Deck 19: Pulmonary Diagnostic Procedures

Question 1

On admission,a patient presents as follows: pH,7.38; respiratory rate,24 breaths/min,regular,pursed-lip breathing; PaO?,66 mm Hg; heart rate,112 beats/min,sinus tachycardia; PaCO?,52 mm Hg; blood pressure,110/68 mm Hg; HCO?-,24 mEq/L; and SpO?,90% on O? 2 L/min nasal cannula.Which of the following diagnoses would be most consistent with the above arterial blood gas values?

A) Acute pulmonary embolism
B) Acute myocardial infarction
C) Congestive heart failure
D) Chronic obstructive pulmonary disease

Answer 1

Chronic obstructive pulmonary disease

Question 2

Which of the following ABG values represents uncompensated metabolic acidosis?

A) pH, 7.29; PaCO?, 57 mm Hg; HCO?-, 22 mEq/L
B) pH, 7.36; PaCO?, 33 mm Hg; HCO?-, 18 mEq/L
C) pH, 7.22; PaCO?, 42 mm Hg; HCO?-, 18 mEq/L
D) pH, 7.52; PaCO?, 38 mm Hg; HCO?-, 29 mEq/L

Answer 2

pH, 7.22; PaCO?, 42 mm Hg; HCO?-, 18 mEq/L

Question 3

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

A) Prepare to intubate.
B) Assess the patient's condition.
C) Turn off the alarm and reapply the oximeter sensor.
D) Increase O? level to 4L/NC.

Answer 3

Assess the patient's condition.

Question 4

A patient presents with absent lung sounds in the left lower lung fields,moderate shortness of breath,and dyspnea.The nurse suspects pneumothorax and notifies the physician or nurse practitioner.Orders for a STAT chest radiography and reading are obtained.Which of the following findings best supports the nurse's suspicions?

A) Blackness in the left lower lung area
B) Whiteness in the left lower lung area
C) Blunted costophrenic angles
D) Elevated left hemidiaphragm

Question 5

Which of the following patients would be considered hypoxemic?

A) A 70-year-old man with a PaO? of 72
B) A 50-year-old woman with a PaO? of 65
C) An 84-year-old man with a PaO? of 96
D) A 68-year-old woman with a PaO? of 80

Question 6

For which of the following conditions is a bronchoscopy indicated?

A) Pulmonary edema
B) Ineffective clearance of secretions
C) Upper gastrointestinal bleed
D) Instillation of surfactant

Question 7

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

A) pH
B) PaO?
C) PaCO?
D) HCO?-

Question 8

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

A) pH
B) PaCO?
C) HCO?-
D) Hemoglobin (Hgb)

Question 9

A 75-kg,5 foot,8 inch patient is on a ventilator.The physician or nurse practitioner states the patient may be ready for extubation.Orders for a negative inspiratory pressure (NIP)and force ventilatory capacity (FVC)tests are written.Which of the following results best suggests that the patient is ready for extubation?

A) NIP, -10; FVC, 4600
B) NIP, -18; FVC, 4700
C) NIP, -22; FVC, 4400
D) NIP, -24; FVC, 4800

Question 10

A patient with chronic obstructive pulmonary disease requires intubation.After the physician 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?

A) Stat chest radiographic examination
B) End-tidal CO? monitor
C) V/Q scan
D) Pulmonary artery catheter insertion

Question 11

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

A) After the specimen is in the container, dilute thick secretions with sterile water.
B) Apply suction when the catheter is advanced to obtain secretions from within the endotracheal tube.
C) Do not apply suction while the catheter is being withdrawn because this can contaminate the sample with sputum left in the endotracheal tube.
D) Do not clear the endotracheal tube of all local secretions before obtaining the specimen.

Question 12

On admission,a patient presents as follows: pH,7.38; respiratory rate,24 breaths/min,regular,pursed-lip breathing; PaO?,66 mm Hg; heart rate,112 beats/min,sinus tachycardia; PaCO?,52 mm Hg; blood pressure,110/68 mm Hg; HCO?-,24 mEq/L; and SpO?,90% on O? 2 L/min nasal cannula.These gases show

A) uncompensated metabolic alkalosis.
B) uncompensated respiratory acidosis.
C) compensated metabolic acidosis.
D) compensated respiratory alkalosis.

Question 13

Which of the following ABG values reflects compensation?

A) pH, 7.26; PaCO?, 55 mm Hg; HCO?-, 24 mEq/L
B) pH, 7.30; PaCO?, 32 mm Hg; HCO?-, 18 mEq/L
C) pH, 7.48; PaCO?, 30 mm Hg; HCO?-, 22 mEq/L
D) pH, 7.38; PaCO?, 58 mm Hg; HCO?-, 30 mEq/L

Question 14

On admission,a patient presents as follows: pH,7.38; respiratory rate,24 breaths/min,regular,pursed-lip breathing; PaO?,66 mm Hg; heart rate,112 beats/min,sinus tachycardia; PaCO?,52 mm Hg; blood pressure,110/68 mm Hg; HCO?-,24 mEq/L; and SpO?,90% on O? 2 L/min nasal cannula.What treatment would the physician or nurse practitioner likely order for this patient?

