COPD & PE
Ch 24, 3.A patient in the ICU with a history of smoking is having tests performed to assess his respiratory function. Which test would be best for measuring the oxygenation of this patients blood? A)SaO2 B)Pulse oximetry C)carbon dioxide D)pH
A) SaO2
Ch 25, 23.The patient is being supported with a positive-pressure mechanical ventilator. The machine in use is a volume-cycled ventilator. Relative to the functioning of this ventilator, what nursing assessment is most important? A)Continuous pulse oximetry B)Vital signs per unit protocol C)Respiratory rate D)Peak inspiratory pressure
D) PIP
Ch 27, 11.A patient is admitted after an acute lung injury from smoke inhalation. If the patient develops acute respiratory distress syndrome (ARDS), what is the first symptom the nurse will find? A)Patchy infiltrate on chest x-ray B)Pulmonary capillary wedge pressure less than 18 C)Increasing tachypnea and air hunger D)Low plasma brain natriuretic peptide (BNP)
C)Increasing tachypnea and air hunger
Ch 24, 5.A patient in her first trimester is in the ICU and is displaying signs of metabolic alkalosis. On speaking with the patient, the nurse learns that she has been experiencing much vomiting, diarrhea, and anxiety in the past week. The nurse should recognize that which of the following is the most likely cause of this acid-base imbalance? A)Pregnancy B)Diarrhea C)Vomiting D)Anxiety
C) Vomiting
Ch 26, 7) An elderly woman in the ICU has chronic obstructive pulmonary disease (COPD), with FEV1 of 20%, and is worried about developing a serious illness that would cause complications with her COPD. Which of the following should the nurse recommend to the patient that could reduce her risk for serious illness or death by about 50%? A)Influenza vaccine B)Lung transplantation C)Heparin D)Lung volume reduction surgery
A) Influenza Vaccine
Quizlet, 3.A client has a pulmonary embolism and is started on oxygen. The student nurse asks why the clients oxygen saturation has not significantly improved. What response by the nurse is best?
a) Breathing so rapidly interferes with oxygenation.
b) Maybe the client has respiratory distress syndrome. c) The blood clot interferes with perfusion in the lungs. d) The client needs immediate intubation and mechanical
ventilation.
c) The blood clot interferes with perfusion in the lungs.
Ch 25, 3.A patient has recently arrived in the ICU following cardiac arterial bypass graft surgery and has not yet emerged from anesthesia. He requires full ventilatory support. Which ventilation mode should the nurse use for this patient? A)Pressure support ventilation mode B)Synchronized intermittent mandatory ventilation mode C)Pressure-controlled ventilation mode D)Assist-control mode
D) Assist Control Mode
Ch 26, 16) A patient being mechanically ventilated with positive end-expiratory pressure and pressure support totaling 30 mm Hg has developed unequal chest expansion, absent breath sounds on the right, and tracheal deviation to the right. The patient is increasingly tachycardic, anxious, and agitated, and his pulmonary compliance is rapidly decreasing. What is the most appropriate nursing action? A)Obtain a chest x-ray to rule out pneumothorax. B)Inititate needle thoracotomy or chest tube insertion. C)Sedate the patient and evaluate ventilator settings. D)Obtain arterial blood gases to evaluate gas exchange.
B) Initiate needle thoracotomy or chest tube insertion
Ch 26, 3) It has been determined that a patient in the ICU has pleural effusion. Which intervention is needed at this point to distinguish between transudative and exudative pleural effusion? A)Chest x-ray B)CT scan C)Ultrasound D)Assessment of pleural fluid
D) Assessment of Pleural Fluid
Ch 25, 8.A patient in the ICU has been on assist-control ventilation via endotracheal intubation for 24 hours but will need to be shifted to a long-term ventilation method. Which of the following would be the most appropriate treatment for this patient? A)Iron lung B)Manual resuscitator C)Tracheostomy tube D)Pressure-controlled ventilation via endotracheal
C) Tracheostomy Tube
Ch 26, 20.What symptom or factor would the nurse find in emphysema but not in chronic bronchitis? A)Cough, thick sputum B)Dyspnea with exertion C)History of smoking D)Hyperinflation of lungs
D) Hyperinflation of the lungs
CH 25, 4.A patient with acute respiratory distress syndrome (ARDS) requires mechanical ventilation but is at risk for barotrauma due to decreased lung compliance. Which mode of ventilation should the nurse use with this patient? A)Pressure support ventilation mode B)Synchronized intermittent mandatory ventilation mode C)Pressure-controlled ventilation mode D)Assist-control mode
C) Pressure Controlled Ventilation
CH 25, 20.A patient being supported with endotracheal intubation and mechanical ventilation is increasingly agitated. What is the most appropriate nursing intervention? A)Administer neuromuscular blockade medication. B)Administer a benzodiazepine. C)Obtain arterial blood gas measurement. D)Ask a family member to stay with the patient.
