PCCN PULMONARY EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 PCCN PULMONARY EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ Post cardiac arrest phase, titration of inspired oxygen to lowest level to achieve O2 sat? Correct Answer: 94% frail chest = multiple rib fractures Correct Answer: = see saw chest movement Pertussis (whooping cough) Correct Answer: -An airborne bacterial infection that affects mostly children younger than 6 years. Patients will be feverish and exhibit a "whoop" sound on inspiration after a coughing attack; highly contagious through droplet infection. -long episodes of cough until vomits -sputum= thick and white airway resistance Correct Answer: pressure difference between the mouth and the alveoli in relation to the rate of flow of inspired gas drug of choice for Tx pertussis 2 Correct Answer: macrolide antibiotics = azithromycin, clarithromycin and erythromycin Macrolides (thromycin) MOA Correct Answer: Inhibit protein synthesis by blocking translocation ("macroslides"); bind to the 23S rRNA of the 50S ribosomal subunit. Bacteriostatic. Gentimicin has what serious complications: Correct Answer: 1. ototoxicity 2. nephrotoxicity =oliguria or anuria 3. never given IV push, only drip 30-60 mins gentimicin effective against? Correct Answer: -gram-negative rods -staphylococci -e. coli -psudomonas aeruginosa Psudomonas aeruginosa Correct Answer: Gram Neg, motile, capsule Aerobic Found in water, soil, decaying veg, skin, MM, feces, Cause infection Opportunistic 3 Tx: based on culture/sensitivity Pulmonary artery pressure (PAP) Correct Answer: Normal Mean PAP 25 / 10 Normal PAP Systolic 20 to 35 Normal PAP diastolic 5 to 15 > than 35 / 15 is inconsistent with weaning. - indicates pulmonary hypertension. - Left ventricular failure. - Fluid overload. Sidenafil (Viagra) Correct Answer: phosphodiesterase inhibitor, potentiates action of nitrates b/c they inhibit breakdown of cGMP. Should not be taken within 6 hrs of nitrate Medication given orally to inhibit rapid rise in pulmonary artery pressure secondary to hypoxia? Correct Answer: sidenafil (Viagra) Laryngeal Mask Airway (LMA) Correct Answer: -An airway consisting of a tube and small mask that is fitted internally over the patient's larynx. 4 -must have an absent gag reflex -does not usually cause hoarseness, does not pass thru vocal cord -cannot be inserted by RN, unless special trained Aspirated content during cardiac arrest? Correct Answer: -onset of symptoms is gradual -may develop ARDS, but not always -if pH > 2.5, very little necrosis will occur -if pH < 2.5, may develop pulmonary edema, necrosis, bleeding, and atelctasis ARDS (acute respiratory distress syndrome) Correct Answer: respiratory insufficiency marked by progressive hypoxia aspiration pneumonitis Correct Answer: An acute lung injury after inhalation or aspiration of regurgitated gastric contents (reflux or emesis). The gastric acid causes a chemical injury rather than an infection. Pulse oximetry should never be used in? Correct Answer: -cardiac arrest -during CPR, blow flow varies 5 SpO2 vs. PaO2 Correct Answer: are not equal SpO2 (saturation of peripheral oxygen) Correct Answer: abbreviation for the percentage of hemoglobin that is saturated with oxygen in arterial blood as measured by a pulse oximeter PaO2 (partial pressure of arterial oxygen) normal range Correct Answer: -80-100 mm Hg -measured by ABGs ABGs Correct Answer: Arterial Blood Gases pH 7.35- 7.45 HCO3 (Bicarbonate) normal values 22-26 mEq/L PaCO2 ( CO2 or carbon dioxide content) 35-45 mm Hg PaO2 (oxygen saturation in arteria blood)- 80-100 mm Hg chest tube Correct Answer: Catheter inserted through the thorax into the chest cavity for removing air or fluid; used after chest or heart surgery or pneumothorax. Chest tube drainage system, suction level should not be higher than? 6 Correct Answer: suction level -40/H2O higher suction may cause reexpansion pulmonary edema, pleural air leaks, and lung entrapment Reexpansion pulmonary edema Correct Answer: Occurs in a lung that has been rapidly rei flayed from low lung volumes. Thoracentesis should be limited to 1000ml unless pleural pressures are monitored and not allowed to become less then -20cmh2o pleural effusion Correct Answer: abnormal accumulation of fluid in the pleural space mucolytic agents Correct Answer: Acetylcysteine (Mucomyst) Side effects of acetylcysteine include? Correct Answer: bronchospasm, due to excessive coughing Emphysema (COPD) Correct Answer: increases lung compliance Lung Compliance (CL) 7 Correct Answer: change in lung volume caused by a given change in transpulmonary pressure; the greater the lung compliance, the more readily the lungs are expanded An effective way to relieve bronchospasms? Correct Answer: -B-2 receptor agonist = lowers cellular calcium levels and relax bronchial smooth muscle. -Selective B-2 receptor agonist do not produce cardiac stimulation. What decreases lung compliance? Correct Answer: -pulmonary edema -pleural effusions -obesity What is the