PCCN Exam Complete Solutions

PCCN Exam Complete Solutions what defines COPD? - ANSWER- a productive cough on most days of the week for at least 3 months total duration in 2 successive years What defines emphysema? - ANSWER- a permanent enlargement of the air spaces that are distal to the terminal bronchioles with destruction of lung parenchyma leading to loss of elastic recoil and loss of alveolar septa and lung hyperinflation. What is a bullae - ANSWER- an enlarged alveolar spaces 1 cm in diameter 2. When should vent circuits be changed? - ANSWER- When they are visible soiled or mechanically malfunctioning 3. Why is it necessary to keep a patient with an infection hydrated, more specifically pneumonia? - ANSWER- Because it keeps secretions thin and prevents them from becoming thick and tenacious. 4. what are three major factors that contribute to status asthmaticus? - ANSWER- Exposure to allergens Noncompliance with medication regimen Respiratory infection 5. What breath sounds can the RN expect to hear for a patient with status asthmaticus? - ANSWER- Inspiratory AND expiratory wheezing with prolonged expiration 5. Pulsus paradoxes is apparent in what two diagnosis? - ANSWER- Status asthmaticus & cardiac tamponade 6. What is pulsus paradoxes? - ANSWER- A drop in systolic blood pressure of 12 mmHg or more during inspiration 7. Why is helium (heliox) given to patients with severe status asthmaticus unrelieved by other medications? - ANSWER- Because it is less dense than nitrogen, and can reduce turbulent airflow across narrowed airways, thus decreasing the WOB and improving the delivery of medications that are inhaled. 8. Define pulmonary hypertension. What does its presence result in? - ANSWER- When the pressure in the pulmonary arteries is abnormally high—leads to R heart failure 9. What patient grouping is predisposed to pulmonary hypertension (GROUP I) - ANSWER- women are 3x more likely than men 10. What test is necessary to diagnose pulmonary hypertension? - ANSWER- Right heart catheterization What defines a "massive" PE? - ANSWER- one that occludes more than 50% of the pulmonary artery bed What predisposes a person to developing PE's? - ANSWER- Virchow's Triad: 1. damaged vascular endothelium 2. venous stasis 3. hyper coagulability of the blood What abnormal heart sound is expected with a pulmonary emboli? - ANSWER- s3 gallop What change occurs in PETCo2 with massive PE? - ANSWER- an abrupt decrease in PECO2 due to dead space ventilation. What patient subset are not candidates for use of LMWH? - ANSWER- patients with renal compromise What patient subsets are at risk for pulmonary aspiration? - ANSWER- 1. the elderly 2. patients with neurologic compromise (CVA, seizure, dementia) 3. head trauma 4. ETOH Overdose 5. vomiting 6. intestinal obstruction 7. GERD What might be causing crackles in the lungs following chest wall damage? - ANSWER- Retained secretions from increased mucous production accompanied by cellular debris and blood. This results in atelectasis and reduced motion of the chest wall. What does "V/Q" mean? - ANSWER- "V" - ventilation - the air that reaches the alveoli "Q" - perfusion - the blood that reaches the alveoli ***These two variables constitute the main determinants of the blood oxygen concentration What ABG change occurs in the case of inadequate tissue perfusion? - ANSWER- metabolic acidosis