Chapter 26: Alterations of Pulmonary Function My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 26: Alterations of Pulmonary Function

Test Bank

MULTIPLE CHOICE

1. A 10-year-old female develops pneumonia. Physical exam reveals subcostal and intercostal retractions. She reports that breathing is difficult and she feels she cannot get enough air. What term should the nurse use to document this condition?

a.

Cyanosis

b.

Dyspnea

c.

Hyperpnea

d.

Orthopnea

ANS: B

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.

Orthopnea is dyspnea that occurs when an individual lies flat.

REF: p. 678

2. A 20-year-old male presents to his primary care provider reporting difficulty breathing when lying down. What term should the nurse use to document this condition?

a.

Dyspnea

b.

Orthopnea

c.

Apnea

d.

Tachypnea

ANS: B

Orthopnea is dyspnea that occurs when an individual lies flat.

Dyspnea is shortness of breath that occurs with activity.

Apnea is cessation of breathing.

Tachypnea is rapid breathing.

REF: p. 679

3. A 50-year-old diabetic male did not take his medication and is now in metabolic acidosis. He is experiencing Kussmaul respirations. What type of breathing will the nurse observe upon assessment?

a.

Audible wheezing or stridor

b.

A slightly increased ventilatory rate, large tidal volumes, and no expiratory pause

c.

Rapid respirations with periods of apnea

d.

Very slow inhalations and rapid expirations

ANS: B

Kussmaul respirations are characterized by a slightly increased ventilatory 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.

REF: p. 679

4. A 30-year-old female received a severe head injury in a motor vehicle accident. She is now experiencing respiratory abnormalities characterized by alternating periods of deep and shallow breathing with periods of apnea. What term should the nurse use when charting this condition?

a.

Cheyne-Stokes

b.

Frank-Starling

c.

Apnea

d.

Orthopnea

ANS: A

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.

REF: p. 679

5. Which patient would the nurse assess for paroxysmal nocturnal dyspnea (PND)? A patient with:

a.

Pulmonary fibrosis

b.

Asthma

c.

Left ventricular failure

d.

Hypotension

ANS: C

Some individuals with cardiac disease awake at night gasping for air and have to sit up or stand to relieve the dyspnea (PND).

PND occurs primarily with cardiac disease, not pulmonary fibrosis.

Individuals with asthma experience orthopnea, rather than PND.

Individuals with left ventricular problems experience PND. It is not associated with hypotension.

REF: p. 679

6. A 20-year-old male is in acute pain. An arterial blood gas reveals decreased carbon dioxide (CO2) levels. Which of the following does the nurse suspect is the most likely cause?

a.

Hyperventilation

b.

Hypoventilation

c.

Apnea

d.

Cyanosis

ANS: A

Individuals with hyperventilation blow off CO2.

Individuals with hypoventilation retain CO2.

Apnea is cessation of breathing.

Cyanosis is a blue color to the skin.

REF: p. 679

7. A 65-year-old female with emphysema presents to the ER for difficulty breathing. Physical exam reveals bluish skin and mucous membranes. How should the nurse chart this condition? Patient has:

a.

Cyanosis

b.

Hemoptysis

c.

Hematemesis

d.

Ischemia

ANS: A

Cyanosis is a blue color to the skin.

Hemoptysis is the coughing up of blood or bloody secretions.

Hematemesis is blood in the vomitus.

Ischemia is a lack of blood supply to tissues.

REF: p. 680

8. A 28-year-old male reports to his primary care provider that he has had a cold for a week and is coughing up bloody secretions. When giving report, what term should the nurse use to describe this condition?

a.

Hematemesis

b.

Cyanosis

c.

Rhinitis

d.

Hemoptysis

ANS: D

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.

REF: p. 679

9. A nurse is reviewing the results of an ABG and finds reduced oxygenation of arterial blood. What term should the nurse use to describe this condition?

a.

Ischemia

b.

