Chapter 36

Question 1

Besides dyspnea, what is the most common characteristic associated with pulmonary disease?
a. Chest pain
b. Digit clubbing
c. Cough
d. Hemoptysis

Answer 1

c. Cough

Pulmonary disease is associated with many signs and symptoms, and their specific characteristics often help in identifying the underlying disorder. The most common
characteristics are dyspnea and cough. Others include abnormal sputum, hemoptysis, altered
breathing patterns, hypoventilation and hyperventilation, cyanosis, clubbing of the digits, and
chest pain.

Question 2

A patient reports needing to sit up at night in order to breathe. What term does the healthcare
professional document about this condition?
a. Hyperpnea
b. Orthopnea
c. Apnea
d. Atelectasis

Answer 2

b. Orthopnea

Orthopnea is seen in patients with heart failure. When they lie down, abdominal pressure on the
lungs causes dyspnea and the person needs to sit up in order to breathe. Hyperpnea is an
increased rate and depth of breathing. Apnea is the absence of breathing. Atelectasis is the
collapse of lung tissue.

Question 3

Kussmaul respirations as a respiratory pattern may be associated with which characteristic(s)?
a. Alternating periods of deep and shallow breathing
b. Increased work of breathing
c. Inadequate alveolar ventilation in relation to metabolic demands
d. Slightly increased ventilatory rate, large tidal volumes, and no expiratory pause

Answer 3

d. Slightly increased ventilatory rate, large tidal volumes, and no expiratory pause

Kussmaul respirations are characterized by a slightly increased ventilatory rate, very large tidal
volume, and no expiratory pause. Alternating periods of deep and shallow breathing characterize
Cheyne-Stokes breathing. Increased work of breathing is seen in labored breathing. Inadequate
alveolar ventilation describes hypoventilation.

Question 4

Respirations that are characterized by alternating periods of deep and shallow breathing are a
result of which respiratory mechanism?
a. Decreased blood flow to the medulla oblongata
b. Increased partial pressure of arterial carbon dioxide (PaCO2)
c. Stimulation of stretch or J-receptors
d. Fatigue of the intercostal muscles and diaphragm

Answer 4

a. Decreased blood flow to the medulla oblongata

Alternating periods of deep and shallow breathing are characteristic of Cheyne-Stokes
respirations and are the result of any condition that slows the blood flow to the brainstem, which
in turn slows impulses that send information to the respiratory centers of the brainstem. The
medulla oblongata contains the respiratory center and is where the autonomic functions of
respiration originate. An increased PaCO2 would lead to Kussmaul respirations. The intercostal
muscles help move the chest wall during breathing and if fatigued, might lead to hypoventilation.

Question 5

A hospitalized patient is complaining of shortness of breath, but the student does not notice
cyanosis. The patient’s hemoglobin is 9 g/dL, so the student asks the healthcare professional to
explain. The professional tells the student that what amount of hemoglobin must be desaturated
before cyanosis occurs?
a. 3
b. 5
c. 7
d. 9

Answer 5

b. 5

Cyanosis generally develops when 5 g/dL of hemoglobin is desaturated, regardless of
hemoglobin concentration. So even though the patient is anemic and has less oxygen-carrying
capacity, if less than 5 g/dL of hemoglobin is desaturated, the patient will not show cyanosis.

Question 6

What does the student learn about ventilation?
a. Hypoventilation causes hypocapnia.
b. Hypoventilation causes alkalosis.
c. Hyperventilation causes hypocapnia.
d. Hyperventilation causes acidosis.

Answer 6

c. Hyperventilation causes hypocapnia.

Hyperventilation is alveolar ventilation that exceeds metabolic demands. The lungs remove
carbon dioxide at a faster rate than produced by cellular metabolism, resulting in decreased
PaCO2 or hypocapnia. A decreased PaCO2 would lead to alkalosis. Hypoventilation would lead
to hypercapnia and acidosis.

