Elsevier Pulmonary Questions
The nurse is admitting a patient with severe community-acquired pneumonia. Select all interventions that are appropriate for this patient. a). Start intravenous (IV) antibiotics. b). Place the patient on the monitor and obtain vital signs. c). Obtain sputum cultures and laboratory work. d). Inquire about allergies and current medications. e). Start a peripheral IV.
ALL OF THE ABOVE Assess the patient and establish any allergies (to Betadine or ChloraPrep for IV insertion and antibiotics) and current medications. (Is the patient already on antibiotics?) Start the peripheral IV and obtain the laboratory work and sputum culture before starting the antibiotics.
The nurse is providing preprocedural teaching for a patient who is going to have a fiber-optic bronchoscopy. Which statement indicates that more teaching is needed? a). "I will receive medication that will make it okay for me to eat before the procedure." b). "I will receive medication that will make me sleepy and keep my heart rate from dropping." c). "I will need to be on a cardiac monitor before, during, and after the procedure." d). "I will have lab work drawn before the procedure to make sure I am not at risk for bleeding."
a). "I will receive medication that will make it okay for me to eat before the procedure." The patient must be NPO (nothing by mouth) for 6 hours before the procedure and until the gag reflex returns.
A nurse is explaining the difference between respiration and ventilation to a nursing student. Which statement made by the student shows that the teaching was effective? a). "Ventilation is the movement of air in and out of the lungs, and respiration is the process of gas exchange." b). "Ventilation involves the lower airways, and respiration involves the upper airways." c). "Ventilation and respiration mean the same thing and can be used interchangeably." d). "Ventilation refers to healthy lungs, and respiration refers to diseased lungs."
a). "Ventilation is the movement of air in and out of the lungs, and respiration is the process of gas exchange." Ventilation refers to the movement of air in and out of the lungs, and respiration refers to the process of gas exchange. All of the other answers are incorrect.
A nurse notes that a patient's trachea is deviated to the left side. What condition could cause this to occur? (Select all that apply.) a). Atelectasis in the left lung b). Pneumothorax in the right lung c). Bilateral pneumonia d). Pleural effusion on the left side e). Bronchiectasis in the left lung
a). Atelectasis in the left lung b). Pneumothorax in the right lung e). Bronchiectasis in the left lung Atelectasis and bronchiectasis cause a tracheal shift to the same side as the problem. Pneumothorax and pleural effusion cause the trachea to deviate toward the normal side (opposite the problem). Bilateral pneumonia does not cause a tracheal shift.
Which of the following actions is an important part of oral care for an intubated patient? (Select all that apply.) a). Brushing the teeth and tongue with a soft-bristled toothbrush b). Using lemon glycerin swabs on the patient's lips and gums c). Using alcohol-based mouthwash every 2 hours d). Using a tonsil suction to keep secretions cleared out of the mouth e). Providing lip moisturizer as needed
a). Brushing the teeth and tongue with a soft-bristled toothbrush d). Using a tonsil suction to keep secretions cleared out of the mouth e). Providing lip moisturizer as needed Oral care consists of brushing the patient's teeth with a soft toothbrush to reduce plaque, brushing the patient's tongue and gums with a foam swab to stimulate the tissue, and performing deep oropharyngeal suction to remove any secretions that have pooled above the patient's cuff. Lemon glycerin swabs and alcohol-based mouthwashes dry out the mouth and lips and are not recommended.
You have just explained to a patient's spouse that her husband has had a severe stroke. She is upset and crying, and her breath hitches in and out. Which part of the central nervous system is controlling her breathing at this time? a). Cerebral cortex b). Medulla c). Pneumotaxic center d). Pons
a). Cerebral cortex The cerebral cortex functions by allowing voluntary ventilation to override the automatic controls of the medulla and pons. Voluntary ventilatory control is most important during behavioral states such as crying, laughing, singing, and talking. During these states, voluntary control may override the automatic control, which responds chiefly to chemical stimuli and to changes in lung inflation.
The nurse is caring for a patient who was just placed on mechanical ventilation and is observing the patient's vital signs. The nurse knows that positive-pressure ventilation can lead to which problems? (Select all that apply.) a). Decreased cardiac output b). Decreased venous return c). Increased renal function d). Decreased intracranial pressure e). Increased hepatic function
a). Decreased cardiac output b). Decreased venous return Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return to the right side of the heart. Impaired venous return decreases preload, which results in a decrease in cardiac output (CO). As a secondary consequence, hepatic and renal dysfunction may occur. In addition, positive-pressure ventilation impairs cerebral venous return. In patients with impaired autoregulation, positive-pressure ventilation can result in increased intracranial pressure.
A patient has been admitted with acute asthma. The patient is very anxious and short of breath. It is important to have an accurate SpO2 measurement; however, the patient continues to wring their hands and swing their feet in agitation. Which site might provide the most accurate measure of oxygen saturation? a). Ear b). Toe c). Ankle d). Wrist
a). Ear Constant motion of extremities may mimic arterial pulsations and lead to false readings. The ear would be more stable at this time. Alternatives are the nose and forehead.
Which statement is true regarding oxygen toxicity? a). It can occur in patients who inhale greater than 50% oxygen for more than 24 hours. b). It causes destruction of oxygen-free radicals. c). The most common presenting symptom is respiratory depression. d). Chest radiography is a useful tool for early diagnosis.
a). It can occur in patients who inhale greater than 50% oxygen for more than 24 hours. Oxygen toxicity can occur in any patient who breathes oxygen concentrations of greater than 50% for longer than 24 hours. The administration of higher-than-normal oxygen concentrations produces an overabundance of oxygen-free radicals. The first symptom is substernal chest pain that is exacerbated by deep breathing. Chest radiographs and pulmonary function tests show no abnormalities until symptoms are severe.
