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The nurse is admitting a patient onto the unit. During the admission process, the nurse begins collecting information regarding the patient's health history. The patient states they have smoked 3 packs a day for 35 years. The nurse quickly identifies that this is ______ pack years.
A. 35 pack years
B. 125 pack years
C. 65 pack years
D. 105 pack years
D: 105
A patient with a known history of deep vein thrombosis (DVT) suddenly develops shortness of breath, chest pain, and hypoxemia. A pulmonary embolism (PE) is suspected.
How does a PE affect the ventilation/perfusion (V/Q) ratio, and what is the result in terms of pulmonary dead space?
A. V/Q mismatch that is representative of reduced ventilation in the affected lung areas, leading to decreased dead space
B. V/Q mismatch that is representative of reduced perfusion in the affected lung areas, leading to increased dead space
C. V/Q mismatch representative of reduced perfusion, causing a shunt and leading to a slight increase in dead space
D. V/Q mismatch representative of an increase in ventilation in the unaffected lung areas leading to increased dead space
B: V/Q mismatch that is representative of reduced perfusion in the affected lung areas, leading to increased dead space
The nurse is caring for a patient that has developed tension pneumothorax. Which of the following signs and symptoms can present with this condition SATA
A.Hypotension
B. Jugular Venous Distention
C. Bradycardia
D. Tracheal deviation
E. Hyperemia
F. Tachypnea
A, B, D, F
Mr. Marquez, a 52-year-old male with a history of COPD, is admitted to the hospital for a hip replacement. Three days after discharge, he returns to the emergency department with a productive cough, fever, and shortness of breath. He is diagnosed with community-acquired pneumonia (CAP). Three weeks later, Mr. Smith is readmitted for complications from his surgery and develops pneumonia again, four days into his hospital stay.
What is the most likely difference in risk factors between community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP)?
A. HAP risk factors include chronic diseases like COPD, while CAP risk factors include recent hospital stays
B. CAP is often caused by exposure to healthcare environments, while HAP is caused by exposure to outdoor pollutants
C. HAP risk factors include prolonged hospital stays and invasive procedures, while CAP is often related to exposure to community pathogens
D. The risk factors for both CAP and HAP are similar, focusing primarily on weakened immune systems due to chronic illness
C: HAP risk factors include prolonged hospital stays and invasive procedures, while CAP is often related to exposure to community pathogens
The nursing professor is lecturing a group of nursing students about asthma. Which of the following statements indicates that further teaching is needed? SATA
A. “Solu-Medrol should be administered before albuterol”
B. “A spacer should used when administering Budesonide to avoid getting thrush”
C. “When using the peak flow meter, the patient should use it three times and obtain the average”
D. “If a patient has difficulty breathing, wheezing, and a peak flow of 60% their personal best, they should go to the ED”
E. “Status Asthmaticus can result in intubation and pulsus paradoxus”
A, C, D
How will the nurse document the pack-year smoking history for a client who reports smoking a pack of cigarettes a day for 10 years, quitting for 4 years, and then smoking 2 packs a day for the last 25 years?
A. 30 pack years
B. 35 pack years
C. 45 pack years
D. 60 pack years
D. 60 years
A 45-year-old female patient presents to the emergency department with sudden onset of shortness of breath, chest pain, and tachycardia. A pulmonary embolism (PE) is confirmed through CT pulmonary angiography. She is hemodynamically stable.
Which of the following is the most appropriate immediate therapeutic intervention?
A. Oral administration of aspirin to reduce clot formation
B. Administer low molecular weight heparin (LMWH) subcutaneously
C. Immediate surgical embolectomy
D. Intravenous administration of thrombolytics (tPA)
B: Administer low molecular weight heparin (LMWH) subcutaneously
When is End-tidal Co2 monitoring used? SATA
A. When weaning a patient from a ventilator
B. In endotracheal Intubation
C. In Cardiopulmonary resuscitation
A, B, C
A 60-year-old male is admitted to the ICU with acute respiratory failure and is placed on mechanical ventilation.
As the ICU nurse caring for him, which of the following interventions is most appropriate to reduce his risk of developing ventilator-associated pneumonia (VAP)?
