Deck 21: Pulmonary Therapeutic Management

Question 1

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.The ventilator high-pressure alarm keeps going off.When you enter the room,the ventilator inoperative alarm sounds.What is the primary action the nurse would take?

A) Troubleshoot the ventilator until the problem is found.
B) Take the patient off the ventilator and manually ventilate her.
C) Call the respiratory therapist for help.
D) Silence the ventilator alarms until the problem is resolved.

Answer 1

Take the patient off the ventilator and manually ventilate her.

Question 2

Nursing management of the patient receiving a neuromuscular blocking agent should include

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.

Answer 2

protecting the patient from the environment.

Question 3

Patient safety precautions when working with oxygen involve

A) observation for signs of oxygen-introduced hyperventilation.
B) restriction of smoking.
C) removal of all oxygen devices when eating to prevent aspiration.
D) administration of oxygen at the nurse's discretion.

Answer 3

restriction of smoking.

Question 4

Which of the following oxygen administration devices can deliver oxygen concentrations of 90%?

A) Nonrebreathing mask
B) Nasal cannula
C) Partial rebreathing mask
D) Simple mask

Question 5

Long-term ventilator management over 21 days is best handled through use of a(n)

A) oropharyngeal airway.
B) esophageal obturator airway.
C) tracheostomy tube.
D) endotracheal intubation.

Question 6

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.The ventilator high-pressure alarm keeps going off.When you enter the room,the ventilator inoperative alarm sounds.Which of the following criteria would indicate that the patient is ready to be weaned?

A) FiO? 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

Question 7

Which of the following levels would be classified as a low-flow system of oxygen administration?

A) O? via nasal cannula at 4 L/min
B) O? via nasal catheter at a FiO? range of 60% to 75%
C) O? via transtracheal catheter at 10 L/min
D) O? via simple mask at 12 L/min.

Question 8

Which of the following statements 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 40 to 50 mm Hg to ensure an adequate seal.
D) Cuff pressure monitoring should be done once every 24 hours.

Question 9

The ventilator variable that causes inspiration is called the

A) cycle.
B) trigger.
C) flow.
D) pressure.

Question 10

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.The ventilator high-pressure alarm keeps going off.When you enter the room,the ventilator inoperative alarm sounds.Which of the following criteria would indicate that the patient is not tolerating weaning?

A) A decrease in heart rate from 92 to 80 beats/min
B) An SpO? of 92%
C) An increase in respiratory rate from 22 to 38 breaths/min
D) Spontaneous tidal volumes of 300 to 350 mL

Question 11

Use of oxygen therapy in the patient who is hypercapnic may result in

A) oxygen toxicity.
B) absorption atelectasis.
C) carbon dioxide retention.
D) pneumothorax.

Question 12

The assist-control mode of ventilation functions in which of the following manners?

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.

Question 13

The finding of normal breath sounds on the right side of the chest and absent breath sounds on the left side of the chest in a newly intubated patient is probably caused by a

A) right mainstem intubation.
B) left pneumothorax.
C) right hemothorax.
D) gastric intubation.

Question 14

Which of the following arterial blood gas values would indicate a need for oxygen therapy?

A) PaO? of 80 mm Hg
B) PaCO? of 35 mm Hg
C) HCO?- of 24 mEq
D) SaO? of 87%

Question 15

Preset positive pressure used to augment the patient's inspiratory effort is known as

A) positive end-expiratory pressure (PEEP).
B) continuous positive airway pressure (CPAP).
C) pressure control ventilation (PCV).
D) pressure support ventilation (PSV).

Question 16

Which of the following statements 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.

Question 17

The correct procedure for selecting an oropharyngeal airway is to:

A) measure from the tip of the nose to the ear lobe.
B) measure from the mouth to the ear lobe.
C) measure from the tip of the nose to the middle of the trachea.
D) measure the airway from the corner of the patient's mouth to the angle of the jaw.

Question 18

Nursing interventions to limit the complications of suctioning include

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.

Question 19

The most accurate and reliable control of FiO? can be achieved through the use of a(n)

A) simple mask.
B) nonrebreathing circuit (closed).
C) air-entrainment mask.
D) nonrebreathing mask.

Question 20

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.The ventilator high-pressure alarm keeps going off.When you enter the room,the ventilator inoperative alarm sounds.All of the following conditions would set off the high-pressure alarm except

A) a leak in the patient's ET tube cuff
B) a kink in the ET tubing
C) coughing
D) increased secretions in the patient's airway

Question 21

Complications of ETT tubes include

A) tracheoesophageal fistula.
B) cricoid abscess.
C) tracheal stenosis.
D) tube obstruction.
E) tube displacements.

Question 22

Which route for ETT placement is used in an emergency?

A) Orotracheal
B) Nasotracheal
C) Nasopharyngeal
D) Trachea

Question 23

Indications to support a pneumonectomy are

A) lesions confined to a single lobe.
B) bronchiectasis.
C) unilateral tuberculosis.
D) lung abscesses or cyst.

Question 24

The therapeutic blood level for theophylline (Xanthines)is

A) 5 to 10 mg/dL.
B) 10 to 20 mg/dL.
C) 20 to 30 mg/dL.
D) 35 to 45 mg/dL.

Question 25

Which of the following statements are true regarding rotational therapy?

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.

Question 26

Identify the clinical manifestations associated with oxygen toxicity.

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 CO?
E) Sore throat and eye and ear discomfort

Question 27

A patient was taken to surgery for a left lung resection earlier today.The patient has been in the postoperative care unit for 30 minutes.When you are completing your assessment,you notice that the chest tube has drained 125 cc of red fluid in the past 30 minutes.The nurse contacts the physician and suspects that the patient has developed

A) pulmonary edema.
B) hemorrhage.
C) acute lung failure.
D) bronchopleural fistula.

Question 28

Which medication may be administered with a bronchodilator because it can cause bronchospasms?

A) ?2-Agonists
B) Mucloytics
C) Anticholinergic agents
D) Xanthines

Question 29

Which of the following should be used when suctioning a mechanically ventilated patient?

A) Three hyperoxygenation breaths (breaths at 100% FiO?)
B) Hyperinflation (breaths at 150% tidal volume)
C) Limit the number of passes to three.
D) Instill 5 to 10 mL of normal saline to facilitate secretion removal.
E) Use intermittent suction to avoid damaging tracheal tissue.

Question 30

The Passy-Muir valve is contraindicated in patients

A) who are trying to relearn normal breathing patterns.
B) who experience low secretions.
C) with laryngeal or pharyngeal dysfunction.
D) who want to speak while on the ventilator.