A patient has just undergone a bronchoscopy. What complication should the patient be monitored for? a). Laryngospasm b). Pulmonary embolism c). Allergic reaction to the dye d). Headache
a). Laryngospasm Laryngospasm may occur after bronchoscopy secondary to mechanical irritation. Headache, pulmonary embolism, and allergic reaction to the dye are not directly related to performance of a bronchoscopy.
A patient is experiencing increasing shortness of breath and chest pain upon inspiration. The results of the chest radiography show the following: flattening of the diaphragm, blurring of the costophrenic angle and cardiac silhouette, and a slight shift in the mediastinal structures. These findings are suggestive of which condition? a). Pleural effusion b). Pneumothorax c). Pulmonary embolus d). Lobular pneumonia
a). Pleural effusion The cardinal radiographic signs of pleural effusion include flattening of the diaphragm, blurring of the costophrenic angle and cardiac silhouette, and a slight shift in the mediastinal structures. Although a shift in the trachea would indicate pneumothorax, pain on inspiration might suggest pulmonary embolus. Pneumonia can result in blurring of cardiac borders, and pleural effusion includes all three findings on chest radiography.
A patient has experienced a respiratory arrest and is being intubated. After the endotracheal tube (ETT) has been placed, the PETCO2 value is lower than expected. What action should be taken next? a). Reposition the ETT as it is probably in the stomach. b). Obtain a chest radiograph to confirm proper ETT placement. c). Replace the capnography because it is probably faulty. d). Repeat the arterial blood gas measurements to confirm the discrepancy.
a). Reposition the ETT as it is probably in the stomach. Noninvasive capnography is often used to verify endotracheal tube (ETT) placement. Generally, PETCO2 values are within 5 mm Hg of measured PaCO2 levels. The value in this case suggests that the tube is most likely in the stomach, where CO2 levels are significantly lower.
Mr. G requires neuromuscular blockade to facilitate mechanical ventilation. Which statement is true about providing nursing care to paralyzed patients? a). Special safety precautions are needed as patients are unable to react to the environment. b). Pain medication is not required because neuromuscular blocking agents have an analgesic effect. c). Patients under the influence of neuromuscular blocking agents are not aware of activity around them. d). There is no mechanism for monitoring the level of blockade.
a). Special safety precautions are needed as patients are unable to react to the environment. Neuromuscular blocking agents only halt skeletal muscle movement and do not inhibit pain or awareness; they must be administered together with a sedative or anxiolytic agent. Patient safety is another concern because these patients cannot react to the environment. Special precautions are taken to protect patients at all times. The level of neuromuscular blockade can be monitored with a peripheral nerve stimulator.
What does the term anatomic dead space mean? a). The conducting airways of the pulmonary system b). The portion of ventilation that goes to unventilated alveoli c). The portion of total ventilation that participates in gas exchange d). The sum of wasted ventilation and physiologic dead space
a). The conducting airways of the pulmonary system Areas in the lungs that are ventilated but in which no gas exchange occur are referred to as dead space regions. The conducting airways are such a region and are referred to specifically as anatomic dead space.
The nurse is caring for a patient who has experienced a pulmonary embolism (PE). Which statement is an important physiologic concept for the nurse to remember about this condition? a). The major hemodynamic compromise after PE is pulmonary hypertension. b). Hypercoagulability is the most significant predisposing factor for PE. c). Pulmonary system effects include bronchoconstriction and decreased alveolar dead space. d). Pulmonary vasodilation occurs as a result of mediators released at the injury site.
a). The major hemodynamic compromise after PE is pulmonary hypertension. Of the three predisposing factors (ie, hypercoagulability, injury to vascular endothelium, and venous stasis), endothelial injury appears to be the most significant. The effects on the pulmonary system are increased alveolar dead space, bronchoconstriction, and compensatory shunting. The major hemodynamic consequence of a pulmonary embolism (PE) is the development of pulmonary hypertension, which is part of the effect of a mechanical obstruction when more than 50% of the vascular bed is occluded. In addition, the mediators released at the injury site and the development of hypoxia cause pulmonary vasoconstriction, which further exacerbates pulmonary hypertension.
A patient on the ventilator has a PaO2 of 95 and an FiO2 of 50%. Calculate the P/F ratio. a). 40 b). 190 c). 475 d). 526
b). 190 The P/F ratio is PaO2 divided by FiO2 or 95 ÷ 50% = 190 in this case.
A patient is placed on a ventilator after cardiac arrest. What pressure should be maintained in the patient's cuff to prevent complications? a). 10 to 20 mm Hg b). 20 to 30 mm Hg c). 30 to 40 mm Hg d). 40 and 50 mm Hg
b). 20 to 30 mm Hg Cuff pressures are maintained within 20 to 30 mm Hg (27 to 41 cm H2O) because greater pressures decrease blood flow to the capillaries in the tracheal wall and lesser pressures increase the risk of aspiration.
A patient is admitted with shortness of breath. Temperature is 39.5° C, blood pressure is 160/82 mm Hg, heart rate is 115 beats/min, and respiratory rate is 26 breaths/min. Chest radiography confirms the presence of right upper lobe pneumonia. Arterial blood gases reveal the following: pH 7.27PaCO2 64 mm HgHCO3 33 mEq/LPaO2 50 mm Hg These findings are indicative of which disorder? a). Obstructive lung disease b). Acute lung failure c). Restrictive lung disease d). Acute respiratory distress syndrome
b). Acute lung failure Diagnosing and following the course of respiratory failure is best accomplished by arterial blood gas (ABG) analysis. ABG analysis confirms the level of PaCO2, PaO2, and blood pH. Acute lung failure is generally accepted as being present when the PaO2 is less than 60 mm Hg. If the patient is also experiencing hypercapnia, the PaCO2 will be greater than 45 mm Hg. In patients with chronically elevated PaCO2 levels, these criteria must be broadened to include a pH less than 7.35.
