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Respiratory - Exam 1 Review Quiz
Terms in this set (25)
A nurse is assessing a patient who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply).
Select one or more:
a. Continuous bubbling in the water seal chamber
b. Rise and fall in the level of water in the water seal chamber with inspiration and expiration
c. Drainage system upright at chest level
d. Exposed sutures without a dressing
e. Gentle constant bubbling in the suction control chamber
B and E
Gentle bubbling in the suction control chamber is an expected finding as air is being removed and arise and fall of the fluid level in the water seal chamber upon inspiration and expiration indicates that the drainage system is functioning properly. Continuous bubbling in the water seal chamber indicates an air leak. The nurse should cover the sutures at the insertion site with an airtight dressing. The drainage system should be maintained in an upright position below the level of the patient's chest.
A nurse is caring for a patient who was in a motor‑vehicle accident. The patient reports chest pain and difficulty breathing. A chest x‑ray reveals the patient has a pneumothorax. Which of the following arterial blood gas findings should the nurse expect?
a. pH 6.98 PaO2 100 mm Hg PaCO2 30 mm Hg HCO3 18 mEq/L
b. pH 7.06 PaO2 86 mm Hg PaCO 2 52 mm Hg HCO3 24 mEq/L
c. pH 7.42PaO2 100 mm Hg PaCO2 38 mm Hg HCO3 23 mEq/L
d. pH 7.58 PaO2 96 mm Hg PaCO2 38 mm Hg HCO3 29 mEq/L
b. pH 7.06 PaO2 86 mm Hg PaCO 2 52 mm Hg HCO3 24 mEq/L
A pneumothorax can cause alveolar hypoventilation and increased carbon dioxide levels, resulting in a state of respiratory acidosis and these ABG's reflect that state
A nurse in the emergency department is assessing a patient who has sustained multiple rib fractures and has a flail chest. Which of the following findings should the nurse expect? (Select all that apply).
Select one or more:
d. Paradoxical chest movement
A, C, D, E
The patient with flail chest will have paradoxical chest movement due to multiple rib fractures. The patient can have tachycardia, cyanosis and hypotension as as manifestations when experiencing a flail chest due to inadequate oxygenation. The patient can have dyspnea and cyanosis as a manifestation when experiencing a flail chest due to injury and the patient's inability to effectively inhale and exhale.
A nurse is assessing a patient who has a pulmonary embolism. Which of the following manifestations should the nurse expect? (Select all that apply)
Select one or more:
c. Pleural friction rub
A, C, E
Expect the patient to have tachypnea, pleural friction rub, hypotension, petechiae and tachycardia.
A nurse is caring for a patient who is receiving mechanical ventilation and is on Assist-Control mode with a positive end expiratory pressure (PEEP) of 10 cm H20. Which of the following statements by the nurse indicates an understanding of PEEP?
a. "It keeps the alveoli open and prevents atelectasis."
b. "It delivers a preset ventilatory rate and tidal volume to the patient."
c. "It guarantees minimal minute ventilation."
d. "It allows preset pressure delivered during spontaneous ventilation."
PEEP maintains pressure in the lungs to keep alveoli open or prevent atelectasis. Pressure Support Ventilation (PSV) allows preset pressure delivered during spontaneous ventilation to decrease the work of breathing. PEEP does not guarantee minimal minute ventilation because no ventilator breaths are delivered by PEEP. Assist‑control (AC) mode delivers a preset ventilatory rate and tidal volume to the patient.
A nurse is reviewing the health records of five patients. Which of the following patients are at risk for developing acute respiratory distress syndrome (ARDS)? (Select all that apply).
Select one or more:
a. A patient who has a hemoglobin of 15.1 mg/dL
b. A patient who experienced acute drug toxicity
c. A patient who has dysphagia
d. A patient following coronary artery bypass graft surgery
e. A patient who experienced a near‑drowning incident
B, C, D, E
A patient who experienced a near‑drowning incident is at risk for developing ARDS due to trauma to the lungs and cerebral edema. A patient following coronary artery bypass graft surgery is at risk for developing ARDS due to trauma to the chest. Hemoglobin of 15.1 mg/dL is within the expected reference range. A patient who has a low hemoglobin is at risk for developing ARDS. A patient who has dysphagia is at risk for developing ARDS due to difficulty swallowing and risk for aspiration. A patient who experienced acute drug
toxicity is at risk for developing ARDS due to damage to the central nervous
A nurse in the emergency department is assessing a patient who was in a motor vehicle crash. Findings include absent breath sounds in the left lower lobe with dyspnea, blood pressure 118/68 mm Hg, heart rate 124/min, respirations 38/min, temperature3 8.6° C (101.4° F), and SaO2 92% on room air. Which of the following actions should the nurse take first?