Hypoxia

c.

Hypoxemia

d.

Hypocapnia

ANS: C

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.

REF: p. 680

10. A group of mountain climbers experience confusion, tachycardia, edema, and decreased renal output after climbing Mount Rainier. A nurse recalls this condition is caused by:

a.

Bronchoconstriction

b.

Hypoventilation

c.

Decreased inspired oxygen

d.

Diffusion abnormalities

ANS: C

The mountain climbers are experiencing decreased inspired oxygen.

Bronchoconstriction would result in wheezing.

Hypoventilation would result in retained CO2.

The mountain climbers are experiencing decreased inspired air, not diffusion problems.

REF: p. 681

11. A nurse remembers a low ventilation-perfusion ratio results in:

a.

Increased dead space

b.

Shunting

c.

Alveolar collapse

d.

Bronchoconstriction

ANS: B

Hypoxemia caused by inadequate ventilation of well-perfused areas of the lung is a form of mismatching called shunting.

Hypoxemia caused by inadequate ventilation of well-perfused areas of the lung is a form of mismatching called shunting, not dead space.

Alveolar collapse is called atelectasis.

Hypoxemia caused by inadequate ventilation of well-perfused areas of the lung is a form of mismatching called shunting, not bronchoconstriction.

REF: p. 681

12. When the pulmonologist discusses the condition in which a series of alveoli in the left lower lobe receive adequate ventilation but do not have adequate perfusion, which statement indicates the nurse understands this condition? When this occurs in a patient it is called:

a.

A right-to-left shunt

b.

Alveolar dead space

c.

A low ventilation-perfusion ratio

d.

Pulmonary hypotension

ANS: B

When certain areas of the alveoli experience inadequate perfusion, it is referred to as dead space.

When certain areas of the alveoli experience inadequate perfusion, it is referred to as dead space. It is not a right-to-left shunt.

Shunting is due to a low ventilation-perfusion ratio.

When certain areas of the alveoli experience inadequate perfusion, it is referred to as dead space, not pulmonary hypotension.

REF: p. 681

13. A 30-year-old male is involved in a motor vehicle accident and sustains trauma to the lungs and chest wall. He experiences respiratory failure. Which of the following lab values would the nurse expect?

a.

Electrolyte imbalances

b.

Elevated PaCO2

c.

Low hematocrit

d.

Elevated pH

ANS: B

In respiratory failure, inadequate gas exchange occurs such that PaO2 = 50 mm Hg or PaCO2 = 50 mm Hg with pH = 7.25.

Electrolyte imbalances do not occur, but changes in blood gas values do.

Hematocrit may be unaffected.

pH will be decreased.

REF: p. 682

14. A nurse is teaching staff about pulmonary edema. Which information should the nurse include? The most common cause of pulmonary edema is:

a.

Right heart failure

b.

Left heart failure

c.

Asthma

d.

Lung cancer

ANS: B

The most common cause of pulmonary edema is left-sided heart disease.

The most common cause of pulmonary edema is left-sided heart disease, not right-sided.

The most common cause of pulmonary edema is left-sided heart disease, not asthma.

The most common cause of pulmonary edema is left-sided heart disease, not lung cancer.

REF: p. 687

15. A 47-year-old male is diagnosed with pulmonary edema. Which assessment findings will the nurse observe?

a.

Thick mucus secretions

b.

Pink, frothy sputum

c.

Hypocapnia

d.

Wheezing

ANS: B

In severe pulmonary edema, pink frothy sputum is expectorated.

In severe edema, pink frothy sputum is expectorated, not thick mucus secretions.

In severe edema, pink frothy sputum is expectorated, not hypocapnia.

In severe edema, pink frothy sputum is expectorated, not wheezing.

REF: p. 687

16. A 65-year-old male recently had a cerebrovascular accident that resulted in dysphagia. He now has aspiration of gastric contents. The nurse assesses the patient for which complication?

a.

