MSN Exam for Emphysema

EXPLANATION

 

✔Correct answer:

False. Nurse Claire should inform Mr. Lee that a lung transplant is not the only method to slow down the progression of emphysema. While a lung transplant is a treatment option for advanced cases, there are other less invasive treatments and management strategies available. These include pharmacotherapy (bronchodilators, corticosteroids), pulmonary rehabilitation, oxygen therapy, and lifestyle changes such as smoking cessation and exercise. Each of these can help manage symptoms and may slow the progression of the disease to some extent.

Think of managing emphysema like maintaining an aging car. A lung transplant is akin to getting a brand-new engine, which is a drastic and expensive measure. However, there are other ways to keep the car running longer, such as regular oil changes, tire rotations, and brake inspections (equivalent to medications and lifestyle changes). These smaller maintenance tasks can extend the life of the car without needing a new engine.

Emphysema involves the destruction of the alveoli, the small air sacs in the lungs responsible for gas exchange. Various treatments aim to improve lung function by either opening up the airways (bronchodilators), reducing inflammation (corticosteroids), or improving the efficiency of oxygen exchange (oxygen therapy). These treatments can help manage symptoms and may slow the disease's progression, although they cannot reverse the damage already done to the alveoli.

 

✘Incorrect answer options:

True. This statement is incorrect because a lung transplant is not the only method to slow down the progression of emphysema. There are various other treatments and management strategies that can help manage symptoms and may slow the disease's progression.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• O'Donnell, D. E., Aaron, S., Bourbeau, J., Hernandez, P., Marciniuk, D. D., Balter, M., ... & Voduc, N. (2007). *Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease*. Canadian Respiratory Journal, 14(Suppl B), 5B-32B.

EXPLANATION

 

✔Correct answer:

Respiratory rate has stabilized at 22 breaths per minute. Albuterol (Proventil) is a bronchodilator commonly used to treat conditions like asthma and chronic obstructive pulmonary disease (COPD), which includes emphysema. The medication works by relaxing the smooth muscles in the airways, allowing them to widen and facilitate better airflow. In a patient with emphysema like Mr. Thompson, the primary therapeutic effect Nurse Murphy would look for is an improvement in respiratory rate and ease of breathing. A stabilized respiratory rate at 22 breaths per minute would indicate that the medication is effectively opening up the airways and improving gas exchange, thus achieving its intended therapeutic effect.

Imagine a traffic jam on a two-lane highway. Cars are moving slowly, and everyone is frustrated. Now, imagine that a third lane suddenly opens up, allowing cars to spread out and move more freely. This is similar to what albuterol does to the airways. It "opens up an extra lane" by relaxing the smooth muscles, allowing air to flow more freely and making it easier to breathe.

In emphysema, the airways are often constricted due to inflammation and the presence of mucus, leading to difficulty in breathing and poor gas exchange. Albuterol acts on the beta-2 adrenergic receptors in the smooth muscles of the airways, causing them to relax. This leads to bronchodilation, or the widening of the airways, which in turn improves airflow and facilitates better oxygenation and removal of carbon dioxide. A stabilized respiratory rate is a clinical indicator that the medication is effectively improving the patient's respiratory function.

 

✘Incorrect answer options:

Pupils are dilated and reactive. Dilated and reactive pupils are not an indicator of the therapeutic effectiveness of albuterol in treating respiratory conditions. Pupil dilation is more related to sympathetic nervous system activation and is not directly related to bronchodilation or improved respiratory function.

Heart rate is measured at 100 beats per minute. While albuterol can cause an increased heart rate as a side effect, this is not an indicator of its therapeutic effectiveness in treating respiratory conditions. An elevated heart rate could actually be a sign of an adverse reaction that may require medical attention.

Urine output is recorded at 40 ml per hour. Urine output is not a relevant indicator for the effectiveness of albuterol in treating respiratory conditions. It is more commonly monitored in conditions related to renal function or fluid balance.

 

References

• Arcangelo, V. P., & Peterson, A. M. (2013). *Pharmacotherapeutics for Advanced Practice: A Practical Approach*. Wolters Kluwer Health.
• Wilkins, R. L., Stoller, J. K., & Kacmarek, R. M. (2019). *Egan's Fundamentals of Respiratory Care*. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

False. Emphysema is a type of Chronic Obstructive Pulmonary Disease (COPD) that generally presents with noticeable symptoms, especially as the disease progresses. Common symptoms include shortness of breath, wheezing, and chronic cough. These symptoms are usually significant enough to prompt medical evaluation. While it's possible for early stages of emphysema to be less symptomatic, the nature of the disease typically leads to symptoms that are noticeable and often debilitating, affecting daily activities and quality of life.

Think of emphysema like a slowly rusting pipe. While a brand-new pipe allows water to flow freely, a rusting one gradually narrows, making it harder for water to pass through. You'll definitely notice when your water flow becomes a trickle instead of a stream. Similarly, emphysema narrows your airways over time, making it increasingly difficult to breathe, something that is hard to ignore.

Emphysema involves the destruction of alveoli, the small air sacs in the lungs responsible for gas exchange. As these air sacs are damaged, it becomes increasingly difficult for the lungs to effectively exchange oxygen and carbon dioxide, leading to symptoms like shortness of breath and fatigue. These symptoms are generally noticeable and prompt individuals to seek medical care.