a. Prepare for chest tube insertion
b. Administer oxygen via a high‑flow mask
c. Initiate IV access
d. Obtain a chest x‑ray
Obtaining a chest x‑ray to determine the level of injury to the lungs is important, but is not the priority action at this time. Preparing the patient for chest tube insertion is important to facilitate lung expansion and restore normal intrapleural pressure, but is not the priority action at this time. According to the airway, breathing, and circulation to patient care, the nurse should place the priority on administering oxygen via high‑flow mask to restore optimal breathing because the patient is experiencing dyspnea and has decreased lung sounds. Initiating IV access to administer medications is important, but is not the priority action at this time.
The nurse is suctioning a patient via an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which nursing intervention is most appropriate?
a. Continue to suction
b. Notify the health care provider immediately
c. Stop the procedure and reoxygenate the patient
d. Ensure that the suction is limited to 15 seconds
During suctioning, the nurse should monitor the patient closely for side effects, including hypoxemia, cardiac irregularities such as a decrease in heart rate resulting from vagal stimulation, mucosal trauma, hypotension, and paroxysmal coughing. If adverse effects develop, especially cardiac irregularities, the procedure is stopped and the patient is reoxygenated.
The nurse is assessing a patient with multiple trauma who is at risk for developing acute respiratory distress syndrome (ARDS). The nurse should assess for which earliest sign of ARDS?
a. Inspiratory crackles
b. Bilateral wheezing
c. Increased respiratory rate
d. Intercostal retractions
The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.
The low-pressure alarm sounds on a ventilator. The nurse assesses the patient and then attempts to determine the cause of the alarm. If unsuccessful in determining the cause of the alarm, the nurse should take what initial action?
a. Check the patient's vital signs
b. Start cardiopulmonary resuscitation
c. Ventilate the patient manually
d. Administer oxygen
If at any time an alarm is sounding and the nurse cannot quickly ascertain the problem, the patient is disconnected from the ventilator and manual resuscitation is used to support respirations until the problem can be corrected. No reason is given to begin cardiopulmonary resuscitation. Checking vital signs is not the initial action. Although oxygen is helpful, it will not provide ventilation to the patient.
Which patient requires immediate intervention by the nurse to decrease the risk for developing a deep vein thrombosis (DVT)?
a. The patient who is obese and scheduled for laparoscopic day surgery
b. The patient who is immobile because of a fractured hip
c. The patient who is admitted for an exacerbation of congestive heart failure
d. The patient who is admitted for an exacerbation of asthma
Immobility and hip fracture are two risk factors for developing a DVT. This patient requires immediate intervention by the nurse.
Thick copious secretions in the mechanically ventilated patient may cause:
a. Increased peak inspiratory pressure (PIP)
b. Increased PaO2
c. Sudden rise in PEEP
d. Increased volume delivered with no additional pressure
Thick, copious secretions in an mechanically ventilated patient would cause an increased peak inspiratory pressure (PIP).
A patient diagnosed with a pulmonary embolism has a reduction in arterial oxygen saturation level and dyspnea. Which is the priority nursing diagnosis for this patient?
a. Impaired Gas Exchange
b. Ineffective Tissue Perfusion
d. Impaired Physical Mobility
A reduction in arterial oxygen saturation level and dyspnea indicate the patient is experiencing impaired gas exchange. This would be the priority for the patient at this time.
A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4mL to an adult client diagnosed with a pulmonary embolism (PE). Which of the following actions should the nurse plan to take?
a. Administer the injection into the client's thigh
b. Insert the needle completely into the client's tissue
c. Expel the air bubble from the prefilled syringe before injecting
d. Aspirate carefully after inserting the needle into the client's skin
Inject the needle on the prefilled syringe completely when administering enoxaparin in order to administer the medication by deep subcutaneous injection. Do not expel the air bubble in the prefilled syringe prior to injection because the medication has been premeasured, and expelling the air could cause medication to be lost. A deep subcutaneous injection of enoxaparin should be administered into the abdomen, not the thigh. Do not aspirate when administering exoxaparin or other heparin products subcutaneously.
The mechanically ventilated patient who becomes restless and agitated should be immediately evaluated for:
c. Sleep deprivation
d. ICU psychosis
Restlessness and agitation are signs of hypoxia that should be monitored for closely in the mechanically ventilated patient.
Which mode of ventilation is best for weaning patients?
a. continuous mandatory ventilation (CMV)
b. synchronized intermittent mandatory ventilation (SIMV)
c. assist control ventilation (AC)
d. pressure cycled ventilation
SIMV allows spontaneous breathing, but at the patient's own rate and tidal volume between the ventilator breaths. SIMV can be used as a main ventilator mode or a weaning mode.