Pneumonia

b.

Bronchiectasis

c.

Pneumothorax

d.

Emphysema

ANS: A

Aspiration of stomach contents could lead to pneumonia.

Aspiration could lead to pneumonia; bronchiectasis is related to dilation and is not associated with aspiration.

Pneumothorax is a collapse of a portion of the lung and is not associated with aspiration.

Emphysema is due to air trapping and is not associated with aspiration.

REF: p. 695

17. A 26-year-old female recently underwent surgery and is now experiencing dyspnea, cough, fever, and leukocytosis. Tests reveal that she has a collapsed lung caused by removal of air from obstructed alveoli. What condition will the nurse observe on the chart?

a.

Compression atelectasis

b.

Bronchiectasis

c.

Absorption atelectasis

d.

Hypoventilation

ANS: C

Absorption atelectasis results from removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated oxygen or anesthetic agents.

Compression atelectasis is caused by external pressure exerted by tumor, fluid, or air in pleural space or by abdominal distention pressing on a portion of lung.

Bronchiectasis is dilation of the bronchi, not atelectasis.

Hypoventilation is inadequate alveolar ventilation of the lungs; it is not due to removal of air.

REF: p. 685

18. A 45-year-old male undergoes lung transplantation. He now suffers from airway occlusion secondary to fibrosis. Which diagnosis will the nurse see on the chart?

a.

Compression atelectasis

b.

Bronchiectasis

c.

Bronchiolitis

d.

Bronchiolitis obliterans

ANS: D

Bronchiolitis is a serious complication of stem cell and lung transplantation and can progress to bronchiolitis obliterans, a fibrotic process that occludes airways and causes permanent scarring of the lungs.

The most likely diagnosis is bronchiolitis obliterans, not compression atelectasis.

The most likely diagnosis is bronchiolitis obliterans, not bronchiectasis.

Bronchiolitis is a serious complication of stem cell and lung transplantation and can progress to bronchiolitis obliterans, not just bronchiolitis.

REF: p. 685

19. A 50-year-old male presents with hypotension, hypoxemia, and tracheal deviation to the left. Tests reveal that the air pressure in the pleural cavity exceeds barometric pressure in the atmosphere. Based upon these assessment findings, what does the nurse suspect the patient is experiencing?

a.

Pleural effusion

b.

Tension pneumothorax

c.

Open pneumothorax

d.

Transudative pneumothorax

ANS: B

Tracheal deviation suggests tension pneumothorax.

Tracheal deviation suggests tension pneumothorax, not pleural effusion.

Tracheal deviation suggests tension pneumothorax; with open pneumothorax, a sucking sound would be heard without tracheal deviation.

Tracheal deviation suggests tension pneumothorax.

REF: p. 684

20. A 60-year-old female with a history of cirrhosis presents with dyspnea, impaired ventilation, and pleural pain. A diagnosis of pleural effusion is made, and a watery fluid is drained. When giving report, the nurse will refer to this fluid as:

a.

Exudative

b.

Purulent

c.

Infected

d.

Transudative

ANS: D

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.

The fluid is watery; thus, it is transudative, not purulent.

The fluid is watery; thus, it is transudative, not infected.

REF: p. 684

21. An 80-year-old female develops pneumonia in the hospital. She becomes cyanotic, tachycardic, and develops a fever and cough. Chest x-ray reveals pus in the pleural space. Which of the following is the most likely diagnosis documented on the chart?

a.

Empyema

b.

Emphysema

c.

Pleurisy

d.

Chyle

ANS: A

The presence of microorganisms in the pleural space is termed empyema.

The presence of microorganisms in the pleural space is termed empyema; emphysema is a total lung disorder.

Pleurisy causes pain with inspiration.

Chyle is milky fluid with lymph and fat.

REF: p. 684

22. A 54-year-old male is diagnosed with empyema. Upon receiving and reviewing the culture result, which organism does the nurse suspect is the most likely cause?

a.