A mechanically ventilated patient has a fever, P/F ratio of 230, and a pulmonary artery occlusive pressure of 15 mm Hg. The patient is coughing and triggering the high-pressure alarm on the ventilator. The radiologist has notified the nurse that the patient's feeding tube is in the right lung, and the patient has developed bilateral infiltrates on the radiograph. The nurse is concerned that the patient is developing what problem? a). Acute pulmonary embolism b). Adult respiratory distress syndrome c). Pneumothorax d). Inadequate nutrition
b). Adult respiratory distress syndrome The patient is showing signs of acute respiratory distress syndrome brought on by the direct lung injury from the misplaced feeding tube. There is no evidence of a pulmonary embolism. A pneumothorax would have shown up on the radiograph as a unilateral problem, not a diffuse infiltrate. Nutrition is not the immediate concern at this moment.
Mr. Z is admitted with acute lung failure. Which statement describes appropriate action for optimizing his oxygenation and ventilation? a). Place Mr. Z in a supine position. b). Allow Mr. Z to rest in between nursing interventions. c). Perform vigorous postural drainage and chest percussion to facilitate secretion clearance. d). Make sure Mr. Z coughs every 2 hours even if he has no secretions.
b). Allow Mr. Z to rest in between nursing interventions. Allowing adequate rest between nursing interventions will minimize oxygen consumption. The supine position is not advantageous because of the risk of aspiration. Postural drainage and chest percussion have been found to be of little benefit, and coughing, unless secretions need to be expelled, should be avoided because it causes collapse of the smaller airways.
A patient has been in the progressive care unit for 3 days with a diagnosis of pneumonia. The patient is being treated with antibiotics, 50% oxygen, and vigorous pulmonary toilet. Which diagnostic testing result would indicate early progression of the patient's condition to acute respiratory distress syndrome? a). PaO2/FiO2 ratio of 325 b). Arterial PaO2 of 58 mm Hg c). Arterial PaCO2 of 58 mm Hg d). Arterial blood pH of 7.29
b). Arterial PaO2 of 58 mm Hg Arterial blood gas analysis reveals a low PaO2 despite increases in supplemental oxygen administration (refractory hypoxemia). The drop in PaO2 is attributable to intrapulmonary shunting secondary to compression, collapse, and flooding of the alveoli and small airways. Initially, the PaCO2 is low as a result of hyperventilation, but eventually the PaCO2 increases as the patient fatigues. The pH is high initially but decreases as respiratory acidosis develops. A ratio of partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) less than or equal to 300 mm Hg is indicative of acute lung injury.
A patient with pneumonia has been in the unit for 3 days. The medical plan includes antibiotics and oxygen therapy. Which finding would indicate the patient is developing acute respiratory distress syndrome (ARDS)? a). Sputum cultures are positive for Streptococcus pneumoniae. b). Arterial blood gas analysis reveals a low PaO2 despite increases in supplemental oxygen. c). Chest radiography shows evidence of pulmonary hypertension. d). High probability ventilation-perfusion scan.
b). Arterial blood gas analysis reveals a low PaO2 despite increases in supplemental oxygen. Arterial blood gas analysis reveals a low PaO2 despite increases in supplemental oxygen administration (refractory hypoxemia). Positive sputum cultures are indicative of pneumonia. Pulmonary hypertension is not indicative of acute respiratory distress syndrome (ARDS). A high probability ventilation-perfusion scan is indicative of a pulmonary embolism. Initially, the PaCO2 is low as a result of hyperventilation, but eventually, the PaCO2 increases as the patient fatigues. The pH is high initially but decreases as respiratory acidosis develops. Initially, the chest radiography findings may be normal because changes in the lungs do not become evident for up to 24 hours. As the pulmonary edema becomes apparent, diffuse, patchy interstitial and alveolar infiltrates appear. This progresses to multifocal consolidation of the lungs, which appears as a "whiteout" on the chest radiographs.
A nurse is performing an assessment on a patient's lungs. While performing percussion on the left lung, the nurse notes a low-pitched resonant sound. This is compatible with what disease process? a). Asthma b). Bronchitis c). Emphysema d). Pneumothorax
b). Bronchitis Bronchitis produces a low-pitched resonant tone. Asthma, emphysema, and pneumothorax produce very low-pitched hyperresonant tones.
During your admission assessment, you note that a patient's chest diameter is greater than expected. This suggests what condition? a). Pneumothorax b). Chronic obstructive pulmonary disease c). Pneumonia d). Pulmonary hypertension
b). Chronic obstructive pulmonary disease An increase in the anteroposterior chest diameter is suggestive of chronic obstructive pulmonary disease.
The sputum culture obtained on admission shows Streptococcus pneumoniae in a patient with a history of coronary artery disease and alcoholism. The nurse suspects the patient has developed which problem? a). Hospital-acquired pneumonia (HAP) b). Community-acquired pneumonia (CAP) c). Health care associated pneumonia d). Ventilator-associated pneumonia (VAP)
b). Community-acquired pneumonia (CAP) The patient has community-acquired pneumonia (CAP). The culture was obtained on admission, S. pneumoniae is a commonly acquired pathogen, and the patient has comorbidities that could lead to CAP. The patient was not in the hospital longer than 48 hours or on the ventilator, and there is no mention of the radiography report describing the location of the pneumonia.