C) Obtain ABG
Ch 26, 2) A patient in the ICU with congestive heart failure demonstrates shortness of breath and complains of pleuritic chest pain. Which of the following conditions, associated with heart failure, should the nurse most suspect in this patient? A)Transudative pleural effusion B)Exudative pleural effusion C)Acute asthma D)Emphysema
A) Transudative pleural effusion
14.The patient is being monitored with an end-tidal CO2 monitor and has values trending upward. What acidbase abnormality should the nurse assess for? A)Metabolic acidosis B)Metabolic alkalosis C)Respiratory acidosis D)Respiratory alkalosis
C) Respiratory Acidosis
Quizlet, 4.A client is on intravenous heparin to treat a pulmonary embolism. The clients most recent partial
thromboplastin time (PTT) was 25 seconds. What order should the nurse anticipate?
a. Decrease the heparin rate.
b. Increase the heparin rate.
c. No change to the heparin rate.
d. Stop heparin; start warfarin
(Coumadin).
ANS: B
For clients on heparin, a PTT of 1.5 to 2.5 times the normal value is needed to demonstrate the heparin is
working. A normal PTT is 25 to 35 seconds, so this clients PTT value is too low. The heparin rate needs to be
increased. Warfarin is not indicated in this situation.
DIF:Applying/Application REF: 619
KEY: Pulmonary embolism| thromboembolic events| anticoagulants| laboratory values
MSC:Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
Ch 25, 22.The patient is being well supported with a positive-pressure mechanical ventilator. Because of the mechanism of action of this type of ventilator, what common complication does the nurse watch for? A)Diminished cardiac output B)Increased somnolence C)Deep venous thrombosis D)Reduced patient control
A) Diminished Cardiac Output
Ch 27, 13.A patient with acute respiratory distress syndrome (ARDS) has severe hypoxia refractory to high levels of oxygen and mechanical ventilation. What is the underlying pathophysiology most responsible for the hypoxia? A)Increased capillary permeability from mediator release B)Increased patchy infiltrate visible on chest x-ray C)Reduced pulmonary afterload effects D)Reduced pulmonary preload effects
A)Increased capillary permeability from mediator release
CH 27, 14.The nurse is caring for a patient who has developed acute respiratory distress syndrome (ARDS) after smoke inhalation. Based on the pathologic changes in ARDS, the nurse expects what outcome during the first several hours? A)Improvement in airway patency with bronchodilator therapy B)Persistent and worsening hypoxia despite mechanical ventilation C)Evidence of hypercarbic respiratory failure with compensation D)General fluid volume deficit from capillary permeability increase
B)Persistent and worsening hypoxia despite mechanical ventilation
CH 25,17.A critically ill patient has an intravenous line inserted into the left subclavian vein. After the procedure, what nursing intervention is used to detect the most serious complication of this procedure?A)Connection of ordered intravenous fluids B)Compatibility evaluation for fluids infused C)Use of a semipermeable plastic site dressing D)Auscultation of bilateral breath sounds
D) Auscultation of Bilateral Breath Sounds
Quizlet ,20.A client has been diagnosed with a very large pulmonary embolism (PE) and has a dropping blood pressure.
What medication should the nurse anticipate the client will need as the priority?
a. Alteplase (Activase)
b. Enoxaparin (Lovenox)
c. Unfractionated heparin
d. Warfarin sodium
(Coumadin)
ANS: A
Activase is a clot-busting agent indicated in large PEs in the setting of hemodynamic instability. The nurse
knows this drug is the priority, although heparin may be started initially. Enoxaparin and warfarin are not
indicated in this setting.
Ch 25, 26.The patient is being supported by mechanical ventilation and is not maintaining adequate oxygenation on current settings. Positive end-expiratory pressure (PEEP) has just been increased from 10 to 12 cm H2O. What nursing assessment finding best indicates that the patient is not tolerating this change? A)Increased cardiac output B)Increased blood pressure C)Significant hypotension D)Increased pulmonary compliance
C)Significant hypotension
Ch 24, 7.A patient in the ICU has just undergone arterial blood gas testing. Her results are as follows: PaO2 is 90 mm Hg, pH is 7.43, PaCO2 is 24, and HCO3 is 19 mEq/L. Which of the following indicates this patients condition? A)Respiratory alkalosis, fully compensated B)Respiratory acidosis, partially compensated C)Metabolic alkalosis, fully compensated D)Metabolic acidosis, partially compensated
A)Respiratory alkalosis
Ch 27,18.A patient with acute respiratory distress syndrome (ARDS) is receiving an inhaled bronchodilator. What nursing assessment indicates the most important expected outcome of the bronchodilator for this patient? A)Decreased audible wheezing B)Slight tachycardia during treatment C)Increase in mucus suctioned D)Reduction of peak airway pressure
D)Reduction of peak airway pressure
Ch 25, 10.A patient in the ICU failed long-term ventilation weaning via CPAP trials. What is the next intervention that should take place? A)The T-piece trial should be performed. B)The patient should be switched to SIMV method. C)The patient should be rested on the ventilator for 24 hours. D)The patient should be switched to the SIMV plus PSV
C) the patient should be rested on the vent for 24 hrs