A. Place the patient in a supine position to promote rest
B. Perform endotracheal tube suctioning only when clinically indicated to avoid contamination
C. Provide oral care with chlorhexidine every 4 to 6 hours
D. Maintain the ventilator circuit and tubing for 7 days without changing to avoid infection risk
C: Provide oral care with chlorhexidine every 4 to 6 hours
A patient with active tuberculosis (TB) typically presents with a non-productive cough that progresses to a productive cough over time as the disease worsens.
True or False ??????????????????????
Ans: True
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives a dose of morphine sulfate, and his respirations decrease to 4 breaths/min. What adjustments may need to be made to the patient's ventilator settings?
A. Add positive end-expiratory pressure (PEEP)
B. Add pressure support
C. Change to assist/control ventilation at a rate of 4 breaths/min
D. Increase the synchronized intermittent mandatory ventilation respiratory rate
D. Increase the synchronized intermittent mandatory ventilation respiratory rate
Mrs. Ramirez, a 50-year-old female, is recovering from abdominal surgery. She is at high risk for developing DVT due to prolonged bed rest. The nurse assesses her and finds no signs of DVT at present, but she remains immobile. Which of the following is the most appropriate nursing intervention to prevent the development of DVT in Mrs. Green?
A. Apply intermittent pneumatic compression devices and encourage fluid restriction
B. Elevate her legs on pillows, avoid ambulation, and administer aspirin
C. Administer subcutaneous heparin, encourage early ambulation, and apply compression stockings
D. Apply ice packs to the legs, provide passive leg exercises, and monitor platelet counts daily
C: Administer subcutaneous heparin, encourage early ambulation, and apply compression stockings
T/F: The nurse notices the patient's End-Tidal CO2 level has increased from 42 to 55 mmHg and there is an increase on the capnograph. This indicates that the patient is hyperventilating.
A. True
B. False
False
A 55-year-old female patient has been on mechanical ventilation for 6 days following sepsis. She suddenly develops a fever, increased sputum production, and her oxygen requirements have risen. A chest X-ray shows new infiltrates.
What is the most likely diagnosis?
A. Aspiration pneumonia
B. Acute respiratory distress syndrome (ARDS)
C. Pulmonary embolism
D. Ventilator-associated pneumonia (VAP)
D: Ventilator-associated pneumonia (VAP)
The patient is scheduled to administer theophylline to the patient at 0800. Recent findings were as follows: HR 120 bpm, BP 110/80, Temperature 98.6°F, O2 Sat 95%, pain 0/10, theophylline level 18 mg/mL. What should the nurse do?
A. Administer the theophylline
B. Withhold the theophylline and alert HCP
C. Administer a beta blocker to lower the heart rate, then administer theophylline
D. Wait to administer medication until the nighttime
B
Bonus question: What's the range for theophylline? 10-20 mg/mL
A nurse in the critical care unit is caring for a patient that requires mechanical ventilation. Suddenly the high pressure alarm sounds. The nurse should assess for which potential causative factors? SATA
A. Endotracheal tube cuff leak
B. Kink in the tubing
C. Excessive secretions
D. Endotracheal tube displacement
E. Biting of the tube
Answer: B, C, E
Mr. Romero, a 68-year-old male, is diagnosed with a deep vein thrombosis (DVT) in his left leg. His medical history includes hypertension, type 2 diabetes, and mild cognitive impairment, which raises concerns about his ability to adhere to complex medication regimens. His current INR is subtherapeutic at 1.4 while on warfarin. The healthcare provider is considering alternative anticoagulation options.
Which treatment option would be most appropriate for Mr. Daniels, considering his subtherapeutic INR and concerns about adherence?
A. Continue warfarin and increase the dose
B. Switch to low molecular weight heparin (LMWH) injections
C. Transition to a direct oral anticoagulant, like apixaban
D. Administer unfractionated heparin with warfarin bridge therapy
C: Transition to a direct oral anticoagulant, like apixaban
Bonus: What foods interact with warfarin?
