Patho II Week 5: Respiratory

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Mang Teban has a history of chronic obstructive pulmonary disease and has the following arterial blood gas results: partial pressure of oxygen (PO2), 55 mm Hg, and partial pressure of carbon dioxide (PCO2), 60 mm Hg. When attempting to improve the client's blood gas values through improved ventilation and oxygen therapy, which is the client's primary stimulus for breathing?
A. High PCO2
B. Low PO2
C. Normal pH
D. Normal bicarbonate (HCO3)
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Mang Teban has a history of chronic obstructive pulmonary disease and has the following arterial blood gas results: partial pressure of oxygen (PO2), 55 mm Hg, and partial pressure of carbon dioxide (PCO2), 60 mm Hg. When attempting to improve the client's blood gas values through improved ventilation and oxygen therapy, which is the client's primary stimulus for breathing?
A. High PCO2
B. Low PO2
C. Normal pH
D. Normal bicarbonate (HCO3)
B. Low PO2
A 7-year-old client is brought to the E.R. He's tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following?
A. Acute asthma
B. Bronchial pneumonia
C. Chronic obstructive pulmonary disease (COPD)
D. Emphysema
A. Acute asthma
Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder?
A. Circumoral cyanosis
B. Increased forced expiratory volume
C. Inspiratory and expiratory wheezing
D. Normal breath sounds
C. Inspiratory and expiratory wheezing
A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions?
A. Acute respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
C. Chronic obstructive bronchitis
A client with emphysema should receive only 1 to 3 L/minute of oxygen if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?
A. The client doesn't notice he needs to breathe.
B. The client breathes only when his oxygen levels climb above a certain point.
C. The client breathes only when his oxygen levels dip below a certain point.
D. The client breathes only when his carbon dioxide level dips below a certain point.
C. The client breathes only when his oxygen levels dip below a certain point.
A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitation?
A. Chronic obstructive bronchitis
B. Emphysema
C. Bronchial asthma
D. Bronchial asthma and bronchitis
B. Emphysema
When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following?
A. Develop infections easily.
B. Maintain current status.
C. Require less supplemental oxygen.
D. Show permanent improvement.
A. Develop infections easily.
Rationale: A client with COPD is at high risk for development of respiratory infections. In emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils and macrophages are recruited and release multiple inflammatory mediators. Oxidants and excess proteases leading to the destruction of the air sacs. The protease-mediated destruction of elastin leads to a loss of elastic recoil and results in airway collapse during exhalation.
Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?
A. To promote oxygen intake.
B. To strengthen the diaphragm.
C. To strengthen the intercostal muscles.
D. To promote carbon dioxide elimination.
D. To promote carbon dioxide elimination.
Rationale: Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonged exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.
A client's arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms would the nurse expect?
A. Cyanosis
B. Flushed skin
C. Irritability
D. Anxiety
B. Flushed skin
Rationale: The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the CNS. On the contrary, chronic respiratory acidosis may be caused by COPD where there is a decreased responsiveness of the reflexes to states of hypoxia and hypercapnia.
The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan?
A. Clubbing of nail beds
B. Hypertension
C. Peripheral edema
D. Increased appetite
C. Peripheral edema
Rationale: Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Right heart failure is most commonly a result of left ventricular failure via volume and pressure overload. Clinically, patients will present with signs and symptoms of chest discomfort, breathlessness, palpitations, and body swelling.
Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD? A. Increased PaCO2 B. Increased PaO2 C. Increased pH D. Increased oxygen saturationA. Increased PaCO2 Rationale: As COPD progresses, the client typically develops increased PaCO2 levels and decreased PaO2 levels. This results in decreased pH and decreased oxygen saturation. These changes are the result of air trapping and hypoventilation. Arterial blood gas (ABG) analysis provides the best clues as to acuteness and severity of disease exacerbation.The nurse would anticipate which of the following ABG results in a client experiencing a prolonged, severe asthma attack? A. Decreased PaCO2, increased PaO2, and decreased pH. B. Increased PaCO2, decreased PaO2, and decreased pH. C. Increased PaCO2, increased PaO2, and increased pH. D. Decreased PaCO2, decreased PaO2, and increased pH.B. Increased PaCO2, decreased PaO2, and decreased pH. Rationale: As the severe asthma attack worsens, the client becomes fatigued and alveolar hypotension develops. This leads to carbon dioxide retention and hypoxemia. The client develops respiratory acidosis. Therefore, the PaCO2 level increases, the PaO2 level decreases, and the pH decreases, indicating acidosis.If a client continues to hypoventilate, the nurse will continually assess for a complication of: A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosisA. Respiratory acidosisOn auscultation, which finding suggests a right pneumothorax? A. Bilateral inspiratory and expiratory crackles. B. Absence of breaths sound in the right thorax. C. Inspiratory wheezes in the right thorax. D. Bilateral pleural friction rub.B. Absence of breaths sound in the right thorax.Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the: A. Contralateral side in a simple pneumothorax. B. Affected side in a hemothorax. C. Affected side in a tension pneumothorax. D. Contralateral side in hemothorax.D. Contralateral side in hemothorax. Rationale: The trachea will shift according to the pressure gradients within the thoracic cavity. If there is no significant air or fluid accumulation, the trachea will not shift. The pressure gradient inside the thorax changes with a pneumothorax. Normally the pressure of the pleural space is negative when compared to atmospheric pressure. When the chest wall expands outwards, the lung also expands outwards due to surface tension between parietal and visceral pleura.A male patient's X-ray result reveals bilateral white-outs, indicating acute respiratory distress syndrome (ARDS). This syndrome results from: A. Cardiogenic pulmonary edema B. Respiratory alkalosis C. Increased pulmonary capillary permeability D. Renal failureC. Increased pulmonary capillary permeability Rationale: ARDS results from increased pulmonary capillary permeability, which leads to noncardiogenic pulmonary edema. ARDS is defined as an acute disorder that starts within 7 days of the inciting event and is characterized by bilateral lung infiltrates and severe progressive hypoxemia in the absence of any evidence of cardiogenic pulmonary edema.Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is: A. Dyspnea B. Chest pain C. A bloody, productive cough. D. A cough with the expectoration of mucoid sputum.D. A cough with the expectoration of mucoid sputum.A male adult client is suspected of having a pulmonary embolism. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? A. Dyspnea B. Bradypnea C. Bradycardia D. Decreased respirationsA. DyspneaWhich phrase is used to describe the volume of air inspired and expired with a normal breath? A. Total lung capacity B. Forced vital capacity C. Tidal volume D. Residual volumeC. Tidal volumeAn elderly client with pneumonia may appear with which of the following symptoms first? A. Altered mental status and dehydration B. Fever and chills C. Hemoptysis and dyspnea D. Pleuritic chest pain and coughA. Altered mental status and dehydration Rationale: Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are the common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He's tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders? A. ARDS B. Asthma C. Chronic obstructive bronchitis D. EmphysemaD. EmphysemaIt's highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons? A. All clients are recommended to have these vaccines. B. These vaccines produce bronchodilation and improve oxygenation. C. These vaccines help reduce the tachypnea these clients experience. D. Respiratory infections can cause severe hypoxia and possibly death in these clients.D. Respiratory infections can cause severe hypoxia and possibly death in these clients.Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema? A. It enhances cardiovascular fitness. B. It improves respiratory muscle strength. C. It reduces the number of acute attacks. D. It worsens respiratory function and is discouraged.A. It enhances cardiovascular fitness.A 69-year-old client appears thin and cachectic. He's short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions? A. ARDS B. Asthma C. Chronic obstructive bronchitis D. EmphysemaD. Emphysema Rationale: In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area available for gas exchange. Very little air movement occurs in the lungs because of bronchial collapse, as well. In the early stages of the disease, the physical examination may be normal. Patients with emphysema are typically referred to as "pink puffers," meaning cachectic and non-cyanotic. Expiration through pursed lips increases airway pressure and prevents airway collapse during respiration, and the use of accessory muscles of respiration indicates advanced disease.Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery? A. Atelectasis B. Bronchitis C. Pneumonia D. PneumothoraxA. Atelectasis Rationale: Atelectasis develops when there's interference with the normal negative pressure that promotes lung expansion. Clients in the postoperative phase often splint their breathing because of pain and positioning, which causes hypoxia. Postoperative atelectasis typically occurs within 72 hours of general anesthesia and is a well-known postoperative complication. The decrease in pressure allows for passive movement of air into the lungs. This process is inhibited by general anesthesia due to diaphragm relaxation. Patients lying supine have cephalad displacement of the diaphragm further decreasing the transmural pressure gradient and increasing the likelihood of atelectasis. It's uncommon for any of the other respiratory disorders to develop.A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect PaCO2 to be which of the following values? A. 15 mm Hg B. 30 mm Hg C. 40 mm Hg D. 80 mm HgD. 80 mm HgA client's ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosisC. Respiratory acidosisA nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience what type of acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosisA. Respiratory acidosisA nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate concentration of 22 mEq/L. The nurse analyzes these results as indicating: A. Metabolic acidosis, compensated. B. Metabolic alkalosis, uncompensated. C. Respiratory alkalosis, compensated. D. Respiratory acidosis, compensated.C. Respiratory alkalosis, compensated.A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Based on this documentation, which of the following did the nurse observe? A. Respirations that are abnormally deep, regular, and increased in rate. B. Respirations that are regular but abnormally slow. C. Respirations that are labored and increased in depth and rate. D. Respirations that cease for several