Virus

b.

Staphylococcus aureus

c.

Klebsiella pneumonia

d.

Moraxella catarrhalis

ANS: B

The most likely cause of empyema is Staphylococcus aureus.

The most likely cause of empyema is Staphylococcus aureus; it is not due to a virus.

The most likely cause of empyema is Staphylococcus aureus; it is not due to Klebsiella.

The most likely cause of empyema is Staphylococcus aureus; it is not due to Moraxella catarrhalis.

REF: p. 684

23. A 15-year-old female is diagnosed with restrictive lung disease caused by fibrosis. The patient had a pulmonary functions test. Which of the following findings is expected?

a.

Increased compliance

b.

Increased tidal volume

c.

Decreased respiratory rate

d.

Decreased functional residual capacity

ANS: D

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 disease.

In restrictive disease, tidal volume decreases.

Respirations may increase with restrictive disease.

REF: p. 686

24. A 57-year-old male presents with cough, sputum production, dyspnea, and decreased lung volume. He is diagnosed with pneumoconiosis. When taking the patients history, which finding is the most probable cause of his illness?

a.

Inhalation of silica, asbestos, mica

b.

Autoimmune disease

c.

Allergic reactions

d.

Flail chest

ANS: A

The dusts of silica, asbestos, and coal are the most common causes of pneumoconiosis.

The dusts of silica, asbestos, and coal are the most common causes of pneumoconiosis; it is not an autoimmune disorder.

The dusts of silica, asbestos, and coal are the most common causes of pneumoconiosis; it is not an allergic response.

The dusts of silica, asbestos, and coal are the most common causes of pneumoconiosis; it is not due to flail chest.

REF: p. 686

25. A 42-year-old female presents with dyspnea; rapid, shallow breathing; inspiratory crackles; decreased lung compliance; and hypoxemia. Tests reveal a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury. Which of the following is the most likely diagnosis the nurse will observe on the chart?

a.

Acute respiratory distress syndrome (ARDS)

b.

Sarcoidosis

c.

Postoperative respiratory failure

d.

Malignant respiratory failure

ANS: A

The patient is experiencing ARDS.

The patients symptoms demonstrate ARDS, not sarcoidosis.

The patients symptoms demonstrate ARDS, not postoperative respiratory failure.

The patient is experiencing ARDS, not malignant respiratory failure.

REF: p. 687

26. Which of the following shows a correct cause and effect sequence in the development of acute respiratory distress syndrome (ARDS)?

a.

Impaired alveolar compliance causing decreased surfactant production

b.

Alveolocapillary membrane injury causing a massive inflammatory response

c.

Hyaline membrane formation and fibrosis causing pulmonary edema

d.

Increased alveolocapillary membrane permeability causing metabolic alkalosis

ANS: B

All disorders causing ARDS cause massive pulmonary inflammation that injures the alveolocapillary membrane and produces severe pulmonary edema and inflammation.

All disorders causing ARDS cause massive pulmonary inflammation that injures the alveolocapillary membrane and produces severe pulmonary edema and inflammation. It does not affect surfactant.

ARDS does not cause hyaline formation.

Metabolic alkalosis occurs late, but inflammation occurs first.

REF: p. 687

27. A 60-year-old female with emphysema is having difficulty expiring a given volume of air. When giving report, the nurse will relay that the patient is most likely experiencing _____ pulmonary disease.

a.

Restrictive

b.

Obstructive

c.

Atelectatic

d.

Pleuritic

ANS: B

Emphysema is a form of obstructive pulmonary disease.

Emphysema is a form of obstructive pulmonary disease, not restrictive.

Emphysema is a form of obstructive pulmonary disease, not atelectatic.

Emphysema is a form of obstructive pulmonary disease, not pleuritic.