Mix and Match! Categorize the following s/sx under emphysema or chronic bronchitis
A. Chronic productive cough for at least 3 consecutive months, in at least 2 consecutive years
B. Tripoding
C. Hyperventilation
D. Recurrent pulmonary infx
E. Cyanosis
F. Use of accessory muscles
G. Pursed lip breathing
H. Edema
I. Barrel chest
Emphysema: Pursed lip breathing, Use of accessory muscles, Barrel chest, Hyperventilation, Tripoding
Chronic Bronchitis: Chronic productive cough for at least 3 consecutive months, in at least 2 consecutive years, Recurrent pulmonary infx, Cyanosis, Edema
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with increased shortness of breath and fatigue. Arterial blood gas (ABG) results are as follows:
pH: 7.35 ,PaCO₂: 52 mmHg , PaO₂: 60 mmHg, HCO₃⁻: 29 mEq/L
Which of the following best describes the patient's ABG results in the context of COPD?
A. Respiratory acidosis with metabolic compensation
B. Respiratory alkalosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Normal ABG values for a patient with COPD
A: Respiratory acidosis with metabolic compensation
A 45-year-old male presents to the clinic with a persistent cough lasting over 3 weeks, night sweats, fever, and unintentional weight loss. He is diagnosed with active pulmonary tuberculosis (TB). As the nurse, you are assessing his condition and planning care. Which of the following are common signs, symptoms, or considerations in the management of a patient with active tuberculosis? (Select all that apply)
A. Cough lasting more than 3 weeks
B. Night sweats and fever
C. Non-contagious after the first week of antibiotic treatment
D. Weight loss and fatigue
E. Use of airborne precautions
An ED nurse assesses a patient who is experiencing tachycardia, dyspnea, hypoxia, has uneven rise/fall of the chest wall, and absent breath sounds on the right side of the chest. The nurse notes a sucking chest wound on the right side of the chest. The nurse identifies this as a….
A. Spontaneous pneumothorax
B. Open pneumothorax
C. Iatrogenic pneumothorax
D. Tension pneumothorax
E. Closed pneumothorax
B. Open pneumothorax
Bonus question: What is a nrs intervention for sucking chest wounds?
Mr. Lopez, a 70-year-old male, is admitted to the hospital for a hip replacement. On day 4 of his hospital stay, he develops a cough, fever, and shortness of breath. A chest X-ray confirms pneumonia. He has no recent history of respiratory infections prior to hospitalization. What is the most likely difference in the pathogens causing Ms. Garcia’s community-acquired pneumonia (CAP) compared to her hospital-acquired pneumonia (HAP)?
A. HAP is more likely caused by Streptococcus pneumoniae, while CAP is caused by multidrug-resistant organisms
B. CAP is often caused by viruses, while HAP is commonly caused by multidrug-resistant bacteria
C. CAP and HAP are usually caused by the same pathogens, but the patient’s immune system is weakened after surgery
D. HAP and CAP are both typically caused by viral infections that resolve with supportive care
B: CAP is often caused by viruses, while HAP is commonly caused by multidrug-resistant bacteria
A nurse assesses a patient who presents with dyspnea, chronic cough, and reduced breath sounds. Upon further investigation, the nurse notes that the patient has hypoxemia and hypercapnia. The nurse suspects COPD, which diagnostic test does the nurse anticipate the HCP will order? SATA
A. Spirometry
B. Thoracentesis
C. CXR
D. Purified Protein Derivative Test (PPD)
E. Alpha1 Antitrypsin Deficiency Screening
A, C, E
A 35-year-old female is admitted to the emergency department with an asthma exacerbation. She is treated with bronchodilators and corticosteroids. The nurse is assessing her response to treatment.
Which of the following lab values is most useful in determining improvement in her asthma exacerbation?
A. Arterial blood gas (ABG) showing PaCO₂ 60 mmHg and PaO₂ 55 mmHg
B. Peak expiratory flow rate (PEFR) of 80% of the patient's personal best
C. White blood cell count (WBC) of 15,000/µL
D. Serum potassium level of 3.0 mEq/L
B: Peak expiratory flow rate (PEFR) of 80% of the patient's personal best
How are we feeling for our first exam?
A. Great
B. Okay
C. Need to study more
D. idc
We got this !! (: