Of the four parts of respiration the part when oxygen and carbon dioxide are exchanged in the body's tissue cells is:
- A. pulmonary ventilation
- B. external respiration
- C. transport of respiratory gases
- D. internal respiration
Correct Answer: D
Rationale: The correct answer is D: internal respiration. This is the part of respiration where oxygen and carbon dioxide are exchanged in the body's tissue cells. During internal respiration, oxygen is delivered to the cells and carbon dioxide is removed. Pulmonary ventilation (choice A) refers to the process of breathing where air is moved in and out of the lungs. External respiration (choice B) is the exchange of gases between the lungs and blood. Transport of respiratory gases (choice C) involves the circulation of oxygen and carbon dioxide in the bloodstream. Internal respiration specifically focuses on the exchange of gases within the tissue cells, making it the correct choice in this scenario.
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The nurse is caring for a patient immediately postoperative after a left pneumonectomy. How should the nurse position the patient?
- A. In high Fowler position
- B. In semi-Fowler position
- C. In a right side-lying position
- D. In a left side-lying position
Correct Answer: D
Rationale: Step-by-step rationale for why choice D is correct:
1. Post-pneumonectomy, positioning the patient on the left side allows the remaining lung to expand fully.
2. This position promotes better ventilation and perfusion, aiding in oxygenation.
3. Placing the patient on the left side also helps prevent pressure on the surgical site.
4. The left side-lying position also facilitates drainage and prevents pooling of secretions in the surgical area.
Summary of why other choices are incorrect:
A. High Fowler position may cause increased pressure on the surgical site and impede lung expansion.
B. Semi-Fowler position may not optimize lung expansion and could lead to decreased oxygenation.
C. Right side-lying position is not ideal as it does not facilitate full expansion of the remaining lung and may cause pooling of secretions.
A nurse cares for a client who has hypertension that has not responded well to several medications. The client states compliance is not an issue. What action would the nurse take next?
- A. Assess the client for obstructive sleep apnea.
- B. Arrange a home sleep apnea test.
- C. Encourage the client to begin exercising.
- D. Schedule a polysomnography
Correct Answer: A
Rationale: The correct answer is A: Assess the client for obstructive sleep apnea. Hypertension that is not responding to medications may be due to underlying sleep apnea, a common comorbidity. By assessing for obstructive sleep apnea, the nurse can identify a potential contributing factor to the client's uncontrolled hypertension. This step is crucial in managing the client's condition effectively.
Summary of other choices:
B: Arranging a home sleep apnea test may be premature without first assessing the client for obstructive sleep apnea.
C: Encouraging the client to begin exercising is important for overall health but may not directly address the uncontrolled hypertension.
D: Scheduling a polysomnography may be necessary if obstructive sleep apnea is suspected after the initial assessment.
Delegation Decision: The nurse is caring for a patient with COPD. Which intervention could be delegated to unlicensed assistive personnel (UAP)?
- A. Assist the patient to get out of bed.
- B. Auscultate breath sounds every 4 hours.
- C. Plan patient activities to minimize exertion.
- D. Teach the patient pursed lip breathing technique.
Correct Answer: A
Rationale: Assisting the patient to get out of bed can be safely delegated to unlicensed assistive personnel (UAP) as it does not require specialized nursing knowledge or skills. It is a basic activity of daily living that can be delegated to support staff while allowing nurses to focus on more complex patient care tasks.
Which of the following structures separates the lung into lobes?
- A. mediastinum
- B. fissure
- C. root
- D. pleura
Correct Answer: B
Rationale: The correct answer is B: fissure. A fissure is a deep groove or division that separates the lung into lobes. Each lung has fissures that divide it into lobes: the right lung has an oblique fissure and a horizontal fissure, while the left lung has an oblique fissure. The mediastinum (A) is the central compartment of the thoracic cavity. The root (C) is the area where structures such as blood vessels and bronchi enter or exit the lung. The pleura (D) is a membrane that covers the lungs but does not separate them into lobes.
The nurse has assessed a patient's family history for three generations. The presence of
which respiratory disease would justify this type of assessment?
- A. Asthma
- B. Obstructive sleep apnea
- C. Community-acquired pneumonia
- D. Pulmonary edema
Correct Answer: A
Rationale: Step-by-step rationale:
1. Asthma is a hereditary respiratory disease, making it important to assess family history.
2. Genetic predisposition plays a role in the development of asthma.
3. Understanding family history helps in identifying potential risk factors.
4. Obstructive sleep apnea, community-acquired pneumonia, and pulmonary edema are not typically hereditary respiratory diseases.
5. Therefore, assessing family history for three generations is justified for asthma.