REF: p. 694

28. When the nurse is asked what causes asthma, how should the nurse respond? Asthma is thought to be caused by:

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

Asthma is an interaction between genetic and environmental factors.

Asthma is both genetic and environmental, but is not recessive.

Asthma is both genetic and environmental, but is not an autoimmune response.

Asthma is not due to excessive antibiotic use in childhood.

REF: p. 689

29. A nurse recalls asthma is classified by:

a.

Pathophysiologic differences

b.

Clinical severity

c.

Genetic traits

d.

Treatment outcomes

ANS: B

The National Asthma Education and Prevention Program offers stepwise guidelines for the diagnosis and management of chronic asthma based on clinical severity.

The National Asthma Education and Prevention Program offers stepwise guidelines for the diagnosis and management of chronic asthma based on clinical severity, not pathophysiologic differences.

The National Asthma Education and Prevention Program offers stepwise guidelines for the diagnosis and management of chronic asthma based on clinical severity, not genetic traits.

The National Asthma Education and Prevention Program offers stepwise guidelines for the diagnosis and management of chronic asthma based on clinical severity, not treatment outcomes.

REF: p. 691

30. A nurse is preparing to teach the staff about asthma. Which information should the nurse include? Airway hyper-responsiveness in asthma is related to:

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

Hyper-responsiveness is due to mast cell degranulation.

An increased sympathetic response would lead to bronchiolar dilation.

Hyper-responsiveness is due to mast cell degranulation, not to release of stress hormones.

Hyper-responsiveness is due to mast cell degranulation; heredity is associated with asthma, but the problem is the mast cells.

REF: p. 689

31. A nurse is preparing to teach the staff about asthma. Which information should the nurse include? Airway obstruction contributing to increased airflow resistance and hypoventilation in asthma is caused by:

a.

Type II alveolar cell injury and decreased surfactant

b.

Alveolar fibrosis and pulmonary edema

c.

Mucus secretion, bronchoconstriction, and airway edema

d.

Collapse of the cartilaginous rings in the bronchi

ANS: C

The mediators of asthma cause vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchospasm), and mucus 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.

REF: p. 689

32. A 10-year-old male is brought to the ER with prolonged bronchospasm and severe hypoxemia. The most likely diagnosis on the chart is:

a.

Exercise-induced asthma

b.

Chronic obstructive pulmonary disease (COPD)

c.

Status asthmaticus

d.

Bronchiectasis

ANS: C

When bronchospasm is not reversed by usual measures, the individual is considered to have severe bronchospasm or status asthmaticus.

When bronchospasm is not reversed by usual measures, the individual is considered to have severe bronchospasm or status asthmaticus; exercise-induced asthma resolves.

COPD is manifested by air trapping and hypercapnia, not by bronchospasm.

Bronchiectasis is manifested by bronchiolar changes, not bronchospasm.

REF: p. 691

33. A 22-year-old female presents with chronic bronchitis. Tests reveal closure of the airway during expiration. While planning care, a nurse recalls this condition is most likely caused by:

a.

Thick mucus from hypertrophied glands

b.

Ventilation-perfusion mismatch

c.

Hyperventilation

d.

Thinning smooth muscle in the bronchioles

ANS: A

Chronic bronchitis is defined by hypersecretion of thick mucus.

Ventilation-perfusion mismatch may occur, but chronic bronchitis is defined as hypersecretion of mucus.

Chronic bronchitis is defined as hypersecretion of mucus; dyspnea may occur, but hyperventilation is not expected.

Chronic bronchitis is defined as hypersecretion of mucus; thickening of smooth muscle occurs, not thinning.

REF: p. 693

34. A 25-year-old male presents with chronic bronchitis of 5 months duration. When obtaining the patients history, which of the following findings is most likely to cause this condition?

a.

Chronic asthma

b.

Air pollution

c.

Cigarette smoke

d.

Recurrent pneumonias

ANS: C

The most likely cause of chronic bronchitis is cigarette smoke.

The most likely cause of chronic bronchitis is cigarette smoke, not chronic asthma.

Air pollution may contribute, but smoking is the most common cause.

Recurrent infections could contribute, but smoking is the most common cause.

REF: p. 694

35. A 25-year-old male presents with chronic bronchitis of 5 months duration. Which of the following is the most significant concern for the nurse to monitor in this patient?

a.

Left heart failure

b.

Pulmonary embolus

c.

Immunosuppression

d.

Recurrent pulmonary infections

ANS: D

Recurrent pulmonary infections are a significant concern for this patient.

Recurrent infections, not left heart failure, are a significant concern for a patient with bronchitis.

Recurrent infections, not pulmonary embolus, are a significant concern for a patient with bronchitis.

Recurrent infections, not immunosuppression, are a significant concern for a patient with bronchitis.

REF: p. 693

36. A 53-year-old male with a 20-year history of smoking is diagnosed with emphysema. When a staff member asks why the patients airways are obstructed, how should the nurse respond? The airways are obstructed because of:

a.

Excessive mucus production

b.

Loss of elastic recoil

c.

Infection and inflammation

d.

Airway edema

ANS: B

The major mechanism of airflow limitation is loss of elastic recoil.

The major mechanism of airflow limitation is loss of elastic recoil, not excessive mucus as with bronchitis.

The major mechanism of airflow limitation is loss of elastic recoil, not infection.

The major mechanism of airflow limitation is loss of elastic recoil, not airway edema.

REF: p. 694

37. A 53-year-old male with a 20-year history of smoking is diagnosed with emphysema. When the nurse is asked what causes this, what is the nurses best response? Changes in his lungs are caused by:

a.

Viral infections

b.

Destruction of alveolar macrophages

c.

Alpha-1-antitrypsin deficiency

d.

Fibrotic lung disease

ANS: C

Changes in the lungs are associated with alpha-1-antitrypsin deficiency.

Changes in the lungs are associated with alpha-1-antitrypsin deficiency; it is not due to viral infections.

Changes in the lungs are associated with alpha-1-antitrypsin deficiency; it is not due to alveolar macrophage destruction.

Changes in the lungs are associated with alpha-1-antitrypsin deficiency; it is not due to fibrotic lung disease.

REF: p. 695

38. Individuals with a recent diagnosis of emphysema should be assessed for which most common presenting factor?

a.

A productive cough

b.

Cyanosis

c.

Dyspnea

d.

Cor pulmonale

ANS: C

Dyspnea is the most common presenting factor of emphysema.

Dyspnea, not a productive cough, is the most common presenting factor of emphysema.

Dyspnea, not cyanosis, is the most common presenting factor of emphysema.

Dyspnea, not cor pulmonale, is the most common presenting factor of emphysema.

REF: p. 694

39. A 60-year-old female with a 25-year history of smoking is diagnosed with emphysema. She has an increased anterior-posterior chest diameter. The nurse attributes this finding to:

a.

Air trapping

b.

Decreased inspiratory reserve volumes

c.

Increased flow rates

d.

Alveolar destruction

ANS: A

Air trapping expands the thorax, putting the respiratory muscles at a mechanical disadvantage.

Air trapping expands the thorax, putting the respiratory muscles at a mechanical disadvantage.

Air trapping, not increased flow rates, expands the thorax, putting the respiratory muscles at a mechanical disadvantage.

Air trapping, not alveolar destruction, expands the thorax putting the respiratory muscles at a mechanical disadvantage.

REF: p. 693

40. A patient asks what causes pneumonia. How should the nurse reply? Pneumonia is caused by:

a.

Use of anesthetic agents in surgery

b.

Atelectasis

c.

Chronic lung changes seen with aging

d.

Viral or bacterial infections

ANS: D

Pneumonia is caused by a viral or bacterial infection.

Pneumonia is caused by a viral or bacterial infection; infections are not caused by anesthetic agents.