The nurse is assessing a patient admitted with shortness of breath. Upon percussion of the anterior chest wall, the nurse notes a very loud and long booming sound. Which disorder is this finding suggestive of? a). Bronchitis b). Emphysema c). Pulmonary edema d). Pleural effusion
b). Emphysema Percussion producing a very loud intensity, long duration with a booming quality indicates hyperresonance, which is seen with emphysema.
Which statement is TRUE regarding tracheostomy tube management? a). Cuff pressure should ensure total tracheal occlusion at all times. b). External humidification should be used to prevent respiratory tract irritation. c). Single-lumen tubes should be used for patients with secretion problems. d). Tracheostomy should be performed after 3 days of intubation.
b). External humidification should be used to prevent respiratory tract irritation. Tracheostomy should be performed if a patient has been intubated or is anticipated to be intubated for longer than 7 to 10 days. Double-lumen tubes have inner cannulas that can quickly be removed if they become obstructed, making the system safer for patients with significant secretion problems. Because the tracheostomy tube bypasses the upper airway system, warming and humidifying of air must be performed by external means. Cuffs can cause damage to the walls of the trachea.
A patient has bronchial breath sounds over the peripheral lung fields. What condition could cause this? (Select all that apply.) a). Asthma b). Lung mass with exudate c). Bronchitis d). Pulmonary edema e). Bronchospasms
b). Lung mass with exudate d). Pulmonary edema Lung mass with exudates and pulmonary edema cause displaced bronchial breath sounds. Rhonchi and wheezes are heard in asthma. Bronchitis produces rhonchi, and bronchospasm produces wheezes.
A nurse is reviewing the pulmonary function test results for a patient with emphysema. The nurse expects the test to show that the patient has which condition? a). Restrictive disease b). Obstructive disease c). Small tidal volumes with rapid respirations d). Diffuse airway narrowing
b). Obstructive disease Emphysema is an obstructive disease with impeded airflow. Restrictive diseases have limited chest wall movement. Small tidal volumes with rapid respirations occur in restrictive diseases. Diffuse airway narrowing occurs in asthma.
A patient has been on a non-rebreathing mask at 10 L/min for 4 days and is complaining of a dry cough, a stuffy nose, and substernal chest pain (pain score 6 of 10) that increases with deep breathing. The chest radiograph shows no changes, and the 12-lead electrocardiography (ECG) findings are normal. The nurse suspects the patient is experiencing which disorder? a). Hypercapnia b). Oxygen toxicity c). Unstable angina d). Absorption atelectasis
b). Oxygen toxicity The patient is experiencing oxygen toxicity from breathing high concentrations of oxygen for several days. Symptoms include substernal chest pain that is exacerbated by deep breathing, dry cough, nasal stuffiness, sore throat, and eye and ear discomforts. Symptoms of hypercapnia include headache and drowsiness. Although the patient has substernal chest pain that increases with deep breathing, this is not a sign of angina because the electrocardiography (ECG) findings are normal. Absorption atelectasis is manifested by decreased breath sounds and increased respiratory rate.
A patient is recovering from acute lung failure. Which results would indicate compensated respiratory acidosis? a). PaO2 90 mm Hg, pH 7.40, PaCO2 45 mm Hg, HCO3- 26 mEq/L b). PaO2 90 mm Hg, pH 7.37, PaCO2 60 mm Hg, HCO3- 39 mEq/L c). PaO2 90 mm Hg, pH 7.25, PaCO2 55 mm Hg, HCO3- 22 mEq/L d). PaO2 90 mm Hg, pH 7.25, PaCO2 40 mm Hg, HCO3- 17 mEq/L
b). PaO2 90 mm Hg, pH 7.37, PaCO2 60 mm Hg, HCO3- 39 mEq/L The body naturally compensates for imbalances such as respiratory acidosis through metabolic responses, in this case, by conserving HCO3- as evidenced by the elevated levels represented by the arterial blood gas (ABG) results. If the pH level is within normal limits and the PaCO2 value and the HCO3- level are abnormal, the condition is compensated because the body has had enough time to restore the pH to within its normal range.
Which mode of ventilation uses low tidal volume in conjunction with normal respiratory rates to limit the effects of barotrauma in patients with adult respiratory distress syndrome (ARDS)? a). Assist control (A/C) ventilation b). Permissive hypercapnia c). Pressure control ventilation (PCV) d). Continuous positive airway pressure (CPAP)
b). Permissive hypercapnia Permissive hypercapnia is the mode with normal rates (not increased) and small tidal volumes to allow the CO2 levels to increase. Assist control (A/C) ventilation has a preset tidal volume that the patient gets from the ventilator whether he or she breathes extra or allows the machine to deliver all breaths. Pressure control ventilation (PCV) sets an inspiratory pressure rather than a tidal volume. Continuous positive airway pressure (CPAP) delivers oxygen and a pressure above baseline to keep the alveoli inflated and prevent atelectasis.
In normal respiration, inspiration is longer than expiration. In which disorders will inspiration be equal to expiration? (Select all that apply.) a). Pneumothorax b). Pneumonia with consolidation c). Pulmonary fibrosis d). Atelectasis e). Effusion
b). Pneumonia with consolidation c). Pulmonary fibrosis In pneumonia with consolidation and pulmonary fibrosis, inspiration and expiration are equal. In pneumothorax, atelectasis, and pleural effusions, inspiration is longer than expiration.