Question 7

A patient has long-standing pulmonary disease and chronic hypoxia. The student assesses the
patient’s fingertips and notices bulbous enlargement of the distal segment of the digits. How
does the student document this finding?
a. Edema
b. Clubbing
c. Angling
d. Osteoarthropathy

Answer 7

b. Clubbing

Clubbing is the selective bulbous enlargement of the end (distal segment) of a digit (finger or
toe) and is commonly associated with diseases that interfere with oxygenation, such as
bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and congenital heart disease.
Edema is swelling caused by fluid retention. The normal angle of the fingernail at the nail
plate/proximal end of the nail is 160 degrees or less. Angling would describe an angle of >180
degrees indicates clubbing. Osteoarthropathy is a generic term for any disease of bone or joint.

Question 8

The student asks the healthcare professional to explain how pulmonary edema and pulmonary
fibrosis cause hypoxemia. What description by the professional is best?
a. Creates alveolar dead space
b. Decreases the oxygen in inspired gas
c. Creates a right-to-left shunt
d. Impairs alveolocapillary membrane diffusion

Answer 8

d. Impairs alveolocapillary membrane diffusion

Diffusion of oxygen through the alveolocapillary membrane is impaired if the alveolocapillary
membrane is thickened or if the surface area available for diffusion is decreased. Abnormal
thickness, as occurs with edema (tissue swelling) and fibrosis (formation of fibrous lesions),
increases the time required for diffusion across the alveolocapillary membrane. These diseases
do not create dead space, decrease the FIo2 of inspired air, or create a shunt.

Question 9

High altitudes may produce hypoxemia through which mechanism?
a. Shunting
b. Hypoventilation
c. Decreased inspired oxygen
d. Diffusion abnormalities

Answer 9

c. Decreased inspired oxygen

The presence of adequate oxygen content of the inspired air is the first factor to consider
regarding hypoxia. Oxygen content is lessened at high altitudes which can produce hypoxemia.
High altitudes do not produce shunting, hypoventilation, or diffusion abnormalities.

Question 10

Which condition is capable of producing alveolar dead space?
a. Pulmonary edema
b. Pulmonary emboli
c. Atelectasis
d. Pneumonia

Answer 10

b. Pulmonary emboli

A pulmonary embolus that impairs blood flow to a segment of the lung results in an area where
alveoli are ventilated but not perfused, which causes alveolar dead space. Alveolar dead space is
not the result of pulmonary edema, atelectasis, or pneumonia.

Question 11

A patient has pulmonary edema. For what condition should the healthcare professional assess the
patient as the priority?
a. Right-sided heart failure
b. Left-sided heart failure
c. Mitral valve prolapse
d. Aortic stenosis

Answer 11

b. Left-sided heart failure

The most common cause of pulmonary edema is left-sided heart failure. When the left ventricle
fails, filling pressures on the left side of the heart increase and cause a concomitant increase in
pulmonary capillary hydrostatic pressure, leading to pulmonary edema.

Question 12

A patient has a pulmonary capillary wedge pressure of 30mmHg. What assessment finding by
the healthcare professional would be most consistent with this reading?
a. Normal lung sounds
b. Pink, frothy sputum
c. Eupnea
d. Rhonchi

Answer 12

b. Pink, frothy sputum

Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or left
atrial pressure of 20 mmHg. Signs of pulmonary edema include dyspnea, hypoxemia, and
increased work of breathing. Physical examination may reveal inspiratory crackles (rales),
dullness to percussion over the lung bases, and evidence of ventricular dilation (S3 gallop and
cardiomegaly). In severe edema, pink, frothy sputum is expectorated, hypoxemia worsens, and
hypoventilation with hypercapnia may develop. Eupnea is normal work of breathing. Rhonchi
are low-pitched rumbling lung sounds due to turbulent airflow due to obstruction or secretions in
the large airways.

Question 13

A patient has a lung problem caused by dysfunction in the pores of Kohn. What action by the
healthcare professional is best?
a. Have the patient drink plenty of water.
b. Give the patient supplemental oxygen.
c. Have the patient do breathing exercises.
d. Withhold pain medicine so the patient stays awake.

Answer 13

c. Have the patient do breathing exercises.

