Pulmonary Flashcards
When assessing a patient with cor pulmonale, you would anticipate any of the following clinical signs, except:
A. Jugular venous distension
B. Mitral valve murmur
C. Hepatosplenomegaly
D. Pedal edema
B
Cor pulmonale is right sided heart failure resulting from pulmonary artery hypertension. Venous congestion resulting from the right sided heart failure can cause JVD, HSM, and peripheral edema. Right sided heart failure would generally cause tricuspid regurgitation/murmur, but not MVR
The most common cause of viral community acquired pneumonia in children is:
A. Streptococcus pneumoniae
B. Influenza
C. Mycoplasma pneumoniae
D. Respiratory syncytial virus
D is correct. CAP results in over 100,000 hospitalizations annually, 66% of which are viral in nature. RSV is the primary offender, as well as parainfluenza, influenza, human rhinovirus, human metapneumovirus, and adenoviruses.
A young mom presents to your clinic with her 3 year old child. She reports the child has had a runny nose and barky cough for the past 3 days and she is concerned he’s having a harder time breathing. VS show a temperature of 99.2 (F), HR 140/min, RR 40/min, O2 sats 98%. The child is generally well-appearing with moderate increased work of breathing. Which pulmonary exam finding would you anticipate?
A. Expiratory wheezes
B. Rhales in bilateral lower lobes
C. Inspiratory stridor
D. Diffuse rhonchi throughout all lung fields
C is correct. A barky cough is a hallmark of croup (aka laryngotracheobronchitis), a viral infection that causes inflammation/edema in the subglottic region. This contributes to the characteristic cough, as well as possible inspiratory stridor.
The advanced practice nurse is providing education to a patient who has recently been diagnosed with asthma. The nurse knows which of the following is a modifiable risk factor that could be contributing to the patient’s asthma?
A Family history of asthma
B. GERD
C. Rural living
D. Obesity
Obesity is a modifiable risk factor for asthma.
A nurse practitioner is caring for a newborn who has just been diagnosed with cystic fibrosis. Which of the following statements would best explain the diagnosis to the parents?
A. “It is an acquired viral or bacterial infection where the air exchange part of the lungs fill with fluid, making it difficult to breathe”
b. “It is a genetic condition that causes the mucus to be thick, which can affect your child’s breathing and digestive tract”
c. “It is an inflammatory lung disease associated with lung immaturity and airway injury”
d. “It is a combination of genetic and environmental factors resulting in reversible airway obstruction and hyperactivity of the pulmonary tract”
B. “It is a genetic condition that causes the mucus to be thick, which can affect your child’s breathing and digestive tract”t is describing cystic fibrosis
Melissa is a nurse who is caring for a patient who is scheduled for a total knee replacement surgery the following day. She informs the patient that they cannot eat or drink after midnight prior to their surgery. The patient is confused if they are having surgery on their leg why they cannot eat or drink. Melissa knows that which of the following is the reason for NPO prior to surgery?
a Increased risk for an allergic reaction
b. Do not want GI upset prior to anesthesia
c. Increased risk for aspiration pneumonia
d. Increased risk for a pulmonary embolism
C. General anesthesia increases the risk for aspiration of oral contents, which can lead to infection and pneumonia, among other risks including airway obstruction therefore fasting for a minimum of 8 hours is recommended
Which of the following causes of impaired ventilation is not attributable to a restriction of the chest wall?
A. empyema
B. Obesity
C. Kyphoscholiosis
D. Pectus Excavatum
A. empyema– in this type of pleural effusion, pus from an infection course accumulates in the pleural space
While assessing a patient admitted w/ CHF exacerbation, the provider notes decreased breath sounds over the left lower lobe with asymmetrical chest expansion. A CXR is ordered, and the image reveals a collection of fluid in the pleural cavity. What are these findings consistent with?
A. Pleural effusion
B. pulmonary edema
C. mediastinal shift
D. atelectasis
A. Pleural effusion, fluid collects between the lungs and the pleural sac
______ is/are still considered a controversial treatment in PARDS
A. corticosteriods
b. non invasive mechanical ventilation
C. ECMO
D. Invasive mechanical ventilation (intubation)
A. corticosteroids are controversial in PARDS but has been associated with improvements in lung function and survival in some studies
Mr. Winter, age 45, was recently diagnosed with emphysema, exhibiting dyspnea and a barrel chest, along with a decreased FEV1 (forced expiratory volume in one second) in his lung function test. He is puzzled as to why he has emphysema, given that he has never smoked and has no exposure to secondhand smoke. Which of the following explanations is correct?
A. You have α1-antitrypsin deficiency, which normally inhibits proteolytic enzymes like elastases from neutrophils. Without this inhibition, unchecked protease activity leads to the destruction of alveolar walls and permanent enlargement of airways, causing obstruction.
