Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 36: Alterations of Pulmonary FunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Besides dyspnea, what is the most common characteristic associated with pulmonary disease?a. Chest painb. Digit clubbingc. Coughd. HemoptysisANS: CPulmonary 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.PTS: 1 DIF: Cognitive Level: Remembering 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. Hyperpneab. Orthopneac. Apnead. AtelectasisANS: BOrthopnea 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.PTS: 1 DIF: Cognitive Level: Remembering 3. Kussmaul respirations as a respiratory pattern may be associated with which characteristic(s)?a. Alternating periods of deep and shallow breathingb. Increased work of breathingc. Inadequate alveolar ventilation in relation to metabolic demandsd. Slightly increased ventilatory rate, large tidal volumes, and no expiratory pauseANS: DKussmaul 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.PTS: 1 DIF: Cognitive Level: Remembering 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 oblongatab. Increased partial pressure of arterial carbon dioxide (PaCO2)c. Stimulation of stretch or J-receptorsd. Fatigue of the intercostal muscles and diaphragmANS: AAlternating 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.PTS: 1 DIF: Cognitive Level: Remembering 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. 3b. 5c. 7d. 9ANS: BCyanosis 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.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. What does the student learn about ventilation?a. Hypoventilation causes hypocapnia.b. Hypoventilation causes alkalosis.c. Hyperventilation causes hypocapnia.d. Hyperventilation causes acidosis.ANS: CHyperventilation 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.PTS: 1 DIF: Cognitive Level: Remembering 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. Edemab. Clubbingc. Anglingd. OsteoarthropathyANS: BClubbing 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.PTS: 1 DIF: Cognitive Level: Remembering 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 spaceb. Decreases the oxygen in inspired gasc. Creates a right-to-left shuntd. Impairs alveolocapillary membrane diffusionANS: DDiffusion 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.PTS: 1 DIF: Cognitive Level: Understanding 9. High altitudes may produce hypoxemia through which mechanism?a. Shuntingb. Hypoventilationc. Decreased inspired oxygend. Diffusion abnormalitiesANS: CThe 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.PTS: 1 DIF: Cognitive Level: Remembering 10. Which condition is capable of producing alveolar dead space?a. Pulmonary edemab.
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