 

✘Incorrect answer options:

True. This statement is incorrect because emphysema generally presents with noticeable symptoms like shortness of breath, chronic cough, and wheezing. These symptoms are often significant enough to affect daily activities and prompt medical evaluation.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. GOLD.
• Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Rodriguez-Roisin, R. (2013). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 187(4), 347-365.

EXPLANATION

 

✔Correct answer:

Chronic Obstructive Bronchitis. Mr. Vasquez's symptoms of a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds, along with his long history of smoking, strongly suggest that he is suffering from Chronic Obstructive Bronchitis. This condition is a type of Chronic Obstructive Pulmonary Disease (COPD) characterized by inflammation of the bronchi, leading to excessive mucus production and cough. The peripheral edema could be indicative of cor pulmonale, a condition where the right side of the heart fails due to long-term high blood pressure in the pulmonary arteries, a complication often seen in severe COPD cases. Cyanotic nail beds indicate poor oxygenation, which is consistent with chronic respiratory issues.

Imagine your home's plumbing system as the respiratory system. In a well-maintained system, water flows freely through the pipes (airways). Now, consider that gunk and debris (mucus) start to build up in the pipes, causing blockages and poor water flow. This is similar to what happens in Chronic Obstructive Bronchitis. The "pipes" (airways) are inflamed and filled with mucus, making it hard for "water" (air) to flow freely, leading to symptoms like cough and poor oxygenation.

In Chronic Obstructive Bronchitis, the bronchi are inflamed and narrowed, leading to airflow obstruction. The goblet cells, which produce mucus, are hyperactive, leading to excessive mucus production that further obstructs airflow. This results in poor gas exchange, leading to hypoxia (low oxygen levels) and hypercapnia (high CO2 levels). Over time, chronic hypoxia can lead to complications like peripheral edema and cyanosis, as seen in Mr. Vasquez.

 

✘Incorrect answer options:

Emphysema. While emphysema is also a type of COPD and is associated with smoking, it primarily involves the destruction of alveoli and does not typically produce thick sputum or peripheral edema. The primary symptom is usually shortness of breath rather than a productive cough.

Asthma. Asthma is characterized by reversible airway obstruction and is often triggered by allergens, exercise, or stress. It does not produce chronic symptoms like thick sputum and peripheral edema, and it is not typically associated with a long history of smoking.

Adult Respiratory Distress Syndrome (ARDS). ARDS is an acute condition often caused by severe illness or trauma. It leads to fluid accumulation in the alveoli, severely impairing gas exchange. While it can cause cyanosis, it would not cause chronic symptoms like a long-term cough with sputum production or peripheral edema.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Rodriguez-Roisin, R. (2013). *Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease*. American journal of respiratory and critical care medicine, 187(4), 347-365.

EXPLANATION

 

✔Correct answer:

False. The leading cause of emphysema is not environmental air pollutants but cigarette smoking. While exposure to air pollutants, occupational dust, and chemicals can contribute to the development of emphysema, cigarette smoking is by far the most significant risk factor. According to various studies and guidelines, up to 85-90% of emphysema cases are caused by smoking. Therefore, Nurse Andrew should inform Ms. Williams that while her proximity to a factory emitting pollutants could be a concern, smoking remains the primary cause of emphysema.

Imagine your lungs as a garden. Smoking is like pouring a strong weed killer all over the garden; it's the most direct and damaging action you can take. Being near a factory emitting pollutants is more like having a neighbor who occasionally sprays weed killer that drifts over into your garden. While the latter is not ideal and can cause some harm, it's not as damaging as directly pouring weed killer on your own garden.

Emphysema involves the destruction of the alveoli, the small air sacs in the lungs responsible for gas exchange. Cigarette smoke contains numerous harmful substances that directly irritate and damage the lung tissue, leading to inflammation and eventually the breakdown of alveoli. Environmental pollutants can also cause harm but are generally less potent and less directly damaging than the substances found in cigarette smoke.

 

✘Incorrect answer options:

True. This statement is incorrect because the leading cause of emphysema is cigarette smoking, not environmental air pollutants. While pollutants can contribute to respiratory issues, they are not the primary cause of emphysema.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• Eisner, M. D., Anthonisen, N., Coultas, D., Kuenzli, N., Perez-Padilla, R., Postma, D., ... & Buist, A. S. (2010). *An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease*. American Journal of Respiratory and Critical Care Medicine, 182(5), 693-718.

EXPLANATION

 

✔Correct answer:

A respiratory disorder characterized by the degradation of walls in overly stretched alveoli. The most accurate description of emphysema is that it is a respiratory disorder characterized by the degradation or destruction of walls in overly stretched alveoli. In emphysema, the elastic fibers within the alveoli are damaged, often due to long-term exposure to irritants like cigarette smoke. This damage leads to the loss of alveolar walls, resulting in larger but fewer alveoli. The destruction of these walls reduces the surface area available for gas exchange, leading to less effective oxygenation of the blood and removal of carbon dioxide.

Imagine the alveoli as tiny balloons in a big cluster, each responsible for holding a small amount of air for gas exchange. In emphysema, these balloons lose their elasticity and some even pop, merging into larger, less efficient balloons. Now, instead of having many small balloons efficiently exchanging air, you have fewer, larger balloons that are not as effective, making it harder to get the oxygen you need.

The alveoli are the primary sites for gas exchange in the lungs. In a healthy lung, they are elastic and can expand and contract easily, facilitating efficient gas exchange. In emphysema, the loss of this elasticity and the destruction of alveolar walls lead to air trapping and hyperinflation of the lungs. This makes it difficult to fully exhale, leading to an increase in the residual volume of the lungs and a decrease in the efficiency of gas exchange.

 

✘Incorrect answer options:

The condition is marked by coughing and sputum production lasting a combined total of two or three months for two consecutive years. This description is more indicative of chronic bronchitis, another form of COPD, rather than emphysema. Chronic bronchitis is characterized by inflammation of the bronchi, leading to excessive mucus production and a chronic cough.

A disorder resulting in a commonly reversible limitation of airflow. This description is more aligned with asthma, which is characterized by episodes of reversible airway constriction in response to various triggers. Unlike emphysema, the airflow limitation in asthma is generally reversible with treatment.

Chronic widening of a bronchus or multiple bronchi. This description refers to bronchiectasis, a condition characterized by the permanent dilation of the bronchi, often due to chronic infection or inflammation. It is not a description of emphysema, which primarily involves the alveoli rather than the bronchi.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Rodriguez-Roisin, R. (2013). *Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease*. American journal of respiratory and critical care medicine, 187(4), 347-365.

EXPLANATION

 

✔Correct answer:

The client has emphysema. A "barrel chest" is a physical characteristic commonly associated with emphysema, a form of chronic obstructive pulmonary disease (COPD). In emphysema, the alveoli (tiny air sacs in the lungs) are damaged, leading to air trapping and hyperinflation of the lungs. This chronic hyperinflation alters the mechanics of the chest wall, leading to a barrel chest. The increased anterior-posterior diameter of the chest is a compensatory mechanism to accommodate the larger lung volume. Therefore, Nurse Patrick should interpret the presence of a barrel chest as indicative of emphysema in Mr. Stevens.

Imagine your lungs as two balloons inside a small box (the chest cavity). Normally, the balloons inflate and deflate easily, fitting well within the box. In emphysema, the balloons are constantly a bit inflated, making the box bulge outward into a barrel shape. This is what happens in emphysema: the lungs are chronically inflated, causing the chest to take on a barrel-like appearance.

In emphysema, the alveoli are damaged, leading to air trapping and hyperinflation of the lungs. This chronic hyperinflation alters the mechanics of the chest wall, leading to a barrel chest. The increased anterior-posterior diameter of the chest is a compensatory mechanism to accommodate the larger lung volume. This is particularly beneficial in emphysema, where the loss of elastic recoil in the lungs makes airway collapse more likely.

 

✘Incorrect answer options:

The client has bronchial asthma. A barrel chest is not typically associated with bronchial asthma. Asthma is characterized by episodes of reversible airway constriction in response to various triggers, but it does not usually lead to the chronic lung changes seen in emphysema.

The client has a combination of bronchial asthma and bronchitis. While it's possible for a person to have both asthma and bronchitis (known as asthmatic bronchitis), a barrel chest is not a characteristic feature of either condition or their combination. It is specifically associated with emphysema.

The client has chronic obstructive bronchitis. Chronic obstructive bronchitis can be a component of COPD, but it is not typically associated with a barrel chest. This physical characteristic is more indicative of emphysema, which involves damage to the alveoli and hyperinflation of the lungs.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Rodriguez-Roisin, R. (2013). *Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease*. American journal of respiratory and critical care medicine, 187(4), 347-365.

EXPLANATION

 

✔Correct answer:

False. Carbon monoxide (CO) is not a waste product expelled from the body during exhalation. The primary waste product expelled during exhalation is carbon dioxide (CO2). Carbon monoxide is a harmful gas that can be produced by burning fossil fuels, and it can be particularly dangerous because it binds to hemoglobin more tightly than oxygen does. This can lead to decreased oxygen delivery to tissues, resulting in hypoxia or even death in severe cases. Therefore, Nurse Peter should clarify that carbon monoxide is not a waste product expelled during exhalation but is a dangerous gas that can be inhaled from external sources like cigarette smoke or car exhaust.

Imagine your blood as a bus service that picks up oxygen from the lungs and delivers it to various "stops" or tissues throughout the body. Carbon dioxide is like the passenger that gets on the bus at these stops and is taken back to the lungs to be expelled. Carbon monoxide, on the other hand, is like a rogue passenger who sneaks onto the bus, takes up a seat, and refuses to get off, making it difficult for the regular passengers (oxygen) to find a seat.

In normal respiration, oxygen is inhaled into the lungs, where it binds to hemoglobin in red blood cells. These red blood cells then transport the oxygen to tissues throughout the body. Carbon dioxide, a waste product of cellular metabolism, is picked up by the red blood cells and transported back to the lungs, where it is expelled during exhalation. Carbon monoxide can interfere with this process by binding to hemoglobin more tightly than oxygen, reducing the amount of oxygen that can be transported and leading to tissue hypoxia.

 

✘Incorrect answer options:

True. This statement is incorrect because carbon monoxide is not a waste product expelled from the body during exhalation. It is a harmful gas that can be inhaled from external sources and can interfere with the body's ability to transport oxygen.

 

References

• West, J. B. (2015). *Respiratory Physiology: The Essentials*. Wolters Kluwer Health.
• American Lung Association. (2020). *The Harmful Effects of Carbon Monoxide*. American Lung Association.

EXPLANATION

 

✔Correct answer:

Promptly report the finding to the attending physician. Subcutaneous emphysema following chest surgery is a concerning sign that may indicate a complication such as a pneumothorax or air leak from the surgical site. It occurs when air escapes into the subcutaneous tissue, often due to a tear or hole in the respiratory tract. Given that Mrs. Williams is only two hours post-surgery, the presence of subcutaneous emphysema along the suture line and the chest dressing is a critical finding that requires immediate attention. Nurse Michael should promptly report this observation to the attending physician for further evaluation and management.

Imagine you've just repaired a leaky boat and you're testing it in the water. If you notice water seeping through the repaired area, you wouldn't just ignore it or try to patch it up yourself; you'd immediately alert the experts to assess the situation. Similarly, subcutaneous emphysema after chest surgery is like that leak, signaling that something might be wrong with the "repair" (surgery), and it's crucial to alert the "experts" (physicians) right away.

Subcutaneous emphysema occurs when air gets trapped in the layers of the skin. This can happen if there is a tear or puncture in the respiratory system, allowing air to escape and infiltrate the surrounding tissues. In the context of post-surgical care, this could indicate a serious issue like an air leak from the surgical site or a pneumothorax, which is the presence of air in the pleural space. Both of these conditions can lead to respiratory distress and are considered medical emergencies.

 

✘Incorrect answer options:

Place a compression dressing over the affected area. Placing a compression dressing could exacerbate the condition by trapping more air and potentially worsening any underlying issue. It does not address the root cause and could delay necessary medical intervention.

Take the patient's pulse oximetry readings. While monitoring oxygen levels is important, it is not the most appropriate immediate action in this case. Subcutaneous emphysema is a sign of a potential serious complication that requires immediate medical evaluation.

Simply document the observed subcutaneous emphysema. Documentation is important, but it should not be the only action taken. This is a potentially serious finding that requires immediate medical attention, and simply documenting it would be insufficient and could lead to adverse outcomes.

 

References

• Furr, A. L., & Watanabe, K. (2019). *Critical Care Nursing of the Surgical Patient*. F.A. Davis Company.
• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). *Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care*. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

The presence of a barrel chest and utilization of pursed-lip breathing. Nurse Sophia would most likely anticipate observing a barrel chest and the utilization of pursed-lip breathing in Mr. Anderson, given his known history of emphysema. A barrel chest is a physical characteristic commonly seen in emphysema patients due to the chronic overinflation of the lungs. The rib cage expands to accommodate the increased lung volume, leading to a more rounded, barrel-like appearance of the chest. Pursed-lip breathing is a technique often used by emphysema patients to improve exhalation and prevent airway collapse, as it creates back pressure in the airways, helping to keep them open for more effective gas exchange.

Imagine the lungs as two balloons inside a small box (the chest cavity). Normally, the balloons inflate and deflate easily, fitting well within the box. In emphysema, the balloons are constantly a bit inflated, making the box bulge outward into a barrel shape. The pursed-lip breathing technique is like slowly letting the air out of the balloons through a small opening, ensuring that they deflate as much as possible without popping.

In emphysema, the alveoli are damaged, leading to air trapping and hyperinflation of the lungs. This chronic hyperinflation alters the mechanics of the chest wall, leading to a barrel chest. The increased anterior-posterior diameter of the chest is a compensatory mechanism to accommodate the larger lung volume. Pursed-lip breathing aids in prolonging exhalation, increasing intrabronchial pressure, and thus preventing airway collapse. This is particularly beneficial in emphysema, where the loss of elastic recoil in the lungs makes airway collapse more likely.

 

✘Incorrect answer options:

Cyanotic skin coloration and clubbing of the fingers. While cyanosis can occur in severe cases of emphysema due to poor oxygenation, clubbing of the fingers is generally not a characteristic feature of emphysema. Clubbing is more commonly associated with conditions like lung cancer or chronic hypoxia.

A slow heart rate (bradycardia) and enhanced tactile fremitus. Bradycardia and enhanced tactile fremitus are not typical clinical signs of emphysema. Bradycardia is more commonly associated with cardiac conditions, and enhanced tactile fremitus is often seen in conditions like pneumonia, where there is consolidation of lung tissue.

Signs of pitting edema and distended jugular veins. While these signs could indicate cor pulmonale, a complication of severe, chronic respiratory diseases, they are not the most likely clinical signs to be observed in a typical case of emphysema. Cor pulmonale is a right-sided heart failure due to long-term high blood pressure in the pulmonary arteries and is a late-stage complication.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Rodriguez-Roisin, R. (2013). *Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease*. American journal of respiratory and critical care medicine, 187(4), 347-365.

EXPLANATION

 

✔Correct answer:

Non-rebreather mask. Nurse Emily should opt for a non-rebreather mask to deliver the highest concentration of oxygen to Linda. This type of mask is designed to allow for oxygen concentrations of up to 90-100%. It includes a reservoir bag that collects oxygen, and one-way valves to prevent exhaled air from entering the bag. This ensures that the patient inhales a high concentration of pure oxygen, which is crucial for Linda given her critically low blood oxygen levels.

Think of the non-rebreather mask as a "VIP lounge" for oxygen. In this lounge, only pure oxygen is allowed, and there's a bouncer (one-way valve) making sure that no "unwanted guests" (exhaled air) get in. This ensures that Linda gets the highest quality of oxygen possible.

In acute respiratory distress, the alveoli in the lungs may not be functioning optimally, leading to poor gas exchange. A high concentration of oxygen is needed to maximize the amount of oxygen that can diffuse across the respiratory membrane into the bloodstream. The non-rebreather mask ensures that a high concentration of oxygen is available for this gas exchange, thereby helping to correct hypoxia and alleviate respiratory distress.

 

✘Incorrect answer options:

Intranasal catheter. Intranasal catheters are generally used for long-term, low-flow oxygen therapy and are not suitable for delivering high concentrations of oxygen. They can provide only up to 40% oxygen concentration, which is insufficient for Linda's acute condition.

Venturi mask. The Venturi mask is precise in delivering a pre-set oxygen concentration but usually maxes out at around 50% oxygen. It's more commonly used in patients with chronic obstructive pulmonary disease (COPD) where too much oxygen can be harmful.

Face tent. Face tents are generally used for patients who need humidified oxygen or have facial injuries that make other devices uncomfortable. They are not designed to deliver high concentrations of oxygen and are therefore not suitable for Linda's acute respiratory distress.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. (2017). *Medical-Surgical Nursing: Assessment and Management of Clinical Problems*. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). *Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care*. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Not more than 2 L/min. For patients with emphysema like Mark, it's crucial to maintain a low flow rate of oxygen, generally not exceeding 2 L/min. The reason for this caution is that patients with chronic obstructive pulmonary diseases (COPD), such as emphysema, often have a blunted respiratory drive. In a healthy individual, rising levels of carbon dioxide (CO2) in the blood stimulate the urge to breathe. However, in patients with emphysema, the respiratory system becomes accustomed to higher levels of CO2, and the primary stimulus for breathing shifts to lower levels of oxygen (hypoxia). Providing too much supplemental oxygen can suppress this already weakened respiratory drive, leading to a dangerous rise in CO2 levels, a condition known as hypercapnia.

Think of Mark's respiratory system as a delicate balance scale. On one side of the scale, you have oxygen, and on the other side, you have carbon dioxide (CO2). In a healthy person, the scale is balanced with the right amount of each gas, thanks to a well-functioning respiratory system that adds or removes weights (gases) as needed. In Mark's case, his scale is already off-balance due to his emphysema. If Nurse Karen adds too much weight to the oxygen side by administering oxygen at a high flow rate, the scale tips even further out of balance. This makes it harder for Mark's body to get rid of the CO2 weight on the other side, leading to a dangerous condition known as hypercapnia.

In emphysema, the alveoli are damaged, reducing the surface area for effective gas exchange. The body adapts to this by relying more on hypoxia as a stimulus for breathing rather than elevated CO2 levels. Administering oxygen at a rate higher than 2 L/min can lead to oxygen-induced hypercapnia. This occurs because the additional oxygen dilutes the CO2 in the alveoli, reducing the gradient for CO2 to be expelled from the bloodstream into the alveoli, thereby increasing blood CO2 levels.

 

✘Incorrect answer options:

Not more than 1 L/min. While it's essential to be cautious with oxygen therapy in emphysema patients, a maximum limit of 1 L/min may be too restrictive and might not provide adequate oxygenation for the patient. The aim is to achieve a balance between preventing hypoxia and avoiding hypercapnia.

Not more than 6 L/min. This flow rate is too high for a patient with emphysema and could lead to oxygen-induced hypercapnia. High flow rates can suppress the respiratory drive in these patients, leading to retention of CO2 and potential respiratory failure.

Not more than 10 L/min. This is dangerously high for a patient with emphysema. Such a high flow rate would almost certainly lead to oxygen-induced hypercapnia and could result in severe respiratory distress or failure.

 

References

• O'Donnell, D. E., Hernandez, P., Kaplan, A., Aaron, S., Bourbeau, J., Marciniuk, D., ... & Voduc, N. (2008). *Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease*. Canadian Respiratory Journal, 15(Suppl A), 1A-8A.
• Hardinge, M., Annandale, J., Bourne, S., Cooper, B., Evans, A., Freeman, D., ... & British Thoracic Society Home Oxygen Guideline Development Group. (2015). *British Thoracic Society guidelines for home oxygen use in adults*. Thorax, 70(Suppl 1), i1-i43.

EXPLANATION

 

✔Correct answer:

It aids in preventing premature collapse of the airways. Nurse Olivia should explain to Mr. Johnson that the primary purpose of pursed-lip breathing is to prevent the premature collapse of the airways during exhalation. In emphysema, the elastic fibers in the lungs are damaged, which makes it difficult to maintain open airways, especially during the exhalation phase. Pursed-lip breathing creates a sort of back pressure or positive end-expiratory pressure (PEEP) in the airways, which helps keep them open longer. This allows for more effective removal of stale air and trapped gases, improving overall gas exchange.

Imagine you're trying to empty a water bottle with a narrow opening. If you turn it upside down quickly, the water gushes out, but some water remains trapped at the bottom. Now, if you turn it upside down and squeeze it slowly, you'll notice that almost all the water gets out. Pursed-lip breathing works similarly; by exhaling slowly through pursed lips, you're ensuring that most of the "trapped air" (akin to the trapped water) gets out of your lungs, making room for fresh, oxygen-rich air.

The technique of pursed-lip breathing increases the time spent in the exhalation phase, which is beneficial for patients with emphysema. The longer exhalation time creates a higher pressure within the bronchioles during the exhalation, preventing their collapse. This is particularly important because emphysema damages the alveoli and their surrounding structures, reducing the natural elastic recoil that helps keep airways open. By preventing airway collapse, pursed-lip breathing enhances the effectiveness of each breath, improving oxygenation and reducing the work of breathing.

 

✘Incorrect answer options:

It enhances the strength of the muscles used for inspiration. While muscle strengthening is important in respiratory conditions, the primary aim of pursed-lip breathing is not to strengthen the inspiratory muscles. Instead, it focuses on improving the mechanics of exhalation to enhance gas exchange.

It minimizes the usage of accessory muscles for breathing. Although pursed-lip breathing can make breathing more efficient, its main purpose is not to reduce the use of accessory muscles. The primary goal is to improve the mechanics of exhalation and prevent airway collapse.

It extends the duration of the inspiratory phase of respiration. Pursed-lip breathing primarily affects the exhalatory phase, not the inspiratory phase. The technique aims to extend the duration of exhalation to improve gas exchange and prevent airway collapse.

 

References

• O'Donnell, D. E., Hernandez, P., Kaplan, A., Aaron, S., Bourbeau, J., Marciniuk, D., ... & Voduc, N. (2008). *Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease*. Canadian Respiratory Journal, 15(Suppl A), 1A-8A.
• Hardinge, M., Annandale, J., Bourne, S., Cooper, B., Evans, A., Freeman, D., ... & British Thoracic Society Home Oxygen Guideline Development Group. (2015). *British Thoracic Society guidelines for home oxygen use in adults*. Thorax, 70(Suppl 1), i1-i43.

EXPLANATION

 

✔Correct answer:

False. Emphysema is a chronic, progressive lung disease that is part of the broader condition known as Chronic Obstructive Pulmonary Disease (COPD). Unfortunately, there is no complete cure for emphysema. The damage to the alveoli (air sacs in the lungs) is irreversible, and the primary goal of treatment is to manage symptoms, improve quality of life, and slow the progression of the disease. Therefore, Nurse Olivia should inform Mrs. Smith that while her symptoms can be managed and her quality of life can be improved, a complete cure for emphysema is not currently available.

Imagine your lungs as a sponge that helps soak up water (oxygen). In emphysema, parts of the sponge become hard and lose their ability to soak up water effectively. While you can take steps to prevent the sponge from getting worse, like avoiding squeezing it too hard (smoking cessation), you can't turn the hard parts back into their original, soft state. The damage is permanent.

In emphysema, the walls of the alveoli are damaged, leading to larger, less efficient air sacs. This affects the lungs' ability to exchange gases like oxygen and carbon dioxide effectively. The loss of alveolar walls also means a loss of elasticity in the lungs, making it harder to exhale fully. Treatments like bronchodilators and pulmonary rehabilitation can help manage symptoms, but they can't reverse the damage to the alveoli.

 

✘Incorrect answer options:

True. This statement is incorrect. Emphysema is a chronic, irreversible condition. While treatments can help manage symptoms and improve quality of life, they cannot completely cure the disease.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• Celli, B. R., & Wedzicha, J. A. (2019). *Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease*. New England Journal of Medicine, 381(13), 1257-1266.

EXPLANATION

 

✔Correct answer:

Adenocarcinoma. Adenocarcinoma is the most common type of lung cancer affecting both men and women. It accounts for about 40% of all lung cancer cases. This type of carcinoma originates in the mucus-producing glands in the lungs and is often found in the outer parts of the lung. Adenocarcinoma is also more common in non-smokers compared to other types of lung cancer, although smokers are also at risk. Given its prevalence, Nurse Emily should focus on adenocarcinoma to provide the most relevant information to her audience.

Think of the lung as a large shopping mall with various types of stores—clothing stores, electronics shops, food courts, and so on. Adenocarcinoma is like the most common type of store in this mall, let's say, clothing stores. Just as you would find clothing stores scattered throughout different sections of the mall, adenocarcinoma can occur in different parts of the lung, most commonly in the outer regions. The reason clothing stores are so prevalent is that they cater to a broad range of shoppers, much like how adenocarcinoma affects both smokers and non-smokers, making it the most common "store" or type of lung cancer you're likely to "shop at" or encounter.

Adenocarcinoma usually starts in the cells that secrete substances like mucus. These cells are found in the alveoli, which are the tiny air sacs in the lungs where gas exchange occurs. When these cells become cancerous, they can multiply uncontrollably, leading to a tumor. The tumor can then invade surrounding tissues and spread to other parts of the body. Because adenocarcinoma is so prevalent, it is crucial for healthcare professionals to be well-versed in its characteristics for early detection and treatment.

 

✘Incorrect answer options:

Large cell carcinoma. Large cell carcinoma is a less common type of lung cancer, accounting for only about 10-15% of all cases. It can appear in any part of the lung and tends to grow and spread quickly, making it more difficult to treat. However, it is not the most prevalent type affecting both men and women.

Small cell carcinoma. Small cell carcinoma is a less common but more aggressive form of lung cancer, accounting for about 10-15% of all lung cancer cases. It is strongly associated with smoking and tends to spread quickly, but it is not the most common type.

Squamous cell carcinoma. Squamous cell carcinoma is another type of non-small cell lung cancer but is less common than adenocarcinoma. It accounts for about 25-30% of all lung cancer cases and is often linked to a history of smoking. It usually starts in the squamous cells that line the airways but is not the most prevalent type.

 

References

• American Cancer Society. (2021). *Cancer Facts & Figures 2021*. American Cancer Society.
• Travis, W. D., Brambilla, E., Nicholson, A. G., Yatabe, Y., Austin, J. H., Beasley, M. B., ... & Dacic, S. (2015). *The 2015 World Health Organization Classification of Lung Tumors*. Journal of Thoracic Oncology, 10(9), 1243-1260.

EXPLANATION

 

✔Correct answer:

Advise the client to engage in pursed-lip breathing. Nurse Jasmine should immediately advise David to engage in pursed-lip breathing. This technique involves inhaling through the nose and exhaling through pursed lips, which helps to improve the efficiency of each breath by increasing the time spent in the exhalation phase. This is particularly important for patients with emphysema, as they often have difficulty with air trapping and incomplete exhalation, leading to hyperinflation of the lungs and decreased gas exchange. Restlessness and confusion in David could be signs of hypoxia, and pursed-lip breathing can help improve oxygenation.

Think of the lungs as balloons that need to be deflated properly to make room for fresh air. In emphysema, the "deflation process" is compromised, much like a balloon with a small tear that makes it difficult to let all the air out. Pursed-lip breathing acts like a controlled, slow release of air from the balloon, ensuring that as much old air as possible is expelled to make room for fresh, oxygen-rich air.

In emphysema, the alveolar walls are damaged, leading to larger but fewer alveoli. This reduces the surface area available for gas exchange, making it harder for oxygen to enter the bloodstream and for carbon dioxide to be expelled. Pursed-lip breathing helps by creating back pressure in the airways during exhalation, which can prevent airway collapse. This allows for more effective removal of trapped air and carbon dioxide, improving overall gas exchange and potentially alleviating symptoms like restlessness and confusion.

 

✘Incorrect answer options:

Elevate the oxygen flow rate for the client. Increasing the oxygen flow rate might seem like a logical step, but it can be dangerous for patients with emphysema. These patients often rely on low levels of oxygen as a stimulus for breathing. Providing too much supplemental oxygen can actually suppress their respiratory drive, leading to hypercapnia (elevated levels of carbon dioxide in the blood), which could worsen David's confusion and restlessness.

Evaluate the client's serum potassium levels. While electrolyte imbalances can cause restlessness and confusion, they are not the immediate concern for a patient showing acute symptoms of respiratory distress due to emphysema. Checking serum potassium levels would not provide the urgent intervention needed to address David's deteriorating respiratory status.

Assess the client's body temperature. Although it's important to monitor for signs of infection or other issues, assessing body temperature is not the immediate priority when a patient with emphysema is showing signs of acute respiratory distress. The focus should be on improving David's oxygenation and ventilation to alleviate his symptoms.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. (2017). *Medical-Surgical Nursing: Assessment and Management of Clinical Problems*. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). *Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care*. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

False. Nurse Allison should inform Mr. Harris that emphysema is a progressive disease, meaning it tends to worsen over time. While treatments can help manage symptoms and slow down the rate of progression, they cannot stop the disease from advancing altogether. The damage to the alveoli (air sacs in the lungs) is irreversible, and as the disease progresses, lung function typically declines, leading to increased symptoms and decreased quality of life.

Imagine emphysema like a snowball rolling down a hill. At first, the snowball is small and manageable, but as it rolls down, it gathers more snow and becomes larger and harder to control. Similarly, emphysema starts off with minor symptoms but gathers "momentum" over time, leading to more severe symptoms and complications.

In emphysema, the walls of the alveoli are damaged, leading to larger, less efficient air sacs. This affects the lungs' ability to exchange gases like oxygen and carbon dioxide effectively. The loss of alveolar walls also means a loss of elasticity in the lungs, making it harder to exhale fully. As the disease progresses, more alveoli are affected, leading to a decline in lung function and an increase in symptoms such as shortness of breath, wheezing, and fatigue.

 

✘Incorrect answer options:

True. This statement is incorrect because emphysema is a progressive disease that generally worsens over time. While treatments can help manage symptoms and slow the rate of progression, they cannot halt the disease's advancement.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• Celli, B. R., & Wedzicha, J. A. (2019). *Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease*. New England Journal of Medicine, 381(13), 1257-1266.

EXPLANATION

 

✔Correct answer:

True. Nurse Lily would be accurate in stating that upon inspiration, air flows through the trachea and then splits into the left and right bronchi. This is the basic anatomical pathway of air during the process of inhalation. The trachea serves as the main airway that connects the larynx (voice box) to the bronchi, which further divide into smaller bronchioles and eventually lead to the alveoli where gas exchange occurs.

Think of the respiratory system as a tree. The trachea is like the main trunk of the tree, and the left and right bronchi are the two major branches that split off from the trunk. When you breathe in, it's like water being drawn up from the roots (your nose/mouth) through the trunk (trachea) and then being distributed into the major branches (left and right bronchi).

During inspiration, the diaphragm contracts and moves downward, creating a negative pressure within the thoracic cavity. This negative pressure draws air into the lungs. The air first enters through the nose or mouth, passes through the pharynx and larynx, and then enters the trachea. The trachea serves as a conduit that directs the air into the left and right primary bronchi, which further divide into smaller bronchioles and eventually lead to the alveoli where gas exchange takes place.

 

✘Incorrect answer options:

False. This statement would be incorrect because the anatomical pathway of air during inspiration does indeed involve air flowing through the trachea and then splitting into the left and right bronchi.

 

References

• Marieb, E. N., & Hoehn, K. (2018). *Human Anatomy & Physiology*. Pearson Education.
• Tortora, G. J., & Derrickson, B. (2018). *Principles of Anatomy and Physiology*. Wiley.

EXPLANATION

 

✔Correct answer:

Habitual cigarette smoking. Nurse William should emphasize that habitual cigarette smoking is the leading risk factor for the development of Chronic Obstructive Pulmonary Disease (COPD). According to various studies and clinical guidelines, smoking is responsible for about 85-90% of all COPD cases. The toxins in cigarette smoke cause inflammation and damage to the lung tissue, leading to chronic bronchitis and emphysema, the two main conditions that make up COPD. Over time, this damage becomes irreversible, significantly impairing lung function and leading to the symptoms commonly associated with COPD, such as shortness of breath, chronic cough, and frequent respiratory infections.

Imagine your lungs as a pristine forest, full of trees that help produce oxygen (akin to alveoli in the lungs). Smoking is like setting a small fire in that forest repeatedly. At first, the forest might recover, but over time, the fires (smoking) will cause irreversible damage, making it harder for the forest to produce oxygen and function properly.

Cigarette smoke contains more than 7,000 chemicals, many of which are toxic and can damage the lungs. When inhaled, these chemicals cause inflammation and trigger an immune response, leading to the production of mucus and the destruction of alveoli. This results in narrowed airways and reduced surface area for gas exchange, causing the hallmark symptoms of COPD. The damage also makes the lungs more susceptible to infections, exacerbating the disease progression.

 

✘Incorrect answer options:

Exposure to occupational hazards like fumes and dust. While occupational exposures can contribute to the development of COPD, they are not the leading risk factor. These exposures account for a much smaller percentage of COPD cases compared to smoking. However, it's important to note that people in certain professions may be at higher risk and should take appropriate precautions.

Inherited genetic abnormalities. Genetic factors like alpha-1 antitrypsin deficiency can predispose individuals to COPD, but these cases are relatively rare. Most people with COPD do not have a genetic predisposition; rather, their condition is primarily caused by environmental factors, with smoking being the most significant.

Prolonged exposure to air pollution. Air pollution can exacerbate symptoms of COPD and may contribute to its onset, but it is not the primary risk factor. In developing countries, indoor air pollution from cooking fires is a significant concern, but even then, cigarette smoking remains the leading cause of COPD globally.

 

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). *Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease*. GOLD.
• Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Rodriguez-Roisin, R. (2013). *Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease*. American journal of respiratory and critical care medicine, 187(4), 347-365.

EXPLANATION

 

✔Correct answer:

Tachycardia and nervousness. Albuterol is a short-acting beta-agonist that works by stimulating beta-2 receptors in the lungs, leading to bronchodilation and improved airflow. However, it can also have some systemic effects, including an increase in heart rate (tachycardia) and feelings of nervousness or jitteriness. These side effects occur because albuterol can also stimulate beta-1 receptors in the heart and beta-2 receptors in the skeletal muscles, leading to increased heart rate and muscle tremors. Therefore, Nurse Allen should advise Mr. Wallace to be vigilant for these potential side effects and to report them if they become bothersome or severe.

Imagine you're using a garden hose to water your plants, and you turn up the pressure to make the water reach plants that are farther away. While this works well for the plants, the increased pressure might also cause some water to splash onto areas you didn't intend to water, like a nearby window. Similarly, albuterol is designed to target the lungs, but its effects can "splash over" to other parts of the body, like the heart and muscles, causing side effects like tachycardia and nervousness.

Albuterol primarily targets beta-2 adrenergic receptors in the lungs, causing bronchodilation and making it easier to breathe. However, it can also have some non-selective effects on beta-1 receptors in the heart, leading to an increased heart rate. Additionally, stimulation of beta-2 receptors in skeletal muscles can cause tremors or feelings of nervousness. These side effects are generally dose-dependent and may be more pronounced at higher doses.

 

✘Incorrect answer options:

Hypotension and bradycardia. Albuterol is more likely to cause an increase in heart rate (tachycardia) rather than a decrease (bradycardia). It is also unlikely to cause low blood pressure (hypotension); in fact, it may cause a slight increase in blood pressure due to its stimulatory effects on the heart.

Drowsiness and constipation. Albuterol is a stimulant medication and is unlikely to cause drowsiness. It also has no known effects on the gastrointestinal system that would lead to constipation.

Hyperglycemia and weight gain. While beta-agonists like albuterol can have some impact on metabolism, they are not commonly associated with hyperglycemia (high blood sugar) or weight gain as side effects. These are more likely to be associated with other classes of medications, such as corticosteroids.

 

References

• Arcangelo, V. P., & Peterson, A. M. (2013). *Pharmacotherapeutics for Advanced Practice: A Practical Approach*. Wolters Kluwer Health.
• Wilkins, R. L., Stoller, J. K., & Kacmarek, R. M. (2019). *Egan's Fundamentals of Respiratory Care*. Elsevier Health Sciences.