Lifespan 3 EXAM 2 PRACTICE QUESTIONS

Which oxygen administration device can deliver oxygen concentrations of 90%? a. Nonrebreathing mask b. Nasal cannula c. Partial rebreathing mask d. Simple mask

a. Nonrebreathing mask

Which route for endotracheal (ET) tube placement is usually used in an emergency intubation? a. Orotracheal b. Nasotracheal c. Nasopharyngeal d. Trachea

a. Orotracheal

Medical management of a patient with status asthmaticus includes 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

*After intubating a patient utilizing an endotracheal tube the breath sounds are checked and your find the patient with no breath sounds on either lung upon ventilation. What has occurred?

Gastric (esophageal) intubation

What ventilator setting can be utilized in a patient with acute respiratory distress syndrome who has developed intrapulmonary shunting?

Administering positive- end expiratory pressure (PEEP)

Which type of oxygen therapy system is not affected by a patient's breathing pattern? A.Low-flow system B.Medium-flow system C.Reservoir system D.High-flow system

D. high-flow system

What is the name of the bedside test to check for correct tube placement?

End-tidal CO2 monitor

what is an example of an oxygen reservoir device?

a simple-mask

Which statement describes the assist-control mode of ventilation? 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.

Which statement is correct concerning endotracheal tube 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 to 30 mm Hg to ensure an adequate seal. 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.

What is the therapeutic blood level for theophylline (Xanthines)? a. 5 to 10 mg/dL b. 10 to 20 mg/dL c. 20 to 30 mg/dL d. 35 to 45 mg/dL

b. 10 to 20 mg/dL

A trauma victim has sustained right rib fractures and pulmonary contusions. Auscultation reveals decreased breath sounds on the right side. Bulging intercostal muscles are noted on the right side. Heart rate (HR) is 130 beats/min, respiratory rate (RR) is 32 breaths/min, and breathing is labored. In addition to oxygen administration, what procedure should the nurse anticipate? a. Thoracentesis b. Chest tube insertion c. Pericardiocentesis d. Emergent intubation

b. Chest tube insertion

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. d. Initiate prompt administration of antibiotics.

b. Ensure everyone is using proper hand hygiene.

Patient safety precautions when working with oxygen include which action? a. Observing for signs of oxygen-associated hyperventilation b. Ensuring the oxygen device is properly positioned c. Removal of all oxygen devices when eating d. Administration of oxygen at the nurse's discretion

b. Ensuring the oxygen device is properly positioned

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? a. Pulmonary edema b. Hemorrhage c. Acute lung failure d. Bronchopleural fistula

b. Hemorrhage

Which medication can cause bronchospasms and should be administered with a bronchodilator? a. Beta-2 agonist b. Mucloytics c. Anticholinergic agents d. Xanthines

b. Mucloytics

What is the medical treatment for a pneumothorax GREATER than 15%? a. Systemic antibiotics to treat the inflammatory response b. An occlusive dressing to equalize lung pressures c. Interventions to evacuate the air from the pleural space d. Mechanical ventilation to assist with re-expansion of the collapsed lung

c. Interventions to evacuate the air from the pleural space

Which airway would be the most appropriate for a patient requiring intubation longer than 21 days? a. Oropharyngeal airway b. Esophageal obturator airway c. Tracheostomy tube d. Endotracheal intubation

c. Tracheostomy tube

Which cause of hypoxemia is the result of blood passing through unventilated portions of the lungs? a. Alveolar hypoventilation b. Dead space ventilation c. Intrapulmonary shunting d. Physiologic shunting

c. Intrapulmonary shunting

Depending on the patient's risk for the recurrence of pulmonary embolism (PE), how long may a patient remain on warfarin once they are discharged from the hospital? a. 1 to 3 months b. 3 to 6 months c. 3 to 12 months d. 12 to 36 months

c. 3 to 12 months

*Which nursing intervention should be used to optimize oxygenation and ventilation in the patient with acute lung failure?

- Provide adequate rest and recovery time between procedures. - Position the patient with the good lung DOWN - Hyperventilate the patient prior to suctioning

Nursing management of the patient with acute lung failure involving both lungs includes which interventions? (select all that apply) - Provide adequate rest between treatments -Pharmaceutical medications to control anxiety - Control fever - Place patient on the right side - place patient on the left side

- Provide adequate rest between treatments -Pharmaceutical medications to control anxiety - Control fever - Place patient on the right side

Patients on a ventilator are at risk for developing ventilator associated pneumonia (VAP). What interventions can be completed for the patients at risk for developing VAP? - Provide mouthcare utilizing chlorhexidine brush 4 times a day - Provide deep vein prophylaxis - Sedation vacation - semi fowler's position (35-45%) - place in supine position

- Provide mouthcare utilizing chlorhexidine brush 4 times a day - Provide deep vein prophylaxis - Sedation vacation - semi fowler's position (35-45%) DO NOT place in supine position

Which statements are true regarding Warfarin therapy following a pulmonary embolism?

