Question 1

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?

Accepted Answer

Although a stat chest radiography examination would be helpful, it has a long turnaround time, and the patient's respiratory status can deteriorate quickly.An end-tidal CO₂ monitor gives an immediate response, and the tube can then be reinserted without delay if incorrectly placed.The other tests are not for endotracheal tube placement.

Question 2

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

Accepted Answer

This test is ordered for the evaluation of pulmonary emboli.Electrocardiography or cardiac enzymes are ordered to evaluate for myocardial infarction; arterial blood gas analysis, chest radiography, and pulmonary function tests are ordered to evaluate for emphysema.Chest radiography and hemodynamic monitoring are ordered for evaluation of acute respiratory distress syndrome.

Question 3

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

Accepted Answer

Re-expansion pulmonary edema can occur when a large amount of effusion fluid (~1000-1500 mL)is removed from the pleural space.Removal of the fluid increases the negative intrapleural pressure, which can lead to edema when the lung does not re-expand to fill the space.The patient experiences severe coughing and shortness of breath.The onset of these symptoms is an indication to discontinue the thoracentesis.

Question 4

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

Accepted Answer

Proper evaluation of the oxygen saturation level is vital.For example, an Sao₂ of 97% means that 97% of the available hemoglobin is bound with oxygen.The word available is essential to evaluating the Sao₂ level because the hemoglobin level is not always within normal limits and oxygen can bind only with what is available.

Question 5

On admission, a patient presents as follows: pH, 7.38; respiratory rate, 24 breaths/min, regular, pursed-lip breathing; PaO₂, 66 mm Hg; heart rate, 112 beats/min, sinus tachycardia; PaCO₂, 52 mm Hg; blood pressure, 110/68 mm Hg; HCO₃^-, 24 mEq/L; and SpO₂, 90% on O₂ 2 L/min nasal cannula.Which of the following diagnoses would be most consistent with the above arterial blood gas values?

Accepted Answer

The fact that the HCO₃^- level has increased enough to compensate for the increased pCO₂ level indicates that this is not an acute condition because the kidneys can take several days to adjust.The other choices would present with a lower HCO₃^-level.The values indicate respiratory acidosis, and one of the potential causes is chronic obstructive pulmonary disease.Potential causes for respiratory alkalosis are pulmonary embolism, acute myocardial infarction, and congestive heart failure.

Question 6

Which of the following conditions will commonly reveal breath sounds with inspiration greater than expiration on assessment?
1)Normal lung
2)Bronchiectasis
3)Emphysema
4)Acute bronchitis
5)Diffuse pulmonary fibrosis
6)Consolidating pneumonia

Accepted Answer

The answer of Which of the following conditions will commonly...

Question 7

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

Accepted Answer

Shifting of the mediastinal structures away from the area of involvement is a sign of a pneumothorax.

Question 8

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

Accepted Answer

The first nursing action would be to assess the patient to see if there is a change in his or her condition.If the patient is stable, then the nurse would turn off the alarm and reapply the oximeter sensor.The pulse oximeter cannot differentiate between normal and abnormal hemoglobin.Elevated levels of abnormal hemoglobin falsely elevate the Spo?.The ability of a pulse oximeter to detect hypoventilation is accurate only when the patient is breathing room air.Because most critically ill patients require some form of oxygen therapy, pulse oximetry is not a reliable method of detecting hypercapnia and should not be used for this purpose.

Question 9

A patient's assessment data present as follows: pH, 7.10; PaCO₂, 60 mm Hg; PaO₂, 40 mm Hg; HCO₃, 24 mEq/L; RR, 34 breaths/min; HR, 128 beats/min; and BP, 180/92 mm Hg.This condition is best described as

Accepted Answer

The pH is below normal range (7.35-7.45), so this is uncompensated acidosis.The PaCO₂ is markedly elevated, and the HCO₃ is normal.This indicates uncompensated respiratory acidosis.Uncompensated respiratory acidosis values include a pH below 7.35, PACO₂ above 45 mm Hg, and HCO₃ of 22 to 26 mEq/L.Uncompensated metabolic acidosis values include a pH below 7.35, PACO₂ of 35 to 45 mm Hg, and HCO₃ above 22 mEq/L.Compensated metabolic acidosis values include a pH of 7.35 to 7.39, PACO₂ below 35 mm Hg, and HCO₃^- below 22 mEq/L.Compensated respiratory acidosis values include a pH of 7.35 to 7.35, PACO₂ above 45 mm Hg, and HCO₃ above 26 mEq/L.

