Download 3280 pathophysiology and more Quizzes Pathophysiology in PDF only on Docsity!
NSG 3280 Unit 4: Respiratory Practice Questions
Q1. A 45-year-old patient with a history of recurrent respiratory infections and no reported allergies is diagnosed with severe asthma. The nurse recognizes that this presentation is classified as intrinsic asthma, characterized by which features? (Select All That Apply) A. Nonallergic etiology. B. Associated with elevated IgE antibodies. C. Usually adult-onset. D. Has a worse prognosis than extrinsic asthma. E. Childhood-onset presentation. Q2. A patient known to have drug-induced asthma presents with severe bronchoconstriction 10 hours after taking an over-the- counter pain reliever. The nurse understands that this reaction results from the shunting of arachidonic acid. What is the most critical consequence of this shunting process? A. Deposition of collagen beneath the basement membrane. B. Release of leukotrienes from mast cells. C. Increased airway reactivity leading to Curschmann spirals. D. Epithelial denudation resulting in mucosal edema. Q3. A nurse is reviewing the long-term impact of chronic asthma inflammation. The distribution of collagen beneath the basement membrane is noted as a key finding. This specific pathological event primarily results in which clinical consequence for the patient? A. Increased viscosity of secretions, leading to a sticky sputum. B. Hyperinflation of the lungs observed on a chest x-ray. C. Airway remodeling and potential medication resistance. D. Increased osmolarity of the respiratory tract.
Q4. A 16-year-old patient reports severe, brief episodes of wheezing that start immediately after finishing a basketball game and resolve quickly. The nurse advises the patient regarding the underlying mechanism of this exercise-induced asthma. The nurse should explain that the bronchoconstriction is triggered by: A. The inhalation of specific IgE allergens present in the gymnasium. B. Increased osmolarity of the respiratory tract due to heat and water loss. C. Airway obstruction caused by mucus casts (Curschmann spirals). D. Non-immunological factors like MSG or Yellow #5 food additives. Q5. A patient is admitted to the emergency department with a persistent asthma attack that has failed to respond to the typical dose of their short-acting bronchodilator. The nurse immediately recognizes this critical complication and should prepare for interventions related to: A. Cor pulmonale. B. Status Asthmaticus. C. Occupational exposure. D. Chronic hypoxemia. Q6. During a severe asthma exacerbation, the patient exhibits tachycardia (HR 115 bpm). The nurse understands this vital sign is a direct physiological indicator of which underlying problem? A. Mast cell activation releasing histamine. B. The location of the obstruction. C. Systemic decreased O2. D. Increased viscosity of secretions.
Q12. The underlying pathological mechanism that connects epithelial denudation and replacement with goblet cells to the clinical manifestation of chest tightness and dyspnea is: A. Collagen distribution. B. Hypertrophy and medication resistance. C. Mucosal edema causing airway inflammation. D. Bronchospasm due to smooth muscle contraction. Q13. A patient with known occupational asthma, triggered by an allergen at work, reports that his symptoms are progressively worse with each passing week he works. The nurse explains that this increasing severity is a characteristic feature of occupational asthma related to: A. The onset being usually adult-onset. B. Symptoms getting more severe with subsequent exposures. C. The delayed reaction time up to 12 hours. D. The non-immunological mechanism. Q14. The nurse observes an asthmatic patient using accessory muscles, exhibiting neck and intercostal retractions, and struggling with prolonged expiration. These findings, especially in conjunction with wheezing, indicate that the patient's condition is: A. Resolving spontaneously. B. Progressing into respiratory distress. C. Stabilizing due to bronchodilator use. D. Indicative only of mild obstruction. Q15. In managing exercise-induced asthma, which physical activities should the nurse advise the patient to prioritize and continue to
participate in, based on lower risk of exacerbation? (Select All That Apply) A. Running. B. Swimming. C. Jogging. D. Cycling. E. Tennis. Q16. The key difference between Extrinsic (allergic) asthma and Drug-Induced (NSAID) asthma lies in the role of the immune system. Which statement accurately captures this difference? A. Extrinsic asthma is not immunologically mediated, while drug-induced asthma relies on T-cell activation. B. Extrinsic asthma is associated with elevated IgE antibodies, while drug- induced asthma is specifically noted as non-immunologically mediated. C. Both types are IgE-mediated, but only drug-induced asthma involves leukotriene release. D. Drug-induced asthma is childhood-onset, while extrinsic asthma is usually adult-onset. Q17. The nurse notes that a patient’s sputum is thick and sticky during an asthma attack. This physical characteristic is a direct result of which component of the acute inflammatory process? A. Smooth muscle contraction. B. Increased viscosity of secretions. C. Airway remodeling. D. Release of Charcot-Leyden crystals. Q18. An asthmatic patient, upon lung auscultation, exhibits prominent wheezing across the lower lobes bilaterally, but very minimal air sounds centrally. The nurse interprets the minimal air sounds centrally as an indicator of:
nurse understands that the inhalation of inorganic coal dust leads directly to which subsequent step? A. Epithelial denudation and replacement with goblet cells. B. Macrophages secreting lysozymes that begin damaging alveolar walls. C. Release of leukotrienes causing immediate bronchospasm. D. Increased osmolarity in the respiratory tract. Q23. The nurse is comparing the pathological outcomes of asthma and pneumoconiosis. Which finding is the most critical difference resulting from the long-term inflammation in pneumoconiosis? A. Increased airway reactivity. B. Increased viscosity of secretions. C. Collagen deposition around the alveoli causing stiffness and difficulty letting O2 in. D. Bronchospasm resulting from smooth muscle contraction. Q24. A patient diagnosed with Silicosis is entering the late stage of the disease. The nurse should be monitoring for the development of right-sided heart failure. This specific complication is termed Cor Pulmonale and is directly caused by: A. Systemic IgE antibody overload. B. Building pressure in the lungs due to fibrosis. C. Status Asthmaticus. D. Acute hyperinflation of the lung tissue. Q25. A patient with known Asbestosis is being assessed for chronic complications. Which physical manifestation is the most definitive sign of long-term, chronic decreased O2 levels associated with progressive pneumoconiosis? A. Tachycardia. B. Use of accessory muscles. C. Productive cough. D. Finger clubbing.
Q26. Which diagnostic finding is exclusive to pneumoconiosis and
would not be expected in a patient with severe asthma?
A. SOB; worse with exertion. B. Tachycardia. C. Mottling and haziness on chest x-ray. D. Sputum positive for eosinophils. Q27. A patient presents with a cough and fatigue, but denies any history of lung disease. Based on their occupational history, the nurse recognizes they have been exposed to silica dust for 15 years. What is the most likely expected finding on the initial chest x-ray in this early stage? A. Mottling and fibroses. B. Hyperinflation. C. Nodules and calcifications. D. No changes until symptoms occur. Q28. The nurse is reviewing the pathological result of pulmonary fibrosis in pneumoconiosis. The stiffening of the alveoli impairs gas exchange primarily by: A. Preventing smooth muscle relaxation. B. Decreasing the ability to let O2 in. C. Increasing the difficulty of moving air out. D. Shunting arachidonic acid. Q29. A construction worker with extensive exposure to asbestos is at high risk for developing which specific type of pneumoconiosis? A. Silicosis. B. Anthracosis. C. Occupational Asthma. D. Asbestosis.
Q34. In the progression of pneumoconiosis, why are the lysozymes secreted by macrophages unable to successfully break down the inhaled dust particles? A. The dust particles are IgE antibodies. B. The dust particles are organic allergens. C. The dust particles are inorganic. D. The dust particles are simple mucus casts. Q35. A major diagnostic difference in pulmonary function testing between severe asthma and progressive pneumoconiosis is: A. Asthma is characterized by severe obstruction (PEFR < 80 L/min), while pneumoconiosis is characterized by alveolar stiffness. B. Pneumoconiosis shows hyperinflation and a flattened diaphragm. C. Asthma is associated with finger clubbing. D. Asthma results in chronic hypoxemia.
Q36. Which structural component of the airway is specifically
replaced by goblet cells during an asthmatic exacerbation, contributing to mucosal edema? A. Smooth muscle fibers. B. Alveolar walls. C. Ciliated columnar epithelial cells. D. Basement membrane collagen. Q37. A nurse observes a chest x-ray showing nodules, calcifications, and fibroses. These findings, when combined with a history of occupational dust exposure, indicate which specific pathological change? A. Airway reactivity. B. Pulmonary fibrosis. C. Epithelial denudation. D. Bronchospasm.
Q38. In monitoring an asthmatic patient, the nurse should interpret the finding of Curschmann spirals in the sputum as confirmation of: A. Enzymes from eosinophil membranes. B. Mucus casts causing structural obstruction within the bronchioles. C. Evidence of inhaled inorganic dust. D. Chronic hypoxemia. Q39. If a patient with asthma requires increased doses of medication over time to achieve the same level of control, the nurse links this decreasing responsiveness to the development of: A. Status Asthmaticus. B. Chronic hypoxemia. C. Airway remodeling. D. Cor pulmonale. Q40. A patient reports symptoms of shortness of breath that are improving after they leave their current workplace, but worsening upon their return. This suggests which type of asthma, regardless of the IgE status? A. Intrinsic. B. Drug-Induced. C. Extrinsic. D. Occupational.