- Vitamin K is the reversal agent - Patients INR should be between 2.0-3.0

Which assessment finding is considered an early sign of adult respiratory distress?

- apprehension - moderate accessory muscle use - restlessness

the nurse is caring for a patient requiring positive pressure ventilation. the nurse assesses for which cardiac complication(s) from mechanical ventilation?

- decreased cardiac output - decreased preload

What are the complications of prone therapy?

- hemodynamic instability - displacement of tubes and lines.

a patient on mechanical ventilation is being screened for readiness to wean. The screening includes what? - patient's level of conciousness - hemodynamic stability - adequacy of oxygentation and ventilation. - desire to breathe

- patient's level of conciousness - hemodynamic stability - adequacy of oxygentation and ventilation.

The Passy-Muir valve is contraindicated in which patient? a. A patient who is trying to relearn normal breathing patterns b. A patient who has minimal secretions c. A patient with laryngeal or pharyngeal dysfunction d. A patient who wants to speak while on the ventilator

c. A patient with laryngeal or pharyngeal dysfunction

Which oxygen therapy device should be used in a patient requiring the delivery of a precise low FiO2? a. Simple mask b. Nasal cannula c. Air-entrainment mask (venturi) d. Partial rebreathing mask

c. Air-entrainment mask (venturi)

What is the medical treatment for a pneumothorax LESS than 15%?

no treatment other than supplemental oxygen and monitoring.

patients with right-sided pneumonia may benefit from placing them in which position?

on the left side

What is the name of the intervention of blowing up a balloon and then letting all of the air out of the balloon to help keep the alveoli open, decreasing the risk for atelectasis?

positive end-expiratory pressure (PEEP)

if a patient is placed on bilevel positive airway pressure to improve oxygenation, what must the nurse ensure occurs?

that the patients mask fits properly.

which route for endotracheal tube placement is usually used in a patient with jaw fracture?

nasotracheal

What condition develops when air enters the pleural space from the lung on inhalation and cannot exit on exhalation? a. Tension pneumothorax b. Sucking chest wound c. Open pneumothorax d. Pulmonary interstitial empyema

a. Tension pneumothorax

Barotrauma resulting in pneumocardium can occur in patients with acute respiratory distress syndrome. What is a complication from this event?

Cardiac Tamponade

The nurse is monitoring a patient receiving oxygen therapy. On auscultation the nurse notes that the patient developed new onset crackles and decreased breath sounds. Which complication of oxygen therapy does the nurse recognize?

Pneumothorax

Use of oxygen therapy in the patient who is hypercapnic may result in which situation? a. Oxygen toxicity b. Absorption atelectasis c. Carbon dioxide retention d. Pneumothorax

c. Carbon dioxide retention

the nurse is reviewing lab results for a patient on warfarin with a pulmonary embolism (PE). What is the international normalized ration (INR) therapeutic range?

2.5-3.0

Which of the following are complications of endotracheal tubes? (Select all that apply.) a. Tracheoesophageal fistula b. Cricoid abscess c. Tracheal stenosis d. Tube obstruction e. Hemorrhage

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

A patient was admitted with 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? a. FiO2 greater than 50% b. Rapid shallow breathing index less than 105 c. Minute ventilation greater than 10 L/min d. Vital capacity/kg greater than or equal to 15 mL

b. Rapid shallow breathing index less than 105

supplemental oxygen administration is effective in treating hypoxemia in a patient with intrapulmonary shunting. A. True B. False

B. False

The nurse is reviewing the arterial blood gas results for a patient. The latest ABGs show pH 7.48, HCO3 23 mEq/ L, Paco2 28 mm Hg, and Pao2 98 mm Hg. What is the correct interpretation of these lab findings?

Respiratory Alkalosis

What are the most common presenting signs and symptoms associated with a pulmonary embolism (PE)? 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

What psychologic factors contribute to long-term mechanical ventilation dependence? (Select all that apply.) a. Fear b. Delirium c. Lack of confidence d. Depression e. Trust in the staff

a. Fear b. Delirium c. Lack of confidence d. Depression

Which interventions minimize the complications associated with suctioning an artificial airway? (Select all that apply.) a. Hyperoxygenate the patient prior to the start of the procedure b. Hyperoxygenate the patient 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. Hyperoxygenate the patient prior to the start of the procedure b. Hyperoxygenate the patient after each pass of the suction catheter

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 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

Which oxygen delivery device is considered a low-flow system? a. Nasal cannula b. Simple face mask c. Reservoir cannula d. Air-entrainment nebulizer

a. Nasal cannula

Nursing management of the patient with acute lung failure includes 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

a. Positioning the patient with the least affected side up b. Providing adequate rest between treatments d. Controlling fever e. Pharmaceutical medications to control anxiety

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

a. Provide adequate rest and recovery time between procedures.

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

a. Right mainstem intubation

What two pathogens are most frequently associated with ventilator-associated pneumonia? 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

What are the clinical manifestations associated with oxygen toxicity? (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 CO2 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 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? a. Troubleshoot the ventilator until the problem is found. b. Take the patient off the ventilator and manually ventilate. 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.

