Pulmonary/Asthma Set III

Several diagnostic tests may be used to identify/diagnose PE. Select all that apply: a. D-Dimer b. aPTT c. Spiral (helical) CT d. V/Q Scan e. Anterior and posterior Chest X-ray

A C D

1. What is used for lubrication of an NG tube? What is viscous lidocaine?

A water soluble lubricant. A lubricant with numbing medication added often used for lubrication of a colonoscope.

The physician has inserted a chest tube in a client with a hemopneumothorax. The nurse should evaluate the effectiveness of the chest tube: a. For administration of oxygen b. To promote formation of scar tissue c. To insert antibiotics into the pleural space d. To remove air and fluid

D

A patient with a pulmonary embolism has an order for Heparin 5units/kg/hr. The patient weighs 170lbs. Available on your unit: 25,000units in 500ml of D5W. Calculate the concentration of solutions and infusion rate.

8 mL/hr

2. The most common cause of ARDS is a. Pulmonary edema b. Congestive heart failure c. Sepsis d. Pulmonary embolism

C

1. A critical diagnostic indicator for asthma management is _____________.

PEFR

Describe the purpose of PEEP as a ventilatory maneuver

The mechanism of action of PEEP relates to its ability to increase FRC and open up collapsed alveoli.

5. A patient is admitted to the hospital and found to be in respiratory alkalosis. With this information, which of the following ABG results would you expect? a. pH 7.40, PaCO2 35, PaO2 90. b. pH 7.50, PaCO2 30, PaO2 60. c. pH 7.12, PaCO2 55, PaO2 65. d. pH 7.36, PaCO2 45, paO2 80.

B

A patient is being mechanically ventilated with the addition of positive end-expiratory pressures of 12 cm H2O. What complications may be associated with this therapy? a. Decreased cardiac output and increased venous return b. Decreased cardiac output and barotrauma c. Increased cardiac output and hypertension d. Increased venous return and decreased renal perfusion

B

In caring for the patient with a chest tube the nurse would do which of the following? Select all that apply a. Keep the patient on bedrest. b. Keep tubing loosely coiled. c. Keep the chest drainage system below the chest d. Maintain all connections in the system tightly sealed e. Mark the level of drainage on the fluid collection column at least each shift f. Observe for tidaling and air leaks per protocol

B, C, D, E, F

A client has been in an automobile accident and the nurse is assessing the client for possible pneumothorax. The nurse should assess the client for a. sudden , sharp chest pain b. wheezing breaths sounds over affected side c. hemoptysis d. cyanosis

A

A nurse is having difficulty arousing a client following an esophogogastroduodenoscopy (EGD). Which of the following is the priority action by the nurse? a. Assess the client's airway. b. Allow the client to sleep. c. Prepare to administer an antidote to the sedative. d. Evaluate preprocedure laboratory findings.

A

A patient's pulmonologist wants his patient to receive 10 breaths/min from the ventilator and when the patient breathes spontaneously, the provider wants the patient to get the pre-set tidal volume as well. This mode of ventilation is called: a. Assist-control ventilation b. Synchronized intermittent mandatory ventilation (SIMV) c. Continuous positive airway pressure (CPAP) d. Positive end-expiratory pressure (PEEP)

A

An important nursing intervention for patients who receive neuromuscular blocking agents (NBA or paralytic) is to: a. administer sedatives in conjunction with the NBA. b. assess urine output hourly. c. avoid suction through the ET tube. d. restrain the patient to avoid self-extubation.

A

When caring for a client with an incisional cholecystectomy the nurse places the highest priority initially on assisting the client to a. Turn, cough and deep breathe b. Choose a low-fat diet c. Perform hourly leg exercises d. Ambulate the evening of the operative day

A

A client has returned to the telemetry unit after a cardiac catheterization. Which is the most important initial post-procedure nursing assessment for this client? a. Monitor laboratory values. b. Observe level of consciousness every 15 minutes. c. Observe the puncture site for swelling and bleeding. d. Monitor skin warmth and turgor.

C

A client is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Recently, the client noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the client, the nurse would most likely learn that the client's childhood health history included: a. Chickenpox b. Poliomyelitis c. Rheumatic fever d. Meningitis

C

A client with esophageal reflux disease has a chronic cough. This symptom may be indicative of what? a. Development of esophageal cancer b. Irritation of the esophagus c. Aspiration of gastric contents d. Esophageal scar formation

C

A client with rib fractures and a pneumothorax has a chest tube inserted that is connected to a water-seal chest tube drainage system. The nurse notes that the fluid in the water seal column is fluctuating with each breath that the client takes. What is the significance of the fluctuation? a. An obstruction is present in the chest tube. b. The client is developing subcutaneous emphysema. c. The chest tube system is functioning properly. d. There is a leak in the chest tube system.

