Med Surg II Quiz 3 (ch. 14-15)

The nurse is caring for a patient who is ventilator-dependent. The patient's plan of care should include interventions to decrease which psychological factors that may be contributing to the patient's condition? (Select all that apply.) a. Fear b. Sensory overload c. Depersonalization d. Depression e. Trust in the staff

a. Fear b. Sensory overload c. Depersonalization d. Depression

A nurse is teaching a nursing student about the modes of volume ventilation. Which statement regarding the assist-control (AC) mode indicates the student understood the information? a. "It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts." b. "It delivers gas at a preset volume, allowing the patient to breathe spontaneously at his or her own volume." c. "It applies positive pressure during both ventilator breaths and spontaneous breaths." d. "It delivers gas at preset rate and tidal volume regardless of the patient's inspiratory efforts."

a. "It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts."

A patient was admitted following an aspiration event on the medical-surgical floor. The patient is receiving 40% oxygen via a simple face mask. The patient has become increasingly agitated and confused. The patient's oxygen saturation has dropped from 92% to 84%. The nurse notifies the practitioner about the change in the patient's condition. What interventions should the nurse anticipate? a. Intubation and mechanical ventilation b. Change in antibiotics orders c. Suction and reposition the patient d. Orders for a sedative

a. Intubation and mechanical ventilation

A patient with a history of chronic obstructive pulmonary disease (COPD) requires oxygen therapy. The nurse knows that the practitioner will probably start with a low-flow system and evaluate the patient once the therapy is started. Which device should the nurse anticipate an order for? a. Nasal cannula b. Simple face mask c. Reservoir cannula d. Air-entrainment nebulizer

a. Nasal cannula

A patient with pneumonia is on 50% oxygen via a simple mask. The practitioner orders the patient's oxygen to be increased to 70%. Which oxygen administration device should the patient be placed on to accomplish this? a. Nonrebreathing mask b. Nasal cannula c. Partial rebreathing mask d. Simple mask

a. Nonrebreathing mask

An exhausted patient has been admitted with status asthmaticus. The nurse anticipates the medical management plan to include which treatments? (Select all that apply.) a. Oxygen therapy b. Bronchodilators c. Corticosteroids d. Antibiotics e. Intubation and mechanical ventilation

a. Oxygen therapy b. Bronchodilators c. Corticosteroids e. Intubation and mechanical ventilation

A patient is receiving mechanical ventilation via an endotracheal tube. The nurse knows that the patient becomes hypoxemic when suctioned. Which interventions should be included in the patient's plan of care to minimize this complication? (Select all that apply.) a. Oxygenate the patient with 100% oxygen prior to the start of the procedure. b. Oxygenate the patient with 100% after each pass of the suction catheter. c. Limit the duration of each suction pass to 20 seconds. d. Instill 5 to 10 mL of normal saline to facilitate secretion removal. e. Use intermittent suction to avoid damaging tracheal tissue.

a. Oxygenate the patient with 100% oxygen prior to the start of the procedure. b. Oxygenate the patient with 100% after each pass of the suction catheter.

Which nursing intervention should be used to optimize oxygenation and ventilation in the patient with acute lung failure? a. Provide adequate rest time between procedures. b. Position the patient with the good lung up. c. Suction the patient every hour. d. Avoid preoxygenating the patient before suctioning

a. Provide adequate rest time between procedures.

When assessing an intubated patient, the nurse observes normal breath sounds on the right side of the chest and absent breath sounds on the left side of the chest. Which problem should the nurse suspect? a. Right mainstem intubation b. Left pneumothorax c. Right hemothorax d. Gastric intubation

a. Right mainstem intubation

Which weaning methods are used in combination with each other? (Select all that apply.) a. SIMV with CPAP b. SIMV with PSV c. CPAP with PSV d. T-piece and PSV e. PEEP with CPAP

a. SIMV with CPAP b. SIMV with PSV c. CPAP with PSV d. T-piece and PSV

A patient has developed ventilator-associated pneumonia (VAP). The nurse knows that the two pathogens most frequently associated with this condition are which? a. Staphylococcus aureus and Pseudomonas aeruginosa b. Escherichia coli and Haemophilus influenzae c. Acinetobacter baumannii and Haemophilus influenzae d. Klebsiella spp. and Enterobacter spp.

