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a. Cyanosis b. Dyspnea c. Hyperpnea d. Orthopnea : ANS: 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 and orthopnea is dyspnea that occurs when an individual lies flat.
a. Dyspnea b. Orthopnea c. Apnea d. Tachypnea : ANS: 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, and tachypnea is rapid breathing
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 : ANS: B - Increased rate, large tidal volumes, and no expiratory pause
Rationale: Kussmaul respirations are characterized by a slightly increased ventila- tory 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. Cheyne-Stokes b. Frank-Starling c. Apnea d. Orthopnea : ANS: 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.
a. Hyperventilation b. Hypoventilation c. Apnea d. Cyanosis : ANS: A - hyperventilation
Rationale: 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.
a. Hematemesis b. Cyanosis c. Rhinitis d. Hemoptysis : ANS: 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.
What term will the nurse use to document these observations?
a. Cyanosis b. Hemoptysis c. Hematemesis d. Ischemia : ANS: A - cyanosis
Rationale: 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. Ischemia b. Hypoxia c. Hypoxemia d. Hypocapnia : ANS: 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. increased dead space. b. shunting. c. alveolar collapse. d. bronchoconstriction. : ANS: B - shunting
Rationale: 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.
a. A right-to-left shunt
b. Alveolar dead space c. A low ventilation-perfusion ratio d. Pulmonary hypotension : ANS: B - alveolar dead space
Rationale: 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.
a. Electrolyte imbalances b. Elevated PaCO c. Low hematocrit d. Elevated pH : ANS: B - Elevated PaCO
Rationale: In respiratory failure, inadequate gas exchange occurs such that PaO2 d 60 mm Hg or PaCO2 e 50 mm Hg with pH d 7.25. Electrolyte imbalances do not occur, but changes in blood gas values do. Hematocrit may be unaffected. pH will be decreased.
a. Pleural effusion b. Tension pneumothorax c. Open pneumothorax d. Transudative pneumothorax : ANS: B - tension pneumothorax
Rationale: 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. exudative. b. purulent. c. infected. d. transudative. : ANS: D - transudative
Rationale: 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
a. Empyema b. Emphysema c. Pleurisy d. Chyle : ANS: A - empyema
Rationale: The presence of pus in the pleural space is termed empyema; emphyse- ma is a total lung disorder. Pleurisy causes pain with inspiration. Chyle is milky fluid with lymph and fat.
a. Virus b. Staphylococcus aureus c. Fungus d. Moraxella catarrhalis : ANS: B - Staphylococcus aureus
Rationale: 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. Compression atelectasis b. Bronchiectasis c. Absorption atelectasis
d. Hypoventilation : ANS: C - absorption atelectasis
Rationale: Absorption atelectasis results from removal of air from obstructed or hy- poventilated 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. Increased compliance b. Increased tidal volume c. Decreased respiratory rate d. Decreased functional residual capacity : ANS: D - decreased functional resid- ual 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. Compliance decreases in restrictive dis- ease. In restrictive disease, tidal volume decreases. Respirations may increase with restrictive disease
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 : ANS: A - inhalation of silicia
Rationale: 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.
a. right heart failure. b. left heart failure. c. asthma.
d. lung cancer. : ANS: B - left heart failure
Rationale: 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.
a. Thick mucous secretions b. Pink, frothy sputum c. Hypocapnia d. Wheezing : ANS: B - pink, frothy sputum
Rationale: 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. Acute respiratory distress syndrome (ARDS)
b. Sarcoidosis c. Postoperative respiratory failure d. Malignant respiratory failure : ANS: A - acute respiratory distress syndrome (ARDS)
Rationale: The patient is experiencing ARDS. The patient's symptoms do not support a diagnosis of sarcoidosis or either postoperative or malignant respiratory failure
a. an autosomal recessive trait. b. autoimmunity. c. excessive use of antibiotics as a young child. d. interactions between genetic and environmental factors. : ANS: D - interac- tions between genetic and environmental factors
Rationale: 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.
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. : ANS: C - exposure to an allergen causing mast cell degranulation
Rationale: 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.