The nurse determines the client with a chest tube to a closed drainage system is experiencing an air leak. Which finding is indicative of this?
a. Continuous bubbling is observed in the water seal during inspiration and expiration
b. Gentle bubbling is observed in the suction control chamber
c. Fluctuation of water levels in the water seal chamber during respiration
d. Tidaling is absent
Continuous bubbling in the water seal chamber during inspiration and expiration indicates an air leak is present. Bubbling is an expected finding in the suction control chamber. Tidaling is normal during the respiratory cycle. Absence of tidaling could indicate an obstruction or kinking of the chest tube.
In the patient with acute respiratory failure, the nurse interprets which set of arterial blood gases as respiratory acidosis with hypoxemia?
a. pH 7.47, PaCO2 30 mm Hg, HCO3- 32 mEq/L, PaO2 75 mm Hg
b. pH 7.37, PaCO2 42 mm Hg, HCO3- 24 mEq/L, PaO2 82 mm Hg
c. pH 7.30, PaCO2 55 mm Hg, HCO3- 22 mEq/L, PaO2 66 mm Hg
d. pH 7.32, PaCO2 48 mm Hg, HCO3- 22 mEq/L, PaO2 88 mm Hg
Arterial blood gases for a patient with respiratory acidosis and hypoxemia include a pH less than 7.35, PaCO2 greater than 45 mm Hg, and PaO2 less than 80 mm Hg.
The nurse caring for a patient with a chest tube notes continuous gentle bubbling in the suction chamber. Which action is most appropriate?
a. Increase the suctioning pressure until the bubbling becomes vigorous
b. Immediately clamp the chest and notify the physician
c. Do nothing because this is an expected finding
d. Check for an air leak because the bubbling should be intermittent
Continuous gentle bubbling should be noted in the suction control chamber. Bubbling should be continuous in the suction control chamber and not intermittent. Increasing the suction pressure only increases the rate of evaporation of water in the drainage system; in addition, increasing the suction can be harmful and is not done without a specific prescription to do so. Chest tubes should only be clamped to check for an air leak or when changing drainage devices (according to agency policy).
A potential cause of a high pressure alarm on the ventilator is:
a. Increased pulmonary compliance
c. Disconnection from the ventilator circuit
A pneumothorax would cause increased pressure in the thoracic cavity and would cause a high pressure ventilator alarm.
In general, respiratory acidosis is caused by:
a. States that induce hyperventilation
b. Respiratory diseases causing hypoventilation and retention of carbon dioxide
c. Hormone imbalances
d. Compensation for metabolic alkalosis
Respiratory acidosis is caused by respiratory conditions that cause hypoventilation and carbon dioxide retention.
Respiratory alkalosis is caused by:
c. Pulmonary congestion
d. Pulmonary edema
Respiratory alkalosis is caused by hyperventilation which causes carbon dioxide to be blown off excessively by the patient.
In the early stages of ARDS, your patient may exhibit which of the following ABG results:
a. pH 7.32, PCO2 50, HCO3 23, PaO2 52
b. pH 7.48, PCO2 55, HCO3 24, PaO2 42
c. pH 7.50, PCO2 25, HCO3 22, PaO2 52
d. pH 7.38, pCO2 55, HCO3 24, PaO2 82
In the early stages of ARDS the patient will have damage to the alveoli causing hypoxemia and the patient's respiratory rate will increase due to respiratory distress which will result in hyperventilation and blowing off of CO2. The patient's ABG results would show a respiratory alkalosis with hypoxemia.
Which of the following ABG results would indicate metabolic acidosis?
a. pH 7.30, PCO2 32, HCO3 24
b. pH 7.48, PCO2 40, HCO3 29
c. pH 7.46, PCO2 30, HCO3 25
d. pH 7.27, PCO2 38, HCO3 19
Metabolic acidosis causes a pH of less than 7.35 and a HCO3 of less than 22. In metabolic acidosis, the pH and the HCO3 go in the same direction and are both decreased.
A nurse is orienting a newly licensed nurse on the purpose of administering vecuronium to a client who has acute respiratory distress syndrome (ARDS). Which of the following statements by the newly licensed nurse indicates understanding of the teaching?
a. "This medication is given to reduce anxiety."
b. "This medication is given to treat infection."
c. "This medication is given to facilitate ventilation."
d. "This medication is given to decrease inflammation."
Vecuronium is a neuromuscular blocking agent given to facilitate ventilation and decrease oxygenation consumption. Antibiotics are given to treat infection. Corticosteroids are given to treat inflammation. Benzodiazepines are given to treat anxiety.
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