a. Staphylococcus aureus and Pseudomonas aeruginosa

A patient has been on 100% oxygen for 36 hours. The nurse is aware that the patient is at risk for oxygen toxicity and should be evaluating the patient for which signs and symptoms? (Select all that apply.) a. Substernal chest pain that increases with deep breathing b. Moist cough and tracheal irritation c. Pleuritic pain occurring on inhalation, followed by dyspnea d. Increasing PaCO2 e. Sore throat and eye and ear discomfort

a. Substernal chest pain that increases with deep breathing c. Pleuritic pain occurring on inhalation, followed by dyspnea e. Sore throat and eye and ear discomfort

A patient who is 2 days postoperative from a hip replacement suddenly develops hypoxemia. The nurse suspects that the patient has developed a pulmonary embolism (PE) when the patient exhibits which signs and symptoms? a. Tachycardia and tachypnea b. Hemoptysis and evidence of deep vein thromboses c. Apprehension and dyspnea d. Right ventricular failure and fever

a. Tachycardia and tachypnea

A patient with acute respiratory distress syndrome (ARDS) has continued to deteriorate. The interprofessional team is discussing the initiation of rotation therapy. Which statements made during the discussion are accurate? (Select all that apply.) a. The patient must be turned at least 40 degrees per side, with a total arc of at least 80 degrees, for at least 18 hours a day for the therapy to be effective. b. Kinetic therapy can decrease the incidence of ventilator-acquired pneumonia in patients with neurologic problems and postoperative patients. c. Use of rotational therapy eliminates the need for other pressure ulcer prevention strategies as the rotation takes the place of turning the patient. d. Continuous lateral rotation therapy helps avoid hemodynamic instability secondary to the continuous, gentle turning of the patient. e. Continuous lateral rotation therapy, with a rotation of less than 40 degrees, has been found to be of minimal benefits for critically ill patients.

a. The patient must be turned at least 40 degrees per side, with a total arc of at least 80 degrees, for at least 18 hours a day for the therapy to be effective. b. Kinetic therapy can decrease the incidence of ventilator-acquired pneumonia in patients with neurologic problems and postoperative patients. e. Continuous lateral rotation therapy, with a rotation of less than 40 degrees, has been found to be of minimal benefits for critically ill patients.

A patient is receiving mechanical ventilation via an endotracheal tube. The plan of care should include monitoring the patient for which complications? (Select all that apply.) a. Tracheoesophageal fistula b. Cricoid abscess c. Tracheal stenosis d. Tube obstruction d. Hemorrhage

a. Tracheoesophageal fistula b. Cricoid abscess c. Tracheal stenosis d. Tube obstruction d. Hemorrhage

The nurse is teaching a new nurse about endotracheal tube cuff management. Which statement by the new nurse would indicate good knowledge about the cuff management? a. "The cuff should be deflated every hour to minimize pressure on the trachea." b. "A small leak should be heard on inspiration if the cuff has been inflated using the minimal leak technique." c. "Cuff pressures should be kept between 20 and 30 cm H2O." d. "Cuff pressure monitoring should be done once every 24 hours."

b. "A small leak should be heard on inspiration if the cuff has been inflated using the minimal leak technique." c. "Cuff pressures should be kept between 20 and 30 cm H2O."

Which patient would be at risk for developing hypoxemic normocapnic respiratory failure (type I)? a. A young adult patient with a recent cervical spinal injury b. An older adult patient with a stroke with swallowing difficulties c. An adult patient with Guillain-Barré syndrome d. A young adult patient admitted with chest trauma and fractured ribs

b. An older adult patient with a stroke with swallowing difficulties

The nurse is caring for a patient with pneumonia. The nurse is alerted when pulse oximeter alarm goes off. The monitor reads 82%. Which action should the nurse should perform first? a. Notify the practitioner and get ready to intubate the patient. b. Assess the patient's condition. c. Turn off the alarm and reapply the oximeter sensor. d. Increase the amount of oxygen being administered to the patient.

b. Assess the patient's condition.