A postoperative patient has a respiratory rate of 10 breaths/min with an SpO2 of 95%. Arterial blood gas (ABG) values are PaO2 85, pH 7.32, PaCO2 51, and HCO3 24. What acid-base disorder is this patient experiencing? a). Respiratory alkalosis b). Respiratory acidosis c). Metabolic alkalosis d). Metabolic acidosis
b). Respiratory acidosis The patient is experiencing respiratory acidosis as evidenced by a pH below 7.35, a PaCO2 above 35, and a normal HCO3. Respiratory alkalosis would have a pH above 7.45, a PaCO2 below 35, and a normal HCO3. Metabolic alkalosis would have a pH above 7.45, an HCO3 above 26, and a normal PaCO2. Metabolic acidosis would have a pH below 7.35, an HCO3 below 22, and a normal PaCO2.
A patient who is short of breath is being prepared for a thoracentesis for a left pleural effusion. Which position would be most appropriate to place this patient during the procedure? a). Lying on his right side with his back flush to the edge of the bed b). Sitting on the side of the bed with his arms supported on the bedside table c). Lying prone with the head of the bed in Trendelenburg to facilitate drainage of fluids d). Lying supine with both arms place beneath the head
b). Sitting on the side of the bed with his arms supported on the bedside table Sitting on the side of the bed provides easy access to the chest wall. If the patient is unable to sit, then the side-lying position with affected side down would be preferable. The Trendelenburg position should never be used.
The nurse is suctioning a patient's endotracheal tube and notices that the heart rate is dropping from 100 to 52 beats/min. What is the priority action? a). Increase the oxygen on the ventilator. b). Stop suctioning and give the patient some extra breaths. c). Administer atropine 0.5 mg intravenously (IV) per protocol. d). Increase the patient's IV fluids.
b). Stop suctioning and give the patient some extra breaths. The patient is experiencing a vagal response to suctioning. The procedure should be stopped immediately, and the patient should be provided extra breaths either manually or on the ventilator. Extra breaths will hyperoxygenate the patient and hopefully reverse the vagal response. Atropine is appropriate only if the patient is symptomatic and hyperoxygenation fails to reverse the bradycardia. Increasing IV fluids may or may not have any effect on the situation. Because the ventilator is already on 100% FiO2 (as part of the procedure for suctioning), the oxygen cannot be increased any higher.
A patient is admitted with severe diabetic ketoacidosis. Laboratory findings reveal a pH of 7.29. Understanding the principles of the oxyhemoglobin dissociation curve, you would expect which finding when you assess the SaO2? a). The SaO2 may be higher than normal. b). The SaO2 may be lower than normal. c). The SaO2 is not affected because he does not have pulmonary disease. d). You must know the HCO3- before you can predict changes in the SaO2.
b). The SaO2 may be lower than normal. The oxygen saturation will be lower because of acidosis. This condition causes a shift in the oxyhemoglobin curve to the right, where oxygen has a lower affinity for hemoglobin and is more readily released into the tissues. Factors that cause this change in oxygen-hemoglobin affinity and shift the curve to the right include fever, increased PaCO2, acidosis, and increased 2,3-DPG levels.
A nurse is working with a nursing student taking care of patient with continuous pulse oximetry. Which action indicates the nursing student needs further education with this device? a). The student checks the patient's capillary refill prior to placement of the probe. b). The student places a digit probe on the patient's ear lobe. c). The student places a digit probe on the patient's great toe. d). The student covers the probe with a towel.
b). The student places a digit probe on the patient's ear lobe. Placement of a digit probe on the patient's ear indicates the student nurse needs further education. Probes should only be used on their designated locations. Digit probes are placed on fingers or toes and not earlobes. Earlobe probes are used on earlobes. Checking for capillary refill is an appropriate practice as the selected area for monitoring must have adequate blood flow. Covering the probe with a towel or blanket is appropriate as excessive light can cause interference.
Which statement is true regarding assessment of breath sounds? a). Place the patient in the left lateral position to better hear abnormal breath sounds. b). Use a systematic approach to assess and contrast all areas of the lungs. c). The bell of the stethoscope should be used to assess for normal breath sounds. d). Breath sounds should be assessed on expiration.
b). Use a systematic approach to assess and contrast all areas of the lungs. When auscultating breath sounds, the patient should be placed in an upright position and sounds assessed on both inspiration and expiration. A systematic approach should be used, moving the diaphragm of the stethoscope from side to side, top to bottom, posteriorly, laterally, and anteriorly.
A nurse is waiting for the results of arterial blood gas analysis on a patient with a neuromuscular disease and is reviewing the purpose of the chemoreceptors. Which statements are true? (Select all that apply.) a). The brainstem controls voluntary ventilation, and the cerebral cortex controls involuntary ventilation. b). Whereas the peripheral chemoreceptors primarily respond to changes in the PaO2 level, the central chemoreceptors respond to changes in PaCO2 levels. c). The pneumotaxic center is located in the pons and regulates depth of inspiration. d). Voluntary ventilation may override automatic controls during laughing, crying, or talking. e). Chemoreceptors are the main effectors of ventilation.
b). Whereas the peripheral chemoreceptors primarily respond to changes in the PaO2 level, the central chemoreceptors respond to changes in PaCO2 levels. d). Voluntary ventilation may override automatic controls during laughing, crying, or talking. The peripheral chemoreceptors primarily respond to changes in the PaO2 level, the central chemoreceptors respond to changes in PaCO2 levels and voluntary ventilation may override automatic controls during laughing, crying, or talking. The brainstem controls involuntary ventilation, and the cerebral cortex controls voluntary ventilation. The pneumotaxic center limits inspiration and triggers exhalation. Chemoreceptors are the main sensors of ventilation.
A patient has just had a chest tube removed. While securing the dressing, you notice that the patient is having difficulty breathing. Upon examination, you note that the trachea has shifted to the left side. These findings are suggestive of which complication? a). Acute lung failure b). Aspiration of secretions c). A pneumothorax d). Atelectasis
c). A pneumothorax The trachea is normally positioned at midline. When a pneumothorax occurs, the trachea shifts in the opposite direction.