The pores of Kohn, which open only during deep breathing, allow air to pass from well-
ventilated alveoli to obstructed alveoli. A dysfunction in this system would lead to absorption
atelectasis, which is the result of gradual absorption of air from obstructed or hypoventilated
alveoli. The professional should have the patient do breathing exercises, including using an
incentive spirometer. Water will thin any secretions the patient has but will not directly improve
ventilation. The patient may need oxygen if the oxygen saturations are low, but this does not
address the cause. Withholding pain medication will lead to a patient being unwilling to move
about or do breathing exercises.

Question 14

In what form of bronchiectasis do both constrictions and dilations deform the bronchi?
a. Varicose
b. Symmetric
c. Cylindric
d. Saccular

Answer 14

a. Varicose

Bronchiectasis is persistent abnormal dilation of the bronchi. Bronchial dilation may be
cylindrical (cylindrical bronchiectasis), with symmetrically dilated airways, as can be seen after
pneumonia and is reversible; saccular (saccular bronchiectasis), in which the bronchi become
large and balloon-like; or varicose (varicose bronchiectasis), in which constrictions and dilations
deform the bronchi, creating a bulbous appearance

Question 15

A patient is brought to the Emergency Department with a gunshot wound to the chest. The healthcare professional assesses an abnormality involving a pleural rupture that acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration. What action by the healthcare professional is the priority?
a. Draw arterial blood gasses.
b. Assist with a chest tube insertion.
c. Give the patient low-flow oxygen.
d. Assess for clubbing of fingernails.

Answer 15

b. Assist with a chest tube insertion.

In a tension pneumothorax, the site of pleural rupture acts as a one-way valve, permitting air to
enter on inspiration but preventing its escape by closing up during expiration. As more and more
air enters the pleural space, air pressure in the pneumothorax begins to exceed barometric
pressure. Air pressure in the pleural space pushes against the already recoiled lung, causing compression atelectasis, and against the mediastinum, compressing and displacing the heart,
great vessels, and trachea. This is an emergency condition requiring chest tube insertion or
immediate needle decompression. Arterial blood gas results will not change the treatment plan.
This patient may need oxygen if definitive treatment is delayed, but it would need to be high-flow oxygen. Clubbing of fingernails occurs in chronic hypoxemic conditions. The professional should assist with immediate needle decompression or chest tube insertion.

Question 16

A patient has a transudative pleural effusion but has minimal symptoms. What action by the
healthcare professional is best?
a. Prepare for an immediate chest tube insertion.
b. Encourage the patient to use the incentive spirometer.
c. Facilitate a blood draw to check protein stores.
d. Arrange for an oncology consultation.

Answer 16

c. Facilitate a blood draw to check protein stores.

In transudative pleural effusion, the fluid, or transudate, is watery and diffuses out of the
capillaries as a result of disorders that increase intravascular hydrostatic pressure or decrease
capillary oncotic pressure. Examples are congestive heart failure, in which venous and left atrial
pressures are increased, and liver or kidney disorders that cause hypoproteinemia.
Hypoproteinemia decreases capillary oncotic pressure, which promotes diffusion of water out of
the capillaries. The best action for the professional is to assess the patient’s protein stores
through blood analysis. The patient does not need a chest tube since the symptoms are minimal.
An incentive spirometer will not provide definitive information to treat the problem. Exudative
effusions are caused by inflammation, infection, or malignancy, so this patient does not need an
oncology consult.

Question 17

Which condition involves an abnormally enlarged gas-exchange system and the destruction of
the lung’s alveolar walls?
a. Transudative effusion
b. Emphysema
c. Exudative effusion
d. Abscess

Answer 17

b. Emphysema

Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied
by the destruction of alveolar walls without obvious fibrosis. An effusion is the presence of fluid
in the pleural space that can be caused by hypoproteinemia (transudative) or malignancy,
infection, or inflammation (exudative). An abscess is a collection of pus.

