A patient has been diagnosed with heart failure that has not yet responded to treatment. What breath sound should the nurse expect to assess on auscultation?

Correct Answer: D

Rationale: The correct answer is D: Crackles. In heart failure, crackles are often heard on auscultation due to fluid accumulation in the lungs. This is a result of the heart's inability to effectively pump blood, leading to congestion in the pulmonary circulation. Crackles are discontinuous, moist sounds that occur during inspiration and sometimes expiration. Expiratory wheezes (A) are typically associated with obstructive airway diseases such as asthma. Inspiratory wheezes (B) are not commonly heard in heart failure. Rhonchi (C) are low-pitched continuous sounds often heard in patients with bronchitis or pneumonia, not specifically in heart failure.

Correct Answer: B

Rationale: The correct answer is B because at label '3', the pressure outside the system is higher than the pressure inside. This is based on the principle that pressure decreases with increasing elevation. As we move upward in a fluid column, the pressure decreases. Therefore, in this scenario, the pressure outside the system (higher elevation) will be greater than the pressure inside the system (lower elevation). A: P outside = P inside - Incorrect, as explained above, pressures are not equal at label '3'. C: P outside < P inside - Incorrect, pressures are not in this relationship at label '3'. D: P outside + P inside - Incorrect, this is not a valid comparison of pressures at label '3'.

Correct Answer: B

Rationale: The correct answer is B: decreased pH. A decrease in pH (increased acidity) causes a rightward shift in the oxygen-hemoglobin dissociation curve, facilitating the release of oxygen from hemoglobin to peripheral tissues. This occurs due to the Bohr effect, where a decrease in pH weakens the bond between hemoglobin and oxygen, allowing for easier oxygen release. Incorrect answers: A: Decreased temperature would actually shift the dissociation curve to the left, making it more difficult for oxygen to be released from hemoglobin. C: Increased tissue PO2 would lead to less oxygen being released from hemoglobin as the gradient for oxygen release decreases. D: Decreased amounts of BPG would result in less oxygen being released as BPG helps facilitate oxygen unloading from hemoglobin in tissues.

Correct Answer: B

Rationale: The correct answer is B: more intense inhalation. The apneustic center is responsible for prolonging inhalation by stimulating the inspiratory neurons in the medulla oblongata. When the apneustic center is stimulated, it disrupts the normal breathing pattern, causing a prolonged and more intense inhalation. This results in deeper and more forceful breaths. Incorrect choices: A: increased respiratory rate - Stimulation of the apneustic center would not lead to an increased respiratory rate, but rather to changes in the depth and intensity of inhalation. C: a shorter respiratory cycle - The apneustic center's stimulation does not lead to a shorter respiratory cycle, but rather to a prolonged inhalation phase. D: less activity in the DRG center - The dorsal respiratory group (DRG) is responsible for initiating inspiration, and the apneustic center does not affect its activity.

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.