Chapter 23 Restrictive Pulmonary Disorders

Chapter 23: Restrictive Pulmonary Disorders MULTIPLE CHOICE 1. Viral pneumonia is characterized by a. a productive cough. b. a dry cough. c. exudative consolidation. d. significant ventilation-perfusion imbalance. ANS: B No exudative fluids are produced. Viral pneumonia does not produce exudates, so the cough is non-productive. Ventilation-perfusion imbalance does not usually occur in viral pneumonia. 2. The characteristic x-ray findings in tuberculosis include a. diffuse white-out. b. Ghon tubercles. c. bibasilar infiltrates. d. tracheal deviation. ANS: B Tuberculosis results in Ghon tubercles that show up as nodules with infiltrates. Diffuse white-out, basilar infiltrates, and tracheal deviation are not characteristic x-ray findings in tuberculosis. 3. Widespread atelectasis, non-cardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates on chest radiograph are characteristic of a. acute respiratory distress syndrome. b. chronic obstructive pulmonary disease. c. asthma. d. cor pulmonale. ANS: A Acute respiratory distress syndrome is characterized by widespread atelectasis, non-cardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates. These findings are not characteristics of chronic obstructive pulmonary disease, asthma, or cor pulmonale. 4. Which is indicative of a left tension pneumothorax? a. Course crackles throughout the left chest b. Tracheal deviation to the left c. Absent breath sounds on the left d. Respiratory acidosis ANS: C A left pneumothorax results in absent breath sounds on the affected side. Crackles will not be heard because breath sounds are not present. Tracheal deviation occurs on the contralateral side. Pneumothorax results in acute respiratory alkalosis. 5. A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for a. pneumonia. b. pneumothorax. c. pulmonary edema. d. pulmonary embolus. ANS: B Pneumothorax leads to a tracheal shift to the side opposite the pneumothorax. Pneumonia, pulmonary edema, and pulmonary embolus do not lead to tracheal shift. 6. A patient with a productive cough and parenchymal infiltrates on x-ray is demonstrating symptomology of a. bacterial pneumonia. b. viral pneumonia. c. tuberculosis. d. acute respiratory distress syndrome. ANS: A Bacterial pneumonia produces a productive cough and parenchymal infiltrates (white shadows) on x-ray. Viral pneumonia does not produce a productive cough. Tuberculosis may produce a productive cough but does not show parenchymal infiltrates (white shadows) on x-ray. Acute respiratory distress syndrome produces a non-productive cough. 7. The organism that causes pulmonary tuberculosis is a. Mycobacterium tuberculosis. b. Haemophilus tuberculosis. c. Tuberculosis tuberculoci. d. Mycococcidio tuberculosis. ANS: A Mycobacterium tuberculosis causes pulmonary tuberculosis. Haemophilus tuberculosis, Tuberculosis tuberculoci, and Mycococcidio tuberculosis do not cause pulmonary tuberculosis. 8. Which clinical manifestation is not likely the result of a tuberculosis infection? a. Productive cough b. Low-grade fever c. Night sweats d. Cyanosis ANS: D Cyanosis is not a typical manifestation of tuberculosis infection. A productive cough, low-grade fever, and night sweats are the typical manifestations of tuberculosis infection. 9. Which disorder is caused by inhalation of organic substances? a. Diffuse interstitial lung disease b. Hypersensitivity pneumonitis c. Sarcoidosis d. Acute respiratory distress syndrome ANS: B Hypersensitivity pneumonitis is caused by inhalation of organic substances that produces an inflammatory immunologic reaction. Diffuse interstitial lung disease is probably related to an immune reaction but not from inhalation of organic substances. Sarcoidosis likely has an immunologic basis, but not from inhalation of organic substances. Acute respiratory distress syndrome is associated with severe trauma, sepsis, and shock. 10. The hallmark manifestation of acute respiratory distress syndrome is a. tachycardia. b. hypotension. c. frothy secretions. d. hypoxemia. ANS: D The hallmark of acute respiratory distress syndrome is hypoxemia caused by intrapulmonary shunting of blood. Tachycardia, hypotension, and frothy secretion occur in this disorder but are not hallmark. 11. The primary cause of infant respiratory distress syndrome is a. prematurity. b. lack of surfactant. c. maternal illegal drug use during pregnancy. d. umbilical cord compression. ANS: B The primary cause of this disorder is lack of surfactant. While premature infants may demonstrate this disorder, the actual cause is lack of surfactant. It is a syndrome seen in premature infants. Maternal illegal drug use during pregnancy and umbilical cord compression are not the primary causes of infant respiratory distress syndrome. 12. Empyema is defined as an a. exudative bronchitis. b. infection in the pleural space. c. infection localized in the lung. d. infection in the blood. ANS: B Empyema is infection in the pleural space. Empyema is not exudative bronchitis, localized infection in the lung, or an infection in the blood. 13. A patient with flail chest will demonstrate a. absence of chest movement with breaths. b. no inspiratory breath sounds. c. fluttering chest movements on expirations. d. outward chest movement on expiration. ANS: D Flail chest is demonstrated by paradoxical inward movement on inspiration and outward movement on expiration. Flail chest is not demonstrated by absence of chest movement with breaths, no inspiratory breath sounds, or fluttering chest movements on expiration. 14. Obstructive sleep apnea would most likely be found in a patient diagnosed with a. myasthenia gravis. b. poliomyelitis. c. Pickwickian syndrome. d. pneumonia. ANS: C Pickwickian syndrome is hypoventilation caused by obesity. Sleep apnea is often a problem in obese individuals. Obstructive sleep apnea is not likely to be found in a patient with myasthenia gravis, poliomyelitis, or pneumonia. 15. Pneumocystitis is a term that refers to a a. fungal pneumonia secondary to HIV. b. viral pneumonia found in transplant recipients. c. non-infectious inflammation in the lung. d. pneumonia secondary to bladder infection. ANS: A Pneumocystitis is a fungal pneumonia secondary to HIV. Pneumocystitis is not a viral pneumonia found in transplant recipients, a non-infectious inflammation of the lung, or a pneumonia secondary to bladder infection. 16. The most definitive diagnostic method for active tuberculosis is acquired via a. sputum culture. b. Mantoux skin test. c. chest x-ray. d. blood culture. ANS: A The most definitive diagnostic method for active tuberculosis is via sputum culture to identify the acid-fast bacillus. The Mantoux skin test does not distinguish between active infection and past infection. Although a chest x-ray will show characteristic nodules, a sputum culture is the most definitive diagnostic method for active tuberculosis. Unless a patient is septic (infection in the blood), the tuberculosis organism will not be found in the blood. 17. A major cause of treatment failure in tuberculosis is a. resistant organism. b. allergy to drugs used. c. noncompliance. d. immunosuppression. ANS: C The major cause of treatment failure in tuberculosis is non-adherence to drug therapy. The major cause of treatment failure in tuberculosis is not a resistant organism, drug allergy, or immunosuppression. 18. Neuromuscular disorders impair lung function primarily because of a. inflammatory events in the lung. b. secondary pneumonia. c. weak muscles of respiration. d. inactivity secondary to the disorder. ANS: C Neuromuscular disorders weaken respiratory muscle function resulting in poor ventilation. Inflammatory events in the lung, secondary pneumonia, and inactivity secondary to the disorder are not the primary reasons neuromuscular disorders impair lung function. 19. Legionnaires disease is characterized by a. presence of systemic illness. b. airborne mechanism of communicability. c. mild symptomatology. d. resolution with or without antimicrobial therapy. ANS: A Legionnaires disease produces system manifestations such as fever, diarrhea, abdominal pain, and pneumonia. The organism that causes Legionnaires disease is transmitted by means of contaminated water. Symptoms are severe, and the disease requires antimicrobial therapy. 20. Bacterial pneumonia leads to hypoxemia caused by a. cardiogenic pulmonary edema. b. upper airway obstruction. c. accumulation of alveolar exudates. d. interstitial edema. ANS: C The inflammatory response to bacterial pneumonia causes accumulation of exudates in the alveoli and impairs oxygenation. Bacterial pneumonia does not cause cardiogenic pulmonary edema. Pneumonia involves lower airway obstruction. Bacterial pneumonia does not lead to interstitial edema. 21. A common characteristic of viral pneumonia is a. high fever. b. alveolar infiltrates on a chest x-ray. c. increased white blood cell count. d. dry cough. ANS: D Viral pneumonia typically manifests with a dry cough. Viral infections usually do not cause high fever. Viral pneumonia typically does not produce alveolar infiltrates or leukocytosis. 22. A major risk factor for the development of active pulmonary tuberculosis (TB) disease is a. contaminated water. b. immunosuppression. c. being a male. d. overuse of antibiotics. ANS: B Immunosuppressed individuals, such as those with HIV, are at high risk for active TB disease. Contaminated water and gender are not major risk factors for pulmonary tuberculosis. Excessive use of antibiotics can lead to opportunistic yeast and fungal infections or cause bacterial resistance to available antibiotics, but it is not a major risk factor for TB. 23. Accumulation of fluid in the pleural space is called a. an abscess. b. pleurisy. c. flail chest. d. pleural effusion. ANS: D Pleural effusion is accumulation of fluid in the pleural space. A lung abscess is a circumscribed area of suppuration and lung tissue destruction. Pleurisy is inflammation of the pleura that often manifests with pain on inspiration, fever, and chills. Flail chest is the fracture of several consecutive ribs. 24. A restrictive respiratory disorder is characterized by a. increased total lung capacity. b. decreased residual volume. c. inspiratory wheezing. d. expiratory wheezing. ANS: B Restrictive respiratory disorders are characterized by decreased residual volume. Restrictive respiratory disorders are not characterized by increased residual volume. Inspiratory and expiratory wheezing are not characteristic of restrictive re spiratory disorder. 25. Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called a. tension pneumothorax. b. open pneumothorax. c. pleural effusion. d. empyema. ANS: A Air that enters the pleural space during inspiration but is unable to exit during expiration causes a tension pneumothorax. The question does not describe open pneumothorax, pleural effusion, or empyema. 26. When a parent of a toddler recently diagnosed with pneumococcal pneumonia asks why their child is so much sicker than a classmate was when they were diagnosed with pneumonia, the nurse replies a. “It sounds as if the classmate was just lucky and less exposed at daycare.” b. “It sounds like your child has a case of bacterial pneumonia, while the classmate had viral pneumonia.” c. “It sounds as if your child is having a severe reaction to bacterial pneumonia. It hits some children harder than others.” d. “It sounds as if your child has a case of viral pneumonia, while the classmate had bacterial pneumonia.” ANS: B Viral pneumonia does not produce exudate so the cough is non-productive. In general, symptoms of viral pneumonia are less severe than those of bacterial pneumonia. The uncle’s case of viral pneumonia has less acute symptoms than the children’s case of bacterial pneumonia. Pneumococcal pneumonia is not necessarily more severe in children. The children most likely have bacterial pneumonia, which is why their symptoms are more acute than the classmate’s case of viral pneumonia. MULTIPLE RESPONSE 1. It is true that diffuse interstitial lung disease ( Select all that apply.) a. leads to loss of alveolar walls. b. may be immunologic in nature. c. produces a productive cough. d. is always reversible. e. shows on x-ray as a “honeycomb lung.” ANS: A, B, E Diffuse interstitial lung disease results in loss of alveolar walls, may be immunologic in nature, and shows a “honeycomb” appearance on x-ray. A non-productive cough is characteristic of this disorder. The disorder is not always reversible. 2. Common characteristics of sarcoidosis include (Select all that apply.) a. presence of CD4+ T cells. b. a non-productive cough. c. leukocytosis. d. granulomas in multiple body systems. e. fatigue, weight loss, and fever. ANS: A, B, D, E Common characteristics of sarcoidosis include the presence of CD4+ T cells; a non-productive cough; granulomas in lungs and other body systems; and fatigue, weight loss, and fever. Leukopenia is characteristic of this disorder. 3. Clinical manifestations of pleural effusion include (Select all that apply.) a. dyspnea. b. sharp pain in expiration. c. productive cough. d. diminished breath sounds. e. a tracheal shift, if large. ANS: A, D, E Clinical manifestations of pleural effusion include dyspnea, diminished breath sounds, and tracheal shift if a large amount of fluid is present. With pleural effusion, pain is worse on inspiration and the cough is non-productive. If productive, an infectious process within the lung is suspected. 4. Chronic occupational lung disease is characterized by ( Select all that apply.) a. causation from long-term inhalation of inorganic material. b. a latent period before symptoms occur. c. hyperactive respiratory macrophages. d. a progressive cough and dyspnea with exercise. e. possible negative chest x-ray when symptom-free. ANS: A, B, D, E Chronic occupational lung disease is caused by long-term inhalation of inorganic material. A latent period of 10 to 20 years may ensue before symptoms occur. One of the earliest manifestations is a progressive cough and dyspnea on exertion. The disease cannot be ruled out by a negative chest x-ray. Impairment of macrophage function is the primary mechanism through which inorganic particles initiate lung disease. 5. Restrictive respiratory disorders include (Select all that apply.) a. pneumothorax. b. emphysema. c. chronic asthma. d. type B COPD. e. ARDS. ANS: A, E Pneumothorax is a restrictive respiratory disorder that involves the pleural space and ARDS is a restrictive respiratory disorder that involves lung parenchyma. Emphysema, chronic asthma, and type B COPD are obstructive respiratory diseases.