Question 18

A patient has been diagnosed with pneumoconiosis and asks the healthcare professional to explain this disease. What description by the professional is best?
a. Pneumococci bacteria
b. Inhalation of inorganic dust particles
c. Exposure to asbestos
d. Inhalation of cigarette smoke

Answer 18

b. Inhalation of inorganic dust particles

Pneumoconiosis represents any change in the lung caused by the inhalation of inorganic dust
particles, which usually occurs in the workplace. The dusts of silica, asbestos, and coal are the
most common causes of pneumoconiosis. Others include talc, fiberglass, clays, mica, slate,
cement, and metals. Pneumococci bacteria would cause pneumococcal pneumonia. Asbestos
exposure can cause mesothelioma. Cigarette smoke is the leading cause of lung cancer.

Question 19

A patient has been diagnosed with acute respiratory distress syndrome (ARDS). For what other
health condition should the healthcare professional assess this patient for as the priority?
a. Heart failure
b. Pneumonia
c. Pulmonary emboli
d. Acute pulmonary edema

Answer 19

b. Pneumonia

ARDS is a fulminant form of respiratory failure characterized by acute lung inflammation and
diffuse alveolocapillary injury not attributed to heart failure or fluid overload. All disorders causing ARDS cause acute immune cell-mediated injury to the alveolocapillary membrane
producing massive inflammation, increased capillary permeability, and alveolar flooding with
protein-rich fluid that overwhelms ion channels and lymphatic removal of fluid. The most common predisposing factors for ARDS are genetic factors, sepsis, and multiple trauma
(especially when multiple transfusions are received). However, there are many other causes, including pneumonia, burns, aspiration, cardiopulmonary bypass surgery, pancreatitis, drug overdose, smoke or noxious gas inhalation, oxygen toxicity, radiation therapy, and disseminated
intravascular coagulation. Alcohol abuse and smoking are preventable environmental risk factors.

Question 20

Which structure(s) in acute respiratory distress syndrome (ARDS) release inflammatory
mediators such as proteolytic enzymes, oxygen-free radicals, prostaglandins, leukotrienes, and
platelet-activating factor?
a. Complement cascade
b. Mast cells
c. Macrophages
d. Neutrophils

Answer 20

d. Neutrophils

The role of neutrophils is central to the development of ARDS. Activated neutrophils release a
battery of inflammatory mediators, among them proteolytic enzymes, oxygen-free radicals (superoxide radicals, hydrogen peroxide, hydroxyl radicals), arachidonic acid metabolites
(prostaglandins, thromboxanes, leukotrienes), and platelet-activating factor. These mediators
cause extensive damage to the alveolocapillary membrane and greatly increase capillary membrane permeability. The described responses are not associated with the other options.

Question 21

Pulmonary edema in acute respiratory distress syndrome (ARDS) is the result of an increase in
what?
a. Levels of serum sodium and water
b. Capillary permeability
c. Capillary hydrostatic pressure
d. Oncotic pressure

Answer 21

b. Capillary permeability

Increased capillary permeability, a hallmark of ARDS, allows fluids, proteins, and blood cells to
leak from the capillary bed into the pulmonary interstitium and alveoli. The resulting pulmonary
edema and hemorrhage severely reduce lung compliance and impair alveolar ventilation. The
pulmonary edema seen in ARDS is not the result of sodium and water concentrations, capillary
hydrostatic pressure, or oncotic pressure.

Question 22

In acute respiratory distress syndrome (ARDS), alveoli and respiratory bronchioles fill with fluid
as a result of which mechanism?
a. Compression on the pores of Kohn, thus preventing collateral ventilation
b. Increased capillary permeability, which causes alveoli to fill with fluid
c. Inactivation of surfactant and the impairment of type II alveolar cells
d. Increased capillary hydrostatic pressure that forces fluid into the alveoli

Answer 22

c. Inactivation of surfactant and the impairment of type II alveolar cells

Lung inflammation and injury damage the alveolar epithelium and the vascular endothelium in
ARDS. Surfactant is inactivated, and its production by type II alveolar cells is impaired as
alveoli and respiratory bronchioles fill with fluid or collapse. The other processes would not
trigger the described response.

Question 23

Which type of pulmonary disease requires more force to expire a volume of air?
a. Restrictive
b. Obstructive
c. Acute
d. Communicable

Answer 23

b. Obstructive

Obstructive pulmonary disease is characterized by airway obstruction that is worse with
expiration. Either more force (i.e., the use of accessory muscles of expiration) or more time is
required to expire a given volume of air. Restrictive disorders are characterized by decreased
lung tissue compliance. Acute means sudden onset, or severe. Communicable means
transmittable.