A. Increased viscosity of secretions, leading to a sticky sputum. B. Hyperinflation of the lungs observed on a chest x-ray. C. Airway remodeling and potential medication resistance. D. Increased osmolarity of the respiratory tract. Answer: C. Airway remodeling and potential medication resistance. Rationale: Collagen distribution beneath the basement membrane can cause hypertrophy, airway remodeling, and medication resistance. Q4. A 16-year-old patient reports severe, brief episodes of wheezing that start immediately after finishing a basketball game and resolve quickly. The nurse advises the patient regarding the underlying mechanism of this exercise-induced asthma. The nurse should explain that the bronchoconstriction is triggered by: A. The inhalation of specific IgE allergens present in the gymnasium. B. Increased osmolarity of the respiratory tract due to heat and water loss. C. Airway obstruction caused by mucus casts (Curschmann spirals). D. Non-immunological factors like MSG or Yellow #5 food additives. Answer: B. Increased osmolarity of the respiratory tract due to heat and water loss. Rationale: Exercise-induced asthma is triggered when heat and water lost during exercise increase the osmolarity of the respiratory tract, leading to mediator release from tissue mast cells and basophils, which causes bronchoconstriction. Q5. A patient is admitted to the emergency department with a persistent asthma attack that has failed to respond to the typical dose of their short-acting bronchodilator. The nurse immediately recognizes this critical complication and should prepare for interventions related to: A. Cor pulmonale. B. Status Asthmaticus. C. Occupational exposure. D. Chronic hypoxemia. Answer: B. Status Asthmaticus. Rationale: Status Asthmaticus is defined as a persistent attack that fails to respond to rescue bronchodilators.
Q6. During a severe asthma exacerbation, the patient exhibits tachycardia (HR 115 bpm). The nurse understands this vital sign is a direct physiological indicator of which underlying problem? A. Mast cell activation releasing histamine. B. The location of the obstruction. C. Systemic decreased O2. D. Increased viscosity of secretions. Answer: C. Systemic decreased O2. Rationale: Tachycardia is listed as a clinical manifestation that equals decreased O2. Q7. A nurse is educating a patient about potential non-allergic triggers found in food and drink. Which items must the patient be instructed to strictly avoid to reduce the risk of an asthma flare-up? (Select All That Apply) A. Beer hops. B. Monosodium glutamate (MSG). C. Aspirin. D. Yellow #5 (tartrazine). E. Silica dust. Answer: A, B, D Rationale: Food and beverage triggers include MSG, Beer hops, and food additives like Yellow #5 (tartrazine). Aspirin is a common drug cause. Silica dust is a cause of pneumoconiosis. Q8. A young child presents with chronic wheezing and a history of severe eczema. The nurse expects the lab work to reveal elevated levels of IgE antibodies, confirming which primary type of asthma? A. Intrinsic. B. Drug-Induced. C. Extrinsic. D. Occupational. Answer: C. Extrinsic. Rationale: Extrinsic asthma is allergic, is childhood- onset, and is associated with elevated levels of IgE antibodies and conditions like eczema.
Answer: B. Symptoms getting more severe with subsequent exposures. Rationale: Occupational asthma is characterized by symptoms getting more severe with subsequent exposures. Q14. The nurse observes an asthmatic patient using accessory muscles, exhibiting neck and intercostal retractions, and struggling with prolonged expiration. These findings, especially in conjunction with wheezing, indicate that the patient's condition is: A. Resolving spontaneously. B. Progressing into respiratory distress. C. Stabilizing due to bronchodilator use. D. Indicative only of mild obstruction. Answer: B. Progressing into respiratory distress. Rationale: Signs that an attack is turning into respiratory distress include the use of accessory muscles with neck and intercostal retractions and prolonged expiration. Q15. In managing exercise-induced asthma, which physical activities should the nurse advise the patient to prioritize and continue to participate in, based on lower risk of exacerbation? (Select All That Apply) A. Running. B. Swimming. C. Jogging. D. Cycling. E. Tennis. Answer: B, D Rationale: Exercises to continue include cycling and swimming. Running, jogging, and tennis are exercises to AVOID. Q16. The key difference between Extrinsic (allergic) asthma and Drug-Induced (NSAID) asthma lies in the role of the immune system. Which statement accurately captures this difference? A. Extrinsic asthma is not immunologically mediated, while drug-induced asthma relies on T-cell activation. B. Extrinsic asthma is associated with elevated IgE antibodies, while drug- induced asthma is specifically noted as non-immunologically mediated.
