Deck 15: Pulmonary Disorders

Question 1

A patient was admitted to the critical care unit 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.The first action that should be taken after the patient's aspiration event is

A) lavaging his airway with normal saline.
B) placing him on his back in a semi-Fowler position.
C) administering manual ventilations with a resuscitation bag.
D) suctioning his airway.

Answer 1

suctioning his airway.

Question 2

Which of the following therapeutic measures would be the most effective in treating hypoxemia in the presence of intrapulmonary shunting associated with 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

Answer 2

Administering positive-end expiratory pressure (PEEP)

Question 3

Depending on the patient's risk for the recurrence of PE, a patient may be placed on warfarin for

A) 1 to 3 months.
B) 3 to 6 months.
C) 3 to 12 months.
D) 12 to 36 months.

Answer 3

3 to 12 months.

Question 4

A patient was admitted to the critical care unit 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.The patient becomes agitated, has decreased level of consciousness, and has an inability to maintain saturation.The nurse expects the next action will include

A) placing the patient on a mechanical ventilator.
B) change in antibiotics to control infection.
C) suctioning and repositioning.
D) administering a sedative to control anxiety.

Question 5

A patient was admitted to the critical care unit 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.The single most important measure to prevent the spread of infection between staff and patients is

A) respiratory isolation.
B) hand washing.
C) use of PPE.
D) antibiotics.

Question 6

Which of the following findings confirms the diagnosis of a PE?

A) Low-probability V/Q scan
B) Negative pulmonary angiogram
C) High-probability V/Q scan
D) Absence of vascular markings on the chest radiograph

Question 7

The most common presenting signs and symptoms associated with PEs are

A) tachycardia and tachypnea.
B) hemoptysis and evidence of deep vein thromboses.
C) apprehension and dyspnea.
D) right ventricular failure and fever

Question 8

Patients with left-sided pneumonia may benefit from placing them in which of the following positions?

A) Reverse Trendelenburg
B) Supine
C) On the left side
D) On the right side

Question 9

Which of the following nursing interventions should be used to optimize oxygenation and ventilation in the patient with acute respiratory 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.

Question 10

Which of the following causes 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) Drug overdose

Question 11

A patient has been admitted to the critical care unit 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 health care provider orders a repeat ABG.The nurse anticipates the following results

A) elevated pH and decreased PaCO₂
B) elevated pH and elevated PaCO₂
C) decreased pH and decreased PaCO₂
D) decreased pH and elevated PaCO₂

Question 12

A pneumothorax greater than 15% requires

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 and facilitate re-expansion of the collapsed lung.
D) mechanical ventilation to assist with re-expansion of the collapsed lung.

Question 13

The major hemodynamic consequence of a massive pulmonary embolus is

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.

Question 14

Which of the following diagnostic criteria is indicative of 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) Increased static and dynamic compliance

Question 15

A patient with acute respiratory failure may require a bronchodilator if which of the following occurs?

A) Excessive secretions
B) Bronchospasms
C) Thick secretions
D) Fighting the ventilator

Question 16

The two most common causes of hospital-acquired pneumonia in the United States are

A) Staphylococcus aureus and Pseudomonas aeruginosa
B) Escherichia coli and Haemophilus influenzae
C) methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa
D) Klebsiella spp. and Enterobacter spp.

Question 17

Supplemental oxygen administration is usually effective in treating hypoxemia related to

A) physiologic shunting.
B) dead space ventilation.
C) hypercapnia with a PaCO₂ of 35 mm Hg.
D) ventilation/perfusion mismatching.

Question 18

Aspiration can best be prevented by

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.

Question 19

According to the National Association of Medical Direction of Respiratory Care Consensus Panel prolonged mechanical ventilation has been defined as

A) "the need for ?30 consecutive days of mechanical ventilation for ?8 hours per day"
B) "the need for ?15 consecutive days of mechanical ventilation for ?12 hours per day"
C) "the need for ?21 consecutive days of mechanical ventilation for ?6 hours per day"
D) "the need for ?40 consecutive days of mechanical ventilation for ?4 hours per day"

Question 20

A patient was admitted to the critical care unit 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.Which test would the nurse expect the health care provider 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

Question 21

Medical management of patient with status asthmaticus that supports oxygenation and ventilation include

A) oxygen therapy.
B) bronchodilators.
C) corticosteroids.
D) antibiotics.
E) intubation and mechanical ventilation.

Question 22

Nursing management of the patient with acute lung failure includes which of the following interventions?

A) Positioning the patient with the least affected side down
B) Providing adequate rest between treatments
C) Performing percussion and postural drainage every 4 hours
D) Controlling fever
E) Pharmaceutical medications to control anxiety

Question 23

Weaning methods that are used in combination with each other include

A) SIMV with CPAP.
B) SIMV with PSV.
C) CPAP with PSV.
D) T-piece and PSV.
E) PEEP with CPAP.

Question 24

Psychologic factors that may contribute to long-term mechanical ventilation dependence include

A) fear.
B) delirium.
C) lack of confidence in the ability to breathe.
D) depression.
E) trust in the staff so the patient displays a lack of effort.