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REVIEWING DATA IN THE PATIENT'S RECORD
Terms in this set (113)
In which of the following conditions would a ventilation scan be normal but a perfusion scan reveals areas of absent blood flow?
A decrease in breathing greater than 30% that causes desaturation
Hyponea is defined as:
Which of the following is the maximum amount of air that can be exhaled from the maximum inspiratory level?
Which of the following pulmonary function measures is least dependent on patient effort?
Which of the following is used to measure to estimate a newborn infant's gestational age after birth?
Which of the following would tend to increase a patient's energy expenditure?
A patient is admitted to the ICU from a post- operative surgical unit with a hospital acquired lobar pneumonia. A sputum gram stain reveals gram negative organism. Which of the following is most likely the cause of pneumonia?
Patient's Medical History
Before preparing to administer therapy to a patient, you should first review the medical records for
The Patient's Dead Space Has Increased
On analysis of the ABG reports for a patient receiving volume control ventilation, you note the PaC02 has been increasing over the past 8 hours, despite the fact that her minute ventilation has remained constant. Which of the following could explain these findings?
Administering a high concentration of 02
Which of the following would be LEAST likely to increase intracranial pressure in a brain-injured patient?
To change or cancel an advance directive, the patient must be of sound mind
Which of the following is TRUE regarding changes to a patient's advance directive?
respiratory muscle strength
Maximum inspiratory pressure (MIP; NIF) measurement provides information about which of the following?
decreased lung volumes
In assessing a patient in the acute phase of ARDS, you would expect to find:
pulmonary arterial hypertension
An echocardiogram on a 48 year-old patient with exertional dyspnea reveals high velocity tricuspid regurgitation, a dilated right ventricle, and an enlarged right atrium. Left ventricular anatomy and systolic/diastolic function are normal. Which of the following is the most likely problem?
right -to-left shunting through a PDA
Which of the following echocardiogram findings are consistent with a diagnosis of persistent pulmonary hypertension of the newborn (PPHN)?
VE of 17 L/min with PaCO2=45 mm Hg
Which of the following measures taken on adult patients indicate an unacceptably high ventilatory demands or work of breathing?
patient is hypotensive
You measure the blood pressure of an adult patient as 88/53 mm Hg. Which of the following chart entries would you use in describing this finding?
.45 x 2.0= 0.90L
A patient scheduled for a right lung pneumonectomy has a preoperative FEV1 of 2.0 L. A split lung quantitative V/Q study indicates a 55%/45% distribution of blood flow to the right and left lungs respectively. The patient's predicted postoperative (PPO) FEV1 would be:
high velocity tricuspid regurgitation
Which of the following echocardiogram findings are consistent with a diagnosis of pulmonary arterial hypertension (PAH)?
obtain an accurate medication history from the patient
The first step in medication reconciliation is to:
6 - 12 mm Hg
The normal range for the pulmonary artery (or capillary) wedge pressure (PAWP/PCWP) as measured via the distal port of a PA catheter (with the balloon inflated) is:
While reviewing the lab chemistry of a patient in metabolic acidosis due to renal failure, you would expect the following electrolyte to be abnormally high:
crackles on auscultation
Your review of a patient's chart notes an admission diagnosis of fluid overload/overhydration. Which of the following findings would be most likely on bedside assessment of the patient?
The normal arterial-venous oxygen content difference or C(a-v)O2 in a healthy adult at rest is about:
On inspection of an ECG rhythm strip from an adult patient, you note the following: rate of 150; regular rhythm; normal P waves, P-R intervals, and QRS complexes. The most likely problem is:
the ICP is abnormally high
An adult patient has an intracranial pressure (ICP) of 24 mm Hg. You can conclude that:
+/- 2 mEq/L
A patient has acute respiratory acidosis. You would expect the base excess (BE) to range between:
the relationship of any disordered breathing to sleep stages
You review a sleep study report in a patient's chart that includes the %time in sleep stages; frequency of arousals; frequency of apneas, hypopneas, and respiratory effort-related arousals; O2 saturation data; the frequency of periodic limb movements; the technician's comments, and the physician's interpretation/conclusions. What is missing from this report?
