exam 3

A patient w/acute lung failure has been on a ventilator for 3 days and is being considered for weaning. The ventilator high-pressure limit alarm keeps alarming. What would cause this problem?

A kink in the ventilator tubing.

The Passy-Muir valve is contraindicated in which patient?

A patient w/laryngeal or pharyngeal dysfunction.

A patient presents w/chest trauma from a motor vehicle accident. Upon assessment, the nurse documents that the patient is complaining of dyspnea, SOB, tachypnea, and tracheal deviation to the right. In addition, the patient's tongue is blue-gray. Based on this assessment data, what additional assessment findings would the nurse expect to find?

Absent breath sounds in the left lung fields.

Which therapeutic measure would be the most effective in treating hypoxemia in the presence of intrapulmonary shunting associated w/ARDS?

Administering positive-end expiratory pressure (PEEP)

Atelectasis can cause a shunt-producing ventilation-perfusion mismatch. What pathophysiologic mechanism explains how this occures?

An alveolus that is receiving perfusion exceeding ventilation.

A patient was admitted to the critical care unit w/acute respiratory failure. The patient has been on a ventilator for 3 days and is being considered for weaning. Which criteria would indicate the patient is not tolerating weaning?

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

A patient's pulse oximeter alarm goes off. The monitor reads 82%. What is the first action the nurse should perform?

Assess the patient's condition

A patient in DKA would exhibit what alteration to the pulmonary system?

Breathe faster to decrease pH

On admission, a patient presents w/respiratory rate of 24 breaths/min, pursed-lip breathing, heart rate of 96 beats/min in sinus tachycardia, and a blood pressure of 110/68 mm Hg. The patient's ABG values on room are are PaO2, 70 mm Hg; pH, 7.38; PaCO2, 52 mm Hg; and 34 mEq/L. What diagnosis would be most consistent w/the above ABG values?

Chronic obstructive pulmonary disease (COPD)

A patient is admitted w/acute lung failure secondary to pneumonia. ABG values on the current ventilator settings are pH, 7.37; PaCO2, 50 mm Hg, and HCO3, 27 mEq/L. What is the correct interpretation of the patient's ABG values?

Compensated respiratory acidosis?????

A patient has been admitted w/diagnosis of 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 conditions?

Decreased pH and elevated PaCO2

A patient is intubated, and sputum for culture and sensitivity is ordered. Which of the following is important for obtaining the best specimen?

Do not apply suction while catheter is being withdrawn b/c this can contaminate the sample w/sputum left in the endotracheal tube.

In a patient who is hemodynamically stable, which procedure can be used to estimate the PaCO2 levels?

End-tidal CO2

A patient w/COPD requires intubation. After the practitioner intubates the patient, the nurse auscultates for breath sounds. Breath sounds are questionable in this patient. Which action would best assist in determining endotracheal tube placement in this patient?

End-tidal CO2 monitor

Which blood gas parameter is the acid-base component that reflects kidney function?

HCO3?????

Determination of oxygenation status by oxygen saturation alone is inadequate. What other value must be known?

Hemoglobin (Hgb)

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 physician and suspects that the patient has developed what complication?

Hemorrhage

Which finding confirms the diagnosis of pulmonary embolism (PE)?

High-probability V/Q scan

Which nursing intervention can minimize the complications of suctioning?

Hyperoxygenating the patient w/100% oxygen

A bronchoscopy is indicated for a patient w/what condition?

Ineffective clearance of secretions

On admission, a patient presents w/a respiratory rate of 28 breaths/min, heart rate of 108 beats/min in sinus tachycardia, and a blood pressure of 140/72 mm Hg. The patient's ABG values on room air are PaO2, 60 mm Hg; pH, 7.32; PaCO2, 45 mm Hg; and 25 mEq/L. What action should the nurse anticipate for this patient?

Initiate oxygen therapy.

A patient was admitted following an aspiration event on the medical-surgical floor. The patient is receiving 40% oxygen via a simple facemask. The patient has become increasingly agitated and confused. The patient's oxygen saturation had dropped from 92% to 84%. The nurse notifies the practitioner about the change in the patient's condition. What interventions should the nurse anticipate?

Intubation and mechanical ventilation

Which statement describes the assist-control mode of ventilation?

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

Which route for endotracheal (ET) tube placement is usually used in an emergency intubation?

Orotracheal

Medical management of a patient w/status asthmaticus includes which treatments?

Oxygen therapy Bronchodilators Corticosteroids Intubation and mechanical ventilation

A patient is admitted w/acute lung failure secondary to COPD. Upon inspection of the patient, the nurse observes that the patient's fingers appear discolored. What does this finding indicate the presence of?

Peripheral cyanosis

Which statement best describes the effects of positive-pressure ventilation on CO?

Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return and CO.

What is the preset positive pressure used to augment the patient's inspiratory effort known as?

Pressure support ventilation (PSV)

A patient was admitted w/acute lung failure. The patient has been on a ventilator for 3 days and is being considered for weaning. Which criteria would indicate that the patient is ready to be weaned?

Rapid shallow breathing index less than 105

When assessing an intubated patient, the nurse notes normal breath sounds on the right side of the chest and absent sound on the left side of the chest. What problem should the nurse suspect?

Right main stem intubation

Which arterial blood gas (ABG) values would indicate a need for oxygen therapy?

SaO2 of 87%

Which statement describes the major difference between tachypnea and hyperventilation?

Tachypnea has decreased depth; hyperventilation has increased depth.

A patient with acute lung failure has been on a ventilator for 3 days and is being considered for weaning. When entering the room, the ventilator inoperative alarm sounds. What action should the nurse take FIRST?

Take the patient off the ventilator and manually resuscitate.

A patient is admitted w/diminished to absent breath sounds on the right side, tracheal deviation to the left side, and asymmetric chest movement. These findings are indicative of which disorder?

Tension pneumothorax

What condition develops when air enters the pleural space from the lung on inhalation and cannot exit on exhalation?

Tension pneumothorax

A patient presents moderately short of breath and dyspneic. A chest radiographic examination reveals a large right pleural effusion w/significant atelectasis. The practitioner would be most likely to prescribe which procedure?

Thoracentesis

What anatomic regions are considered physiologic dead space?

Trachea and unperfused alveoli

Which of the following are complications of endotracheal tubes?

Tracheoesophageal fistula Cricoid abscess Tracheal stenosis Tube obstruction

Which airway would be the most appropriate for a patient requiring intubation longer than 21 days?

Tracheostomy tube

A patient presents w/the following ABG values; pH, 7.20; PaO2, 106 mm Hg; PaCO2, 35 mm Hg; and 11 mEq/L. What is the interpretation of this patient's ABG?

Uncompensated metabolic acidosis

The patient's ABG values on room air are PaO2, 40 mm Hg; pH, 7.10; PaCO2, 44 mm Hg; and 16 mEq/L. What is the interpretation of the patient's ABG?

Uncompensated metabolic acidosis

The patient's arterial blood gas (ABG) values on room air are PaO2, 70 mm Hg; pH, 7.31; PaCO2, 52 mm Hg; and 24 mEq/L. What is the interpretation of this patient's ABG?

Uncompensated respiratory acidosis

A patient is admitted with s/s of a PE. What diagnostic test is most conclusive to determine this diagnosis?

V/Q scan?????