For which situation does a patient with acute lung failure require a bronchodilator? a. Excessive secretions b. Bronchospasms c. Thick secretions d. Fighting the ventilator

b. Bronchospasms

A patient was admitted with acute lung failure secondary to pneumonia. What is the single most important measure to prevent the spread of infection between staff and patients? a. Place the patient in respiratory isolation. b. Ensure everyone is using proper hand hygiene. c. Use personal protective equipment when touching the patient. d. Initiate prompt administration of antibiotics.

b. Ensure everyone is using proper hand hygiene.

The patient management plan for a patient receiving oxygen therapy should include which interventions? a. Observing the patient for signs of oxygen-associated hyperventilation b. Ensuring the oxygen device is properly positioned on the patient c. Removal of all oxygen devices when the patient is eating d. Titrating the patient's oxygen at the nurse's discretion

b. Ensuring the oxygen device is properly positioned on the patient

A patient was taken to surgery for a left lung resection. The patient returned to the unit 30 minutes ago. Upon completion of the assessment, the nurse notices that the chest tube has drained 150 mL of red fluid in the past 30 minutes. The nurse contacts the practitioner and suspects that the patient has developed what complication? a. Pulmonary edema b. Hemorrhage c. Acute lung failure d. Bronchopleural fistula

b. Hemorrhage

A patient with acute lung failure has been mechanically ventilated for 3 days and is being evaluated for a spontaneous breathing trial. The ventilator high-pressure limit alarm keeps alarming. The patient should be evaluated for which problem? a. Leak in the patient's endotracheal tube cuff b. Kink in the ventilator tubing c. Disconnection from the ventilator d. Faulty oxygen filter

b. Kink in the ventilator tubing

The nurse is caring for a patient who is ventilator-dependent. The interprofessional team feels the patient's main problem is increased ventilatory workload. The patient's collaborative plan of care should include which interventions to address this issue? (Select all that apply.) a. Decrease the respiratory rate on the ventilator. b. Optimize the ventilator settings and trigger sensitivity. c. Position the patient with the head of the bed elevated at least 30 degrees. d. Insert a nasogastric tube to relieve abdominal distention. e. Replace a small endotracheal tube with a larger tube or a tracheostomy.

b. Optimize the ventilator settings and trigger sensitivity. c. Position the patient with the head of the bed elevated at least 30 degrees. d. Insert a nasogastric tube to relieve abdominal distention. e. Replace a small endotracheal tube with a larger tube or a tracheostomy.

The practitioner indicates in her notes that the patient has mild acute respiratory distress syndrome (ARDS). The patient is requiring mechanical ventilation and has a PEEP of 5 cm H2O. The nurse would anticipate the patient having which finding? a. Radiologic evidence of bibasilar atelectasis b. PaO2/FiO2 ratio of 220 mm Hg c. Pulmonary artery occlusion pressure greater than 18 mm Hg d. Oxygen saturation of 92%

b. PaO2/FiO2 ratio of 220 mm Hg

While caring for a patient with severe left-sided pneumonia, the nurse observes that the patient's oxygen saturation varies depending on the patient's position. Given this information the patient would probably benefit from being placed in which position? a. Reverse Trendelenburg b. Supine c. On the left side d. On the right side

d. On the right side

The patient management plan of a patient with acute lung failure should include which interventions? (Select all that apply.) a. Positioning the patient with the least affected side up b. Providing adequate rest between treatments c. Performing percussion and postural drainage every 4 hours d. Controlling fever e. Pharmaceutical medications to control anxiety

b. Providing adequate rest between treatments d. Controlling fever e. Pharmaceutical medications to control anxiety