0.1 L/cm H20
Total compliance of the respiratory system (lung + thorax) in normal subjects is about:
postpone the therapy until contacting the physician
A physician's order for an aerosolized bronchodilator indicates three times the normal dose. Which of the following actions is appropriate?
rules out an underlying pneumothorax
While assisting a physician with a transthoracic ultrasound exam, you observe gliding or shimmering of the pleural layer during breathing. This observation
pH = 7.47 PCO2 = 32 torr PO2 = 60 torr
Which of the following arterial blood gas results would most likely be reported for a patient who is having a mild asthma attack?
enhanced oxygen unloading at the tissues
A patient has a temperature of 104 °F (40 °C). What effect will this have on oxygen transport?
A higher than normal white blood cell count would be consistent with which of the following?
is usually obtained at the time of admission
A patient's advanced directive:
anxiety or agitation
When inspecting the monitor of an adult patient in ICU, you note a heart rate of 138/min with a regular rhythm. Which of the following is the most likely cause of this observation?
Where in the medical record would one go to find information on a patient's understanding of the drugs they are taking and their methods of administration?
the patient is hyperventilating
A patient has a PCO2 of 22 torr. Based on this information you may rightly conclude that:
a ventilatory disorder must be co-existing
A patient has a confirmed metabolic acidosis with a normal PCO2. What inferences can you draw from these findings?
A patient receiving long-term positive pressure ventilatory support exhibits a progressive weight gain and a reduction in the hematocrit. Which of the following is the most likely cause of this problem?
B-type natriuretic peptide
You are providing BiPAP with 100% O2 to 55 year old female admitted to the ED with signs and symptoms of acute pulmonary edema. Which of the following laboratory tests would you recommend to help the doctor determine whether or not the patient is suffering from congestive heart failure (CHF)?
In the lab results section of her medical record, you note an overall WBC of 22,000 for a febrile patient who appear acutely ill and in moderate respiratory distress. Which of the following is this patient's most likely diagnosis?
To what section of a patient's chart should you refer to understand any important cultural or religious influences on the provision of care?
the findings confirm a diagnosis of mild obstructive sleep apnea
A polysomnography report indicates an average of 12 mainly obstructive apnea/hypopnea events per hour. Which of the following statements is most consistent with this observation?
Your review of a patient's chart notes an admission diagnosis of fluid depletion/dehydration. Which of the following findings would be most likely on bedside assessment of the patient?
Patients should fast for at least 4 hours prior to the study
Which of the following is required to assure valid results for a patient undergoing a positron emission tomography (PET) scan?
A patient exhibits respiratory alkalosis. Which of the following problems is most likely?
FRC less than predicted
In reviewing the chart of a 65 year-old patient diagnosed with COPD and chronic hypoxemia, you would expect to see which of the following findings?
arterial oxygen content
Which of the following is the best index of oxygen transport for a patient who has been resuscitated after carbon monoxide poisoning?
A patient is admitted to the ICU from a post-operative surgical unit with a hospital-acquired lobar pneumonia. A sputum Gram stain reveals Gram-positive organisms. Which of the following is the most likely cause of the pneumonia?
Which of the following laboratory values is most consistent with a diagnosis of fluid overload (overhydration)?
compensated metabolic acidosis
On reviewing the blood gas report on a patient, you note a PaCO2 of 25 torr, a base excess (BE) of -10 mEq/L, and a pH of 7.35. You would characterize this acid-based abnormality as:
large segmental areas with normal ventilation but no perfusion
Which of the following would represent an abnormal V/Q scan suggesting pulmonary embolism?
combined restrictive and obstructive disease
As compared to predicted normals, a patient has a reduced TLC, and a decreased FEV1%. Test results are repeatable. Which of the following is the most likely underlying problem?
airflow + respiratory effort
Which two polysomnography channels are essential in differentiating obstructive from central sleep apneas?
can be ruled out
The V/Q scan report for a patient suspected of having a pulmonary embolism (PE) indicates perfusion throughout both lungs with no visible perfusion defects. In addition the patient's D-dimer blood test is normal. Based on this information, a diagnosis of PE
drug allergies and adverse reactions
In addition to obtaining information on a patient's prescribed and over-the-counter medications, a good medication history should also include which of the following?
