Georgia Military College

PATHO HCR 240

Patho- Mod 3

Ch 29 -Quiz

1)Put these steps in order to describe the process of oxygen transport from the alveolar to the cellular level.

2.A client has been admitted to the hospital for new-onset dyspnea and is undergoing testing for obstructive lung disease. In reviewing the results of the pulmonary function studies, the nurse would expect to note a decrease in which value with obstructive lung disease?

3. A client with asbestosis-induced pulmonary fibrosis asks the nurse why breathing is so difficult at times. The nurse explains that the scar tissue in the client’s lung tissues causes which of these?

4. An infant with a ventricular septal defect (VSD) does not fully oxygenate his blood. Large quantities of deoxygenated blood enter the left ventricle from the right ventricle via the VSD. What type of disorder is this?

5. A respiratory therapist is describing the characteristics of the oxygen–hemoglobin dissociation curve to a group of nurses caring for some respiratory clients. The respiratory therapist is describing what will happen to a client's oxygen saturation level if the partial pressure of oxygen decreases from 100 to 95 mm Hg. What will happen if this occurs?

6. The most common cause of pulmonary edema is left-sided heart failure. Which explanation best describes the pathophysiology causing the development of pulmonary edema?

7. A client with chronic asthma is experiencing a severe asthma attack and is becoming increasingly agitated. The nurse supports the client's ability to move more air in and out of the lungs by instructing the client to stabilize his accessory muscles. The nurse understands that by stabilizing the accessory muscles, the:

8. The nurse is caring for a client who is 2 days postoperative following a total hip replacement. The client is refusing to participate in physical therapy, complaining of extreme fatigue and severe pain with any movement. The nurse administers pain medication and then encourages the client to sit up to more effectively cough and deep breathe to increase ventilation by:

9. An 82-year-old man with chronic obstructive pulmonary disease (COPD) is at the clinic for a regular checkup. Because of his diagnosis, the nurse would expect his respiratory rate under normal circumstances to be:

10. What is a function of the bronchial circulation?

11. A nurse is speaking to a client who tested positive for the presence of M. tuberculosis but has a normal chest x- ray. The nurse explains that the client does not have the active disease because of which function of the alveolar macrophages?

12. While discussing carbon dioxide transport within the body, the instructor asks, “What enzyme helps carbon dioxide with water to form bicarbonate?” Which student response is correct?

13. Due to complications, a postoperative client has been unable to mobilize for several days following surgery and has developed atelectasis. Which process would his care team expect?

14. A client with a history of asthma comes to the clinic complaining of wheezing and difficulty in breathing when harvesting the field. The assessment findings include use of accessory neck muscles, prolonged expiration, intercostal retractions, decreased breath sounds, and expiratory wheezes. Based on these findings, the nurse determines which anatomical receptors in the lungs have been stimulated?

15. When a client with a history of asthma takes a walk outside on a windy day with high pollen counts, she may experience an asthma attack, resulting in an increase in respiration rate and wheezing. The body’s response is likely related to which pathophysiologic principle?

16. When thinking in terms of airway radius with regard to resistance, the lung structure responsible for the most airway resistance to airflow would be:

17. A nurse educator is explaining a client's lung disease and describing how some of the air that he is moving with each breath is not actually participating in gas exchange. The nurse is describing what phenomenon?

18. The nurse is caring for a group of clients. Which clients should the nurse identify as experiencing a shift to the right on the oxygen dissociation curve?

A client with:

1. 1. Anemia
   2. Pulmonary edema
   3. Fever

19. A client with rheumatoid arthritis is being started on immunosuppressive therapy. It would be most important for the nurse to inform the health care provider about the client's history of:

20. Alveolar oxygen levels directly impact the blood vessels in the pulmonary circulation. In a person with lung disease, there is vasoconstriction throughout the lung, causing a generalized hypoxia. What can prolonged hypoxia lead to?

21. A client arrives in the emergency department suffering a traumatic brain injury as a result of a car accident. While assessing this client, the nurse notices the client has an irregular breathing pattern consisting of prolonged inspiratory gasps interrupted by expiratory efforts. The underlying physiologic principle for these signs would include:

22. Nursing students in an anatomy class are observing lung tissue under the microscope in order to identify regions of the lung. The slide shows a basement membrane, capillary lumen, macrophages, and brush cells. This tissue is identified as which region of the lung?

23. The nurse teaches a client scheduled for surgery about pulmonary function testing (PFT). Which statement, if made by the client, indicates teaching was effective?

24. A nurse is conducting a class on healthy living with COPD and presents potential complications with the disease. Many clients with COPD have bronchospasms, airway inflammation, and excess mucus production, which contribute to obstruction to the alveoli. Which physiologic condition could result from the obstruction?

25. People with emphysema often have a difficult time with air trapping, which is air left in the lungs following expiration, often due to the destruction of the alveoli. Pulmonary rehabilitation educates people who suffer from this disease to use which muscles to help air leave the lungs more effectively?