Question 24

Which immunoglobulin (Ig) may contribute to the pathophysiologic characteristics of asthma?
a. IgA
b. IgE
c. IgG
d. IgM

Answer 24

b. IgE

Asthma is a familial disorder, and more than 100 genes have been identified that may play a role
in the susceptibility of and the pathogenetic mechanisms that cause asthma, including those that
influence the production of interleukin (IL)-4, IL-5, and IL-13; IgE; eosinophils; mast cells;
adrenergic receptors; and leukotrienes. The pathophysiologic characteristics of asthma are not
associated with other immunoglobulins.

Question 25

A healthcare professional is educating a patient about asthma. The professional states that good
control is necessary due to which pathophysiologic process?
a. Norepinephrine causes bronchial smooth muscle contraction and mucus secretion
but it also causes high blood pressure.
b. Uncontrolled inflammation leads to increased bronchial hyperresponsiveness and
eventual scarring.
c. The release of epinephrine leads to development of cardiac dysrhythmias.
d. Immunoglobulin G causes smooth muscle contraction which will eventually
weaken the respiratory muscles.

Answer 25

b. Uncontrolled inflammation leads to increased bronchial hyperresponsiveness and
eventual scarring.

The late asthmatic response begins 4 to 8 hours after the early response when the release of toxic
neuropeptides contributes to increased bronchial hyperresponsiveness. Untreated inflammation
leads to increased scarring and remodeling of pulmonary tissue, so good control of asthma is
necessary to prevent that complication. Poor asthma control does not specifically lead to
hypertension or dysrhythmias, nor will it permanently weaken respiratory muscles.

Question 26

A patient comes to the Emergency Department with inspiratory and expiratory wheezing,
dyspnea, nonproductive cough, and tachypnea. What treatment does the healthcare professional
anticipate for this patient as the priority?
a. Sputum culture
b. History of illness exposure
c. Antibiotics
d. Inhaled bronchodilator

Answer 26

d. Inhaled bronchodilator

Asthma is characterized by expiratory wheezing, dyspnea, nonproductive coughing, prolonged
expiration, tachycardia, and tachypnea. Severe attacks involve the use of accessory muscles of
respiration, and wheezing is heard during both inspiration and expiration. The treatment consists
of inhaled -agonist bronchodilators, oxygen if needed, and corticosteroids. After the patient has
been stabilized, the healthcare professional attempts to determine the cause of the attack, which
would include a possible sputum culture and getting a history of any recent exposures to illness.
Antibiotics will be given for a bacterial infection, such as pneumonia or pharyngitis, that led to
the attack.

Question 27

A healthcare professional is educating a patient on asthma. The professional tells the patient that
the most successful treatment for chronic asthma begins with which action?
a. Avoidance of the causative agent
b. Administration of broad-spectrum antibiotics
c. Administration of drugs that reduce bronchospasm
d. Administration of drugs that decrease airway inflammation

Answer 27

a. Avoidance of the causative agent

Chronic management of asthma begins with the avoidance of allergens and other triggers. The
need for other treatments is reliant on the avoidance of triggers.

Question 28

Which factor contributes to the production of mucus associated with chronic bronchitis?
a. Airway injury
b. Pulmonary infection
c. Increased Goblet cell size
d. Bronchospasms

Answer 28

c. Increased Goblet cell size

Continual bronchial inflammation causes bronchial edema and increases the size and number of
mucous glands and goblet cells in the airway epithelium. Thick, tenacious mucus is produced
and cannot be cleared because of impaired ciliary function. The lung’s defense mechanisms are
therefore compromised, increasing a susceptibility to pulmonary infection, which contributes to
airway injury. Frequent infectious exacerbations are complicated by bronchospasm with dyspnea
and productive cough.