The nurse is caring for a patient with massive pulmonary embolus. Which pathophysiologic hemodynamic consequence should the nurse anticipate the patient may develop? a. Increased systemic vascular resistance leading to left heart failure b. Pulmonary hypertension leading to right heart failure c. Portal vein blockage leading to ascites d. Embolism to the internal carotids leading to a stroke

b. Pulmonary hypertension leading to right heart failure

A patient with acute lung failure has been mechanically ventilated for 3 days and is being evaluated for a spontaneous breathing trial. Which parameter would indicate that the patient is ready to be weaned? a. Negative inspiratory force of—10 cm H2O b. Rapid shallow breathing index of 95 c. Minute ventilation of 7 L/min d. Vital capacity of 8 mL/kg

b. Rapid shallow breathing index of 95

A patient with acute lung failure has been mechanically ventilated for 3 days and is being evaluated for a spontaneous breathing trial. When the nurse enters the room, the ventilator inoperative alarm sounds. Which action should the nurse perform FIRST? a. Troubleshoot the ventilator until the problem is found. b. Take the patient off the ventilator and manually ventilate the patient. c. Call the respiratory therapist for help. d. Silence the ventilator alarms until the problem is resolved.

b. Take the patient off the ventilator and manually ventilate the patient.

A patient at risk for the recurrence of a pulmonary embolism (PE) is being discharged home. The patient asks "How long do I have to remain on warfarin?" Which response from the nurse is the most accurate? a. "You only have to take warfarin for 1 month and then you can stop." b. "You could be on warfarin for up to 6 months depending on your lab work." c. "Depending on your risk, it could be anywhere from 3 to 12 months." d. "Most patients have to stay on warfarin for at least 36 months."

c. "Depending on your risk, it could be anywhere from 3 to 12 months."

A patient with acute respiratory distress syndrome (ARDS) continues to have ongoing problems with hypoxemia. Which therapeutic measure should the nurse anticipate the practitioner will order next? a. Sedating the patient to blunt noxious stimuli b. Increasing the FiO2 on the ventilator c. Administering positive-end expiratory pressure (PEEP) d. Restricting fluids to 500 mL per shift

c. Administering positive-end expiratory pressure (PEEP)

A patient with acute lung failure has been mechanically ventilated for 3 days and has been started on a spontaneous breathing trial. Which parameter would indicate that the patient is not tolerating weaning? a. A decrease in heart rate from 92 to 80 beats/min b. An SpO2 of 92% c. An increase in respiratory rate from 22 to 38 breaths/min d. Spontaneous tidal volumes of 300 to 350 mL

c. An increase in respiratory rate from 22 to 38 breaths/min

A patient with a history of chronic obstructive pulmonary disease (COPD) requires oxygen therapy. The nurse knows that oxygen therapy places this patient at high risk for the developing which complication? a. Oxygen toxicity b. Absorption atelectasis c. Carbon dioxide retention d. Pneumothorax

c. Carbon dioxide retention

A patient has been admitted with severe shortness of breath and pleuritic chest pain. The practitioner suspects the patient may have a pulmonary embolism (PE). Which finding would confirm this diagnosis? a. Low-probability V/Q scan b. Negative pulmonary angiogram c. High-probability V/Q scan d. Absence of vascular markings on the chest radiograph

c. High-probability V/Q scan

A patient with severe unilateral pneumonia has been admitted with severe hypoxemia. The nurse suspects the underlying cause of the hypoxemia is which pathophysiologic process? a. Alveolar hypoventilation b. Dead space ventilation c. Intrapulmonary shunting d. Physiologic shunting

c. Intrapulmonary shunting2. For which situation does a patient with acute lung failure require a bronchodilator?

The patient with a tracheostomy tube is having difficulty communicating while on the ventilator. Before suggesting the Passy-Muir valve, the nurse should evaluate the patient for the presence of which situation would be a contraindication to this therapy? a. Actively weaning b. Minimal secretions c. Laryngeal dysfunction d. Normal pharyngeal function

c. Laryngeal dysfunction

The nurse is developing a plan of care for a patient with an endotracheal tube (ETT). Which interventions should be incorporated into the plan to minimize the complications of suctioning? a. Insert the suction catheter no more than 4 inches into the tube. b. Premedicate the patient with atropine before suctioning. c. Limit the suction pass to less than 15 seconds. d. Increase the vacuum suction to 180 mm Hg before suctioning.

c. Limit the suction pass to less than 15 seconds.