B. Your symptoms may be due to left-sided heart disease. When the left ventricle fails, increased pressure can cause fluid to leak into the lungs, resulting in dyspnea.
C. This condition could arise from blood clots in the legs that obstruct pulmonary blood flow, releasing substances that cause vasoconstriction and respiratory issues.
D. This may be related to carcinoma of the true vocal cords that has spread to your lungs.
A. The two most common phenotypes of Chronic Obstructive Pulmonary Disease (COPD) are chronic bronchitis and emphysema. Emphysema is characterized by the abnormal, permanent enlargement of gas-exchange airways, accompanied by the destruction of alveolar walls without significant fibrosis. Both phenotypes are linked to an enhanced chronic inflammatory response in the airways to noxious particles or gases. Emphysema features inflammation, an imbalance between proteases and antiproteases, oxidative stress, and apoptosis of lung structural cells. Nonsmokers with inherited α1-antitrypsin deficiency typically develop COPD at an older age compared to those with the deficiency who smoke. Hepatic fibrosis may also occur. Due to the emergence of effective treatments, some experts now recommend screening all individuals with diagnosed COPD for α1-antitrypsin deficiency. Family screening is advised for those who test positive. Supportive treatment for lung disease associated with α1-antitrypsin deficiency is the same as that for COPD, including keeping influenza, COVID-19, and pneumococcal vaccinations up to date, as well as pharmacologic management based on clinical severity.
Which of the following comparisons of signs and symptoms of pulmonary diseases is correctly described?
A. In a communicating pneumothorax, the pressure of air in the pleural space equals barometric pressure, as air drawn in during inspiration is expelled during expiration. In tension pneumothorax, pleural pressure exceeds barometric pressure because air enters during inspiration but cannot escape during expiration.
B. Dyspnea is a feeling of breathlessness, while orthopnea specifically refers to breathlessness when lying flat.
C. Chylothorax is the presence of lymphatic fluid in the pleural space, whereas hemothorax is the presence of blood in the pleural space.
D. Absorption atelectasis is the collapse of alveoli due to the absorption of gases from obstructed alveoli, while compression atelectasis occurs due to external pressure on the alveoli.
A In open (communicating) pneumothorax, air drawn into the pleural space during inspiration is expelled during expiration. In tension pneumothorax, the rupture site acts as a one-way valve, allowing air to enter but preventing its escape, leading to increased pressure and lung compression (p.1159).
Which of the following steps describes the development of a specific pulmonary disease?
1) Damage to pulmonary capillary endothelial and alveolar epithelial cells occurs within 72 hours due to direct or indirect injuries, such as pneumonia or COVID-19.
2) This damage activates neutrophils, macrophages, and platelets, leading to the release of inflammatory cytokines and increased capillary permeability.
3) Fluids, proteins, and blood cells leak into the pulmonary interstitium, flooding the alveoli (Exudative phase) and causing significant reduction in alveolar ventilation, resulting in a V/Q mismatch and severe hypoxemia.
4) The initial increase in respiratory rate causes hypocapnia and respiratory alkalosis.
5) Damage to epithelial cells reduces surfactant production, leading to atelectasis and pulmonary edema, marking the start of the proliferative phase of this disease.
6) The fibrotic stage involves remodeling and fibrosis of lung tissue.
A. Cystic fibrosis
B. Atelectasis
C. ARDS
D. Acute epiglottitis
ARDS - acute respiratory distress syndrome
Gastric Esophageal Reflux Disease places a patient at higher risk for:
A. Chronic Cough
B. Aspiration Pneumonia
C. Laryngeal Cancer
D. All of the Above
all of the above are true as patients with GERD
All of the following are appropriate interventions to stabilize and treat a 3 year old male with suspected epiglottis except:
A. Obtain chest/soft tissue neck X-ray
B. Administer broad spectrum antibiotics
C. Physical examination of throat
D. Keep the patient calm and undisturbed
Physical examination of throat should be avoided, due to possible “laryngospasm and cause respiratory collapse” (
While evaluating a patient for pneumoconiosis, as the provider you know it is most important to ask the patient:
A. Family history
B. Occupational history
C. Smoking history
D. Onset of illness
B— pneumoconiosis is a lung disease that occurs from inhalation of inorganic dusts generally progressing for fibrosis. This is typically seen in coal workers and miners as silicosis and coal workers lung.
1 week onset of insult with new or worsening respiratory symptoms, bilateral opacities on imaging not fully explained by other respiratory pathology and respiratory failure not explained by cardiac failure or pulmonary edema are diagnostic criteria to diagnose what disease?
