NUR 430 NCLEX Questions Exam 2(Answered)100% correct

Which manifestation is not associated with the exudative phase of acute lung injury? A) Increased airway resistance and work of breathing B) Cellular granulation and deposits of collagen in the capillary membrane C) Loss of surfactant, resulting in alveolar collapse D) Development of interstitial edema B) Cellular granulation and deposits of collagen in the capillary membrane All are pathophysiologic manifestations of the exudative phase except cellular granulation and deposits of collagen in the capillary membrane, which occurs during the fibroproliferative phase as healing begins. Mr. D, a 28-year-old man, has been admitted to the intensive care unit for monitoring after a motor vehicle accident (MVA). Your physical assessment reveals multiple abrasions and bruising across the chest but an otherwise healthy young man. Suddenly, Mr. D complains of difficulty breathing. You quickly perform an assessment of his respiratory status and observe that his O2 saturation has dropped dramatically, there are decreased breath sounds on the left, and it appears that there is some tracheal deviation. What would be your next logical action? A) Notify Mr. D's physician and prepare for a stat V/Q scan. B) Start Mr. D on O2 at 4 L/min nasal cannula and prepare an aminophylline drip. C) Call the rapid response team and prepare for emergency insertion of a chest tube. D) Notify Mr. D's physician of these changes. C) Call the rapid response team and prepare for emergency insertion of a chest tube. The signs and symptoms Mr. D is experiencing are classic indications of development of a pneumothorax. The characteristics that particularly differentiate this diagnosis are the bruising on the chest after MVA and the deviated trachea. 00:43 01:01 Risk factors for pulmonary thromboembolism include the following predisposing factors except: A) ischemia. B) injury to the endothelial lining of blood vessels. C) hypercoagulable states. D) venous stasis. A) ischemia. Risk factors for pulmonary thromboembolism include the following predisposing factors: venous stasis such as in atrial fibrillation, decreased cardiac output, and immobility; injury to the vascular endothelium, such as in local vessel injury, infection, and atherosclerosis; and hypercoagulability, such as in polycythemia. Which statement is true regarding status asthmaticus? A) Initial arterial blood gas levels indicate severe hypoxemia and respiratory acidosis. B) Low-flow oxygen therapy should be used cautiously in patients with asthma. C) Small, frequent doses of bronchodilators should be started immediately. D) Corticosteroids, although useful in the treatment of status asthmaticus, usually require 6 to 8 hours to take effect. D) Corticosteroids, although useful in the treatment of status asthmaticus, usually require 6 to 8 hours to take effect. The onset of action of corticosteroids is 6 to 8 hours. A patient in status asthmaticus often initially presents with alkalosis caused by tachypnea and hyperventilation, but as fatigue sets in, hypoventilation and hypercapnia result in acidosis. These patients often require high-flow oxygen therapy and high-dose bronchodilators. Ms. H has been in the MICU for 3 days now with a diagnosis of pneumonia. She is being treated with antibiotics, 50% oxygen, and vigorous pulmonary toilet. Despite your best efforts, her condition continues to get worse. Which of the following would indicate the development of acute respiratory distress syndrome (ARDS)? A) Initially, the Paco2 is elevated on arterial blood gas analysis. B) Arterial blood gas analysis reveals a low Pao2 despite increases in supplemental oxygen. C) Chest radiography shows evidence of pulmonary hypertension. D) Respiratory acidosis is present initially on arterial blood gas analysis. B) Arterial blood gas analysis reveals a low Pao2 despite increases in supplemental oxygen. Arterial blood gas analysis reveals a low Pao2 despite increases in supplemental oxygen administration (refractory hypoxemia). Initially, the Paco2 is low as a result of hyperventilation, but eventually, the Paco2 increases as the patient fatigues. The pH is high initially but decreases as respiratory acidosis develops. Initially, the chest radiography findings may be normal because changes in the lungs do not become evident for up to 24 hours. As the pulmonary edema becomes apparent, diffuse, patchy interstitial and alveolar infiltrates appear. This progresses to multifocal consolidation of the lungs, which appears as a "whiteout" on the chest radiographs. A mechanically ventilated patient has a fever, P/F ratio of 230, and a pulmonary artery occlusive pressure of 15 mm Hg. The patient is coughing and triggering the high-pressure alarm on the ventilator. The radiologist has notified the nurse that the patient's feeding tube is in the right lung, and the patient has developed bilateral infiltrates on the radiograph. The nurse is concerned that the patient is developing: A) acute pulmonary embolism. B) acute lung injury. C) pneumothorax. D) inadequate nutrition. B) acute lung injury The patient is showing signs of acute lung injury brought on by the direct lung injury from the misplaced feeding tube. There is no evidence of a pulmonary embolism. A pneumothorax would have shown up on the radiograph as a unilateral problem, not a diffuse infiltrate. Nutrition is not the immediate concern at this moment. Which mode of ventilation uses low tidal volume in conjunction with normal respiratory rates to limit the effects of barotraumas in patients with adult respiratory distress syndrome (ARDS)? A) Assist control (A/C) ventilation B) Permissive hypercapnia C) Pressure control ventilation (PCV) D) Continuous positive airway pressure (CPAP) B) Permissive hypercapnia Permissive hypercapnia is the mode with "normal" rates (not increased) and small tidal volumes to allow the CO2 levels to increase. A/C ventilation has a preset tidal volume that the patient gets from the ventilator whether he or she breathes extra or allows the machine to deliver all breaths. PCV sets an inspiratory pressure rather than a tidal volume. CPAP delivers oxygen and a pressure above baseline to keep the alveoli inflated and prevent atelectasis. The sputum culture obtained on admission shows Streptococcus pneumonia in a patient with a history of coronary artery disease and alcoholism. The nurse reflects that the patient has: A) hospital-acquired pneumonia (HAP). B) community-acquired pneumonia (CAP). C) bilateral pneumonia. D) ventilator-associated pneumonia (VAP). B) community-acquired pneumonia (CAP). The patient has CAP. The culture was obtained on admission, S. pneumoniae is a commonly acquired pathogen, and the patient has comorbidities that could lead to CAP. The patient was not in the hospital longer than 48 hours or on the ventilator, and there is no mention of the radiography report describing the location of the pneumonia. The nurse is discussing the pharmacologic treatment of a pulmonary embolism (PE) with a nursing student. Which statement made by the nursing student indicates that the education was effective? A) "Heparin is administered to break down the existing clots." B) "Heparin is titrated to achieve a prothrombin time of two to three times the control value." C) "Heparin should be continued until the warfarin is started." D) "Streptokinase can be used to treat patients with massive pulmonary embolism and hemodynamic instability." D) "Streptokinase can be used to treat patients with massive pulmonary embolism and hemodynamic instability." Streptokinase is a fibrinolytic reserved for severe PE. Heparin is administered to prevent further clots from forming and has no effect on the existing clot. The heparin should be adjusted to maintain the activated partial thromboplastin time (aPTT) in the range of two to three times of upper normal. Warfarin should be started at the same time, and when the international normalized ratio (INR) reaches 3.0, the heparin should be discontinued. The INR should be maintained between 2.0 and 3.0. Mr. Z is admitted with acute lung failure. Which statement describes appropriate action for optimizing his oxygenation and ventilation? A) Place Mr. Z in a supine position. B) Allow Mr. Z to rest in between nursing interventions. C) Perform vigorous postural drainage and chest percussion to facilitate secretion clearance. D) Make sure Mr. Z coughs every 2 hours even if he has no secretions. B) Allow Mr. Z to rest in between nursing interventions.