26. The nurse caring for a client with adult respiratory distress syndrome (ARDS) caused by a near drowning is explaining why he is having such difficulty breathing. Which are some accurate explanations of surfactant's role in this client's dyspnea?
    1. Reduce surface tension in the alveoli.
    2. Increase lung compliance.
    3. Prevent end-expiratory alveolar collapse.
    4. Regulate the immune system in the lungs.

27. The pulmonary rehabilitation specialist is educating medical students on a respiratory disease process that causes a severe compromise in exhalation due to air trapping. Air trapping is caused by the loss of elastic recoil, especially in the alveoli, which occurs after overstretching in which disease?

28. The nurse is reviewing the near-drowning client's pulmonary function tests and is concerned that the forced vital capacity (FVC) is decreased. Which principle accurately describes FVC?

29. Clients with chronic diseases such as chronic obstructive pulmonary disease (COPD), when given oxygen at a level that increases PO2 above 60 mm Hg (7.98 kPa) would experience:

30. A nurse on an acute medical unit is providing care for a number of clients with a variety of diagnoses. Which client most likely exhibits risk factors for impaired coughing? A client with:

31. Which form accounts for the greatest percentage of carbon dioxide transport?

32. Completion of a client's pulmonary function study has yielded the following data: tidal volume, 500 mL; inspiratory reserve, 3100 mL; expiratory reserve, 1200 mL; residual volume, 1200 mL; functional residual capacity, 2400 mL. What is this client's inspiratory capacity?

33. A client with a history of chronic obstructive pulmonary disease (COPD) is undergoing pulmonary function testing. Which instructions should the technician provide to determine the client's forced vital capacity (FVC)?

34. A client asks the nurse what anatomic airway dead space is. What would be the nurse’s best response?

35. The client with airway obstruction may experience perfusion of the lungs without ventilation due to what disorder?

36. Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop below 60 mm Hg, causes what response in the pulmonary circulation?

37. The nurse is caring for a postoperative client in traction. Which activity would be most beneficial for preventing atelectasis in this client?

38. A client who is in a room at 1 atmosphere (760 mm Hg) is receiving supplemental oxygen therapy that is being delivered at a concentration of 50%. What is the consequent PO₂?

39. A nursing student is studying the respiratory airways in the lungs, in particular the alveoli. A fellow student asks which cells are most instrumental in the destruction of foreign substances that may enter the alveoli with inspired air. The most accurate response would be:

40. People with emphysema often have a difficult time with air trapping, which is air left in the lungs following expiration, often due to the destruction of the alveoli. Pulmonary rehabilitation educates people who suffer from this disease to use which muscles to help air leave the lungs more effectively?

41. A client is preparing for a hip replacement surgery and his physician orders pulmonary function tests (PFTs) to be done pre-surgery. Upon arrival to the lab for the PFTs, the client is anxious and asks the nurse why his physician would order these tests since he does not have any pulmonary diseases. The nurse responds that although the client should speak with his physician, the most likely reason is:

42. The nurse is assessing a client’s respiratory status for lung expansion and airway resistance. Which type of lung receptors respond to changes in pressure occurring in the walls of the airways?

43. A client has experienced a bout of coughing after aspirating some of his secretions. The client's coughing was triggered by which of the following?

44. A distressed, confused client is admitted to the hospital ER with a penetrating right chest stab wound. The nurse assesses the client and notes a lack of breath sounds in the right lung. The nurse knows this is likely the result of:

45. A nurse is instructing a class for people with newly diagnosed asthma to encourage healthy lifestyle choices. The nurse explains that stimulation of certain lung receptors with things such as smoke, cigarette smoke, inhaled dust, or cold air can lead to constriction of the conducting airways resulting in rapid, shallow breathing. How does the nurse identify these receptors?

46. A client with chronic obstructive pulmonary disease (COPD) has chronically elevated carbon dioxide levels. How does the nurse best ensure safe delivery of supplemental oxygen to this client?

47. The nurse is caring for a client with adult respiratory distress syndrome. The nurse knows that the pathophysiology of this disorder is related to which type of pulmonary alveolar cells?

48. A client with lung cancer is scheduled for the removal of the right lung. The nurse should anticipate that after surgery the client will experience a significant decrease in which physiologic measurement?

49. A client is brought into the ER with rapid, deep respirations at a rate of 25 breaths per minute and decreased level of consciousness. A stat MRI shows a lesion in the brain stem that may have infiltrated which regulator of respiratory function responsible for detecting changes in carbon dioxide levels?

50. The nurse and nursing student are assessing a client experiencing shock. The nurse teaches the student that which finding reflects compensatory sympathetic stimulation in a shock state?

51. The nurse is monitoring trends in the client's arterial blood gases and recognizes that changes in ventilation will result from which of the following?
    1. Oxygen
    2. pH
    3. Carbon dioxide

52. Select the clinical situation that would result in increased diffusion of gases from the arterial blood into the alveoli.

53. In addition to being the site of gas exchange, the lungs also perform which function?