ECCO Caring for Patients with Pulmonary Disorders: Part 1 Questions and Answers Graded A

ECCO Caring for Patients with Pulmonary Disorders: Part 1 Questions and Answers Graded A Which may affect pulse oximetry accuracy? The absence of peripheral circulation in cardiac arrest prevents accurate monitoring with pulse oximetry. - Cardiac Arrest A nurse checks that a patient can remove the NIPPV mask in the event of emesis. What are other nursing care priorities for patients using NIPPV? - Check for dryness or irritation of eyes, nasal passages, and upper airway - Assess respiratory rate and depth, and changes in LOC - Examine skin for breakdown across nasal bridge or any pressure points. A patient with a hemothorax is admitted. Which intervention should the nurse anticipate? Attach chest tube drain to wall suction. Prepare for chest tube insertion. A patient with COPD on PEEP reports sudden chest pain. The nurse observes tracheal deviation, tachycardia, and shortness of breath. What other conditions should the nurse expect? - Decreased chest excursion on one side - Decreased partial pressure of O2 (PaO2) levels and increased partial pressure of (PaCO2) - Decreased oxygen saturation (SaO2) level *signs that indicate pneumothorax* For which of these patients requiring oxygen therapy is an air entrainment system indicated? With air entrainment masks, the percentage of oxygen to be delivered is set. A patient has the following ABG results: pH 7.25, PaCO2 43, PaO2 80, SaO2 91%, and HCO3^- 18. What is the most likely underlying cause Low pH and low HCO3 indicate a metabolic cause of the acidosis. Following a chest x-ray, for which report should the nurse notify the provider? ETT is positioned in the right mainstem bronchus. A patient with pulmonary artery hypertension is receiving epoprostenol. Which intervention is indicated? Maintaining the continuous infusion rate for epoprosternol is critical. Epoprostenol is a life-sustaining drug, and interruption of the infusion can lead to serve rebound of symptoms and even death. - Have the next bags tubing primed in advance. A patient who underwent a pneumonectomy is admitted. For which complication should the nurse observe? Increased cough with frothy sputum A patient who underwent a thoracotomy is admitted. Which intervention is indicated? Maintain patency of chest drainage system. Which ABG test result requires that the provider be notified immediately? A pH <7.2 is a critical value. Which patient in the immediate postoperative period should be given an NC? A patient requiring: FiO2 of 0.4 or less A patient with a history of COPD and pulmonary hypertension on conventional therapy develops worsening symptoms. Cardiac catheterization reveals elevated pulmonary vascular resistance and the PA pressure does not respond to calcium channel blockers or PDE-5 inhibitors. Which should the nurse initially anticipate? Epoprostenol (Floan) If the patient fails conventional therapies, other pharmacologic therapies specific to PAH include: prostacyclins, prostanoids, endothelin receptor antagonists (ERAs), phosphodiesterase (PDE) inhibitors, and guanylate cyclase simulator (GCS). For which complication should the nurse observe in a patient following bronchoscopy? Dysrhythmias Cardiac dysrhythmias may occur during or after a bronchoscopy. A patient with a hip fracture from a fall develops pleuritic chest pain, dyspnea, and dry cough. The patient's SPO2 is 90%. CTPA is positive for PE. The nurse should anticipate administration of which of the following? Unfractionated heparin A patient admitted 48 hours ago has a temperature of 38.9C (102F), cough with purulent sputum, crackles that don't clear, and decreased right lower lobe breath sounds. Which should the nurse anticipate? Broad-spectrum antibiotics Treatment for pneumonia is based on identifying the organism through sputum and blood cultures, and initiating appropriate antibiotic therapy. A broad-spectrum antibiotic will be initiated if the organism is unknown on admission. Which patient has an indication for ventilatory replacement? A patient with ABG results of: Indicators that the patient may require more advanced oxygen delivery/ventilatory replacement include changes in LOC, decreased pH, increased PaCO2, and decreased PaO2. - pH 7.20, PaO2 58, PaCO2 55, HCO2 24, SaO2 88%cf In a patient with pulmonary embolism, which sequelae should the nurse anticipate? Pulmonary emboli disrupt gas exchange and oxygenation, and cause right heart strain. - Right ventricular failure - Hypoxemia - Cardiac Ischemia Which patient is most likely to have an indication for a non-rebreather mask? A patient: With carbon monoxide poisoning Mr. DeMontel is admitted after a thoracotomy. He has a chest tube drainage system to his left chest with orders for suction at -20 cm H2O. What is the priority nursing assessment? Verify that the chest tube connection is secured. Connection of the chest tube to the drainage system is essential for lung expansion. A nurse caring for a patient with ARDS on BiPAP observes rapid progression of dyspnea and tachypnea with RR between 37 and 41. What intervention should the nurse anticipate? Call emergency response team for intubation. A patient post-thoracotomy develops a right tension pneumothorax. Which sign or symptom should the nurse anticipate? Tachycardia A tension pneumothorax alters the return circulation to the heart, causing tachycardia. A patient with respiratory failure following cardiac surgery has crackles in bilateral posterior lower lobes and a temperature of 38.6C (101.5F), and is on 4 L/min NC. Which three interventions will promote normal respiratory function? Adequate oxygenation, effective coughing, positioning, anxiety reduction and bronchodilators optimize gas exchange and airway functioning. - Reduce anxiety - Promote effective coughing - Keep PaO2 >60 mm Hg Which are nursing priorities for patient care before, during, or after thoracentesis? - Continually monitor vital signs and SpO2 - Position patient sitting on or lying near edge of bed. - Assist with attaching tube ti evacuation collection bottle. Vital signs and SpO2 monitoring is continuous. Positioning occurs prior to the procedure. Attaching the tubing to the evacuation collection bottle occurs during the procedure. A patient is admitted with COPD exacerbation. ABGs are: pH 7.28, PaO2 60 mm Hg, PaCO2 76 mm Hg, HCO3^- 27 mEq/L, and SaO2 86% on FiO2 50% via air entrainment device. Which treatment would you anticipate next? NIPPV A patient is admitted with tachycardia, wheezing, and a nonproductive cough. Which treatment(s) should the nurse anticipate? Bronchodilators Mrs. Elinskas is admitted for acute CHF with sharp chest pain, diminished breath sounds, cough, and orthopnea Which intervention should the nurse anticipate? Administering of furosemide (Lasix) Which patient has an indication for oxygen therapy with a low-flow device? A patient: - Who is postoperative for brain tumor removal A patient has declining SpO2 despite supplemental O2 and uncompensated respiratory acidosis. What is the priority action? - Call the provider immediately