C

A patient with acute respiratory failure is placed on a non-rebreather mask. Which of the following findings would alert the nurse that the equipment is not hooked up correctly? a. The bag is inflated 2/3 full b. The mask is covering both the mouth and nose c. The bag is not inflated d. Oxygen is set at 15 liters

C

Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia? a. Coma b. Apathy c. Irritability d. Depression

C

A patient admitted with pneumonia is being discharged today. Which of the following orders would be appropriate to delegate to the nursing assistant? Select all that apply. a. Administer the influenza vaccine b. Teach the patient about medication side effects c. Ambulate the patient in the hallway 3 times prior to discharge d. Provide oral care prior to discharge e. Take the patient's vital signs every 4 hours f. Evaluate the effectiveness of the pain medication given

C, D, E

The best indicator of kidney function in Acute Kidney Injury is ?

Creatinine *second best is GFR*

A nurse is admitting a client with bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? a. Propanolol b. Metoclopramide c. Ranitidine d. Vasopressin

D

A nurse is providing discharge instructions for a client on anew antihypertensive medication. Which of the following statements should be included? a. "Be sure to limit your potassium intake while taking this medicine." b. "You should check your blood pressure twice a day while taking this medication." c. "Your medication dose will be increased if you develop tachycardia." d. "Change positions slowly when you move from sitting to standing."

D

The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following? a. Decreased cardiac output b. Pleural effusion c. Inadequate peripheral circulation d. Decreased oxygenation of the blood

D

The nurse performs a focused respiratory assessment on a patient. Which assessment finding should be addressed first when initiating care? a. A respiratory rate of 36. b. A temperature of 101.6 c. A BP of 170/90. d. Patient appears confused.

D

Which of the following findings would suggest pneumothorax in a trauma victim? a. pronounced crackles b. inspiratory wheezing c. dullness on percussion d. absent breath sounds

D

Which of the following signs would indicate that a patient is ready to begin weaning from mechanical ventilation? a. Respiratory rate of 30 breaths per minute b. Patient arouses to stimulus only c. Patient requiring 90% FIO2 to keep O2 saturation >90% d. Spontaneous tidal volumes of 4 to 5 L/kg

D

Which of these is not a risk factor for pulmonary embolism? a. obesity b. smoking c. central venous catheters d. elevated blood glucose e. oral contraceptives f. fractured long bones

D

True or false: Wheezing is a good indicator of the severity of an asthma exacerbation?

False silent chest is the most serious finding

Multiple rib fractures as a result of a traumatic injury can lead to what type of chest wall injury? What is a classic symptom/presentation of this type of injury?

Flail chest, paradoxic chest wall movement

When a patient presents with an acute, severe exacerbation of asthma, we begin by treating with a short-acting beta adrenergic inhaled/nebulized medication. What are at least 2 other medications that may be used to manage the exacerbation?

IV corticosteroids, anticholinergic bronchodilators (ipratropium), one time dose of IV magnesium sulfate

How would you verify correct placement of an endotracheal tube (ETT)? Intially? (2 ways) How do you confirm placement?

Initially, listen to breath sounds bilaterally and watch for symmetrical movement of the chest wall with ventilations. Along with that, you can use an end tidal CO2 monitor to confirm placement in the trachea. You always must confirm with a chest x-ray.

Cardiac tamponade is distinctly identified by what 3 symptoms?

Muffled heart sounds, neck vein distention/JVD, hypotension

4. Interpret the following ABG results: pH 7.49 PaCO2 30 HCO3 20 PaO2 81

Partially compensated respiratory alkalosis with adequate oxygenation.

What are the common side effects from an inhaled short acting beta-adrenergic agonist? Name 3.

Tachycardia, palpitations (dysrhythmias), tremors, excitability

How do we differentiate PE form cardiac chest pain? List 4 symptoms that might help us.

Tachypnea, cough, hemoptysis, crackles, wheezing, sudden change in mental status

Describe the process for administering a meter-dosed-inhaler.

Take off the cap and shake well Breathe out all the way Hold the inhaler the way your provider says As you start breathing in slowly through your mouth, press down on the inhaler one time Keep breathing in slowly as deep as you can Hold your breathe as you count to 10 slowly, if you can For inhaled quick relief meds (Beta 2 agonists) wait about 1 minute before 2nd puff For ICS rinse mouth after use of inhaler.

Since DVT is the most prevalent risk factor for developing a pulmonary embolism, name at least 3 things that are important for the prevention of DVT and PE in our patients.

a. Early ambulation b. Adequate hydration c. Sequential compression devices d. Prophylactic anticoagulation

In asthma treatment, when either inhaled or IV corticosteroids are used we expect what effect in the patient's airways?

a. bronchodilation b. analgesia c. anti-inflammation d. oxygen transport

A non-pharmacologic comfort measure for a patient with abdominal pain that may relieve pressure on abdomen. Name at least 2

left lateral Sims position or side-lying with knees drawn to chest, splinting for support, NG insertion for decompression of stomach contents