PREP U- Chap 10 Pellico
he nurse is administering anticoagulant therapy with heparin. What International Normalized Ratio (INR) would the nurse know is within therapeutic range? 0.5 to 1.0 1.5 to 2.5 2.0 to 2.5 3.0 to 3.5
2.0 to 2.5 Explanation: Low-molecular- weight heparin and fondaparinux (Arixtra) are the cornerstones of therapy, but IV unfractionated heparin may be used during the initial phase (ACCP, 2012). The early maintenance phase of anticoagulation typically consists of overlapping regimens of heparins or fondaparinux for at least 5 days with an oral vitamin K antagonist (e.g., warfarin [Coumadin]). A 3- to 6-month regimen of long-term maintenance with warfarin is typical but depends on the risks of recurrence and bleeding (ACCP, 2012). Heparin must be continued until the INR is within a therapeutic range, typically 2.0 to 3 (Kearon, Kahn, Agnelli, et al., 2008). Reference:
Acute respiratory failure (ARF) occurs when oxygen tension (PaO2) falls to less than __________ mm Hg (hypoxemia) and carbon dioxide tension (PaCO2) rises to greater than __________ mm Hg (hypercapnia).
50 and 50 Explanation: Acute respiratory failure (ARF) is classified as hypoxemic (decrease in arterial oxygen tension [PaO2] to <50 mm Hg on room air) and or hypercapnic (increase in arterial carbon dioxide tension [PaCO2] to >50 mm Hg with an arterial pH of <7.35).
The nurse assesses a patient recently diagnosed with absorptive atelectasis. She is aware that the most common condition that causes the inactivation of surfactant is which of the following? ARDS Lung tumors Pneumothorax Pleural effusions
ARDS Explanation: The most common condition that causes an inactivation of surfactant is acute respiratory distress syndrome (ARDS), in which pulmonary edema fluid dilutes and/or reduces surfactant production. The loss of surfactant causes a reduction in surface tension of the alveoli and leads to their collapse.
A client has been battling typical pneumonia for about a month, and currently using a second course of antibiotics. What complications can result from pneumonia? Select all that apply. CHF shock septicemia chronic bronchitis
CHF shock septicemia Explanation: Empyema (collection of pus in the pleural cavity), pleurisy (inflammation of the pleura), septicemia (infective microorganisms in the blood), atelectasis, hypotension, etc.
A patient with pulmonary hypertension has a positive vasoreactivity test. What medication does the nurse anticipate administering to this patient? Calcium channel blockers Angiotensin converting enzyme inhibitor Beta blockers Angiotensin receptor blockers
Calcium channel blockers Explanation: Patients with a positive vasoreactivity test may be prescribed calcium channel blockers. Calcium channel blockers have a significant advantage over other medications taken to treat PH in that they may be taken orally and are generally less costly; however, because calcium channel blockers are indicated in only a small percentage of patients, other treatment options, including prostanoids, are often necessary (Rubin & Hopkins, 2012).
The nurse is aware that the clinical manifestations of atelectasis are correlated to the severity of the affected collapse. Which of the following indications are consistent with a smaller, affected area? Select all that apply.
Crackles Decreased breath sounds Decreased tactile fremitus Explanation: For a small atelectatic area, findings include crackles, decreased breath sounds, and decreased tactile fremitus over the affected lung area(s). For a large atelectatic area, findings include trachea deviation toward the atelectatic area, decreased fremitus, bronchial breath sounds, egophony (secondary to lobar or lung collapse), and asymmetry of the chest.
The nurse is assessing a patient who has been admitted with possible ARDS. What findings would distinguish ARDS from cardiogenic pulmonary edema? Elevated white blood count Elevated troponin levels Elevated myoglobin levels Elevated B-type natriuretic peptide (BNP) levels
Elevated B-type natriuretic peptide (BNP) levels Explanation: Common diagnostic tests performed in patients with potential ARDS include plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization. The BNP level is helpful in distinguishing ARDS from cardiogenic pulmonary edema.
A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure?
Partial pressure of arterial oxygen (PaO2) Explanation: In acute respiratory failure, administering supplemental oxygen elevates the PaO2. In acute respiratory distress syndrome, elevation of the PaO2 requires positive end-expiratory pressure. In both situations, the PaCO2 is elevated and the pH and HCO3- are depressed.
