Chapter 25- Patient Management- Respiratory System My Nursing Test Banks

 

1.

A patient with Duchennes muscular dystrophy requires an intermittent short-term therapy to maintain alveolar ventilation. The patient is not a candidate for aggressive mechanical ventilation as provided through an artificial airway. Which of the following would be the most appropriate treatment for this patient?

A)

Manual resuscitator

B)

Negative-pressure ventilator

C)

Volume ventilator

D)

Pressure ventilator

2.

A patient in the ICU is on a volume ventilator. The nurse recognizes that which of the following are true for this type of ventilator? Select all that apply.

A)

Peak inspiratory pressure varies from breath to breath and must be monitored closely.

B)

Amount of pressure depends on patients lung compliance and patient-ventilator resistance factors.

C)

The device fits like a tortoise shell, forming a seal over the chest.

D)

Exhaled tidal volume must be monitored closely.

E)

Volume varies based on changes in resistance or compliance.

F)

Small tidal volumes are used at frequencies greater than 100 breaths/minute.

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

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

5.

A patient with acute respiratory distress syndrome (ARDS) has been receiving ventilation in assist-control mode for the past 48 hours. The fraction of inspired oxygen (FiO2) is set to 70% and tidal volume is set to 15 mL/kg of body weight. What complication or complications should the nurse be most concerned about in this situation? Select all that apply.

A)

Barotrauma

B)

Oxygen toxicity

C)

Volutrauma

D)

Hypoxemia

6.

A patient with acute respiratory distress syndrome (ARDS) is receiving pressure-controlled ventilation with positive end-expiratory pressure (PEEP) of 10 cm H2O. Which of the following nursing interventions will help protect this patient from one of the complications of PEEP?

A)

Administration of antihypertensive medication

B)

Increased administration of IV fluids

C)

BiPAP ventilation via full facemask

D)

Increase tidal volume to 20 mL/kg of body weight

7.

A patient with chronic obstructive pulmonary disease has just been started on pressure-controlled ventilation with positive end-expiratory pressure (PEEP) of 18 cm H2O. The fraction of inspired oxygen is set to 50%. Which of the following is a sign of tension pneumothorax that the nurse should watch for?

A)

An abrupt decrease in peak inspiratory pressure

B)

Tracheal deviation from the midline

C)

Syncope

D)

Bradypnea

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 intubation

9.

A patient in the CCU is on a ventilator with oral intubation. The nurse notices that a pressure sore is forming on the patients lip where it comes into contact with the endotracheal tube. Which nursing action would be most appropriate?

A)

Reposition the endotracheal tube from one side to the other

B)

Retape the endotracheal tube

C)

Use twill tape

D)

Place an oral bite block in the patients mouth

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 method.

11.

The patient is scheduled for a lobectomy. As part of preoperative teaching, the nurse stresses the importance of coughing and deep breathing postoperatively. What positive outcome from this procedure does the nurse expect?

A)

Thicker and less mobile secretions

B)

Lower incidence of atelectasis

C)

Increased risk for pneumonia

D)

Increased need for pain medication

12.

The patient has consolidation of his right lateral lower lung segments and is receiving chest physiotherapy. What position is best for draining this portion of the lung?

A)

Semi-Fowlers

B)

Supine

C)

Left side-lying

D)

Right side-lying

13.

The patient is receiving supplemental oxygen therapy. What finding most clearly demonstrates achievement of one of the goals of oxygen therapy?

A)

Therapy is discontinued after 3 days.

B)

Increased respiratory rate and depth

C)

Verbalization of relief of dyspnea

D)

Reduction of arterial carbon dioxide pressure

14.

The patient is receiving supplemental oxygen therapy. What finding would be most indicative of a life-threatening complication of oxygen therapy?

A)

Increased somnolence

B)

Eupneic respirations

C)

SaO2 100%

D)

Skin irritation under mask

15.

The nurse is assisting with endotracheal intubation. In what circumstance would the nurse question the use of nasotracheal intubation?

A)

Confused patient

B)

Fractured mandible

C)

Acute sinusitis

D)

Possible cervical spine fracture

16.

