Nokea
At high altitudes all of the following things occur in an effort to acclimatise EXCEPT
- A. Hypoventilation
- B. Polycythaemia
- C. Increased numbers of capillaries per unit volume in peripheral tissues
- D. O2 dissociation curve shifts to right
Correct Answer: A
Rationale: The correct answer is A: Hypoventilation. At high altitudes, the body adapts to the decreased oxygen availability by increasing red blood cell production (polycythaemia) to enhance oxygen-carrying capacity. This is supported by the shift of the oxygen dissociation curve to the right, facilitating oxygen unloading in tissues. Additionally, increased capillaries in peripheral tissues improve oxygen delivery. However, hypoventilation, or decreased breathing rate, is not a typical response to high altitudes. In fact, the body usually compensates by increasing ventilation to maintain adequate oxygen levels.
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A patient with a decreased level of consciousness is in a recumbent position. How should the nurse best assess the lung fields for a patient in this position?
- A. Inform that physician that the patient is in a recumbent position and anticipate an order for a portable chest x-ray.
- B. Turn the patient to enable assessment of all the patient's lung fields.
- C. Avoid turning the patient, and assess the accessible breath sounds from the anterior chest wall.
- D. Obtain a pulse oximetry reading, and, if the reading is low, reposition the patient and auscultate breath sounds.
Correct Answer: B
Rationale: The correct answer is B because turning the patient to enable assessment of all the lung fields is the best approach to assess lung sounds comprehensively. By turning the patient, the nurse can listen to breath sounds on both the anterior and posterior chest walls, ensuring a thorough assessment. Option A is incorrect as it assumes the need for a chest x-ray without first performing a physical assessment. Option C is incorrect as it limits assessment to only the anterior chest wall, potentially missing abnormalities in the posterior lung fields. Option D is incorrect as obtaining a pulse oximetry reading and repositioning the patient should not replace the need for a physical assessment of lung sounds.
Which of the following anatomical structures is not part of the conducting zone?
- A. pharynx
- B. nasal cavity
- C. alveoli
- D. bronchi
Correct Answer: C
Rationale: The correct answer is C: alveoli. The conducting zone of the respiratory system includes structures that transport air to and from the gas exchange sites. Alveoli are the primary sites of gas exchange, not part of the conducting zone. Pharynx (A), nasal cavity (B), and bronchi (D) are all part of the conducting zone as they help in air transportation but do not directly participate in gas exchange like alveoli do. Therefore, alveoli is the correct answer as it does not belong to the conducting zone.
Which statement is false about anatomical dead space?
- A. Anatomical dead space varies with age
- B. Can be estimated by the Fowlers method
- C. Significantly large in shallow breathing
- D. Measured by plotting N2 concentration against expired volume as in Bohr’s method
Correct Answer: D
Rationale: The correct answer is D because Bohr's method measures physiological dead space, not anatomical dead space. Anatomical dead space is constant and not affected by N2 concentration. A: Anatomical dead space does vary with age due to changes in lung dimensions. B: Fowlers method estimates anatomical dead space by measuring tidal volume and respiratory rate. C: Anatomical dead space is not significantly large in shallow breathing as it mainly involves the conducting airways, not the alveoli.
Which of the following conditions is evident by persistent hoarseness?
- A. Bacterial infection
- B. Laryngeal cancer
- C. Aphonia
- D. Peritonsillar abscess
Correct Answer: B
Rationale: The correct answer is B. Persistent hoarseness is a hallmark symptom of laryngeal cancer. A (bacterial infection) may cause temporary hoarseness but not persistent. C (aphonia) refers to complete loss of voice, not hoarseness. D (peritonsillar abscess) affects the throat but does not typically cause persistent hoarseness.
The ED nurse is assessing the respiratory function of a teenage girl who presented with acute shortness of breath. Auscultation reveals continuous wheezes during inspiration and expiration. This finding is most suggestive of what?
- A. Pleurisy
- B. Emphysema
- C. Asthma
- D. Pneumonia
Correct Answer: C
Rationale: The continuous wheezes heard on auscultation during both inspiration and expiration in a teenage girl with acute shortness of breath are highly suggestive of asthma. Asthma is characterized by airway inflammation and bronchoconstriction, leading to wheezing on both inspiration and expiration. Other choices like pleurisy typically present with sharp chest pain worsened by breathing, emphysema with decreased breath sounds and barrel chest, and pneumonia with crackles and possibly fever.