A client presents to a physician's office complaining of dyspnea with exertion, weakness, and coughing up blood. Further examination reveals peripheral edema, crackles, and jugular vein distention. The nurse anticipates the physician will make which diagnosis? Pulmonary hypertension Chronic obstructive pulmonary disease (COPD) Empyema Pulmonary tuberculosis
Pulmonary hypertension Explanation: Dyspnea, weakness, hemoptysis, and right-sided heart failure are all signs of pulmonary hypertension. Clients with COPD present with chronic cough, dyspnea on exertion, and sputum production. Those with empyema are acutely ill and have signs of acute respiratory infection or pneumonia. Clients with pulmonary tuberculosis usually present with low-grade fever, night sweats, fatigue, cough, and weight loss.
A client diagnosed with tuberculosis (TB) is taking medication for the treatment of TB. The nurse should instruct the client that he will be safe from infecting others approximately how long after initiation of the chemotherapy regimen?
Two to 3 weeks after initiation of bacteriocidal drugs Explanation: The client needs to take the prescribed medications for approximately 2 to 3 weeks before discontinuing precautions against infecting others. Effectiveness of the drug therapy is determined by negative sputum smears obtained on three consecutive days. Although results can vary among clients, the majority respond to therapy within 2 to 3 weeks.
A nurse is aware that the diagnostic feature of ARDS is sudden:
Unresponsive arterial hypoxemia. Explanation: Clinically, the acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs 12 to 48 hours after the initiating event. A characteristic feature is arterial hypoxemia that does not respond to supplemental oxygen.
Arterial blood gas analysis would reveal which of the following related to acute respiratory failure? PaO 80 mm Hg pH 7.28 PaCO 32 mm Hg pH 7.35
pH 7.28 Explanation: Acute respiratory failure (ARF) is defined as a decrease in the arterial oxygen tension (PaO) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO) to greater than 50 mm Hg (hypercapnia), with an arterial pH of less than 7.35.
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first?
Administer oxygen by nasal cannula as ordered. Explanation: When a pulmonary embolus places a client at risk for oxygen deprivation, the body compensates by hyperventilating. This causes respiratory alkalosis, as reflected in the client's ABG values. However, the most significant ABG value is the PaO2 value of 60 mm Hg, which indicates hypoxemia. To manage hypoxemia, the nurse should increase oxygenation by administering oxygen via nasal cannula as ordered. Instructing the client to breathe into a paper bag would cause depressed oxygenation when the client reinhaled carbon dioxide. Auscultating breath sounds or encouraging deep breathing and coughing wouldn't improve oxygenation.
The nursing instructor is discussing pulmonary arterial hypertension with the nursing students. What would the instructor describe as the pathophysiology of secondary pulmonary arterial hypertension? Bronchial thickening causes increased resistance and pressure in the pulmonary vascular bed. Chronic lung disease causes scaring in the bronchioles raising pressure in the pulmonary vascular bed. Left-sided heart failure causes increased resistance and pressure in the pulmonary vascular bed. Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed.
Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed. Explanation: In secondary pulmonary arterial hypertension, alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed. Therefore options A, B, and C are incorrect.
A physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which treatment?
Daily doses of isoniazid, 300 mg for 6 months to 1 year Explanation: All clients exposed to persons with tuberculosis should receive prophylactic isoniazid in daily doses of 300 mg for 6 months to 1 year to avoid the deleterious effects of the latent mycobacterium. Daily oral doses of isoniazid and rifampin for 6 months to 2 years are appropriate for the client with active tuberculosis. Isolation for 2 to 4 weeks is warranted for a client with active tuberculosis.
The nurse is planning the care for a patient at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan? (Select all that apply.) Encouraging a liberal fluid intake Assisting the patient to do leg elevations above the level of the heart Instructing the patient to dangle the legs over the side of the bed for 30 minutes, four times a day Using elastic stockings, especially when decreased mobility would promote venous stasis Applying a sequential compression device
Encouraging a liberal fluid intake Assisting the patient to do leg elevations above the level of the heart Using elastic stockings, especially when decreased mobility would promote venous stasis Applying a sequential compression device Explanation: The use of anti-embolism stockings or intermittent pneumatic leg compression devices reduces venous stasis. These measures compress the superficial veins and increase the velocity of blood in the deep veins by redirecting the blood through the deep veins. Elevating the leg (above the level of the heart) also increases venous flow. Legs should not be dangled or feet placed in a dependent position while the patient sits on the edge of the bed; instead, feet should rest on the floor or on a chair.