best position to place a patient to minimize the venous air embolism? Correct Answer: -Trendelenburg with left decubitus tilt Trendelenburg position Correct Answer: lying on back with body tilted so that the head is lower than the feet Venous air embolism Correct Answer: -IV catheters - PRIME TUBING, Penetrating chest trauma 8 -Lethal air bolus: 3-8mL/kg -Air after CVP line placement- *30% mortality* -Tx: left side lying trendelenburg 100% oxygen Risk factors for development of thrombolic emboli? Correct Answer: -carcinoma/neoplasm -obesity -trauma -dysrhythmias -CHF s-prolong immobility carcinoma Correct Answer: a malignant tumor that occurs in epithelial tissue Neoplasms Correct Answer: abnormal growths of new tissue that are classified as benign or malignant restrictive airway disease 9 Correct Answer: Conditions, such as pulmonary fibrosis, where patients experience difficulty expanding their lungs with air (inhaling), though usually with normal flow through the larger respiratory components, resulting in decreased airflow, lung volume, and blood oxygenation Indicates patient is suffering from acute respiratory distress? Correct Answer: Sternocleodomastoid retractions Sternocleodomastoid retractions Correct Answer: -using accessory muscles to facilitate ventilation Ceased wheezing during asthma attack? Correct Answer: indicates patient is in complete respiratory failure Wheezing not usually presented in? Correct Answer: pneumonia Slo-Bid and Theo-Dur Correct Answer: -form of theophylline -side effects = muscle cramps, jitterness, headache, nausea, vomiting, dysrhythmias and GI issues Long acting B2 agonist used for Tx of asthma? 10 Correct Answer: -salmeterol (Serevent) -formoterol (Foradil) Short acting B2 agonist used for Tx of asthma? Correct Answer: -albuterol -metaproterenol -levalbuterol AHA classification of acute pulmonary embolisms? Correct Answer: -massive = sustained BP< 90mmHg for more than 15 minutes, use of inotropes not the result of other causes, or signs of shock -submassive = evidence of right ventricular dysfunction or myocardial necrosis -low risk = no conditions mesothelioma Correct Answer: Rare malignant tumor arising in the pleura and associated with asbestos exposure. pulse oximetry is unreliable at what O2%? Correct Answer: under 70% oxyhemoglobin dissociation curve 11 Correct Answer: Relationship between available oxygen and amount of oxygen carried by hemoglobin. Theophyline Toxicity Correct Answer: Hypotension, Albuminuria, Tachycardia and Anorexia 10-20 ABG sample with small amounts of heparin. Effect? Correct Answer: -decrease the bicarbonate Theophylline measured in? Correct Answer: -mcg/ml -0.5 mg/kg given = 1mcg/ml in blood theophylline levels Patients taking theophylline should avoid? Correct Answer: -high protein, low carbohydrate diet = increase theophylline elimination = low serum levels Cough and dyspnea after thoracentesis > 1000ml? Correct Answer: Reexpansion pulmonary edema A measurement of total oxygen consumption is? Correct Answer: SvO2 12 Non-rebreather mask Correct Answer: allows higher levels of oxygen to be added to the air taken in by the patient Hyperoxia Correct Answer: excess oxygen in the blood Chronic hypoxia leads to? Correct Answer: -respiratory acidosis -increase of sodium bicarbonate levels -decrease in chloride levels hypoxemia Correct Answer: decreased level of oxygen in the arterial blood hypoxia Correct Answer: decreased level of oxygen in the cellular level respiratory alkalosis Correct Answer: -hyperventilation -unable to get enough oxygen -due to bronchial constriction 13 respiratory acidosis Correct Answer: A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2. Heliox Correct Answer: -mixture of helium and oxygen -tx of status ath agonal gasps Correct Answer: abnormal breathing pattern characterized by slow, gasping breaths, sometimes seen in patients in cardiac arrest residual volume Correct Answer: Amount of air remaining in the lungs after a FORCED exhalation functional residual capacity Correct Answer: volume of air remaining in the lungs after a normal tidal volume expiration Gas exchange between atmosphere, alveoli, and pulmonary vasculature? Correct Answer: passive diffusion Effect of fever on ABGs? 14 Correct Answer: -pH will rise -fever causes oxyhemoglobin curve to shift to the right -more oxygen will be given off to the tissues -ABG machine has to calibrate to account for the temperature Type 1 alveolar epithelial cells Correct Answer: -forms a barrier for alveoli -easily inflamed by inhaled toxins or heated air -maintain blood-gas interface. type 2 aveolar cells Correct Answer: secrete surfactant Alveolar pores (of Kohn) Correct Answer: communicating channels through holes in the alveolar wall allowing gas movement between alveoli A Dx of asthma can be made by? Correct Answer: -a decrease of FEV1 FEV1 Correct Answer: forced expiratory volume in one second 15 FiO2 of room air Correct Answer: 21% FiO2 calculation Correct Answer: -room air = 20% -each O2 liter = 