Question 10

The creation of sound waves across the body surface to determine abnormal densities is known as

Accepted Answer

Percussion is the process of creating sound waves on the surface of the body to determine abnormal density of any underlying areas.Palpation is the process of touching the patient to judge the size, shape, texture, and temperature of the body surface or underlying structures.Inspection is the process of looking intently at the patient.Auscultation is the process of concentrated listening with a stethoscope to determine characteristics of body functions.

Question 11

On admission, a patient presents as follows: pH, 7.38; respiratory rate, 24 breaths/min, regular, pursed-lip breathing; PaO₂, 66 mm Hg; heart rate, 112 beats/min, sinus tachycardia; PaCO₂, 52 mm Hg; blood pressure, 110/68 mm Hg; HCO₃, 24 mEq/L; and SpO₂, 90% on O₂ 2 L/min nasal cannula.What treatment would the physician or nurse practitioner likely order for this patient?

Accepted Answer

Increasing the FiO₂ on this patient could decrease the respiratory rate and increase the severity of the patient's CO₂ retention.The patient's arterial blood gas (ABG)values do not warrant intubation at this time.Additional sodium bicarbonate is not indicated because this patient has a fully compensated pH.A repeat ABG may be ordered to assess the patient's ongoing respiratory status.Other factors must be considered when reviewing a patient's ABGs, including oxygen saturation, oxygen content, base excess and deficit, and anion gap analysis.

Question 12

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?

Accepted Answer

Thoracentesis is a procedure that can be performed at the bedside for the removal of fluid or air from the pleural space.It is used most often as a diagnostic measure; it may also be performed therapeutically for the drainage of a pleural effusion or empyema.No evidence is present that would necessitate a V/Q scan.A bronchoscopy cannot assist in fluid removal.A problem with this chest radiograph is not indicated.

Question 13

For which of the following conditions is a bronchoscopy indicated?

Accepted Answer

Bronchoscopy visualizes the bronchial tree.If secretions are present, they can be removed by suctioning and sent for culture to help adjust antibiotic therapy.

Question 14

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

Accepted Answer

The bicarbonate (HCO₃^-)is the acid-base component that reflects kidney function.The bicarbonate is reduced or increased in the plasma by renal mechanisms.The normal range is 22 to 26 mEq/L.pH measures the hydrogen ion concentration of plasma.PaO₂ measures partial pressure of oxygen dissolved in arterial blood plasma.PaCO₂measures the partial pressure of carbon dioxide dissolved in arterial blood plasma.

Question 15

Which of the following patients would be considered hypoxemic?

Accepted Answer

Normal PaO₂ is 80 to 100 mm Hg in persons younger than 60 years.The formula for determining PaO₂ for a person older than 60 years of age is 80 mm Hg minus 1 mm Hg for every year of age above 60 years of age, for example, 70 years old = 80 mm Hg - 10 mm Hg = 70 mm Hg; 84 years old = 80 mm Hg - 20 mm Hg = 60 mm Hg; and 68 years old = 80 mm Hg - 8 mm Hg = 72 mm Hg.

Question 16

The use of observation for assessment is known as

Accepted Answer

Inspection is the process of looking intently at the patient.Palpation is the process of touching the patient to judge the size, shape, texture, and temperature of the body surface or underlying structures.Percussion is the process of creating sound waves on the surface of the body to determine abnormal density of any underlying areas.Auscultation is the process of concentrated listening with a stethoscope to determine characteristics of body functions.

Question 17

A patient presents with the following values: pH, 7.20; paO₂, 106 mm Hg; paCO₂, 35 mm Hg; and HCO₃^-, 11 mEq/L.These values are most consistent with

Accepted Answer

The pH indicates acidosis, and the HCO₃^- is markedly decreased, indicating a metabolic disorder.Uncompensated metabolic acidosis values include a pH below 7.35, PACO₂ of 35 to 45 mm Hg, and HCO₃^- above 22 mEq/L.Uncompensated respiratory acidosis values include a pH below 7.35, PACO₂ above 45 mm Hg, and HCO₃^- of 22 to 26 mEq/L.Uncompensated respiratory alkalosis values include a pH above 7.45, PACO₂ below 35 mm Hg, and HCO₃^- of 22 to 26 mEq/L.Uncompensated metabolic alkalosis values include a pH above 7.45, PACO₂ of 35 to 45 mm Hg, and HCO₃^- above 26 mEq/L.

Question 18

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

Accepted Answer

To prevent contamination of secretions in the upper portion of the endotracheal tube, do not apply suction while the catheter is being withdrawn.Clear the endotracheal or tracheostomy tube for all local secretions, avoiding deep airway penetration.This will prevent contamination with upper airway flora.Do not dilute thick secretions with sterile water.This will compromise the specimen.