A patient has a suspected pulmonary embolus. While awaiting a ventilation-perfusion scan, the patient is placed on a Ventimask mask at an FiO2 of 50%, which is maintaining the PaO2 at approximately 70 mm Hg. Which values would indicate significant pulmonary shunting? a). PaO2/FiO2 ratio of 300 b). PaO2/PAO2 ratio of 220 c). Alveolar-arterial (A-a) gradient of 220 mm Hg d). PaO2 alone demonstrates significant shunting
c). Alveolar-arterial (A-a) gradient of 220 mm Hg A normal PAO2/FiO2 ratio is greater than 286, PaO2/PAO2 ratio is greater than 60, and A-a gradient is less than 20 mm Hg. The PaO2 cannot by itself indicate the degree of shunting present.
Which would be an expected chest tube assessment finding after thoracic surgery? a). Drainage of 150 mL/h for the first 4 hours after surgery b). Increase in air leak size during the first 24 hours after surgery c). Blood clots that would require careful milking of the chest tubes d). Serous draining in the immediate postoperative period
c). Blood clots that would require careful milking of the chest tubes If blood clots are present in the drainage tubing or an obstruction is present, the chest tubes may be carefully milked. Drainage will initially appear bloody, becoming serosanguineous and then serous over the first 2 to 3 days after surgery. Approximately 100 to 300 mL of drainage will occur during the first 2 hours after surgery, which will decrease to less than 50 mL/h over the next several hours. In the early phase, an air leak is commonly heard. As healing occurs, this leak should disappear.
A patient has been admitted following a motor vehicle collision in which the patient sustained multiple abrasions and bruising across the chest. Suddenly, the patient complains of difficulty breathing, the O2 saturation has dropped dramatically, there are decreased breath sounds on the left, and it appears that there is some tracheal deviation. What would be your next logical action? a). Notify the patient's practitioner and prepare for a stat V/Q scan. b). Start the patient on O2 at 4 L/min nasal cannula and prepare an aminophylline drip. c). Call the rapid response team and prepare for emergency insertion of a chest tube. d). Notify the patient's practitioner of these changes.
c). Call the rapid response team and prepare for emergency insertion of a chest tube. The signs and symptoms are classic indications of development of a pneumothorax. The characteristics that particularly differentiate this diagnosis are the bruising on the chest after motor vehicle accident (MVA) and the deviated trachea.
What is one strategy to prevent ventilator-associated pneumonia (VAP)? a). Maintain the head of the bed at 10 degrees. b). Perform oral care with peroxide daily. c). Conduct a spontaneous awakening trial daily. d). Assess readiness to extubate biweekly.
c). Conduct a spontaneous awakening trial daily. One strategy to prevent ventilator-associated pneumonia (VAP) is to conduct a spontaneous awakening trial daily. The head of the bed should be maintained at 30 to 45 degrees. Oral care should be performed with chlorhexidine. Readiness to extubate should be assessed at least daily.
A patient with a tracheostomy requires a sputum sample for further analysis. Which statement regarding this procedure is correct? a). Using the side of the tracheostomy tube as a guide, slide the suction catheter as far as it will go without forcing it. b). Apply suction to the catheter until secretions return to the sputum trap, continuing to apply suction as you withdraw the catheter. c). Do not attempt to flush the catheter with sterile water. d). Maintain the specimen at room temperature until transported to the laboratory.
c). Do not attempt to flush the catheter with sterile water. Contact with the inside of the tracheostomy tube and applying suction upon catheter withdrawal may contaminate the specimen with secretions from the upper airways. It is not necessary to "clear" the suction catheter with sterile water. This may dilute the specimen and render results that are not useful. After the specimen has been obtained, it should be refrigerated if immediate transport to the laboratory is not available.
A patient admitted after a motor vehicle crash has a spinal cord injury at C4. What is the priority nursing diagnosis for this patient? a). Risk for disuse syndrome b). Ineffective airway clearance c). Impaired gas exchange d). Alteration in skin integrity
c). Impaired gas exchange With a spinal cord injury of C4 or higher, the muscles of ventilation are paralyzed. This results in alveolar hypoventilation and impaired gas exchange. Although the other nursing diagnoses may be relevant, they are not the top priority in this situation.
A patient has been admitted with severe left lower lobe pneumonia. You know that the exudates created by the pneumonia will prevent perfusion of those alveolar areas affected. What is this phenomena referred to? a). Alveolar dead space b). Hypoxic vasoconstriction c). Intrapulmonary shunting d). Wasted ventilation
c). Intrapulmonary shunting Alveoli receiving perfusion but not ventilation are unable to participate in gas exchange. This is referred to as intrapulmonary shunting. Blood is returned to the left side of the heart unoxygenated.
Which pulmonary function test measures inspiratory muscle strength? a). Tidal volume b). Vital capacity c). Maximal inspiratory pressure d). Minute ventilation
c). Maximal inspiratory pressure Maximal inspiratory pressure is used to evaluate the strength of inspiratory muscles and is often used to determine readiness to wean from mechanical ventilation. Tidal volume measures the volume of air inhaled after a normal inhalation, vital capacity is the maximum amount of air that can be exhaled after a maximal inhalation, and minute ventilation is the volume of air expired per minute.