seconds.A. Respirations that are abnormally deep, regular, and increased in rate.A nurse understands that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Metabolic alkalosisD. Metabolic alkalosisA nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note on assessment of this client? A. Increased oxygen saturation with exercise. B. Hypocapnia C. A hyperinflated chest on x-ray film. D. A widened diaphragm noted on chest x-ray film.C. A hyperinflated chest on x-ray film.Which of the following organisms most commonly causes community-acquired pneumonia in adults? A. Haemophilus influenzae B. Klebsiella pneumoniae C. Streptococcus pneumoniae D. Staphylococcus aureusC. Streptococcus pneumoniaeThe right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is reddened and raised about 3mm where the test was given. This PPD would be read as having which of the following results? A. Indeterminate B. Needs to be redone C. Negative D. PositiveC. Negative Rationale: This test would be classed as negative. A 5 mm raised area would be a positive result if a client was HIV+ or had recent close contact with someone diagnosed with TB. If the patient is at a high risk of developing an active infection, a repeat test is recommended after an initial negative test to rule out the possibility of missing a case. However, a decision is made based on the risk factors.A client has active TB. Which of the following symptoms will he exhibit? A. Chest and lower back pain. B. Chills, fever, night sweats, and hemoptysis. C. Fever of more than 104*F and nausea. D. Headache and photophobia.B. Chills, fever, night sweats, and hemoptysis.A high level of oxygen exerts which of the following effects on the lung? A. Improves oxygen uptake. B. Increases carbon dioxide levels. C. Stabilizes carbon dioxide levels. D. Reduces amount of functional alveolar surface area.D. Reduces amount of functional alveolar surface area. Rationale: Oxygen toxicity causes direct pulmonary trauma, reducing the amount of alveolar surface area available for gaseous exchange, which results in increased carbon dioxide levels and decreased oxygen uptake. Continued exposure to high concentrations of oxygen results in heightened free radical production. This may damage the pulmonary epithelium, inactivate the surfactant, form intra-alveolar edema, interstitial thickening, fibrosis, and ultimately lead to pulmonary atelectasis.A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this? A. Acute asthma B. Chronic bronchitis C. Pneumonia D. Spontaneous pneumothoraxD. Spontaneous pneumothoraxA pulse oximetry gives what type of information about the client? A. Amount of carbon dioxide in the blood B. Amount of oxygen in the blood C. Percentage of hemoglobin carrying oxygen D. Respiratory RateC. Percentage of hemoglobin carrying oxygen Rationale: The pulse oximeter determines the percentage of hemoglobin carrying oxygen. This doesn't ensure that the oxygen being carried through the bloodstream is actually being taken up by the tissue. Pulse oximetry is a non-invasive monitor that measures the oxygen saturation in the blood by shining light at specific wavelengths through tissue (most commonly the fingernail bed).What effect does hemoglobin amount have on oxygenation status? A. No effect B. More hemoglobin reduces the client's respiratory rate. C. Low hemoglobin levels cause reduced oxygen-carrying capacity. D. Low hemoglobin levels cause increased oxygen-carrying capacity.C. Low hemoglobin levels cause reduced oxygen-carrying capacity. Rationale: Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is low, the amount of oxygen-carrying capacity is also low. More hemoglobin will increase oxygen-carrying capacity and thus increase the total amount of oxygen available in the blood. If the client has been tachypneic during exertion, or even at rest, because oxygen demand is higher than the available oxygen content, then an increase in hemoglobin may decrease the respiratory rate to normal levels.Which of the following statements best explains how opening up collapsed alveoli improves oxygenation? A. Alveoli need oxygen to live. B. Alveoli have no effect on oxygenation. C. Collapsed alveoli increase oxygen demand. D. Gaseous exchange occurs in the alveolar membrane.D. Gaseous exchange occurs in the alveolar membrane.Which of the following best describes pleural effusion? A. The collapse of alveoli. B. The collapse of bronchiole. C. The fluid in the alveolar space. D. The accumulation of fluid between the linings of the pleural space.D. The accumulation of fluid between the linings of the pleural space. Rationale: The pleural fluid normally seeps continually into the pleural space from the capillaries lining the parietal pleura and is reabsorbed by the visceral pleural capillaries and lymphatics. Any condition that interferes with either the secretion or drainage of this fluid will lead to a pleural effusion.The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurse's instructions? Select all that apply. A. "I will need to dispose of my old clothing when I return home." B. "I should always cover my mouth and nose when sneezing." C. "It is important that I isolate myself from family when possible." D. "I should use paper tissues to cough in and dispose of them properly." E. "I can use regular plates and utensils whenever I eat."B. "I should always cover my mouth and nose when sneezing." C. "It is important that I isolate myself from family when possible." D. "I should use paper tissues to cough in and dispose of them properly." E. "I can use regular plates and utensils whenever I eat." Rationale: Review pathology of disease (active and inactive phases; dissemination of infection through bronchi to adjacent tissues or via bloodstream and/or lymphatic system) and potential spread of infection via airborne droplet during coughing, sneezing, spitting, talking, laughing, singing.