RN exams respiratory practice questions set 7

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Physiological dead space (VDphys) includes anatomic dead space (VDanat, ~150 ml, conducting airways) plus alveolar dead space (VDalv, ventilated but non-perfused alveoli). Normally, VDphys ≈ VDanat (~150 ml), but in disease, it's equal to or greater due to added VDalv. Lung diseases like pulmonary embolism increase VDphys by raising VDalv from poor perfusion. A high V/Q ratio (ventilation > perfusion), as in PE, also increases VDphys, as ventilated alveoli lack blood flow. However, VDphys isn't equal to alveolar dead space alone VDalv is just one component. VDphys = VDanat + VDalv, so stating it equals VDalv excludes the anatomic portion, which is always present (e.g., trachea, bronchi). This misdefinition is wrong, as physiological dead space encompasses both, not just wasted alveolar volume, a distinction critical for understanding gas exchange inefficiencies in pathology.

Correct answer:

The correct answer is B: more intense inhalation. The apneustic center is responsible for prolonging inhalation by stimulating the inspiratory neurons in the medulla oblongata. When the apneustic center is stimulated, it disrupts the normal breathing pattern, causing a prolonged and more intense inhalation. This results in deeper and more forceful breaths. Incorrect choices: A: increased respiratory rate - Stimulation of the apneustic center would not lead to an increased respiratory rate, but rather to changes in the depth and intensity of inhalation. C: a shorter respiratory cycle - The apneustic center's stimulation does not lead to a shorter respiratory cycle, but rather to a prolonged inhalation phase. D: less activity in the DRG center - The dorsal respiratory group (DRG) is responsible for initiating inspiration, and the apneustic center does not affect its activity.

Correct answer:

The correct answer is D: Impaired gas exchange related to airflow obstruction. This is the most important nursing diagnosis for a patient with chronic obstructive pulmonary disease because impaired gas exchange directly impacts the patient's ability to breathe and obtain oxygen. Addressing this issue is crucial in managing the patient's condition and preventing further complications. A: Activity intolerance related to fatigue may be a concern for the patient, but it is secondary to the primary issue of impaired gas exchange. B: Anxiety related to actual threat to health status is important to address, but it is not the most critical nursing diagnosis for this patient. C: Risk for infection related to retained secretions is a valid concern, but it is not as immediate and directly life-threatening as impaired gas exchange in a patient with chronic obstructive pulmonary disease.

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The correct answer is D: What is your occupation? This is the most important question because inhalation anthrax is commonly associated with certain occupations, like handling animal products or working in agricultural settings. Knowing the client's occupation can help identify potential sources of exposure. A: Are any family members also ill? - While important for assessing potential spread of infection, this question does not directly help in determining the cause of the anthrax infection. B: Have you traveled recently? - Travel history is relevant for certain infectious diseases, but for inhalation anthrax, occupational exposure is a more crucial factor to consider. C: How long have you been ill? - Timing of symptoms is important for diagnosis and treatment, but knowing the client's occupation provides more specific information in the case of suspected inhalation anthrax.

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Idiopathic pulmonary fibrosis (IPF) scars lung interstitium, reducing elasticity and volumes. Functional residual capacity (FRC), the resting volume (~2.5-3 L normally), decreases in IPF (e.g., to 2 L) as stiff lungs limit expansion, a hallmark of restrictive disease. Tidal volume (VT, ~500 ml) typically decreases, not increases, as breathing becomes shallow due to restricted capacity, often requiring faster rates to maintain ventilation. Pulmonary vascular resistance rises, not falls, as fibrosis compresses capillaries, increasing resistance and risking right heart strain. Total lung capacity (TLC, ~6 L) also drops (e.g., to 4 L), reflecting reduced maximum volume, not higher. Lower FRC aligns with IPF's mechanics stiff lungs reduce resting and total volumes, impair gas exchange, and elevate work of breathing, distinguishing it from options contradicting restrictive physiology.

