TEST BANK FOR CRITICAL CARE NURSING 8TH EDITION BY URDEN.

TEST BANK FOR CRITICAL CARE NURSING 8TH EDITION BY URDEN. Chapter 16: Pulmonary Anatomy and Physiology Urden: Critical Care Nursing, 8th Edition MULTIPLE CHOICE 1. At what anatomic site does the trachea divide into the right and left mainstem bronchi? a. Posterior larynx b. Cricoid cartilage c. Epiglottis d. Major carina ANS: D The trachea is a hollow tube approximately 11 cm in length and 2.5 cm in diameter. It begins at the cricoid cartilage and ends at the bifurcation (the major carina) from which the two mainstem bronchi arise. PTS: 1 DIF: Cognitive Level: Remembering REF: pp. 415-416|Figure 16-5 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 2. Which physiologic mechanism is a passive event in a spontaneously breathing patient? a. Coughing b. Inhalation c. Exhalation d. Yawning ANS: C Inhalation involves the contraction of the diaphragm, an active event, as do yawning and coughing. Exhalation in the healthy lung is a passive event requiring very little energy. PTS: 1 DIF: Cognitive Level: Remembering REF: p. 414 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 3. What substance do Alveolar type II cells secrete? a. Trypsin b. Chyme c. Amylase d. Surfactant ANS: D The most important function of the type II cells is their ability to produce, store, and secrete pulmonary surfactant. Trypsin and amylase are proteins used for digestion. Chyme is a semifluid mass of partly digested food that is expelled by the stomach into the duodenum. PTS: 1 DIF: Cognitive Level: Remembering REF: p. 418 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 4. Which pulmonary condition is related to a lack of surfactant? a. Pulmonary embolus b. Pulmonary hypertension c. Pulmonary atelectasis d. Pulmonary edema ANS: C Surfactant is responsible for preventing the alveoli from completely collapsing on exhalation. Lack of this lipoprotein allows the alveoli to collapse, producing atelectasis. Lack of surfactant is not responsible for the other conditions. PTS: 1 DIF: Cognitive Level: Understanding REF: p. 418 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 5. What is the main function of the conducting airways? a. Gas exchange b. Cool the inhaled air c. Remove moisture from inhaled air d. Prevent the entry of foreign material ANS: D The conducting airways consist of the upper airways, the trachea, and the bronchial tree. Their major functions are to warm and humidify the inhaled air, prevent the entrance of foreign matter into the gas exchange areas, and serve as a passageway for air entering and leaving the gas exchange regions of the lungs. PTS: 1 DIF: Cognitive Level: Remembering REF: pp. 414-415 OBJ: Nursing Process Step: Assessment TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 6. A patient has sustained a stroke and is no longer able to control his epiglottis. Why should the nurse be concerned about the patient? a. The patient is at increased risk of aspiration. b. The patient will need surgery to close his epiglottis. c. The patient will need a tracheostomy to breathe. d. The patient is at risk for a pneumothorax. ANS: A The epiglottis is responsible for closing over the trachea and preventing entry of swallowed material into the lungs. An inability to control the epiglottis increases the risk of aspiration and may warrant placement of a feeding tube. The patient will still be able to breathe. Closure of the epiglottis over the trachea will occlude the airway. PTS: 1 DIF: Cognitive Level: Understanding REF: p. 415 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 7. Patients who have aspiration pneumonitis often present with right lower lobe involvement more than left lower lobe involvement. Why does this occur? a. The left mainstem bronchus angles down more than the right. b. More people are right-side dominant. c. The right mainstem bronchus angles down more than the left. d. The right mainstem bronchus is narrower than the left. ANS: C The right bronchus is wider than the left and angles at 20 to 30 degrees from the midline. Because of this angulation and the forces of gravity, the most common site of aspiration of foreign objects is through the right mainstem bronchus into the lower lobe of the right lung. PTS: 1 DIF: Cognitive Level: Understanding REF: pp. 415-416 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 8. Which artery(s) have the lowest oxygen saturation? a. Aorta b. Subclavian c. Carotid d. Pulmonary ANS: D The pulmonary artery delivers blood from the right ventricle to the lungs, where they receive oxygen from the alveoli. The aorta, subclavian artery, and carotid artery are all supplied from the left ventricle, where the oxygen concentration is highest. PTS: 1 DIF: Cognitive Level: Remembering REF: p. 419 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 9. Which range would be considered normal for pulmonary artery systolic pressures? a. 15 to 30 mm Hg b. 4 to 12 mm Hg c. 25 to 35 mm Hg d. 1 to 11 mm Hg ANS: A Pulmonary artery systolic pressure ranges from 15 to 30 mm Hg, pulmonary artery diastolic pressure ranges from 4 to 12 mm Hg, and pulmonary artery mean pressure ranges from 9 to 18 mm Hg. Pulmonary hypertensions is defined as pulmonary artery systolic pressure of greater than 35 mm Hg. PTS: 1 DIF: Cognitive Level: Remembering REF: p. 419 OBJ: Nursing Process Step: Assessment TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 10. The oxygen saturation of a healthy individual rarely reaches 100% on room air. This can best be explained by what concept? a. Physiologic shunting b. Alveolar capillary diffusion c. Collateral air passages d. Anatomic dead space ANS: A The mixing of venous blood from the bronchial circulation with the oxygenated blood in the left atrium decreases the saturation of left atrial blood to a range between 96% and 99%. This is referred to as physiologic shunting. For this reason, while a person is breathing room air, the oxygen saturation of arterial blood is less than 100%. PTS: 1 DIF: Cognitive Level: Remembering REF: p. 420 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 11. Which pulmonary alteration increases the work of breathing in the patient with emphysema? a. Decreased lung recoil b. Decreased chest wall compliance c. Increased lung compliance d. Increased airway resistance ANS: A Emphysema results in destruction and enlargement of the alveoli, leading to decreased lung recoil and increased work of breathing. Emphysema results in decreased lung compliance not increased compliance. Emphysema does not affect chest wall compliance or airway resistance. PTS: 1 DIF: Cognitive Level: Understanding REF: pp. 420-422|Box 16-2 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 12. What anatomic regions are considered physiologic dead space? a. Respiratory bronchiole and unperfused alveoli b. Trachea and perfused alveoli c. Trachea and unperfused alveoli d. Trachea and mainstem bronchi ANS: C Respiratory bronchioles participate in gas exchange. The areas in the lungs that are ventilated but in which no gas exchange occurs are known as dead space regions (trachea and mainstem bronchi). These unperfused alveoli are known as alveolar dead space. Anatomic dead space plus alveolar dead space is called physiologic dead space. PTS: 1 DIF: Cognitive Level: Remembering REF: p. 421 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity 13. If a patient sustained an injury to the apneustic center in the lower pons area, in which area should the nurse most expect the patient to exhibit problems? a. Respiratory rate b. Triggering exhalation c. Respiratory rhythm d. Depth of respiration ANS: D The apneustic center in the lower pons is thought to work with the pneumotaxic center to regulate the depth of inspiration. The pneumotaxic center in the pons is responsible for limiting inhalation and triggering exhalation. This response also facilitates control of the rate and pattern of respiration. The ventral respiratory group, located in the medulla, is responsible for inspiration and expiration during periods of increased ventilation. PTS: 1 DIF: Cognitive Level: Remembering REF: pp. 423-44|Figure 16-18 OBJ: Nursing Process Step: N/A TOP: Pulmonary MSC: NCLEX: Physiologic Integrity