A patient was admitted with pneumonia. A stat arterial blood gas (ABG) is obtained as the patient appears to be worsening, and the results show a PaO2 of 52 mm Hg. The rapid response team is called, and the patient's oxygen is increased to 100%. Which oxygen delivery system would be most appropriate? a). Nasal cannula b). Face mask c). Nonrebreather circuit d). Air entrainment mask
c). Nonrebreather circuit Oxygen delivery through a nasal cannula or simple face mask is variable and can deliver only 25% to 50% oxygen. An air entrainment mask is designed to provide a fixed FiO2 of 24% to 50%. Only the nonrebreather circuit can deliver the desired 100% FiO2.
A patient has a history of respiratory problems. The nurse is assessing the patient's chest and notes that the sternum and lower ribs are displaced posteriorly, creating a pit-shaped depression in the chest. What is this finding called? a). Barrel chest b). Kyphosis c). Pectus excavatum d). Pectus carinatum
c). Pectus excavatum The patient has pectus excavatum, or "funnel chest." Barrel chest has an increased anteroposterior diameter with the sternum forward and the ribs outward. Kyphosis is a rearward curvature of the spine. In pectus carinatum, or "pigeon breast," the sternum projects forward.
Which statement is true regarding the use of prone positioning in a patient with acute respiratory distress syndrome (ARDS)? a). It can be used safely in all patients. b). A strict schedule of turning every 2 hours must be adhered to for greatest success. c). Prone positioning improves perfusion to less damaged areas of the lung. d). It is not useful in mobilizing secretions.
c). Prone positioning improves perfusion to less damaged areas of the lung. In acute respiratory distress syndrome (ARDS), the dependent areas of lung tissue are most affected. The prone position allows perfusion of the healthier tissue. It is contraindicated in patients with head and spinal trauma and may cause edema. Care must be taken to keep the eyes moist and taped shut while the patient is prone to avoid corneal ulcerations.
The physician orders rotation therapy for a patient experiencing acute lung injury. Which technique should be used for the therapy to be effective? a). Rotate patient 30 degrees side to side for 10 minutes every hour b). Prone patient for 2 hours every 6 hours c). Rotate patient 40 degrees per side for at least 18 hours per day d). Prone patient for 6 hours and supine for 6 hours
c). Rotate patient 40 degrees per side for at least 18 hours per day Studies have found that to achieve benefits, rotation must be aggressive, and the patient must be at least 40 degrees per side, with a total arc of at least 80 degrees, for at least 18 hours a day. Rotating the patient 30 degrees has not been shown to be effective. Placing the patient prone is not a form of rotation therapy. No clear standards are available on how long a patient should be placed prone.
A patient is placed on a 100% nonrebreathing mask. The SpO2 is 98%. Which statement best describes why oxygen saturation is not a 100%? a). Infiltrates from pneumonia are causing a ventilation-perfusion mismatch. b). The patient is experiencing a small pneumothorax, resulting in pulmonary shunting. c). This finding is attributable to normal physiologic shunting. d). The patient also has pulmonary hypertension and is therefore unable to use exogenous oxygen delivered by the mask.
c). This finding is attributable to normal physiologic shunting. The left atrium normally contains pure oxygenated blood, with a hemoglobin saturation level of 100%. The mixing of venous blood from the bronchial circulation with the oxygenated blood in the left atrium decreases the saturation of left atrial blood to a range between 96% and 99%. The dumping of venous blood into the left atrium is known as an anatomic shunt. The thebesian veins, which drain the right coronary circulation, are also responsible for the addition of venous blood to the left atrium. These two systems constitute the normal anatomic shunt, which comprises approximately 3% to 5% of the total cardiac output.
Which statement is true regarding complications of noninvasive ventilation (NIV)? a). Masks should allow moderate air leaks for patient comfort. b). Agitation while undergoing NIV should be treated aggressively with sedation. c). When using a full face mask, the patient's hands should not be restrained. d). Placement of a nasogastric tube is contraindicated.
c). When using a full face mask, the patient's hands should not be restrained. Insufflation of the stomach places the patient at risk for aspiration. A nasogastric tube is placed for decompression as necessary. Heavy sedation should be avoided. A patient who requires noninvasive ventilation with a face mask should never be restrained. The patient must be able to remove the mask if it becomes displaced or if the patient vomits. A properly fitted mask minimizes air leakage and discomfort for the patient.
Which arterial blood gas (ABG) is considered compensated? a). pH 7.22, PaCO2 55, HCO3 25 b). pH 7.33, PaCO2 62, HCO3 35 c). pH 7.35, PaCO2 48, HCO3 28 d). pH 7.50, PaCO2 42, HCO3 33
c). pH 7.35, PaCO2 48, HCO3 28 The arterial blood gas (ABG) of pH 7.35, PaCO2 of 48, and HCO3 of 28 is a compensated respiratory acidosis. The pH has come back within normal range as a result of the retaining HCO3 to buffer for the excess PaCO2. The ABG of pH 7.22, PaCO2 of 55, and HCO3 of 25 is an uncompensated respiratory acidosis. The ABG of pH 7.33, PaCO2 of 62, and HCO3 of 35 is a partially compensated respiratory acidosis. The ABG of pH 7.50, PaCO2 of 42, and HCO3 of 33 is an uncompensated metabolic alkalosis.
The nurse is discussing the pharmacologic treatment of a pulmonary embolism (PE) with a nursing student. Which statement made by the nursing student indicates that the education was effective? a). "Heparin is administered to break down the existing clots." b). "Heparin is titrated to achieve a prothrombin time of two to three times the control value." c). "Heparin should be continued until the warfarin is started." d). "rt-PA can be used to treat patients with massive pulmonary embolism and hemodynamic instability."
d). "rt-PA can be used to treat patients with massive pulmonary embolism and hemodynamic instability." Recombinant tissue-type plasminogen activator (rt-PA) is a fibrinolytic reserved for severe pulmonary embolism (PE). Heparin is administered to prevent further clots from forming and has no effect on the existing clot. The heparin should be adjusted to maintain the activated partial thromboplastin time (aPTT) in the range of two to three times of upper normal. Warfarin should be started at the same time, and when the international normalized ratio (INR) reaches 3.0, the heparin should be discontinued. The INR should be maintained between 2.0 and 3.0.