4% -example: 6L NC = 20% (room air) + 6(NC liter) multiple by 4% = Fi02 of 44% Non-rebreather mask at 10-15L flow rate. What percentage of oxygen delivered? Correct Answer: 60-80% Pleur Evac Drainage System Correct Answer: -auto-transfusion connection -make sure all clamps are open Home O2 tanks Correct Answer: -store tanks in upright position -do not wear synthetic material = static electricity -only lemon-glycerin swabs, not alcohol Excessive ventilation during cardiac arrest may? Correct Answer: -cause cerebral vasocontriction -decrease cardiac output 16 -increase intrathoracic pressure Best position for a patient with ARDS? Correct Answer: -prone position prone position Correct Answer: lying on abdomen, facing downward (head may be turned to one side) dyspnea on exertion Correct Answer: difficulty breathing upon movement/ambulation Pulmonary hypertension s/s? Correct Answer: -dyspnea on exertion -right side HF -increased respiratory/heart rate -fatigue/lethargy -enlarge liver -pulmonary congestion -cyanosis= late sign of pulmonary hypertension Pulmonary Hypertension Treatment Correct Answer: Control underlying disease process if possible Oxygen administration to decrease vasoconstriction 17 Avoidance of exercise/exertion Vasodilators/diuretics Calcium Channel Blocker = Viagra-off label treatment Advanced PH is irreversible Lung or heart/lung transplant only option Pulmonary hypertension, untreated? Correct Answer: increased right ventricular pressure Pulmonary hypertension, screening for collagen vascular disease and coagulation disorders? Correct Answer: -increase risk of blood pooling due to decrease blood flow Rapid Sequence Intubation (RSI) Correct Answer: -A specific set of procedures, combined in rapid succession, to induce sedation and paralysis and intubate a patient quickly. -Contraindications = (1) total loss of facial and/or oropharyngeal landmarks (2) total upper airway obstruction. Both require surgical intervention Sillick maneuver with Rapid Sequence Intubation RSI Correct Answer: -prevent vomiting and aspiration of gastric content Sv02 18 Correct Answer: Mixed Venous Oxyhemoglobin Obtained from Pulmonary Artery (60-75%) more desaturated than SCV02 because it has passed through the heart and Coronary arteries 02 usage at tissue level. pulmonary function tests (PFTs) Correct Answer: tests that measure the ventilation mechanics of the lungs: airway function, lung volume, and the capacity of the lungs to exchange oxygen and carbon dioxide efficiently Vital Capacity (VC) Correct Answer: amount of air exhaled after a maximal inspiration Functional Residual Capacity (FRC) Correct Answer: volume of air remaining in the lungs after a normal tidal volume expiration Ketamine (Ketalar) Correct Answer: Classification: General anesthetic Action: Produces a state of anesthesia while maintaining airway reflexes, heart rate, and blood 19 pressure. Indications: Pain and as anesthesia for procedures of short duration. Adverse Effect: hypotension and sinus bradycardia, other cardiac arrhythmias {rare), respiratory depression, Contraindications: Patients in whom a significant elevation in blood pressure would be hazardous {hypertension, stroke, head trauma, increased intracranial mass or bleeding, Ml). Use with caution in patients with increased ICP or increased intraocular pressure {glaucoma) and patients with hypovolemia, dehydration, or cardiac disease {especially angina and CHF). Dosage: Administer slowly over a period of 60 seconds. IV, 10: • Adult: 1 to 4.5 mg/kg IV/10. 1 to 2 mg/kg produces anesthesia typically within 30 seconds that typically lasts 5 to 10 minutes. Special Considerations: Pregnancy class C Promotes upper lung lobes draining? Correct Answer: semi reclining/ upright position hemothorax, proper location of chest tube? Correct Answer: fifth intercostal space, midaxillary line 20 Hypoxemic drive Correct Answer: aortic and carotid arteries carbon monoxide poisoning Correct Answer: -severe = carboxyhemogloblin levels higher than 20-40% -comatose/die = carboxyhemogloblin levels higher than 60% -smokers = 5-10% -normal = 2% subcutaneous emphysema (crepitus) Correct Answer: -Air escapes into the tissues, dissects fascial planes under the skin and accumulates making areas appear puffy. Slight finger pressure produces a crackling sound and feel. Lightly dot the area. -usually in the thorax -may result from positive pressure vent, rupture alveoli, pneumothorax absorption atelectasis Correct Answer: alveolar collapse that occurs when high concentrations of oxygen are given and oxygen replaces nitrogen in the alveoli; if airway obstruction occurs, the oxygen is absorbed into the bloodstream and the alveoli collapse. positive PPD test 21 Correct Answer: Indicates patient has been exposed to TB at sometime but does not indicate a patient is actively contagious. Chest X-ray should be done to look for presence of TB. Rimantadine Correct Answer: Antiviral, tx influenza TB medications Correct Answer: Isoniazid Rifampin Pyrazinamide Ethambutol