Unit7: Ch 29 (Porth's 5th Ed) - Structure and Function of the Respiratory System Flashcards
(40 cards)
- As a result of dehydration, a client’s epithelial cells are producing insufficient amounts
of mucus. Consequently, the client’s mucociliary blanket is compromised. Which of the
following changes would the care provider anticipate as a direct result of this change?
A) Impaired function of the client’s cilia
B) Decreased levels of oxygen saturation
C) Increased amounts of bacteria in the lungs
D) Increased carbon dioxide levels
Ans: C
Feedback:
The primary role of the mucociliary blanket is to trap foreign particles and bacteria and
thus prevent their entry into the lungs. Impaired ciliary function may result in an
inadequate mucociliary blanket, but the opposite relationship is unlikely. Decreased
oxygen and increased carbon dioxide levels may eventually result, but not as a direct or
immediate consequence.
- A 21-year-old male client has suffered a head injury during a crash on his motorcycle,
and a deficit that assessments have revealed is an impaired swallowing mechanism. He
has also developed aspiration pneumonia. Which of the following statements most
accurately captures an aspect of his condition?
A) His vocal folds are likely not performing their normal function.
B) His epiglottis is covering his larynx.
C) His vocal folds have been compromised.
D) His tracheobronchial is intermittently obstructed.
Ans: A
Feedback:
The vocal folds contribute to blocking of the airways during swallowing; compromise to
this function is likely to allow food to enter the lungs. The epiglottis is performing its
normal, protective role against aspiration when it covers the larynx, and the vocal folds
contribute to sound enunciation, not swallowing or protection against aspiration.
Tracheobronchial obstruction would not contribute to aspiration
- A male, lifetime smoker has died because of chronic obstructive pulmonary disease.
Which of the following phenomena regarding his alveoli would his care team expect in
the weeks prior to his death?
A) Proliferation of natural killer (NK) cells in the alveolar lumen
B) Large numbers of alveolar macrophages in septal connective tissue
C) The presence of tubercles in the interalveolar spaces
D) Compensatory regeneration of type I alveolar cells
Ans: B
Feedback:
Smokers often retain large numbers of carbon-filled macrophages in their septal
connective tissue. NK cell proliferation is not a noted phenomenon in the alveoli, and
tubercles are associated specifically with tuberculosis infection. Type I alveoli are
incapable of regeneration.
- Reviewing pathology for an exam on pulmonary vasculature, the nursing student states
that blood enters the right side of the heart via the vena cavae, then to the right atrium,
right ventricle, and then which vessel carries the deoxygenated blood into the
pulmonary system?
A) Pulmonary capillaries
B) Pulmonary artery
C) Pulmonary vein
D) Ductus arteriosus
Ans: B
Feedback:
Deoxygenated blood leaves the right heart through the pulmonary artery. Return of
oxygenated blood to the heart occurs by way of the pulmonary vein, which empties into
the left atrium.
- The nurse is hearing diminished breath sounds and a “grating” sound during
respirations. This is consistent with excess collection of fluid in the pleural cavity. The
medical term for this is
A) pleurisy.
B) pleural effusion.
C) pneumothorax.
D) poor lung compliance.
Ans: B
Feedback:
Pleural effusion is used to describe an abnormal collection of fluid or exudates in the
pleural cavity. Pleurisy is an inflammation in the pleural space, and pneumothorax is an
abnormal collection of air in the pleural space
- Which of the following statements best conveys an aspect of the respiratory pressures
that govern ventilation?
A) Intrapleural pressure slightly exceeds that of the inflated lung.
B) The chest wall exerts positive pressure on the lungs that contributes to expiration.
C) The lungs are prevented from collapsing by constant positive intrapulmonary
pressure.
D) Negative intrapleural pressure holds the lungs against the chest wall.
Ans: D
Feedback:
Negative intrapleural pressure holds the lungs in place against the chest wall and
prevents their natural elastic properties from causing them to collapse. Intrapleural
pressure is negative in relation to the inflated lung, and the chest wall exerts negative
pressure on the lungs that keeps them from contracting and contributes to inspiration.
Intrapulmonary pressure oscillates between positive and negative relative to
atmospheric pressure with expiration and inspiration.