Pneumonia is caused by a viral or bacterial infection; atelectasis does not cause pneumonia.

Pneumonia is caused by a viral or bacterial infection; lung changes in aging are normal changes, not infectious.

REF: p. 694

41. When the nurse observes a diagnosis of nosocomial pneumonia, the patient generally acquires this pneumonia:

a.

At day care centers

b.

On airplanes

c.

During hospitalization

d.

In the winter season

ANS: C

Nosocomial infections are acquired in the hospital.

Nosocomial infections are acquired in the hospital, not day care centers.

Nosocomial infections are acquired in the hospital, not airplanes.

Nosocomial infections are acquired in the hospital; it may happen in any season.

REF: p. 694

42. A 30-year-old male prison inmate contracted tuberculosis during an outbreak. When the nurse reviews the lab results, the organism that caused this condition is a:

a.

Bacterium

b.

Fungus

c.

Virus

d.

Parasite

ANS: A

The organism that causes tuberculosis is a bacterium.

The organism that causes tuberculosis is a bacterium, not a fungus.

The organism that causes tuberculosis is a bacterium, not a virus.

The organism that causes tuberculosis is a bacterium, not a parasite.

REF: p. 697

43. A 30-year-old male prison inmate contracted tuberculosis during an outbreak. While planning interactions, the nurse realizes the patient can transmit this disease through:

a.

Skin contact

b.

Fecal-oral contact

c.

Airborne droplets

d.

Blood transfusions

ANS: C

Tuberculosis is transmitted through airborne droplets.

Tuberculosis is transmitted through airborne droplets, not skin contact.

Tuberculosis is transmitted through airborne droplets, not fecal-oral contact.

Tuberculosis is transmitted through airborne droplets, not through a blood transfusion.

REF: p. 697

44. A 70-year-old female is in the hospital for pelvic fracture. She develops pulmonary thromboembolism. The nurse realizes this embolus is composed of:

a.

Fat

b.

Air

c.

Tissue fragment

d.

Blood clot

ANS: D

A thromboembolism is composed of a blood clot.

A thromboembolism is composed of a blood clot, not fat.

A thromboembolism is composed of a blood clot, not air.

A thromboembolism is composed of a blood clot, not a tissue fragment.

REF: p. 698

45. Which of the following patients is at highest risk for developing pulmonary 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

The 72-year-old is at risk for immobility and at increased risk for PE.

The 72-year-old is at risk for immobility and at increased risk for PE.

The 72-year-old is at risk for immobility and at increased risk for PE.

The 72-year-old is at risk for immobility and at increased risk for PE.

REF: p. 698

46. An 80-year-old female is in the hospital for a bone fracture. While there she develops a large, nonlethal pulmonary embolus. Which of the following is a direct result of the obstruction to pulmonary blood flow?

a.

Pulmonary hypertension

b.

Systemic hypertension

c.

Pulmonary edema

d.

Risk of cerebral emboli

ANS: A

Significant obstruction of the pulmonary vasculature leads to increased pulmonary artery pressures (pulmonary hypertension).

The pressure is in the pulmonary bed; it is not systemic.

Pulmonary edema occurs secondary to heart failure.

Pulmonary emboli obstruct blood flow in the pulmonary vasculature, they do not increase the risk of cerebral emboli.

REF: p. 698

47. When a patient has a massive pulmonary embolism (PE), what complications will the nurse monitor for?

a.

Damage to the lung microcapillaries

b.

Chronic obstructive pulmonary disease (COPD)

c.

Disseminated intravascular coagulation (DIC)

d.

Shock and death

ANS: D

A massive PE will lead to shock and death.

A massive PE will lead to shock and death; damage to lung capillaries can occur, but death is more likely.

COPD is not associated with PE.

DIC may occur, but is not as likely as shock and death.

REF: pp. 698-699

48. A 50-year-old male is diagnosed with pulmonary embolism (PE). Which of the following symptoms most likely occurred before treatment?