A. COPD
B. ARDS
C. Pulmonary embolism
D. Asthma
B ARDS
Acute respiratory distress syndrome is acute lung inflammation and alveolocapillary injury that is the result of lung injury or systemic process. There are many causes of ARDs like multi trauma and sepsis but they all start with inflammation that progresses to flooding of the alveoli from capillary leaking or exudative phase to the fibrotic stage of remodeling the lungs with fibrinous tissue. This progression to the fibrotic stage permanently damages the lung leading to long term respiratory compromise. (
A 14 month old child arrives to the clinic with complaints of rhinorrhea and low grade fever. Upon physical exam the child has a seal-like barking cough and inspiratory stridor and deep retractions with respirations. What is a likely diagnosis for this child?
A. Acute asthma exacerbation
B. Acute epiglottitis
C. Tonsil infection
D. Viral croup
croup
Viral croup is the inflammation of the supraglottic air way. This is often caused by a viral infection in children 6 months to 2 years of age. The inflammation and edema causes an upper airway obstruction resulting in the barking cough and retractions. The negative intrathoracic pressure caused by the obstruction causes further airway collapse and can lead to respiratory failure and hypoxia.Treatment depends on the level of severity. Often humidified oxygen is used and if stridor at rest is present the patient may require inpatient treatment with inhaled epinephrine and corticosteroids.
When providing education to a family with a newborn regarding SIDS and Safe sleep practices. What statement indicates further education is required?
A Its ok to have 1 blanket in the crib with baby
B The baby should be placed on their back for sleep
C No one is allowed to smoke in the house or near the baby
D We will learn CPR for emergencies
A. the etiology of SIDs is unknown but we do know risk factors and ways to try to prevent the occurrence of SIDs. Mitigating risk factors include safe sleep practices like having the infant sleep alone on a firm surface with no loose or bulky clothing or blankets. This includes no pillows or toys.
A patient is asking about treatments for asthma, and that patient asks which is the most effective for managing their asthma symptoms?
A. Avoidance of allergens
B. Short-acting beta-agonists
C. Continuous low-dose inhaled corticosteroids with or without long-acting beta-agonist
D. Formoterol
C
Continuous low-dose inhaled corticosteroids with or without long-acting beta-agonists (correct answer) – using these for even the mildest form of asthma is most effective in managing symptoms (Rogers & Brashers, 2023). Page 1170
A patient presents to the emergency room with a pulmonary embolism, what is the primary treatment for a PE?
A. Pneumatic calf compression
B. Anticoagulant therapy
C. Leg elevation
D. Ambulation
B
the primary treatment for PE is anticoagulant therapy; this is the treatment of choice for most individuals with stable oxygenation and hemodynamics
An infant is admitted to the emergency room with suspected bronchopulmonary dysplasia, which is considered an infant predisposition risk factor for this infant.
A. Protein oxidation
B. Premature birth <28 weeks
C. Barotrauma
D. Lipid peroxidation
B
Infant predisposition risk factors include premature birth < 28 weeks, male sex, genetic susceptibility, race, altered microbiome, and sepsis (Rogers & Brashers, 2023). Page 1198
Ryan is a nursing student who is learning about the pulmonary system. Which of the follow statements would indicate that he understands the pathophysiology of chronic obstructive lung disease exacerbation?
A. Wheezing occurs from persistent bronchial inflammation and bronchoconstriction
B. Hypercapnia occurs when hypertrophied bronchial smooth muscle constricts airways and traps air in the distal portions of the lungs (hyperinflation)
C. Cyanosis occurs when the inflamed and mucus filled airways impair the body’s ability to inhale enough oxygen
D. Polycythermia occurs to increase the number of oxygen carrying cells
E All of the above
ALL
COPD results in progressive damage from inflammation, oxidative stress, extracellular matrix proteolysis, apoptotic and autophagic cell death. Thick mucus and hyperthrophied bronchial smooth muscle constricts airways and leads to obstruction. The expiratory obstruction traps air in the distal portion of the lungs, leading to hypoventilation, hypoxemia, and hypercapnia (Rogers & Brashers, 2023, pp. 1173-1175)
Risk factors for surfactant deficiency disorder includes the following, except:
A Prematurity
B Vaginal birth
C Multiple pregnancies
D Perinatal asphyxia
B. Vaginal birth helps to prevent surfactant deficiency disorder due to the lung compression during delivery
Which of the following statements are true about cystic fibrosis?
A Cystic fibrosis only involves the respiratory tract
B Cystic fibrosis involves thin copious secretions
C The typical features of cystic fibrosis include mucus plugging, chronic inflammation and chronic infection
D All of the above
C. As a result of the mutations in the cystic fibrosis transmembrane conductance regulator, the typical features of cystic fibrosis include mucus plugging, chronic inflammation and chronic infection (Rogers & Brashers, 2023, p. 1205)