Which statement is true regarding status asthmaticus? a). Initial arterial blood gas levels indicate severe hypoxemia and respiratory acidosis. b). Low-flow oxygen therapy should be used cautiously in patients with asthma. c). Small, frequent doses of bronchodilators should be started immediately. d). Corticosteroids, although useful in the treatment of status asthmaticus, usually require 6 to 8 hours to take effect.
d). Corticosteroids, although useful in the treatment of status asthmaticus, usually require 6 to 8 hours to take effect. The onset of action of corticosteroids is 6 to 8 hours. A patient in status asthmaticus often initially presents with alkalosis caused by tachypnea and hyperventilation, but as fatigue sets in, hypoventilation and hypercapnia result in acidosis. These patients often require high-flow oxygen therapy and high-dose bronchodilators.
You are caring for a patient admitted with asthma. During your assessment, you would expect to find which abnormality? a). "Funnel chest" b). Right tracheal shift c). Dull percussive sounds d). Decreased fremitus
d). Decreased fremitus Structural changes associated with asthma interfere with the normal vibrations created during breathing, resulting in decreased sensation upon palpation.
A patient is admitted for exacerbation of asthma. When auscultating for breath sounds, which finding would confirm this diagnosis? a). Vesicular breath sounds throughout all lung fields b). Muffled breath sounds with localized crackles c). Absent breath sounds in the bases; crackles on expiration d). Distant breath sounds with audible wheezing
d). Distant breath sounds with audible wheezing Asthma is characterized by intermittent episodes of airway obstruction caused by bronchospasm, excessive bronchial secretion, or edema of bronchial mucosa; resultant airway resistance, especially during expiration, produces symptoms of wheezing, dyspnea, and chest tightness. Wheezes are high-pitched, squeaking, whistling sounds produced by airflow through narrowed small airways. They are heard mainly on expiration but may be heard throughout the ventilatory cycle.
What is the proper sequencing of an assessment of the pulmonary system? a). Inspection, auscultation, palpation, and percussion b). Inspection, palpation, auscultation, and percussion c). Inspection, auscultation, percussion, and palpation d). Inspection, palpation, percussion, and auscultation
d). Inspection, palpation, percussion, and auscultation The proper sequence for assessing the pulmonary system is inspection, palpation, percussion, and auscultation.
Which statement is true regarding status asthmaticus? a). Initial arterial blood gas levels indicate severe hypoxemia and respiratory acidosis. b). Low-flow oxygen therapy should be used cautiously in patients with asthma. c). Small, frequent doses of bronchodilators should begin immediately. d). Intravenous or oral corticosteroids usually take 6 to 8 hours to take effect.
d). Intravenous or oral corticosteroids usually take 6 to 8 hours to take effect. Intravenous or oral corticosteroids are used in the treatment of status asthmaticus. Their antiinflammatory effects limit mucosal edema, decrease mucus production, and potentiate beta-2 agonists. It usually takes 6 to 8 hours for the effects of the corticosteroids to become evident. The patient in status asthmaticus often initially presents with alkalosis caused by tachypnea and hyperventilation, but as fatigue sets in, hypoventilation and hypercapnia result in acidosis. These patients often require high-flow oxygen therapy and high-dose bronchodilators.
A patient is admitted with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results would be consistent with this diagnosis? a). PaO2 90 mm Hg, pH 7.42, PaCO2 48 mm Hg, HCO3- 35 mEq/L b). PaO2 90 mm Hg, pH 7.37, PaCO2 60 mm Hg, HCO3- 39 mEq/L c). PaO2 90 mm Hg, pH 7.25, PaCO2 55 mm Hg, HCO3- 22 mEq/L d). PaO2 90 mm Hg, pH 7.25, PaCO2 40 mm Hg, HCO3- 17 mEq/L
d). PaO2 90 mm Hg, pH 7.25, PaCO2 40 mm Hg, HCO3- 17 mEq/L The pH and HCO3- levels indicate metabolic acidosis. Compensatory mechanisms have not yet begun, as evidenced by the normal PaCO2 and decreased pH.
A patient is scheduled to begin weaning from mechanical ventilation today. Which assessment would be the best indicator of the patient's readiness to be weaned? a). Minute ventilation greater than 10 L/min b). Respiratory rate at least 30/min c). FiO2 less than 50% d). Rapid shallow breathing index less than 105 (RSBI)
d). Rapid shallow breathing index less than 105 (RSBI) The rapid shallow breathing index (RSBI) is calculated using the minute ventilation and respiratory rate. The other parameters alone are not as predictive of weaning success.
Which clinical manifestation is associated with the exudative phase of acute respiratory distress syndrome (ARDS)? a). Increased work of breathing b). Increasing agitation c). Fine crackles d). Respiratory alkalosis
d). Respiratory alkalosis Respiratory alkalosis is one finding associated with the exudative phase of acute respiratory distress syndrome (ARDS). Increasing agitation, fine crackles, and increased work of breathing are associated with the fibroproliferative phase of ARDS.
A patient has aspirated a tooth and is undergoing a bronchoscopy for retrieval. In which lobe will the object most likely be found? a). Left upper lobe b). Right upper lobe c). Left lower lobe d). Right lower lobe
d). Right lower lobe The right main stem bronchus is straighter and wider than the left, so foreign objects are more likely to end up in the right lower lobe. The other options are possible but not as likely.