During the administration of an aerosol treatment, the patient's respiratory rate drops from 15 breaths/min to 6 breaths/min. Identify this breathing pattern.
Which of the following laboratory values is most consistent with a diagnosis of fluid depletion (dehydration)?
Six hours after a confused 71 year-old male is admitted to the ED with dyspnea, diaphoresis and hypotension, lab results indicate elevated creatine kinase isoenzyme (CK-MB) and troponin I. These finding are most consistent with:
traumatic brain injury
The primary indication for monitoring intracranial pressure (ICP) is:
A patient has a pH of 7.22 and a PaCO2 of 60 torr. Based on these data, what is the primary acid-base disturbance?
prevent medication errors
The major goal of medication reconciliation is to:
development of thoracoabdominal paradox
When monitoring a patient during a spontaneous breathing trial (SBT), which of the following observations would cause you to stop the trial and return the patient to ventilatory support?
a statement by the technician performing the test regarding its validity
To meet quality assurance standards, the patient's chart report of a blood gas or hemoximetry test result should include:
An adequately hydrated patient should have on average an hourly urinary output of at least:
0.1 - 0.4 L/cm H2O
Normal lung compliance is approximately:
Which of the following VD/VT ratios is inconsistent with the ability of a patient to maintain adequate CO2 removal at a tolerable level of ventilation?
use of generic vs. brand name medications
In obtaining a medication history from a patient admitted for an acute exacerbation of asthma, which of the following information would you consider least important?
the patient has developed a fever
On analysis of the ABG reports for a patient receiving volume control ventilation, you note that her PaCO2 has been increasing over the last 8 hours, despite the fact that her minute ventilation has remained constant. Which of the following could explain this finding?
congestive heart failure
Which of the following would tend to cause a patient to experience fluid overload (overhydration)?
the results of this sleep study are within normal limits
Results of a sleep study on a 57 year old female reveal an average of 2 apneic periods/hr, each lasting about 6 seconds, and all associated with snoring. During apneic spells, the patient tries to breathe. Which of the following conclusions can you draw from this information?
2000 kcal/24 hr
A normal resting energy expenditure (REE) for a 70 kg male would be about:
FRC - ERV= RV
A patient has a vital capacity of 3600 ml, a functional residual capacity of 6,000 ml and expiratory reserve volume of 1000 ml. What is her residual volume?
'low flow O2, titrate to SpO2 > 90%'
Which of the following is an appropriate order for oxygen therapy?
On reviewing the results of the attending physician's physical examination of a patient's chest, you note 'a hyperresonant percussion note on the left.' Which of the following is the most likely problem?
In assessing a new adult admission to a medical unit, you note a respiratory rate of 35/minute. The most likely cause of this observation is:
ask the prescribing physician to modify the order
If a physician writes an admission order for respiratory care that does not meet conventional standards, it would be most appropriate for a you to do which of the following?
Which of the following measures can be obtained from a forced vital capacity spirogram?
In reviewing the medical record of a 60 YO trauma patient, you note that a ventilation-perfusion scan was ordered. For what potential problem is the patient being evaluated?
Which of the following can be used to assess gestational age or fetal maturity before birth?
