Question 1

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

Sputum Gram stain and culture

Accepted Answer

A sputum Gram stain and culture are done to facilitate the identification of the infectious pathogen.In 50% of cases,though,a causative agent is not identified.A diagnostic bronchoscopy may be needed,particularly if the diagnosis is unclear or current therapy is not working.In addition,a complete blood count (CBC)with differential,chemistry panel,blood cultures,and arterial blood gas analysis is obtained.

Question 2

What two pathogens are most frequently associated with ventilator-associated pneumonia?&#10;A) Staphylococcus aureus and Pseudomonas aeruginosa&#10;B) Escherichia coli and Haemophilus influenzae&#10;C) Acinetobacter baumannii and Haemophilus influenzae&#10;D) Klebsiella spp. and Enterobacter spp.

Accepted Answer

Pathogens that can cause hospital-associated pneumonia (HAP)include Escherichia coli,H.influenzae,methicillin-sensitive S.aureus,S.pneumoniae,P.aeruginosa,Acinetobacter baumannii,methicillin-resistant S.aureus (MRSA),Klebsiella spp.,and Enterobacter spp.Two of the pathogens most frequently associated with ventilator-associated pneumonia (VAP)are S.aureus and P.aeruginosa.

Question 3

Which nursing intervention should be used to optimize oxygenation and ventilation in the patient with acute lung failure?&#10;A) Provide adequate rest and recovery time between procedures.&#10;B) Position the patient with the good lung up.&#10;C) Suction the patient every hour.&#10;D) Avoid hyperventilating the patient.

Accepted Answer

Providing adequate rest and recovery time between various procedures prevents desaturation and optimizes oxygenation.In acute lung failure,the goal of positioning is to place the least affected area of the patient's lung in the most dependent position.Patients with unilateral lung disease should be positioned with the healthy lung in a dependent position.Hyperventilate the patient before suctioning; suction patients as needed.

Question 4

What is the major hemodynamic consequence of a massive pulmonary embolus?&#10;A) Increased systemic vascular resistance leading to left heart failure&#10;B) Pulmonary hypertension leading to right heart failure&#10;C) Portal vein blockage leading to ascites&#10;D) Embolism to the internal carotids leading to a stroke

Accepted Answer

The major hemodynamic consequence of a pulmonary embolus is the development of pulmonary hypertension,which is part of the effect of a mechanical obstruction when more than 50% of the vascular bed is occluded.In addition,the mediators released at the injury site and the development of hypoxia cause pulmonary vasoconstriction,which further exacerbates pulmonary hypertension.

Question 5

Patients with left-sided pneumonia may benefit from placing them in which position?&#10;A) Reverse Trendelenburg&#10;B) Supine&#10;C) On the left side&#10;D) On the right side

Accepted Answer

Patients with unilateral lung disease should be positioned with the healthy lung in a dependent position.Because gravity normally facilitates preferential ventilation and perfusion to the dependent areas of the lungs,the best gas exchange would take place in the dependent areas of the lungs.Thus,the goal of positioning is to place the least affected area of the patient's lung in the most dependent position.Patients with unilateral lung disease should be positioned with the healthy lung in a dependent position.

Question 6

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?&#10;A) 1 to 3 months&#10;B) 3 to 6 months&#10;C) 3 to 12 months&#10;D) 12 to 36 months

Accepted Answer

The patient should remain on warfarin for 3 to 12 months depending on his or her risk for thromboembolic disease.

Question 7

Which cause of hypoxemia is the result of blood passing through unventilated portions of the lungs?&#10;A) Alveolar hypoventilation&#10;B) Dead space ventilation&#10;C) Intrapulmonary shunting&#10;D) Physiologic shunting

Accepted Answer

Hypoxemia is the result of impaired gas exchange and is the hallmark of acute respiratory failure.Hypercapnia may be present,depending on the underlying cause of the problem.The main causes of hypoxemia are alveolar hypoventilation,ventilation-perfusion (V/Q)mismatching,and intrapulmonary shunting.Intrapulmonary shunting occurs when blood passes through a portion of a lung that is not ventilated.Physiologic shunting is normal and not a cause of hypoxemia.

Question 8

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

Accepted Answer

Arterial blood gas analysis reveals a low PaO₂ despite increases in supplemental oxygen administration (refractory hypoxemia).Initially,the PaCO₂ is low as a result of hyperventilation,but eventually the PaCO₂ increases as the patient fatigues.The pH is high initially but decreases as respiratory acidosis develops.

Question 9

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.

Accepted Answer

When aspiration is witnessed,emergency treatment should be instituted to secure the airway and minimize pulmonary damage.The patient's head should be turned to the side,and the oral cavity and upper airway should be suctioned immediately to remove the gastric contents.