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

An individual with PE usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety.

Individuals with PE experience chest pain and shortness of breath, not a cough.

Individuals with PE experience chest pain and shortness of breath, not wheezing.

Individuals with PE experience chest pain and shortness of breath; Kussmaul respirations are associated with acidosis.

REF: p. 698

49. A 60-year-old male undergoes surgery for a bone fracture. Which of the following nursing measures would be most effective for preventing pulmonary embolism (PE) in this patient?

a.

Ensure that patient uses supplemental oxygen.

b.

Prevent deep vein thrombosis formation.

c.

Check hematocrit and hemoglobin levels frequently during the postoperative period.

d.

Promote aggressive fluid intake.

ANS: B

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.

Prevention of DVT is the most effective measure for preventing PE; oxygen will not prevent emboli.

Prevention of DVT is the most effective measure for preventing PE; checking hemoglobin and hematocrit will not prevent emboli.

Fluid intake will help, but it is not as important as preventing DVT.

REF: p. 698

50. A 50-year-old male with a 30-year history of smoking was diagnosed with lung cancer. He was previously exposed to air pollution, asbestos, and radiation at his job. Which of the following should the nurse realize had the greatest impact on the development of his cancer?

a.

Radiation

b.

Cigarette smoke

c.

Asbestos

d.

Air pollution

ANS: B

The most common cause of lung cancer is tobacco smoking.

The most common cause of lung cancer is tobacco smoking, not radiation.

The most common cause of lung cancer is tobacco smoking, not asbestos.

The most common cause of lung cancer is tobacco smoking, not air pollution.

REF: p. 701

51. A 60-year-old male with a 40-year history of smoking presents with chest pain, cough, sputum production, and pneumonia. Tests reveal widespread metastatic cancer, and the primary care provider plans radiation therapy. Which of following is the most likely type of cancer to be documented on the chart?

a.

Adenoma

b.

Non-small cell carcinoma

c.

Small cell carcinoma

d.

Basal cell carcinoma

ANS: B

For individuals with non-small cell carcinoma, adjunctive radiation and chemotherapy may improve outcomes.

Adenomas of the lung are usually asymptomatic.

Small cell carcinomas are more easily treated.

Basal cell carcinoma does not affect the bronchi.

REF: p. 702

MULTIPLE RESPONSE

1. Which of the following assessment findings would be expected in pulmonary embolism (PE)? (Select all that apply.)

a.

Chest pain

b.

Tachycardia

c.

Tachypnea

d.

Fever

e.

Hemoptysis

ANS: A, B, C, D, E

An individual with PE usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety. Occasionally syncope (fainting) or hemoptysis occurs. With large emboli, a pleural friction rub, pleural effusion, fever, and leukocytosis may be noted. Recurrent small emboli may not be detected until progressive incapacitation, precordial pain, anxiety, dyspnea, and right ventricular enlargement are exhibited. Massive occlusion causes severe pulmonary hypertension and shock.

REF: p. 698

2. Which of the following are characteristic of idiopathic pulmonary arterial hypertension (IPAH)? (Select all that apply.)

a.

Male gender

b.

Fatigue

c.

Dyspnea

d.

Jugular vein distention

e.

Weight gain

ANS: B, C, D

IPAH is a rare condition and usually occurs in women between the ages of 20 and 40. Manifestations of fatigue, chest discomfort, tachypnea, and dyspnea (particularly with exercise) are common. Examination may reveal peripheral edema, jugular venous distension, a precordial heave, and accentuation of the pulmonary component of the second heart sound.

REF: p. 699

COMPLETION

1. A nurse is monitoring a patient for pulmonary hypertension. Which mean pulmonary artery pressure reading will indicate to the nurse that pulmonary hypertension is occurring? Pulmonary artery pressure above _____ mm Hg.

ANS: 25

REF: p. 699

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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