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. : ANS: C - mucous secretion, bronchoconstriction and airway edema
Rationale: The mediators of asthma cause vasodilation, increased capillary per- meability, 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. Exercise-induced asthma b. Chronic obstructive pulmonary disease (COPD) c. Status asthmaticus d. Bronchiectasis : ANS: C - status asthmaticus
Rationale: When bronchospasm is not reversed by the usual measures, the individ- ual is considered to have severe bronchospasm or status asthmaticus since exer- cise- induced asthma resolves. COPD is manifested by air trapping and hypercapnia, not by bronchospasm. Bronchiectasis is manifested by bronchiolar changes, not by bronchospasm.
a. thick mucus from hypertrophied glands. b. ventilation-perfusion mismatch. c. hyperventilation. d. thinning smooth muscle in the bronchioles. : ANS: A - thick mucus from hypertrophied glands
Rationale: Chronic bronchitis is defined by hypersecretion of thick mucus. Ventila- tion- perfusion mismatch may occur, but chronic bronchitis is defined as hypersecre- tion of mucus. Neither hyperventilation nor thinning of smooth muscle occurs.
a. A productive cough b. Cyanosis c. Dyspnea
d. Cor pulmonale : ANS: C - Dyspnea
Rationale: 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. air trapping. b. decreased inspiratory reserve volumes. c. increased flow rates. d. alveolar destruction. : ANS: A - air trapping
Rationale: 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 anteri- or- posterior chest diameter.
a. use of anesthetic agents in surgery. b. atelectasis. c. chronic lung changes seen with aging. d. viral or bacterial infections. : ANS: D - viral or bacterial infections
Rationale: 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
a. at daycare centers. b. on airplanes. c. during hospitalization. d. in the winter season. : ANS: C - during hospitalization
Rationale: Nosocomial infections are acquired in the hospital. Nosocomial infections are not associated with daycare centers or airplanes and may happen in any season.
a. Chronic asthma b. Air pollution c. Cigarette smoke d. Recurrent pneumonias : ANS: C - cigarette smoke
Rationale: 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. excessive mucus production. b. loss of elastic recoil.
c. infection and inflammation. d. airway edema. : ANS: B - loss of elastic recoil
Rationale: 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.
a. Pneumonia b. Bronchiectasis c. Pneumothorax d. Emphysema : ANS: A - pneumonia
Rationale: 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. viral infections. b. destruction of alveolar macrophages. c. ±1a-ntitrypsin deficiency.
d. fibrotic lung disease. : ANS: C - ±1A-ntitrypsin deficiency
Rationale: ±1A-ntitrypsin deficiency is suggested in individuals who develop emphy- sema 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.
a. Bacterium b. Fungus c. Virus d. Parasite : ANS: A - bacterium
Rationale: The organism that causes tuberculosis is a bacterium. Tuberculosis is not a fungus, a virus, or a parasite.
a. skin contact. b. fecal-oral contact. c. airborne droplets. d. blood transfusions. : ANS: C - airborne droplets
Rationale: Tuberculosis is transmitted through airborne droplets. Tuberculosis is not transmitted through skin contact, fecal-oral contact, or through a blood transfusion.
a. fat. b. air. c. tissue fragment. d. blood clot. : ANS: D - blood clot
Rationale: A thromboembolism is most commonly composed of a blood clot. A thromboembolism is less commonly composed of fat, air, or tissue fragments.
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 : ANS: D
Rationale: A 72-year-old is at risk for immobility and at increased risk for PE.
a. Dry cough and inspiratory crackles b. Shallow respirations and wheezing c. Chest pain and shortness of breath d. Kussmaul respirations and back pain : ANS: 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. Individuals with PE do not experience a cough or wheezing. Kussmaul respirations are associ- ated with acidosis.
a. Ensure that patient uses supplemental oxygen. b. Prevent deep vein thrombosis formation. c. Check hematocrit and hemoglobin levels frequently during the postopera- tive period. d. Promote aggressive fluid intake. : ANS: 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. Oxygen will neither prevent emboli nor check hemoglobin and hematocrit. Fluid intake will help, but it is not as important as preventing DVT