Question 29

A patient with emphysema comes to the clinic and reports increased, productive cough. What
diagnostic test should the healthcare professional facilitate as the priority?
a. Chest x-ray
b. Peak expiratory flow
c. Pulmonary function tests
d. Sputum culture

Answer 29

a. Chest x-ray

The cough in emphysema is generally not productive, unless the patient has an acute
exacerbation, which can be caused by a pulmonary infection. The best way to diagnose an
infection such as pneumonia is with a chest x-ray. A sputum culture would be helpful to specify
the organism for tailored treatment, but is not required for the diagnosis. Pulmonary function
studies might be ordered later to see if the patient’s disease has progressed, but would not be
ordered during an acute illness. Peak expiratory flow is usually used to monitor asthma. The
professional should expedite a chest x-ray.

Question 30

A patient has been diagnosed with primary emphysema but claims there is no history of
smoking. What action by the healthcare professional is most appropriate?
a. Facilitate genetic testing on the patient.
b. Ask the family if the patient smokes.
c. Schedule pulmonary function studies.
d. Get baseline arterial blood gasses.

Answer 30

a. Facilitate genetic testing on the patient.

Although emphysema is usually caused by smoking, a mutation in the 1-antitrypsin gene results
in the development of the disease in younger, nonsmokers. The healthcare professional would
facilitate this test. There is no reason to ask the family of a patient about the patient’s smoking
history unless the patient was unable to answer questions on his or her own. Pulmonary function
studies will be done at some time, but does not help determine the etiology of the disease.
Baseline arterial blood gasses would not be needed.

Question 31

Which of these is the most common route of lower respiratory tract infection?
a. Aspiration of oropharyngeal secretions
b. Inhalation of microorganisms
c. Microorganisms spread to the lung via blood
d. Poor mucous membrane protection

Answer 31

a. Aspiration of oropharyngeal secretions

Aspiration of oropharyngeal secretions is the most common route of lower respiratory tract
infection; thus the nasopharynx and oropharynx constitute the first line of defense for most
infectious agents. Inhalation of microorganisms and spread of organisms via the blood do occur
but much less frequently. Poor mucus membrane protection would increase a person’s risk of
infection but is not a common direct route of infection.

Question 32

A patient has recently been diagnosed with emphysema. What initial step in management of this
disease does the healthcare professional discuss with the patient?
a. Inhaled anticholinergic agents
b. Beta agonists
c. Cessation of smoking
d. Surgical reduction of lung volume

Answer 32

c. Cessation of smoking

Chronic management of emphysema begins with smoking cessation. As long as the patient
continues to smoke, the disease will worsen. Pharmacologic management includes inhaled
anticholinergic agents and beta agonists. Pulmonary rehabilitation, improved nutrition, and
breathing techniques all can improve symptoms. Oxygen therapy is indicated in chronic
hypoxemia but must be administered with care. In selected patients, lung volume reduction
surgery or transplantation can be considered.

Question 33

The student asks a professor to explain how tuberculosis (TB) can remain dormant in some
people. What explanation by the professor is best?
a. It does not remain dormant but some host defenses can kill the bacteria.
b. The bacilli can become isolated within tubercles in the lungs.
c. Macrophages attack and phagocytize new areas of infection.
d. Virulence factors in the bacilli weaken over time leading to apoptosis.

Answer 33

b. The bacilli can become isolated within tubercles in the lungs.

Neutrophils, lymphocytes, and macrophages seal off colonies of the TB bacilli, forming
granulomatous tubercles of scar tissue that isolates them. In this manner, and with developing
immunity, TB can remain dormant sometimes for years or for life. Some bacilli are killed by host
defenses but not enough to rid to body of the disease. Macrophages do phagocytize some of the
bacilli. Virulence factors do not weaken over time.

Question 34

Pulmonary artery hypertension (PAH) results from which alteration?
a. Narrowed pulmonary capillaries
b. Narrowed bronchi and bronchioles
c. Destruction of alveoli
d. Ischemia of the myocardium

Answer 34

a. Narrowed pulmonary capillaries

PAH is characterized by endothelial dysfunction with an overproduction of vasoconstrictors
(e.g., thromboxane, endothelin) and decreased production of vasodilators (e.g., nitric oxide,
prostacyclin), resulting in narrowed pulmonary capillaries. This process does not occur in
bronchi and bronchioles and does not include destruction of the alveoli or ischemia of the
myocardium.