- The emergency department is awaiting the arrival of a spinal cord–injured patient.
Knowing the innervation of the diaphragm, a patient with which type of injury may be
in need of immediate mechanical ventilation? Injury to the
A) C4 area.
B) C7 area.
C) T1 area.
D) T4 area.
Ans: A
Feedback:
The diaphragm is the principal muscle of inspiration. It is innervated by the phrenic
nerve roots, which arise from the cervical level of the spinal cord, mainly from C4 but
also C3 and C5
- A client who presented with shortness of breath and difficulty climbing stairs has been
diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli.
Upon assessment of the lungs, what clinical manifestations should the nurse expect?
A) Rapid, deep breaths
B) Wheezing throughout lung fields
C) Short, shallow breaths
D) Pursed-lip breaths with slow, steady breaths
Ans: C
Feedback:
Scarring diminishes the elasticity of the lung tissue, resulting in noncompliant lungs that
are more difficult to inflate. In order to maintain a sufficient tidal volume and oxygen
level with the lungs that require extra work to expand, the individual must take
shallower, more rapid breaths. The effort and time required for him to breathe deeply
would detract from his ability to bring in enough air.
- A female patient is requiring supplementary oxygen by face mask due to her reduced
lung compliance. Which of the following pathophysiological processes is most likely a
contributor to her low lung compliance?
A) The woman’s lungs have more recoil than a healthy person’s.
B) Her type II alveolar cells are producing a slight excess of surfactant.
C) Turbulent airflow is taking place in the patient’s large airways.
D) Her thoracic cage is less flexible than when she was healthy
Ans: D
Feedback:
Impaired thoracic cage flexibility can be a contributor to reduced lung compliance.
Increased recoil and a modest excess of surfactant would increase lung compliance, and
turbulent flow in the airways is a normal, not pathological, finding.
- While working in the newborn ICU, the nurses receive a call that an infant, gestational
age of 23 weeks, is being air flighted to the level 3 trauma nursery. The priority
intervention for this infant would be
A) insertion of an umbilical line for fluids.
B) intubation and mechanical ventilation.
C) insertion of a feeding tube.
D) insertion of an intraventricular catheter
Ans: B
Feedback:
The type II alveolar cells that produce surfactant do not begin to mature until 26th to
27th week of gestation; consequently, many premature infants have difficulty in
producing sufficient amounts of surfactant. This can lead to alveolar collapse and severe
respiratory distress. The only answer (B) to facilitate respiratory is mechanical
ventilation. IV fluids and nutrition are important but not a priority of airway/breathing
problems. There is no indication that the infant has increased ICP and would need an
intraventricular catheter.
- A 60-year-old male hospital patient with a diagnosis of chronic obstructive pulmonary
disease (COPD) is undergoing lung function tests to gauge the progression of his
disease. Which of the following aspects of the lung volumes will the respiratory
therapist be most justified in using to guide interpretation of the test results?
A) Vital capacity will equal the patient’s combined inspiratory reserve, expiratory
reserve, and tidal volume.
B) Vital capacity will equal the total lung capacity.
C) Resting tidal volume will exceed that of tidal volume during activity.
D) Expiratory reserve will equal residual lung volume.
Ans: A
Feedback:
Vital capacity is determined by combining inspiratory reserve, expiratory reserve, and
tidal volume. Total lung capacity always exceeds vital capacity, given that it is not
possible to completely empty the lungs. Tidal volume becomes wider during exercise,
and expiratory reserve is neither equal to nor synonymous with residual volume.
- A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her
diagnosis of emphysema. Which of the following pathological processes occur as a
result of her emphysema? Select all that apply.
A) Decreased elastic recoil due to alveolar damage
B) Decreased residual lung volume due to impaired alveolar ventilation
C) Increased anatomical dead space due to reduced tidal volume
D) Increased alveolar dead space due to incorrect intrapleural pressure
Ans: A, C, D
Feedback:
In lung pathology such as emphysema, large amounts of air are trapped at the end of a
given breath, a situation that corresponds to increased residual volume and decreased
vital capacity. Elastic recoil would tend to suffer, and both alveolar and anatomical dead
space consequently increase
- The physician mentions the patient has developed alveolar dead space. The nurse
recognizes that this means
A) air that is moved in and out of the lungs with each breath.
