected assessment finding associated with pulmonary edema.

A 42-year-old 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. What is the most likely diagnosis supported by the patient's condition?

a.

Acute respiratory distress syndrome (ARDS)

b.

Sarcoidosis

c.

Postoperative respiratory failure

d.

Malignant respiratory failure

A. Acute respiratory distress syndrome (ARDS)

The patient is experiencing ARDS. The patient's symptoms do not support a diagnosis of sarcoidosis or either postoperative or malignant respiratory failure.

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.

Asthma is an interaction between genetic and environmental factors. Asthma is not a recessive trait or an autoimmune response. Asthma is not due to excessive antibiotic use in childhood.

Airway hyperresponsiveness 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.

Hyperresponsiveness is due to mast cell degranulation. An increased sympathetic response would lead to bronchiolar dilation. Hyperresponsiveness is not due to release of stress hormones. Heredity is associated with asthma, but the problem is the mast cells.

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.

mucous secretion, bronchoconstriction, and airway edema.

d.

collapse of the cartilaginous rings in the bronchi.

C. mucous secretion, bronchoconstriction, and airway edema.

The mediators of asthma cause vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchospasm), and mucous secretion from mucosal goblet cells with narrowing of the airways and obstruction to airflow. Acute respiratory distress syndrome involves type II injury. Alveolar fibrosis with pulmonary edema is not associated with asthma. Asthma is not associated with collapse of bronchiolar rings.

A 10-year-old is brought to the ER with prolonged bronchospasm and severe hypoxemia. The symptomology supports which diagnosis?

a.

Exercise-induced asthma

b.

Chronic obstructive pulmonary disease (COPD)

c.

Status asthmaticus

d.

Bronchiectasis

C. Status asthmaticus

When bronchospasm is not reversed by the usual measures, the individual is considered to have severe bronchospasm or status asthmaticus since exercise-induced asthma resolves. COPD is manifested by air trapping and hypercapnia, not by bronchospasm. Bronchiectasis is manifested by bronchiolar changes, not by bronchospasm.

A 22-year-old presents with chronic bronchitis. Tests reveal closure of the airway during expiration. 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.

Chronic bronchitis is defined by hypersecretion of thick mucus. Ventilation-perfusion mismatch may occur, but chronic bronchitis is defined as hypersecretion of mucus. Neither hyperventilation nor thinning of smooth muscle occurs.

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

Dyspnea, not a productive cough, is the most common presenting factor of emphysema.

Neither cyanosis nor cor pulmonale is a common presenting factor of emphysema.

A 60-year-old with a 25-year history of smoking is diagnosed with emphysema. Assessment shows 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.

Air trapping, not increased flow rates, expands the thorax, putting the respiratory muscles at a mechanical disadvantage. Neither decreased inspiratory reserve volumes nor alveolar destruction is associated with an increased anterior-posterior chest diameter.

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.

Pneumonia is caused by a viral or bacterial infection; infections are not caused by anesthetic agents. Neither atelectasis nor lung changes associated with normal aging cause pneumonia.

The patient generally acquires nosocomial pneumonia:

a.

at daycare centers.

b.

on airplanes.

c.

during hospitalization.

d.

in the winter season.

C. during hospitalization.

Nosocomial infections are acquired in the hospital. Nosocomial infections are not associated with daycare centers or airplanes and may happen in any season.

What is the most likely cause of chronic bronchitis in a 25-year-old?

a.

Chronic asthma

b.

Air pollution

c.

Cigarette smoke

d.

Recurrent pneumonias

C . Cigarette smoke

The most likely cause of chronic bronchitis is cigarette smoke. Chronic bronchitis in such a patient is not commonly associated with chronic asthma. Air pollution and recurrent infections may contribute, but smoking is the most common cause.

A 20-year history of smoking causes airways to be obstructed as a result of:

a.

excessive mucus production.

b.

loss of elastic recoil.

c.

infection and inflammation.

d.

airway edema.

B. loss of elastic recoil.

The major mechanism of airflow limitation is a loss of elastic recoil, not excessive mucus as with bronchitis. The major mechanism of airflow limitation in this situation is not associated with infection or airway edema.

Aspiration of oral secretions increases a patient's risk for which complication?

a.

Pneumonia

b.

Bronchiectasis

c.

Pneumothorax

d.

Emphysema

A. Pneumonia

Aspiration could lead to pneumonia; bronchiectasis is related to dilation and is not associated with aspiration. Neither pneumothorax nor emphysema is associated with aspiration.

A 30-year-old is diagnosed with emphysema. Changes in this patient's lungs are caused by:

a.

viral infections.

b.

destruction of alveolar macrophages.

c.

α1-antitrypsin deficiency.

d.

fibrotic lung disease.

C. α1-antitrypsin deficiency.

α1-Antitrypsin deficiency is suggested in individuals who develop emphysema before 40 years of age; it is not due to viral infections. Changes in the lungs are not associated with alveolar macrophage destruction or with fibrotic lung disease.

The organism that causes tuberculosis is a:

a.

bacterium.

b.

fungus.

c.

virus.

d.

parasite.

A. bacterium.

The organism that causes tuberculosis is a bacterium. Tuberculosis is not a fungus, a virus, or a parasite.

The patient diagnosed with tuberculosis can transmit this disease through:

a.

skin contact.

b.

fecal-oral contact.

c.

airborne droplets.

d.

blood transfusions.

C. airborne droplets.

Tuberculosis is transmitted through airborne droplets. Tuberculosis is not transmitted through skin contact, fecal-oral contact, or through a blood transfusion.

A 70-year-old hospitalized for a pelvic fracture develops a pulmonary embolism. The nurse realizes this embolus is most commonly composed of:

a.

fat.

b.

air.

c.

tissue fragment.

d.

blood clot.

D. blood clot.

A thromboembolism is most commonly composed of a blood clot. A thromboembolism is less commonly composed of fat, air, or tissue fragments.

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

A 72-year-old is at risk for immobility and at increased risk for PE.

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

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

An individual with PE usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety. Individuals with PE do not experience a cough or wheezing. Kussmaul respirations are associated with acidosis.

A 60-year-old undergoes surgery for a bone fracture. Which nursing measure 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.

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. Oxygen will neither prevent emboli nor check hemoglobin and hematocrit.

Fluid intake will help, but it is not as important as preventing DVT.

A 50-year-old is diagnosed with lung cancer. The health history includes a 30-year history of smoking, exposure to air pollution, asbestos, and radiation. What had the greatest impact on the development of his cancer?

a.

Radiation

b.

Cigarette smoke

c.

Asbestos

d.

Air pollution

B. Cigarette smoke

The most common cause of lung cancer is tobacco smoking. While considered risk factors, neither exposure to radiation, asbestos, nor air pollution is the most common of the known triggers.

MULTIPLE RESPONSE

Which assessment finding would be expected in pulmonary embolism (PE)? (select all that apply)

a.

Chest pain

b.

Tachycardia

c.

Tachypnea

d.

Fever

e.

Hemoptysis

A. Chest pain , B. Tachycardia, C. Tachypnea, D. Fever, E. Hemoptysis

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.

MULTIPLE RESPONSE

Which is a 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.Fatigue, C. Dyspnea, D. Jugular vein distention

IPAH is a rare condition that 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 distention, a precordial heave, and accentuation of the pulmonary component of the second heart sound.