50 kg x 70 mL/kg
A normal vital capacity for a female patient who is five feet two inches tall and weighs 50 kilograms would be approximately:
The gold standard for monitoring intracranial pressure (ICP) is the:
FORCEFUL exhalation expels gas below the resting level. The amount of gas that can be exhaled below the resting expiratory level is the:
Which of the following conditions is most likely to cause an elevated white blood count?
cerebral perfusion pressure
The difference between the mean arterial pressure (MAP) and intracranial pressure (ICP) is the:
When inspecting the monitor of an adult patient in ICU, you note a heart rate of 141/min with a regular rhythm. Which of the following is the most likely cause of this observation?
the alveolar ventilation per minute will decrease
If the rate of breathing increases without any change in total minute ventilation (VE constant):
percent of sleep time with abnormally low SpO2
A sleep study report should include which of the following information about blood oxygen levels?
Positron emission tomography
A noninvasive imaging technique that detects changes in cells as they metabolize and is good at identifying rapidly growing cells such as those found in cancer tumors best describes:
patient's medication knowledge
In addition to obtaining information on a patient's prescribed and over-the-counter medications, a good medication history should also include which of the following?
Which of the following lung volumes/capacities can be measured using simple spirometry?
decreased LV ejection fraction (< 45%)
Which of the following echocardiogram findings are consistent with a diagnosis of systolic heart failure?
injection of edrophonium (Tensilon)
Diagnosis of myasthenia gravis may be confirmed via:
Normal oxygen consumption for a 70 kg male would be about:
A patient experiencing acute postoperative dyspnea undergoes a V/Q scan, with results indicating an intermediate probability of pulmonary embolism (PE). Other than dyspnea, the only significant clinical findings are a moderate hypoxemia and tachycardia. Which of the following would you recommend?
diastolic heart failure
An echocardiogram on a 56 year-old patient who experiences dyspnea and palpitations on exertion reveals the following left ventricular data: elevated end-diastolic pressure, normal end-diastolic volume, decreased chamber compliance, and an ejection fraction of 58%. In addition, the exam reveals that her left atrium is enlarged and there is bulging of the interatrial septum to the right. Which of the following is the most likely problem?
A written DNR order must be placed in the patient's chart by the attending physician
Which of the following is TRUE regarding Do Not Resuscitate (DNR) orders?
Which of the following must be documented by the prescribing physician in order for a patient to be reimbursed for home oxygen therapy?
BUN 58mg/dL& Creatinine 4.3mg/dL
Which of the following blood test indicates potential renal failure?
-To diagnose a
- To predict
For which of the following purposes would you recommend a V/Q scan?
An 75-kg (165-lb) patient receiving mechanical ventilation is being considered for weaning. Which of the following measurements indicate readiness for a weaning assessment?
Which of the following are needed to determine the I:E ratio on a mechanical ventilator delivering volume-controlled breaths in the A/C mode?
A patient is admitted with signs and symptoms of pulmonary congestion and edema, but tests for CHF are all negative. However, because cardiac murmurs are heard on auscultation, the patient undergoes cardiac catheterization to assess for valve abnormalities. Which of the following valve abnormalities could be causing the patient's pulmonary congestion?
obstructive sleep apnea
In reviewing a sleep study, you note 20 to 25 episodes per hour like that depicted in example 'B' in the following figure. What type of abnormal respiratory event does this indicate?
- Low pH
- High Glucose
A patient is admitted to the emergency room with a diagnosis of diabetic ketoacidosis. Which of the following clinical chemistry test results would you expect to find in this patient?
- Arterial Blood
Which of the following measures should be obtained and reviewed when assessing a patient's readiness to begin weaning from mechanical ventilation?
- Cardiac Output
- Arterial O2
Which of the following determine the amount of oxygen delivered to the tissues?
- Those Receiving Many Different
- Those with Language or
- Very Young
or Very Old
Which of the following patients are at high risk for medications errors?
Laboratory findings in allergic asthma usually include which of the following?
- MAP = 90mmHg
- ICP = 15mmHg
Which of the following monitored parameters indicate adequate cerebral perfusing pressure (CPP)?
- Vitamins and
Which of the following should be included in a patient's medication history?
Procedures that can confirm a diagnosis of Pneumocystis carinii (jiroveci) pneumonia (PCP/PJP) include which of the following?
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