Question 10

For which situation does a patient with acute lung failure require a bronchodilator?&#10;A) Excessive secretions&#10;B) Bronchospasms&#10;C) Thick secretions&#10;D) Fighting the ventilator

Accepted Answer

Bronchodilators aid in smooth muscle relaxation and are of particular benefit to patients with airflow limitations.Mucolytics and expectorants are no longer used because they have been found to be of no benefit in this patient population.

Question 11

Supplemental oxygen administration is usually effective in treating hypoxemia related which situation?&#10;A) Physiologic shunting&#10;B) Dead space ventilation&#10;C) Alveolar hyperventilation&#10;D) Ventilation-perfusion mismatching

Accepted Answer

The answer of Supplemental oxygen administration is usually effective in...

Question 12

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

Accepted Answer

The answer of A patient was admitted following an aspiration...

Question 13

Which diagnostic criteria is indicative of mild adult respiratory distress syndrome (ARDS)?&#10;A) Radiologic evidence of bibasilar atelectasis&#10;B) PaO&#8322;/FiO&#8322; ratio less than or equal to 200 mm Hg&#10;C) Pulmonary artery wedge pressure greater than 18 mm Hg&#10;D) Increase in static and dynamic compliance

Accepted Answer

The answer of Which diagnostic criteria is indicative of mild...

Question 14

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?&#10;A) Place the patient in respiratory isolation.&#10;B) Ensure everyone is using proper hand hygiene.&#10;C) Use personal protective equipment.&#10;D) Initiate prompt administration of antibiotics.

Accepted Answer

The answer of A patient was admitted with acute lung...

Question 15

What are the most common presenting signs and symptoms associated with a pulmonary embolism (PE)?&#10;A) Tachycardia and tachypnea&#10;B) Hemoptysis and evidence of deep vein thromboses&#10;C) Apprehension and dyspnea&#10;D) Right ventricular failure and fever

Accepted Answer

The answer of What are the most common presenting signs...

Question 16

Which finding confirms the diagnosis of a pulmonary embolism (PE)?&#10;A) Low-probability ventilation-perfusion (V/Q) scan&#10;B) Negative pulmonary angiogram&#10;C) High-probability V/Q scan&#10;D) Absence of vascular markings on the chest radiograph

Accepted Answer

The answer of Which finding confirms the diagnosis of a...

Question 17

What condition develops when air enters the pleural space from the lung on inhalation and cannot exit on exhalation?&#10;A) Tension pneumothorax&#10;B) Sucking chest wound&#10;C) Open pneumothorax&#10;D) Pulmonary interstitial empyema

Accepted Answer

The answer of What condition develops when air enters the...

Question 18

What nursing intervention can facilitate the prevention of aspiration?&#10;A) Observing the amount given in the tube feeding&#10;B) Assessing the patient's level of consciousness&#10;C) Encouraging the patient to cough and to breathe deeply&#10;D) Positioning a patient in a semirecumbent position

Accepted Answer

The answer of What nursing intervention can facilitate the prevention...

Question 19

Which therapeutic measure would be the most effective in treating hypoxemia in the presence of intrapulmonary shunting associated with acute respiratory distress syndrome (ARDS)?&#10;A) Sedating the patient to blunt noxious stimuli&#10;B) Increasing the FiO&#8322; on the ventilator&#10;C) Administering positive-end expiratory pressure (PEEP)&#10;D) Restricting fluids to 500 mL per shift

Accepted Answer

The answer of Which therapeutic measure would be the most...

Question 20

What is the medical treatment for a pneumothorax greater than 15%?&#10;A) Systemic antibiotics to treat the inflammatory response&#10;B) An occlusive dressing to equalize lung pressures&#10;C) Interventions to evacuate the air from the pleural space&#10;D) Mechanical ventilation to assist with re-expansion of the collapsed lung

Accepted Answer

The answer of What is the medical treatment for a...

Question 21

Nursing management of the patient with acute lung failure includes which interventions?&#10;A) Positioning the patient with the least affected side up&#10;B) Providing adequate rest between treatments&#10;C) Performing percussion and postural drainage every 4 hours&#10;D) Controlling fever&#10;E) Pharmaceutical medications to control anxiety

Accepted Answer

The answer of Nursing management of the patient with acute...

Question 22

Medical management of a patient with status asthmaticus includes which treatments?&#10;A) Oxygen therapy&#10;B) Bronchodilators&#10;C) Corticosteroids&#10;D) Antibiotics&#10;E) Intubation and mechanical ventilation

Accepted Answer

The answer of Medical management of a patient with status...

Question 23

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

Accepted Answer

The answer of A trauma victim has sustained right rib...

Question 24

What psychologic factors contribute to long-term mechanical ventilation dependence?&#10;A) Fear&#10;B) Delirium&#10;C) Lack of confidence&#10;D) Depression&#10;E) Trust in the stuff

Accepted Answer

The answer of What psychologic factors contribute to long-term mechanical...

Deck 19: Pulmonary Disorders