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The nurse is caring for a patient with a lower respiratory tract infection. When planning a focused respiratory assessment, the nurse should know that this type of infection most often causes what?
- A. Impaired gas exchange
- B. Collapsed bronchial structures
- C. Necrosis of the alveoli
- D. Closed bronchial tree
Correct Answer: A
Rationale: Step 1: Lower respiratory tract infection affects the lungs where gas exchange occurs.
Step 2: Infections can lead to inflammation and fluid buildup in the lungs.
Step 3: This impairs the exchange of oxygen and carbon dioxide.
Step 4: Impaired gas exchange can lead to hypoxemia and respiratory distress.
Step 5: Therefore, the correct answer is A: Impaired gas exchange. Other choices are incorrect because they do not directly relate to the physiological consequences of a lower respiratory tract infection.
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Which of the following changes does not occur at birth when an infant takes his or her first breaths?
- A. Blood flow to the lungs decreases
- B. The resistance in the pulmonary arteries decreases
- C. Changes in blood flow cause the foramen ovale to close
- D. Air enters the alveoli
Correct Answer: A
Rationale: The correct answer is A because at birth, when an infant takes their first breaths, blood flow to the lungs increases due to the expansion of the pulmonary vasculature. This allows for proper oxygenation of the blood. Choice B is incorrect as the resistance in the pulmonary arteries decreases to accommodate the increased blood flow to the lungs. Choice C is incorrect as changes in blood flow do cause the foramen ovale to close, ensuring proper circulation. Choice D is incorrect as air entering the alveoli is essential for oxygen exchange to occur in the lungs.
Actual exchange of gases in the lungs occurs in the
- A. bronchi.
- B. alveoli.
- C. bronchioles.
- D. tracheas.
Correct Answer: B
Rationale: The correct answer is B: alveoli. Alveoli are tiny air sacs in the lungs where the exchange of oxygen and carbon dioxide takes place through diffusion. This process is crucial for oxygenating the blood and removing carbon dioxide. Bronchi (A), bronchioles (C), and trachea (D) are all parts of the respiratory system, but they do not participate directly in gas exchange. Bronchi are the main airways that branch off from the trachea, bronchioles are smaller airways that lead to the alveoli, and the trachea is the main airway that carries air to and from the lungs.
The partial pressure of carbon dioxide in the interstitial space of peripheral tissues is approximately
- A. 35 mm Hg
- B. 45 mm Hg
- C. 55 mm Hg
- D. 70 mm Hg
Correct Answer: B
Rationale: The correct answer is B (45 mm Hg) because the partial pressure of carbon dioxide in the interstitial space of peripheral tissues is around 40-45 mm Hg. This value is higher than in the arterial blood (around 40 mm Hg) due to the production of CO2 by tissues. Choice A (35 mm Hg) is too low for interstitial CO2 levels. Choice C (55 mm Hg) and D (70 mm Hg) are too high and not consistent with normal physiological values. Overall, the correct answer aligns with the typical range of interstitial CO2 pressure in peripheral tissues.
A nurse working in a geriatric clinic sees clients with "cold" symptoms and rhinitis. The primary health care provider (PHCP) often leaves a prescription for diphenhydramine. What action by the nurse is best?
- A. Teach the client about possible drowsiness.
- B. Instruct the client to drink plenty of water.
- C. Consult with the PHCP about the medication.
- D. Encourage the client to take the medication with food.
Correct Answer: C
Rationale: The correct answer is C: Consult with the PHCP about the medication. This is the best action because diphenhydramine may not be the most appropriate medication for older adults due to potential side effects like increased risk of falls, confusion, and urinary retention. Consulting with the PHCP will ensure that the medication is safe and effective for the client.
A: Teaching about drowsiness is important but not the priority.
B: Drinking water is generally good advice but not specific to diphenhydramine.
D: Taking medication with food can help reduce stomach upset but doesn't address the concerns related to diphenhydramine in older adults.
All of the following are unpaired cartilage except.
- A. cricoid cartilage
- B. epiglottis
- C. Corniculate cartilage
- D. thyroid
Correct Answer: C
Rationale: The correct answer is C: Corniculate cartilage. Corniculate cartilage is a paired cartilage found in the larynx, specifically at the apex of the arytenoids. The other choices, such as cricoid cartilage, epiglottis, and thyroid cartilage, are all unpaired cartilages. Cricoid cartilage is a complete ring, the epiglottis is a leaf-shaped cartilage, and the thyroid cartilage is the largest cartilage in the larynx. Therefore, Corniculate cartilage is the only paired cartilage among the options provided.