Adult Health I Chapter 10 Exam Questions And Answers

The most common cause of atelectasis is ______.ANS - Obstruction of the airways Atelectasis is caused by:ANS - Mucus, foreign bodies, bronchial tumors, and oxygen toxicity List three primary goals of chest physiotherapy.ANS - Remove bronchial secretions, improve ventilation, and increase the efficiency of the respiratory muscles The eighth leading cause of death in the United States and the most common infectious cause of death is _______.ANS - Pneumonia List the five most common classifications for pneumonia.ANS - Community-acquired pneumonia, hospital-acquired pneumonia, ventilator-associated pneumonia, health-care associated pneumonia and pneumonia in an immunocompromised patient Hospital-acquired pneumonia occurs when at least one of three conditions exist.ANS - Host defenses are impaired, microorganisms reach the lower respiratory tract (usually by microaspiration of oropharyngeal microorganisms), or a highly virulent organism is present. Name the four classic clinical manifestations of pneumonia.ANS - Fever, cough, dyspnea, and leukocytosis Oxygen toxicity can occur when FiO2 levels are greater than _____ % for ______ time.ANS - 60% for longer than 48 hours. The leading cause of death from infectious disease in the world is _____.ANS - Pulmonary tuberculosis Pulmonary tuberculosis infects about _____% of the world's population.ANS - 33% The clinical syndrome of acute respiratory distress syndrome (ARDS) is characterized by:ANS - A sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest X-ray, hypoxemia refractory to supplemental oxygen, and reduced lung compliance. The most common signs of pulmonary embolism found on physical assessment are:ANS - Tachypnea, crackles, tachycardia, and the presence of an S4 heart sound, split S2, and cyanosis or hypoxemia Mucolytic agent that loosens mucusANS - Mucomyst Given to maintain blood pressure in the threat of septic shockANS - Vasopressors Used to combat shock in patients with severe pneumoniaANS - Corticosteroids Used as a first-line drug to treat tuberculosisANS - Rifampin Used to treat the symptoms of pulmonary edemaANS - Inotropics For ventilator-dependent patients with acute respiratory failureANS - Neuromuscular blockers Used as an anticoagulantANS - Lovenox A thrombolytic agent used to lyse a clotANS - Alteplase What is the sequence of the pathophysiology of tuberculosis?ANS - Susceptible person inhales mycobacteria, which are transmitted to the alveoli; exudate accumulates in the alveoli causing bronchopneumonia (2 to 10 weeks, post-exposure); granulomas, surrounded by macrophages, from a protective wall; a fibrous mass forms, called a Ghon tubercle; tubercle becomes necrotic forming a cheesy mass; mass calcifies and forms a collagenous scar. Bacteria are dormant and disease progression stops. What is the sequence of the pathophysiology of pneumonia?ANS - An inflammatory reaction occurs in the alveoli, producing an exudate; white blood cells, mostly neutrophils migrate into the alveoli and fill the air-filled spaces with cellular debris; alveolar edema and lung tissue consolidation occurs; microorganisms release toxins that further damage respiratory cells; alveolar and bronchial tissues swell and infiltrate with the white blood cells; diffusion is compromised and arterial hypoxemia results. Describe the risk factors associated with the development of atelectasis.ANS - Postoperative patients, especially those who undergo abdominal and/or thoracic procedures, are at risk due to anesthetic- and/or narcotic-induce hypoventilation, incisional pain, abdominal distention, and immobility. Additional risk factors include chronic lung disease, morbid obesity, tobacco use, anesthesia time greater than 4 hours, prior cerebrovascular accident, lung cancer, pleural effusions, and nasogastric tube placement. Discuss the seven nursing activities that can be used to prevent atelectasis.ANS - Change patient's position frequently, especially from supine to upright, to promote ventilation and prevent secretions from accumulating; encourage early mobilization from bed to chair, followed by early ambulation; encourage appropriate deep breathing and coughing to mobilize secretions and prevent them from accumulating; teach/reinforce appropriate techniques for incentive spirometry; administer prescribed opioids and sedatives judiciously to prevent respiratory depression; perform postural drainage and chest percussion, if indicated; institute suctioning to remove tracheobronchial secretions, if indicated. Discuss the factors that predispose a patient to hospital-acquired pneumonia.ANS - Impaired host defense (e.g. severe acute or chronic illness), a variety of cormorbid conditions, supine positioning, aspiration, altered mental status, malnutrition, prolonged hospitalization, hypotension, and metabolic disorders. The morality is related to the virulence of the organisms, their resistance to the antibiotics, and the patient's underlying condition. Explain why a high concentration of oxygen is contraindicated in the patient with chronic obstructive pulmonary disease.ANS - Oxygen, like other medications, should be administered with caution and careful assessment of the patient's response. A high concentration of oxygen is contraindicated in the patient with COPD because it may worsen alveolar ventilation by decreasing the patient's ventilatory drive, leading to further respiratory decompensation. Explain the statement that a positive reaction to a tuberculin skin test does not mean that active disease is present.ANS - A significant (positive) reaction does not necessarily mean that active disease is present in the body. More than 90% of people who are tuberculin-significant reactors do not develop clinical tuberculosis. However, all significant reactors are candidates for active tuberculosis. A non-significant (negative) skin test does not exclude tuberculosis infection or disease, because patients who are immunosuppressed cannot develop an immune response that is adequate to produce a positive skin test. Describe the most frequent clinical manifestations of cancer of the lung.ANS - Lung cancer develops insidiously and is asymptomatic until late in its course. The signs and symptoms depend on the location and size of the tumor, the degree of obstruction, and the existence of metastases to regional or distant sites. The most frequent symptom of lung cancer is cough or change in a chronic cough. The cough starts as a dry, persistent cough, without sputum production. When obstruction of airways occurs, the cough may become productive due to infection.