The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response related to risk for lung cancer in smokers is most accurate?

Correct Answer: A

Rationale: Lung cancer risk in smokers is heavily influenced by the age of smoking initiation, with earlier exposure amplifying cumulative damage to lung tissue. Starting young extends the duration of carcinogen exposure (e.g., polycyclic aromatic hydrocarbons), increasing DNA mutations and oncogenic potential, as evidenced by higher incidence in lifelong smokers who began in adolescence. Risk does decrease after cessation dropping significantly within 10-15 years contradicting the notion of permanent risk or mandatory annual X-rays, which aren't standard for all ex-smokers. Cigarette type (e.g., tar, nicotine levels) matters, but pack-years and initiation age outweigh this factor. Other risk factors (e.g., radon, genetics) contribute but are secondary to smoking's dose-dependent effect. The nurse's accurate response educates students on the preventable, time-sensitive nature of this risk, reinforcing cessation's protective impact.

Correct Answer: C

Rationale: Bronchiectasis involves chronic, irreversible dilation of bronchi and bronchioles from repeated inflammation or infection, destroying muscle and elastic tissue. This widening traps mucus, fostering recurrent infections and obstruction, leading to respiratory difficulties like chronic cough and dyspnea. Acute bronchospasm, tightening of airways, is asthma's hallmark, not bronchiectasis's structural damage. Alveolar distention and impaired diffusion occur in emphysema, affecting gas exchange at the alveolar level, not bronchial dilation. Excessive gas exchange isn't a feature bronchiectasis reduces effective ventilation. The student nurse's recognition of this pathophysiology confirmed by imaging (e.g., CT showing bronchial widening) prepares them to anticipate copious sputum and infection risk, guiding care like chest physiotherapy to manage this distinct airway disease.

Correct Answer: B

Rationale: Severe arthritis in the hands precludes safe, effective metered-dose inhaler (MDI) use in a COPD patient, as it impairs the dexterity needed to press the canister and coordinate inhalation critical for drug delivery to the lungs. Poor technique reduces efficacy of bronchodilators or corticosteroids, worsening dyspnea. Ongoing smoking doesn't affect MDI mechanics, though it harms prognosis. Requiring both corticosteroids and beta2-agonists is common in COPD, manageable with separate or combined MDIs, not precluding use. Cataracts impair vision but not hand function; spacers can aid if technique falters. The nurse's recognition of arthritis prompts alternatives (e.g., nebulizers), ensuring medication delivery despite physical limitations, per COPD device selection principles.

Correct Answer: B

Rationale: A peak flow meter measures the highest airflow during a forced expiration, known as peak expiratory flow rate (PEFR), in liters per minute. This handheld device assesses airway obstruction in asthma patients exhale maximally after a deep breath, gauging how fast air exits narrowed passages. Lower readings signal worsening bronchospasm or inflammation, guiding therapy (e.g., rescue inhaler use) via personal best zones (green, yellow, red). Forced inspiration isn't measured inhalation isn't limited in asthma. Normal inspiration or expiration reflects tidal breathing, not obstruction severity. The educator's teaching demonstrating technique (e.g., standing, full effort) ensures the patient tracks lung function daily, aligning with asthma self-monitoring to prevent exacerbations effectively.

Correct Answer: D

Rationale: Leg exercises prevent venous stasis and thrombus formation post-anesthesia by promoting circulation in the lower extremities. General anesthesia slows blood flow, and immobility reduces muscle contractions that pump venous blood, increasing clot risk. Exercises like ankle circles or calf pumps, done regularly, counteract this, reducing deep vein thrombosis odds. Coughing, diaphragmatic breathing, and incentive spirometry target lung expansion, preventing atelectasis, not circulatory stasis. The nurse's focus on leg exercises demonstrated pre- and postoperatively ensures blood flow, aligning with protocols to minimize thromboembolism, a significant postoperative risk.