Correct answer:

The correct answer is D, Impaired gas exchange. This is the priority because the client's O2 saturation of 88% indicates poor oxygenation, which can lead to serious complications like hypoxemia. The fever and nonproductive cough are symptoms of pneumonia contributing to impaired gas exchange. Addressing this issue is crucial to prevent respiratory distress. A: Fatigue - While important, fatigue is a secondary concern compared to impaired gas exchange, which directly affects oxygenation and can be life-threatening. B: Hyperthermia - The client's fever is likely related to the pneumonia but managing impaired gas exchange takes precedence as it directly impacts oxygen delivery to tissues. C: Impaired mobility - While assisting the client out of bed is necessary, the priority is to address the underlying problem of impaired gas exchange to prevent respiratory compromise.

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A lower tracheostomy involves an incision below the thyroid isthmus, typically between the 2nd and 4th tracheal rings, to create an airway. The superior thyroid artery (A) arises from the external carotid and supplies the upper thyroid, far from this site. The inferior thyroid artery (B), from the thyrocervical trunk, supplies the lower thyroid and lies posterior, near the recurrent laryngeal nerve, but is less exposed. The inferior thyroid veins (C) drain the thyroid plexus into the brachiocephalic veins, running anteriorly across the trachea, making them highly vulnerable during midline incision. The internal jugular vein (D) lies lateral, near the carotid sheath, and is less at risk unless the incision deviates significantly. Anatomical variations (e.g., a thyroid ima artery) exist, but C is the most consistently endangered due to its anterior position and delicate nature.

Correct answer:

The correct answer is B: more intense inhalation. The apneustic center is responsible for prolonging inhalation by stimulating the inspiratory neurons in the medulla oblongata. When the apneustic center is stimulated, it disrupts the normal breathing pattern, causing a prolonged and more intense inhalation. This results in deeper and more forceful breaths. Incorrect choices: A: increased respiratory rate - Stimulation of the apneustic center would not lead to an increased respiratory rate, but rather to changes in the depth and intensity of inhalation. C: a shorter respiratory cycle - The apneustic center's stimulation does not lead to a shorter respiratory cycle, but rather to a prolonged inhalation phase. D: less activity in the DRG center - The dorsal respiratory group (DRG) is responsible for initiating inspiration, and the apneustic center does not affect its activity.

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The correct answer is B: CO2 concentration increases. When CO2 levels rise in the blood, it leads to an increase in the acidity of the blood, triggering the respiratory centers in the brain to increase the rate and depth of respiration in order to expel excess CO2 and restore the pH balance. Explanation for other choices: A: Oxygen concentration increases - An increase in oxygen concentration does not directly stimulate an increase in respiration rate or depth. The respiratory drive is primarily regulated by CO2 levels. C: Bicarbonate concentration increases - While bicarbonate is involved in the acid-base balance in the body, it does not directly influence the rate and depth of respiration. D: Bicarbonate concentration decreases - A decrease in bicarbonate concentration may affect acid-base balance, but it does not have a direct effect on respiratory rate and depth.

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A stab wound causing pneumothorax allows air into the pleural space, disrupting the negative intrapleural pressure (~-4 to -6 mmHg) that keeps lungs expanded. This equalizes pleural pressure to atmospheric (760 mmHg), eliminating the force opposing lung elastic recoil, which pulls the lung inward to collapse toward the hilum, reducing its volume. Meanwhile, the chest wall's outward recoil, no longer countered by lung tension, causes it to expand outward, increasing thoracic diameter. Thus, the lung collapses and the chest wall expands, a classic pneumothorax feature. Both expanding defies recoil mechanics, fixing at FRC ignores pressure loss, and collapse-collapse misrepresents chest wall behavior. This dynamic reflects the opposing elastic properties unleashed by pleural breach, critical for understanding respiratory compromise and interventions like chest tube placement.