B) air that cannot participate in gas exchange and remains in the main bronchus.
C) air is trapped in the conducting airways.
D) alveoli are ventilated but not perfused.
Ans: D
Feedback:
Alveolar dead space results from alveoli that are ventilated but not perfused.
- Due to complications, a male postoperative patient has been unable to mobilize
secretions for several days following surgery and develops atelectasis. Which of the
following processes would his care team anticipate with relation to his health problem?
A) Vasodilation in the alveolar vessels in the affected region of his lung
B) Increased workload for the left side of the patient’s heart
C) Increased blood flow to the area of atelectasis
D) Directing blood flow away from the lung regions that are hypoxic
Ans: D
Feedback:
Regional hypoxia, such as with a diagnosis of atelectasis, is associated with
vasoconstriction and redirection of blood away from, not toward, the affected area of the
lung. This also contributes to an increased workload for the right side of the heart.
- A 44-year-old woman has developed calf pain during a transatlantic flight. She is
extremely short of breath upon arrival at her destination. She was subsequently
diagnosed with a pulmonary embolism (PE) that resolved with anticoagulant therapy.
Which of these statements best characterizes the underlying problem of her PE?
A) Ventilation was occurring, but perfusion was inadequate causing shortness of
breath.
B) The combination of normal perfusion but compromised ventilation caused
hypoxia.
C) She developed a transient anatomic shunt resulting in impaired oxygenation.
D) Impaired gas diffusion across alveolar membranes resulted in dyspnea and
hypoxia.
Ans: A
Feedback:
Impaired blood flow to a portion of the lung, such as with a PE, is associated with
ventilation without perfusion, rather than perfusion without ventilation. The situation is
not related to an anatomic shunt or impaired diffusion across alveolar membranes.
- Following a winter power outage, a client who had been using a home gasoline
generator began to experience dizziness and headaches and was diagnosed with carbon
monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon
monoxide poisoning?
A) To increase the amount of oxygen carried in the dissolved state
B) To increase the production of unbound hemoglobin
C) To stimulate the release of oxygen at the capillaries
D) To remove bound CO from hemoglobin
Ans: A
Feedback:
While increased alveolar PO2 improves the oxygen saturation of hemoglobin, carbon
monoxide occupies the hemoglobin sites usually available for oxygen. With much of the
blood composed, temporarily, of carboxyhemoglobin, it is necessary to rely upon
alternate means to deliver oxygen to the tissues. Plasma’s normally low carrying
capacity for dissolved oxygen can be increased by administration of 100% oxygen in the
high atmospheric pressure of a hyperbaric chamber
- Which of the following situations is most likely to result in an increased binding affinity
of hemoglobin for oxygen?
A) A client is in respiratory acidosis, with a low pH.
B) Three of four binding sites on a client’s hemoglobin molecule are occupied by
oxygen.
C) A client’s body temperature is elevated as a result of an infectious process.
D) An increase in 2,3-diphosphoglycerate enhances the loading of oxygen.
Ans: B
Feedback:
As each binding site on a hemoglobin molecule is occupied, the affinity of the
remaining sites for oxygen binding is increased. Increased affinity is associated with
alkalosis, not acidosis, and fever causes reduced affinity. Exercise increases the
unloading of oxygen, a situation characterized by low affinity.
- A nurse in a respiratory unit of a hospital is providing care for a client with end-stage
lung disease. Consequently, measurement of the client’s arterial blood gases indicates
increased PCO2. Which of the following associated consequences would the nurse
anticipate?
A) A shift to the left of the oxygen–hemoglobin dissociation curve
B) Lower than normal production of HCO3
C) Higher than normal production of H+
D) An absence of carbaminohemoglobin
Ans: C
Feedback:
As a result of the combination of water and carbon dioxide, hydrogen ions are produced
along with bicarbonate. This would be associated with a shift to the right of the
oxygen–hemoglobin dissociation curve, increased bicarbonate output, and higher than
normal levels of carbaminohemoglobin.
- Which of the following neurological patients is most likely to have abnormalities in
breathing regulation?