After pulmonary surgery, the patient returns to the critical care unit with a left pleural chest tube in place connected to a disposable three-chamber unit that is connected to suction at negative 20 cm H2O. What must the nurse ensure so that the goal for chest tube placement is met?

A)

The water-seal chamber has the amount of water defined by the manufacturer.

B)

The suction control chamber has vigorous bubbling at all times.

C)

The drainage unit is prepared using sterile water only.

D)

Suction is applied between negative 10 and 20 cm H2O.

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

18.

The patient is to undergo chest tube placement. What is the best nursing intervention to prevent a complication of this procedure?

A)

Facilitate chest tube removal on day 3.

B)

Use the supine position during chest tube removal.

C)

Premedicate with an intravenous opioid.

D)

Keep drainage tubing off the bed.

19.

A patient with asthma is receiving a bronchodilator medication. If this therapy is helpful to the patient, the nurse would expect to find which of the following?

A)

Increased productiveness of cough

B)

More intense wheezing

C)

Persistent tachycardia

D)

Reduced peak expiratory flow rate

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.

21.

A patient in severe congestive heart failure is at risk for the development of acute respiratory failure and is receiving supplemental oxygen therapy. What nursing assessment parameter is most indicative of acute respiratory failure?

A)

Dependent pitting edema that is worsening

B)

New onset of systolic gallop

C)

Conversion to atrial fibrillation

D)

Arterial PaO2 45 mm Hg

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

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

24.

The patient is being supported with a positive-pressure mechanical ventilator set to a synchronized intermittent mandatory ventilation (SIMV) rate of 8 breaths per minute. What situation, if found by the nurse, would indicate a ventilator malfunction?

A)

SIMV rate 8, patient rate 30, total rate 38 breaths per minute

B)

SIMV rate 6, patient rate 2, total rate 8 breaths per minute

C)

SIMV rate 8, patient rate 0, total rate 8 breaths per minute

D)

SIMV rate 8, patient rate 8, total rate 16 breaths per minute

25.

The patient is being supported with mechanical ventilation and is requiring very high levels of inspired oxygen to maintain his arterial blood gases at acceptable levels. In an attempt to reduce the amount of oxygen required, positive end-expiratory pressure (PEEP) at 5 cm H2O is added to the ventilator settings. What is the most important effect of PEEP?

A)

Increases number of open alveoli

B)

Increases patient comfort

C)

Assists in ventilator weaning

D)

Compensates for tubing resistance

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

27.

A patient with multiple trauma and several other comorbidities is being supported with endotracheal intubation and mechanical ventilation and is scheduled for a tracheostomy. The family questions the appropriateness of this procedure. In explaining the rationale for the procedure to the family, what is the most important nursing point?

A)

There is a physicians order for the procedure.

B)

Unit protocol mandates tracheostomy after a patient has been intubated for 7 days.

C)

A tracheostomy will greatly increase the patients comfort.

D)

Tracheostomies at 3 to 7 days result in fewer ventilated days.

28.

As part of the care of a mechanically ventilated patient, the nurse provides oral and subglottic suctioning every 2 hours. What is the best rationale for this nursing action?

A)

Stimulates cough and deep breathing

B)

Reduces pulmonary microbial colonization

C)

Maintains oral mucosal moisture

D)

Part of Universal Precautions protocols

29.

The patient has been on a mechanical ventilator for 2 weeks. Weaning from mechanical ventilation is to start today. Based on the length of time that the patient has been ventilated, what information should the nurse emphasize to the patient and the family?

A)

Extubation is expected later today, as the patient is relatively young.

B)

Delays and setbacks are expected before independence is achieved.

C)

The best method is continuous positive airway pressure (CPAP).

D)

Elevation of the head of the bed will provide for the most patient comfort.

Answer Key

1.

B

2.

A, B

3.

D

4.

C

5.

A, B, C

6.

B

7.

B

8.

C

9.

A

10.

C

11.

B

12.

C

13.

C

14.

A

15.

C

16.

A

17.

D

18.

C

19.

A

20.

C

21.

D

22.

A

23.

D

24.

B

25.

A

26.

C

27.

D

28.

B

29.

B

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