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PCCN REVIEW - PULMONARY EXAM QUESTIONS AND ANSWERS

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PCCN REVIEW - PULMONARY EXAM QUESTIONS AND ANSWERS

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PCCN REVIEW - PULMONARY EXAM QUESTIONS
AND ANSWERS


Your patient had an exacerbation of COPD. The rapid response team was called and is curr
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




ently intubating the patient and preparing him for transfer to ICU. When the family visits, the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




y are shocked to see the people working with the patient. No one had told them the patient h
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




ad deteriorated and required intubation. After the patient is intubated and is being wheeled
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




past them, family members try to communicate verbally with the patient, but he does not res
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




pond except to gesture. The nurse should tell the family members:
xc xc xc xc xc xc xc xc xc xc




-They must leave the area because they are exciting the patient.
xc xc xc xc xc xc xc xc xc xc




-The tube used for breathing prevents the patient from speaking
xc xc xc xc xc xc xc xc xc




-They must speak with the doctor, who will explain why the patient cannot speak
xc xc xc xc xc xc xc xc xc xc xc xc xc




-The patient is very ill and may die. - ans-
xc xc xc xc xc xc xc xc xc




The tube used for breathing prevents the patient from speaking
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This is a case where communication is clearly the problem. The family should have been inf
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ormed by someone that the patient needed assistance with breathing and that they should
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




expect a transfer. It should also have been mentioned how the patient might look in the ICU.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




In addition, it could have been communicated about the patient's inability to speak.
xc xc xc xc xc xc xc xc xc xc xc xc xc




The other answers are all non-
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theraputic responses. The family is clearly distressed, so a simple explaination in best.
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Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




a time because of his ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




ess. Ben states, "I can't be here now. What if something like this happens to me again?" The
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nurse's best response would be:
xc xc xc xc xc




-The nurses in our unit can take care of you
xc xc xc xc xc xc xc xc xc




-We are not very far away at the nurses' station
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-Your insurance will not cover another day there
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-You sound concerned about leaving the ICU - ans-
xc xc xc xc xc xc xc xc




You sound concerned about leaving the ICU
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Theraputic communication occurs when the patient's feelings are validated. This response
xc xc xc xc xc xc xc xc xc xc xc




allows for the patient to express the concerns he has about the transfer. The other answers
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




are closed and judgmental and do not allow for any expression of feeling from the patient.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




a time because of his ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




ess. A set of blood gases drawn just prior to his transfer show:
xc xc xc xc xc xc xc xc xc xc xc xc

,pH 7.52, PaCO2 31, HCO3 22, PaO2 87.
xc xc xc xc xc xc xc




These results would indicate: xc xc xc




-Respiratory acidosis xc




-Respiratory alkalosis xc




-Metabloic acidosis xc




-Metabolic alkalosis - ans-Respiratory alkalosis xc xc xc xc




Ben was quite anxious and tachycardic. His RR probably was increased because of both a
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




nxiety and his condition. xc xc xc xc




He would blow off CO2.
xc xc xc xc xc




His pH is below normal, so it is uncompensated.
xc xc xc xc xc xc xc xc




The HCO3 is low, indicating alkalosis
xc xc xc xc xc




The interpretation would be:
xc xc xc




Uncompensated Respiratory Alkolosis
xc xc xc




Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




a time because of his ARDs. On arrival to your unit, you note that he is tachycardic and restl
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




ess. Ben is finally released from the hospital. He plans to visit his family in Denver. Part of th
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




e patient teaching for Ben should include information on the effects of high altitude on his ab
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




ility to oxygenate effectively. Which of the following changes would be expected on his bloo
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




d gas results?
xc xc




-The pH would decrease xc xc xc




-No effect xc




-The O2 saturation would decrease xc xc xc xc




-The PaO2 would increase - ans-The O2 saturation would decrease
xc xc xc xc xc xc xc xc xc




At higher altitudes, there is decreased atmospheric pressure to force oxygen into the lungs.
xc xc xc xc xc xc xc xc xc xc xc xc xc x




To compensate for the lower pressure, the person must breathe faster. The percentage of
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc




oxygen remains the same, but the partial pressure of the oxygen decreases. Aterial PaO2 d
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




ecreases, as does O2 saturation. The rapid breathing will result in hyperventillation, raising
xc xc xc xc xc xc xc xc xc xc xc xc xc




the pH and lowering the PaCO2 level.
xc xc xc xc xc xc




SaO2 values account for what % of O2 carreid within the bloodstream?
xc xc xc xc xc xc xc xc xc xc xc




-2-3%
-10-24%
-97-98%
-100% - ans-97-98% xc xc




The % of total oxygen carried within the bloodstream attributed to the SaO2 is 97-98%.
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc

,SaO2 is the arterial saturation of hemoglobin. The % corresponds to the
xc xc xc xc xc xc xc xc xc xc xc xc




% of hemoglobin on the red blood cells that carries O2. Typically this
xc xc xc xc xc xc xc xc xc xc xc xc xc




% is documented as normal when within 93-99%.
xc xc xc xc xc xc xc xc




PaO2 is the xc xc xc




% of O2 within the bloodstream that is free or dissolved in the plasma. This value is docume
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




nted in mmHg and is considered normal when within the range of 80-100 mmHg.
xc xc xc xc xc xc xc xc xc xc xc xc xc




Hypoxemia is best defined as: xc xc xc xc




-A decrease in O2 at the cellular level
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-A decrease in O2 levels in arterial blood
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-A decrease in O2 levels in venous blood
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-A decrease in O2 levels from the brain - ans-A decrease in O2 levels in arterial blood
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




Hypoxemia is a decrease in O2 levels in arterial blood or PaO2 < 80 mmHg. xc xc xc xc xc xc xc xc xc xc xc xc xc xc




Hypoxia is defined as a decreased oxygen level at the cellular level.
xc xc xc xc xc xc xc xc xc xc xc




Decreased O2 levels within veins refer to PaO2 < 50mmHg xc xc xc xc xc xc xc xc xc




Decreased O2 levels within the brain refer to ScVO2 < 20 xc xc xc xc xc xc xc xc xc xc




Your patient has been diagnosed with pulmonary HTN. Which of the following compensato
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ry mechanisms would be expected if the patient suffered from chronic hypoxia?
xc xc xc xc xc xc xc xc xc xc xc




-Polycythemia
-Hypoplasia of the pulmonary vasculature xc xc xc xc




-Thinning of blood vessels in the lungs xc xc xc xc xc xc




-Cor pulmonale - ans-Polycythemia
xc xc xc




Effects of acute hypoxia are reversible. xc xc xc xc xc




Chronic hypoxia causes permanent changes in the lungs and pulmonary vasculature (hype
xc xc xc xc xc xc xc xc xc xc xc




rplasia and hypertrophy). This will cause thickening of the blood vessels and will narrow the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




lumen. xc




Polycythemia develops and the blood viscosity increases. The increased number of cells w xc xc xc xc xc xc xc xc xc xc xc xc




ill be available to carry O2 but the increased viscosity will increase pressure in the pulmonar
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




y vasculature and force the right ventricle to pump harder to maintain the CO level. The right
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




venticle will hypertrophy and eventually weaken, and the patient will develop right heart fail
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




ure (cor pulmonale).
xc xc




Type II alveolar cells produce: xc xc xc xc




-Macrocytes
-Phagocytes
-Surfactant
-CO2 - ans-Surfactant xc xc




Surfactant is a lipoprotein that functions by increasing surface tension of alveoli and allow al
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




veoli to expand and contract. Some residual pressure should be present in the alveoli at the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc

, end of respiration to keep the alveoli open (physiologic PEEP). If surfactant production is im
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




paired, the alveoli's ability to exchange O2 is compromised.
xc xc xc xc xc xc xc xc




Type I cells line the outside of the alveoli.
xc xc xc xc xc xc xc xc




If you hear faint breath sounds on the left side of the chest and normal sounds on the right si
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




de immediately after your patient is intubated, most likely:
xc xc xc xc xc xc xc xc




-The patient has a tumor xc xc xc xc




-The doctor has intubated the esophagus
xc xc xc xc xc




-The ET is at the carina xc xc xc xc xc




-The right mainstem has been intubated - ans-The right mainstem has been intubated
xc xc xc xc xc xc xc xc xc xc xc xc




The right mainstem bronchus is somewhat wider and has less of an angle off the mainstem
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




bronchus, so it is much more readily intubated. xc xc xc xc xc xc xc




John is a 32 year old engineer that has been on hemodialysis for 3 years. He missed his last
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc x




2 treatments. He is lethargic, lacks stamina, and is very edematous. His ABGs show: pH 7.
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




30, PaCO2 32, HCO3 17, PaO2, 90.
xc xc xc xc xc xc




John's results indicate: xc xc




-Metabolic alkalosis xc




-Respiratory acidosis xc




-Metabolic acidosis xc




-Respiratory alkalosis - ans-Metabolic acidosis xc xc xc xc




More specifically, this ABG indicates an
xc xc xc xc xc xc




Uncompensated Metabolic Acidosis. xc xc xc




The pH is low, as is the PaCO2.
xc xc xc xc xc xc xc




You ask a fellow nurse to carry a newly drawn ABG specimen to the lab. She does not plave
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




the sample on ice. What effect will the lack of icing have on the sample:
xc xc xc xc xc xc xc xc xc xc xc xc xc xc




-None
-It will invalidate the sample
xc xc xc xc




-The pH will rise xc xc xc




-The PaCO2 will rise - ans-It will invalidate the sample
xc xc xc xc xc xc xc xc xc




The PaCO2 will rise approximately 3-10 mmHg per hour.
xc xc xc xc xc xc xc xc




The PaO2 and the pH will decrease.
xc xc xc xc xc xc




Your patient must have an ABG. The respiratory therapist says he is out of prepared syring
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




es, so he obtains a syringe into which he places heparin. What effect will too much heparin
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc




have on the sample, if any? xc xc xc xc xc

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