A patient with 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. A leak in the patient's endotracheal (ET) tube cuff b. A kink in the ventilator tubing c. The patient is disconnected from the ventilator d. A faulty oxygen filter

b. A kink in the ventilator tubing

Which statements regarding rotation therapies are accurate? (Select all that apply.) a. Continuous lateral rotation therapy (CLRT) can be effective for improving oxygenation if used for at least 18 hours/day. b. Kinetic therapy can decrease the incidence of ventilator-acquired pneumonia in neurologic and postoperative patients. c. Use of rotational therapy eliminates the need for other pressure ulcer prevention strategies. d. CLRT helps avoid hemodynamic instability secondary to the continuous, gentle turning of the patient. e. CLRT has minimal pulmonary benefits for critically ill patients.

b. Kinetic therapy can decrease the incidence of ventilator-acquired pneumonia in neurologic and postoperative patients. e. CLRT has minimal pulmonary benefits for critically ill patients.

Which diagnostic criteria is indicative of mild adult respiratory distress syndrome (ARDS)? a. Radiologic evidence of bibasilar atelectasis b. PaO2/FiO2 ratio less than or equal to 200 mm Hg c. Pulmonary artery wedge pressure greater than 18 mm Hg d. Increase in static and dynamic compliance

b. PaO2/FiO2 ratio less than or equal to 200 mm Hg

What nursing interventions should be included in the nursing management of the patient receiving a neuromuscular blocking agent? a. Withholding all sedation and narcotics b. Protecting the patient from the environment c. Keeping the patient supine d. Speaking to the patient only when necessary

b. Protecting the patient from the environment

What is the major hemodynamic consequence of a massive pulmonary embolus? 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

Which ventilator phase variable initiates the change from exhalation to inspiration? a. Cycle b. Trigger c. Flow d. Pressure

b. Trigger

Which finding confirms the diagnosis of a pulmonary embolism (PE)? a. Low-probability ventilation-perfusion (V/Q) scan b. Negative pulmonary angiogram c. High-probability ventilation perfusion (V/Q) scan d. Absence of vascular markings on the chest radiograph

c. High-probability V/Q scan

What nursing intervention can minimize the complications of suctioning? (select all that apply) a. Inserting the suction catheter no more than 5 inches b. Premedicating the patient with atropine c. Hyperoxygenating the patient with 100% oxygen d. Increasing the suction to 150 mm Hg e. utilizing in-line suction to decrease chance of contamination.

c. Hyperoxygenating the patient with 100% oxygen e. utilizing in-line suction to decrease chance of contamination

A patient was admitted in acute lung failure. The patient is receiving 40% oxygen via a simple facemask. 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

What is an indication for a pneumonectomy? a. Peripheral granulomas b. Bronchiectasis c. Unilateral tuberculosis d. Single lung abscess

c. Unilateral tuberculosis

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. bronchospams

Which therapeutic measure would be the most effective in treating hypoxemia in the presence of intrapulmonary shunting associated with acute respiratory distress syndrome (ARDS)? 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 was admitted to the critical care unit with acute respiratory 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 not tolerating weaning? (select all that apply) 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. use of accessory muscles

c. An increase in respiratory rate from 22 to 38 breaths/min d. use of accessory muscles

A patient was admitted after a left pneumonectomy. The patient is receiving 40% oxygen via a simple facemask. The morning chest radiography study 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.

The patient was placed on positive pressure ventilation 3 days ago through an ETT. What nursing action minimizes the complication of ventilator associated pneumonia?

clean mouth with chlorohexidine

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

Patients with left-sided pneumonia may benefit from placing them in which position? a. Reverse Trendelenburg b. Supine c. On the left side d. On the right side

d. On the right side

What nursing intervention can facilitate the prevention of aspiration? 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 a patient in a semirecumbent position

d. Positioning a patient in a semirecumbent position

Which statement best describes the effects of positive-pressure ventilation on cardiac output? a. Positive-pressure ventilation increases intrathoracic pressure, which increases venous return and cardiac output. b. Positive-pressure ventilation decreases venous return, which increases preload and cardiac output. c. Positive-pressure ventilation increases venous return, which decreases preload and cardiac output. d. Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return and cardiac output.

d. Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return and cardiac output.

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

Which arterial blood gas (ABG) values would indicate a need for oxygen therapy? a. PaO2 of 80 mm Hg b. PaCO2 of 35 mm Hg c. HCO of 24 mEq d. SaO2 of 87%

d. SaO2 of 87%

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 (v/q mismatch)

d. Ventilation-perfusion mismatching

A patient is admitted with acute respiratory distress syndrome requiring intubation. When assessing breath sounds after intubation, the nurse notes breath sounds are absent. What problem should the nurse suspect?

left pneumothorax

WHy would a bronchodilator be used in a patient with acute lung failure?

for bronchospasms