A) Increase O? to 6 L/min.
B) Prepare for emergency intubation.
C) Administer 1 ampule of sodium bicarbonate.
D) Repeat ABG testing in 4 hours.

Question 15

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

A) PaO?/FIO? ratio
B) A-a gradient
C) Residual volume (RV)
D) End-tidal CO?

Question 16

V/Q scans are ordered to evaluate the possibility of which of the following?

A) Pulmonary emboli
B) Acute myocardial infarction
C) Emphysema
D) Acute respiratory distress syndrome

Question 17

A patient presents moderately short of breath and dyspneic.A chest radiographic examination reveals a large right pleural effusion with significant atelectasis.The physician or nurse practitioner would be most likely to order which of the following procedures?

A) Thoracentesis
B) Bronchoscopy
C) Ventilation/perfusion (V/Q) scan
D) Repeat chest radiograph

Question 18

Which of the following signs or symptoms would be most consistent with the following values? pH,7.20; pO?,106 mm Hg; pCO?,35 mm Hg; HCO?-,11 mEq/L.

A) Diarrhea
B) Shortness of breath
C) Central cyanosis
D) Peripheral cyanosis

Question 19

A patient presents with the following values: pH,7.20; pO?,106 mm Hg; pCO?,35 mm Hg; and HCO?-,11 mEq/L.These values are most consistent with

A) uncompensated respiratory acidosis.
B) uncompensated metabolic acidosis.
C) uncompensated metabolic alkalosis.
D) uncompensated respiratory alkalosis.

Question 20

A patient's assessment data present as follows: pH,7.10; PaCO?,60 mm Hg; PaO?,40 mm Hg; HCO?-,24 mEq/L; RR,34 breaths/min; HR,128 beats/min; and BP,180/92 mm Hg.This condition is best described as

A) uncompensated respiratory acidosis.
B) uncompensated metabolic acidosis.
C) compensated metabolic acidosis.
D) compensated respiratory acidosis.

Question 21

A patient is admitted with acute respiratory failure attributable to pneumonia.Smoking history reveals that the patient smoked two packs of cigarettes a day for 25 years,stopping 10 years ago.ABG values on the current ventilator settings are pH,7.37; PaCO?,50 mm Hg; and HCO?-,27 mEq/L.Chest radiography reveals a large right pleural effusion.Which of the following is the correct interpretation of the patient's ABG values?

A) Compensated respiratory acidosis
B) Compensated metabolic alkalosis
C) Uncompensated respiratory alkalosis
D) Uncompensated metabolic acidosis

Question 22

Severe coughing and shortness of breath during a thoracentesis are indicative of which of the following complications?

A) Re-expansion pulmonary edema
B) Pleural infection
C) Pneumothorax
D) Hemothorax

Question 23

Which of the following chest radiography findings is consistent with a left pneumothorax?

A) Flattening of the diaphragm
B) Shifting of the mediastinum to the right
C) Presence of a gastric air bubble
D) Increased radiolucency of the left lung field

Question 24

A static lung compliance of 40 mL/cm H?O is indicative of which of the following disorders?

A) Pneumonia
B) Bronchospasm
C) Pulmonary emboli
D) Upper airway obstruction

Question 25

Risk factors that need to be considered with thoracentesis include

A) coagulation defects.
B) intra-aortic balloon pump.
C) pleural effusion.
D) uncooperative patient.
E) empyema.

Question 26

Preprocedural medications for a diagnostic bronchoscopy may include

A) aspirin for anticoagulation.
B) vecuronium to inhibit breathing.
C) codeine to decrease the cough reflex.
D) cimetidine to decrease hydrochloric acid secretion.

Question 27

Place the steps for analyzing arterial blood gases in the proper order.
1)Assess HCO?- level for metabolic abnormalities.
2)Assess PaO? for hypoxemia.
3)Examine PaCO? for acidosis or alkalosis.
4)Re-examine pH to determine level of compensation.
5)Examine pH for acidemia or alkalemia.

A) 5, 1, 2, 4, 3
B) 2, 5, 3, 1, 4
C) 1, 2, 4, 3, 5
D) 1, 3, 4, 5, 2

Question 28

A patient is admitted with acute respiratory failure attributable to pneumonia.Smoking history reveals that the patient smoked two packs of cigarettes a day for 25 years,stopping 10 years ago.ABG values on the current ventilator settings are pH,7.37; PaCO?,50 mm Hg; and HCO?-,27 mEq/L.Chest radiograph reveals a large right pleural effusion.Intrapulmonary shunting value of 35% indicates

A) normal gas exchange of venous blood.
B) an abnormal finding indicative of a shunt-producing disorder.
C) a serious and potentially life-threatening condition.
D) metabolic alkalosis.

Question 29

Nursing management of a patient undergoing a diagnostic procedure involves

A) positioning the patient for the procedure.
B) monitoring the patient's responses to the procedure.
C) monitoring vital signs.
D) teaching the patient about the procedure.
E) medicating the patient before and after procedure.

Question 30

A patient is admitted with signs and symptoms of a pulmonary embolus (PE).The diagnostic test most conclusive to determine this diagnosis is a(n)

A) ABG.
B) bronchoscopy.
C) pulmonary function test.
D) V/Q scan.