C. Both types are IgE-mediated, but only drug-induced asthma involves leukotriene release. D. Drug-induced asthma is childhood-onset, while extrinsic asthma is usually adult-onset. Answer: B. Extrinsic asthma is associated with elevated IgE antibodies, while drug-induced asthma is specifically noted as non- immunologically mediated. Rationale: Extrinsic asthma is IgE-mediated (allergic). Drug-induced asthma caused by NSAIDs is specifically noted as not immunologically mediated. Q17. The nurse notes that a patient’s sputum is thick and sticky during an asthma attack. This physical characteristic is a direct result of which component of the acute inflammatory process? A. Smooth muscle contraction. B. Increased viscosity of secretions. C. Airway remodeling. D. Release of Charcot-Leyden crystals. Answer: B. Increased viscosity of secretions. Rationale: Inflammation in the airways leads to increased viscosity of secretions, causing them to become sticky. Q18. An asthmatic patient, upon lung auscultation, exhibits prominent wheezing across the lower lobes bilaterally, but very minimal air sounds centrally. The nurse interprets the minimal air sounds centrally as an indicator of: A. Resolved bronchospasm. B. Imminent respiratory distress. C. IgE antibody activation. D. Airway remodeling. Answer: B. Imminent respiratory distress. Rationale: Minimal air sounds are a sign that an attack is turning into respiratory distress. Q19. The three defining key features that characterize the pathophysiology of asthma are essential for diagnosis and management. These three features include:
Q22. A patient, previously employed in a coal mine, is diagnosed with Anthracosis. In tracing the primary pathological sequence, the nurse understands that the inhalation of inorganic coal dust leads directly to which subsequent step? A. Epithelial denudation and replacement with goblet cells. B. Macrophages secreting lysozymes that begin damaging alveolar walls. C. Release of leukotrienes causing immediate bronchospasm. D. Increased osmolarity in the respiratory tract. Answer: B. Macrophages secreting lysozymes that begin damaging alveolar walls. Rationale: Pneumoconiosis starts when macrophages are sent to deal with the inhaled inorganic dust. Because the dust is inorganic, the lysozymes secreted by the macrophages are unsuccessful and begin damaging the alveolar walls instead. Q23. The nurse is comparing the pathological outcomes of asthma and pneumoconiosis. Which finding is the most critical difference resulting from the long-term inflammation in pneumoconiosis? A. Increased airway reactivity. B. Increased viscosity of secretions. C. Collagen deposition around the alveoli causing stiffness and difficulty letting O2 in. D. Bronchospasm resulting from smooth muscle contraction. Answer: C. Collagen deposition around the alveoli causing stiffness and difficulty letting O2 in. Rationale: In pneumoconiosis, inflammation in the alveoli leads to collagen deposition (scar tissue), resulting in pulmonary fibrosis. This causes alveoli to become stiff and have trouble letting O2 in. Q24. A patient diagnosed with Silicosis is entering the late stage of the disease. The nurse should be monitoring for the development of right-sided heart failure. This specific complication is termed Cor Pulmonale and is directly caused by: A. Systemic IgE antibody overload. B. Building pressure in the lungs due to fibrosis.
C. Status Asthmaticus. D. Acute hyperinflation of the lung tissue. Answer: B. Building pressure in the lungs due to fibrosis. Rationale: Cor pulmonale is defined as right-sided heart failure due to building pressure in the lungs from fibrosis. Q25. A patient with known Asbestosis is being assessed for chronic complications. Which physical manifestation is the most definitive sign of long-term, chronic decreased O2 levels associated with progressive pneumoconiosis? A. Tachycardia. B. Use of accessory muscles. C. Productive cough. D. Finger clubbing. Answer: D. Finger clubbing. Rationale: Finger clubbing is explicitly listed as a sign of chronic decreased O2. Tachycardia and accessory muscle use are
signs of acute decreased O2, typical of asthma.
Q26. Which diagnostic finding is exclusive to pneumoconiosis and
would not be expected in a patient with severe asthma?
A. SOB; worse with exertion. B. Tachycardia. C. Mottling and haziness on chest x-ray. D. Sputum positive for eosinophils. Answer: C. Mottling and haziness on chest x-ray. Rationale: Chest x- ray findings for pneumoconiosis (late stage) include mottling, haziness, nodules, fibroses, and calcifications. Asthma x-rays show hyperinflation and a flattened diaphragm. SOB and tachycardia can occur in both conditions. Q27. A patient presents with a cough and fatigue, but denies any history of lung disease. Based on their occupational history, the nurse recognizes they have been exposed to silica dust for 15 years. What is the most likely expected finding on the initial chest x-ray in this early stage? A. Mottling and fibroses.