A patient was admitted in acute lung failure. The patient is receiving 40% oxygen via a simple face mask. The morning chest radiography study reveals right lower lobe pneumonia. Which test would the nurse expect the practitioner to order to identify the infectious pathogen? a. CBC with differential b. Wound culture of surgical site c. Sputum gram stain and culture d. Urine specimen

c. Sputum gram stain and culture

The nurse is caring for a patient who has been mechanically ventilated via an endotracheal tube for 19 days. Weaning trials have been unsuccessful. During multidisciplinary rounds, the topic of the patient's airway is discussed. Which airway may be more appropriate for this patient at this time? a. Oropharyngeal airway b. Esophageal obturator airway c. Tracheostomy tube d. Endotracheal intubation

c. Tracheostomy tube

The nurse will be getting a postoperative patient who is having a pneumonectomy. The nurse suspects the patient may have had which condition? a. Peripheral granulomas b. Bronchiectasis c. Unilateral tuberculosis d. Single lung abscess

c. Unilateral tuberculosis

To select the correct size of an oropharyngeal airway, the nurse should ensure the airway extends from which area to which area? a. Tip of the nose to the ear lobe b. Middle of the mouth to the ear lobe c. Tip of the nose to the middle of the trachea d. Corner of the mouth to the angle of the jaw

d. Corner of the mouth to the angle of the jaw

A patient has been admitted with the diagnosis of acute respiratory distress syndrome (ARDS). Arterial blood gasses (ABGs) revealed an elevated pH and decreased PaCO2. The patient is becoming fatigued, and the practitioner orders a repeat ABG. Which set of results would be indicative of the patient's current condition? a. Elevated pH and decreased PaCO2 b. Elevated pH and elevated PaCO2 c. Decreased pH and decreased PaCO2 d. Decreased pH and elevated PaCO2

d. Decreased pH and elevated PaCO2

The practitioner has ordered the addition of positive end-expiratory pressure (PEEP) to the current mechanical ventilation settings. Which effect will this change have on the patient's hemodynamics? a. PEEP increases intrathoracic pressure, which increases venous return and cardiac output. b. PEEP decreases venous return, which increases preload and cardiac output. c. PEEP increases venous return, which decreases preload and cardiac output. d. PEEP increases intrathoracic pressure, which decreases venous return and cardiac output.

d. PEEP increases intrathoracic pressure, which decreases venous return and cardiac output.

The nurse is developing a patient management plan for an older adult patient who has had a stroke. The patient is unable to adequately swallow and is receiving tube feedings. Which nursing intervention should be incorporated into the plan of care? a. Observing the amount given in the tube feeding b. Assessing the patient's level of consciousness c. Encouraging the patient to cough and to breathe deeply d. Positioning the patient in a semi fowler's position

d. Positioning the patient in a semi fowler's position

To limit respiratory muscle fatigue, the practitioner would like to augment the patient's inspiratory effort. The nurse should anticipate the addition of which therapy? a. Positive end-expiratory pressure (PEEP) b. Continuous positive airway pressure (CPAP) c. Pressure control ventilation (PCV) d. Pressure support ventilation (PSV)

d. Pressure support ventilation (PSV)

A patient with pneumonia is reporting shortness of breath. The nurse suspects the patient is hypoxemic and may need additional oxygen therapy. Which arterial blood gas (ABG) value would validate the nurse's suspicions? a. PaO2 of 80 mm Hg b. PaCO2 of 35 mm Hg c. HCO3− of 24 mEq d. SaO2 of 87%

d. SaO2 of 87%

A patient was admitted after a left pneumonectomy. The patient is receiving 40% oxygen via a simple face mask. The morning chest X-ray reveals right lower lobe pneumonia. After eating breakfast, the patient suddenly vomits and aspirates. What action should the nurse take next? a. Lavage the airway with normal saline b. Place the patient supine in a semi-Fowler position c. Manually ventilate the patient d. Suction the airway

d. Suction the airway

Supplemental oxygen administration is usually effective in treating hypoxemia related to which situation? a. Physiologic shunting b. Dead space ventilation c. Alveolar hyperventilation d. Ventilation/perfusion mismatching

d. Ventilation/perfusion mismatching