Question 19

On admission, a patient presents as follows: pH, 7.38; respiratory rate, 24 breaths/min, regular, pursed-lip breathing; PaO₂, 66 mm Hg; heart rate, 112 beats/min, sinus tachycardia; PaCO₂, 52 mm Hg; blood pressure, 110/68 mm Hg; HCO₃, 34 mEq/L; and SpO₂, 90% on O₂ 2 L/min nasal cannula.These gases show

Accepted Answer

The pH is closer to the acidic level, so the primary disorder is acidosis.Compensated respiratory acidosis values include a pH of 7.35 to 7.39, PACO₂ greater than 45 mm Hg, and HCO₃ greater than 26 mEq/L.Uncompensated respiratory acidosis values include a pH below 7.35, PACO₂ above 45 mm Hg, and HCO₃^-of 22 to 26 mEq/L.Compensated respiratory alkalosis values include a pH of 7.41 to 7.45, PACO₂ below 35 mm Hg, and HCO₃ below 22 mEq/L.Uncompensated metabolic alkalosis values include a pH above 7.45, PACO₂ of 35 to 45 mm Hg, and HCO₃^- above 26 mEq/L.

Question 20

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

Accepted Answer

Capnography is the measurement of exhaled carbon dioxide (CO₂)gas; it is also known as end-tidal CO₂ monitoring.Normally, alveolar and arterial CO₂ concentrations are equal in the presence of normal V/Q relationships.In a patient who is hemodynamically stable, the end-tidal CO₂ (Petco₂)can be used to estimate the PaCO₂.Normally, the PaO₂/FiO₂ ratio is greater than 286; the lower the value, the worse the lung function.The a 2-a gradient (P[a 2- a]O₂)is normally less than 20 mm Hg on room air for patients younger than 61 years.This estimate of intrapulmonary shunting is the least reliable clinically, but it is used often in clinical decision making.Residual volume is the amount of air left in the lung after maximal exhalation.A normal value is 1200 to 1300 mL.

Quiz 14: Pulmonary Clinical Assessment and Diagnostic Procedures

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?

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

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

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

Which of the following conditions will commonly reveal breath sounds with inspiration greater than expiration on assessment? 1) Normal lung 2) Bronchiectasis 3) Emphysema 4) Acute bronchitis 5) Diffuse pulmonary fibrosis 6) Consolidating pneumonia

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

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

A patient's assessment data present as follows: pH, 7.10; PaCO₂, 60 mm Hg; PaO₂, 40 mm Hg; HCO₃, 24 mEq/L; RR, 34 breaths/min; HR, 128 beats/min; and BP, 180/92 mm Hg.This condition is best described as

The creation of sound waves across the body surface to determine abnormal densities is known as

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?

For which of the following conditions is a bronchoscopy indicated?

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

Which of the following patients would be considered hypoxemic?

The use of observation for assessment is known as

A patient presents with the following values: pH, 7.20; paO₂, 106 mm Hg; paCO₂, 35 mm Hg; and HCO₃^-, 11 mEq/L.These values are most consistent with

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

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

Quiz 14: Pulmonary Clinical Assessment and Diagnostic Procedures

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?

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

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

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

Which of the following conditions will commonly reveal breath sounds with inspiration greater than expiration on assessment? 1) Normal lung 2) Bronchiectasis 3) Emphysema 4) Acute bronchitis 5) Diffuse pulmonary fibrosis 6) Consolidating pneumonia

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

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

A patient's assessment data present as follows: pH, 7.10; PaCO2, 60 mm Hg; PaO2, 40 mm Hg; HCO3, 24 mEq/L; RR, 34 breaths/min; HR, 128 beats/min; and BP, 180/92 mm Hg.This condition is best described as

The creation of sound waves across the body surface to determine abnormal densities is known as

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?

For which of the following conditions is a bronchoscopy indicated?

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

Which of the following patients would be considered hypoxemic?

The use of observation for assessment is known as

A patient presents with the following values: pH, 7.20; paO2, 106 mm Hg; paCO2, 35 mm Hg; and HCO3-, 11 mEq/L.These values are most consistent with

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

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

A patient's assessment data present as follows: pH, 7.10; PaCO₂, 60 mm Hg; PaO₂, 40 mm Hg; HCO₃, 24 mEq/L; RR, 34 breaths/min; HR, 128 beats/min; and BP, 180/92 mm Hg.This condition is best described as

A patient presents with the following values: pH, 7.20; paO₂, 106 mm Hg; paCO₂, 35 mm Hg; and HCO₃^-, 11 mEq/L.These values are most consistent with

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