Question 35

Squamous cell carcinoma of the lung is best described as a tumor that causes which alterations?
a. Abscesses and ectopic hormone production
b. Pneumonia and atelectasis
c. Pleural effusion and shortness of breath
d. Chest wall pain and early metastasis

Answer 35

b. Pneumonia and atelectasis

Typically, the tumors are centrally located near the hila and project into bronchi. Because of this
central location, nonproductive cough or hemoptysis is common. Pneumonia and atelectasis are
often associated with squamous cell carcinoma. Chest pain is a late symptom associated with
large tumors. Ectopic hormone secretion can occur with small cell carcinoma of the lung.
Adenocarcinoma, large cell carcinoma, and mesothelioma can produce pleural effusions. Early
metastasis and chest wall pain occur with large cell carcinoma although many types do have
early metastases. Chest pain is also a common finding, although chest wall pain is specific to
large cell carcinoma.

Question 36

A patient is diagnosed with a pneumothorax and asks the healthcare professional to explain this
condition. What statement by the professional is most accurate?
a. Blood in your chest cavity
b. Air in the pleural space
c. Pus in the pleural space
d. Collapse of small airways

Answer 36

b. Air in the pleural space

Pneumothorax is the presence of air or gas in the pleural space caused by a rupture in the visceral
pleura (which surrounds the lungs) or the parietal pleura and chest wall. Blood in the pleural
space describes a hemothorax. Pus in the pleural space is an empyema. Collapse of small airways
describes atelectasis.

Question 37

A patient has been diagnosed with an empyema. What does the healthcare professional tell the
patient about this condition?
a. We will have to drain the pus out of your pleural space.
b. You will be given a long course of antiviral medication.
c. These blebs in your lungs can rupture with exercise.
d. We will watch you for respiratory muscle fatigue.

Answer 37

a. We will have to drain the pus out of your pleural space.

Empyema is the presence of pus in the pleural space. The usual treatment is drainage of the
pleural space with a chest tube and administration of antibiotics (not antivirals). Blebs are the
cause of some cases of spontaneous pneumothorax and they can rupture with exercise.
Respiratory muscle fatigue may develop with empyema, but this is a vague finding not directly
related to empyema.

Question 38

Fluid in the pleural space characterizes which condition?
a. Pleural effusion
b. Atelectasis
c. Bronchiectasis
d. Ischemia

Answer 38

a. Pleural effusion

Pleural effusion is the presence of fluid in the pleural space. Atelectasis is the collapse of small
airways. Bronchiectasis is persistent and abnormal dilation of bronchi. Ischemia is inadequate
blood supply to the tissues.

Question 39

A patient has silicosis. Which medication classification does the healthcare professional educate
the patient about?
a. Corticosteroids
b. Antibiotics
c. Bronchodilators
d. Expectorants

Answer 39

a. Corticosteroids

No specific treatment exists for silicosis, although corticosteroids may produce some
improvement in the early, more acute stages. Patients with silicosis are not usually treated with
antibiotics, bronchodilators, or expectorants unless individual circumstances warrant these drugs.

Question 40

What medical term is used for a condition that results from pulmonary hypertension, creating
chronic pressure overload in the right ventricle?
a. Hypoxemia
b. Hypoxia
c. Bronchiectasis
d. Cor pulmonale

Answer 40

d. Cor pulmonale

Cor pulmonale develops as pulmonary hypertension and creates chronic pressure overload in the
right ventricle similar to that created in the left ventricle by systemic hypertension. Hypoxemia is
low oxygen in the blood. Hypoxia is low oxygen in tissues. Bronchiectasis is persistent abnormal
dilation of bronchi.

Question 41

Aspiration

Answer 41

Passage of fluid and solid particles into the lung

Question 42

Bronchilitis

Answer 42

Inflammatory obstruction of small airways

Question 43

Atelectasis

Answer 43

Lung tissue collapse

Question 44

Pulmonary fibrosis

Answer 44

Excessive amount of connective tissue in the lung

Question 45

Bronchiectasis

Answer 45

Abnormal dilation of the bronchi