A) A 23-year-old male who has an injury to his frontal lobe following a sports injury
B) A 45-year-old female with a spinal cord injury at C7 following a motor vehicle
accident
C) A 34-year-old male with damage to his upper and lower pons following a blow to
the back of the head
D) A 66-year-old male with temporal lobe infarcts secondary to a stroke
Ans: C
Feedback:
The respiratory center is located in the pons. Damage to the temporal lobe, frontal lobe,
or spinal cord at C7 is less likely to affect respiration.
- A nurse in an acute medical unit is providing care for a number of patients with a
variety of diagnoses. Which of the following patients most likely exhibits risk factors
for impaired coughing? A patient with
A) an injury to her cerebellum.
B) a nasogastric (NG) tube attached to suction.
C) a diagnosis of viral pneumonia.
D) diagnosis of diabetes mellitus and morbid obese.
Ans: B
Feedback:
An NG tube can inhibit the closing of the upper airways that is required for normal
coughing. Pneumonia, obesity, diabetes, and injury to the cerebellum are unlikely to
affect the ability to cough
- As part of a public health initiative, a nurse is teaching a group of older adults a bout
ways to promote and maintain their health. Recognizing that the common cold i s a
frequent source of ailment, the nurse i s addressing this health problem. Which of the
following teaching points about the common cold is most accurate?
A) “You shouldn’t be taking antibiotics for a cold until your doctor has confir med
exactly which bug is causing your cold.”
B) “It’s important to both cover your mouth when you cough or sneeze a nd
encourage others t o do so, since most colds are spread by inhaling the germs.”
C) “Scientists don’t yet know exactly what virus causes the cold, and there is not
likely to be a vaccine until this is known.”
D) “Use caution when choosing over-the-counter drugs for your cold; most people do
best with rest and antifever medications.”
Ans: D
Feedback:
The efficacy of over-the-counter cold remedies is minimal, and all have a risk of
unwanted side effects; rest and antipyretics are normally sufficient since cold viruses are
normally self-limiting. No cold-causing virus will respond to antibiotics, and most colds
are spread by the fingers. There is no one specific virus that causes the common cold,
and numerous different viruses cause similar symptoms
- Which of the following patients who presented to a walk-in medical clinic is most l ikely
to be diagnosed with rhinosinusitis rather than a common cold?
A) A man complaining of of general fatigue, a headache, and facial pain with a
temperature of 100.9°F
B) A woman presenting with malaise, lethargy, and copious nasal secretions
C) A man with a dry, stuffy nasopharynx, a sore throat, and a temperature of 98.9°F
D) A woman complaining of generalized aches and who has a hoarse voice and
reddened, painful upper airways
Ans: A
Feedback:
Fever and facial pain are more commonly associated with rhinosinusitis rather than the
common cold. The other noted symptoms are indicative of the common cold rather than
rhinosinusitis.
- A child with rhinosinusitis should be monitored for complications. Which o f the
following assessment findings would alert the nurse that a complication is developing?
A) Purulent nasal discharge
B) Temperature of 100.8°F
C) Periorbital edema
D) Complaints of headache
Ans: C
Feedback:
Expected s/s of acute viral rhinosinusitis include facial pain, headache, purulent nasa l
discharge, decreased sense of smell, and fever. Complications can lead to intracrania l
and orbital wall problems. Facial swelling over the involved sinus, abnormal extraoc ular
movements, protrusion of the eyeball, periorbital edema, or changes in mental sta tus
may indicate intracranial complications.
- A family physician is performing patient teaching about the influenza virus with eac h
patient who has come to the clinic to receive that year’s vaccine. Which of the following
statements by the patient best reflects an accurate understanding of the flu virus?
A) “I could come down with viral or bacterial pneumonia as a result of a bad f lu
bug.”
B) “I know my vaccination is especially important since there aren’t any drugs that can treat the flu once I get sick with it.”
C) “The emphasis on bundling up, staying warm, and drinking lots of fluids is
outdated and actually ineffective.”
D) “Like all vaccines, it is ideal if everyone in a population gets immunized against
the flu.
Ans: A
Feedback:
Viral and bacterial pneumonia are known sequelae of influenza. Antiviral drugs do exist
for the flu, and the efficacy of staying warm and increasing fluid consumption have
been demonstrated. The flu vaccine is recommended for higher risk individuals, and
guidelines do not indicate the need for all individuals to be vaccinated.
