FCCN LEVEL 1 TEST PAPER UPDATED EXAM QUESTIONS
AND SOLUTIONS RATED A+
✔✔P/F ratio - ✔✔tells us the degree of sickness of our pt's lungs, and helps assess
oxygenation
PaO2/FiO2
normal is 300-500
✔✔pneumonia - ✔✔inflammation of the lungs due to presence of infection. alveoli fill
with sludge, leading to poor ventilation and oxygenation
✔✔types of pneumonia - ✔✔-Community Acquired: onset in the community
-Hospital Acquired: 48 hrs or longer after hospital admission
-Ventilator associated: within 48-72 hrs of intubation
-Aspiration: breathing in food or liquid
✔✔pneumonia s/s - ✔✔-cough, likely productive
-fatigue
-fever/chills
-chest pain with respirations
-SOB
✔✔pneumonia treatment - ✔✔-antibiotic therapy based on culprit organism (sputum
sample)
-respiratory cares (cough/deep breathe, incentive spirometry, mobilization)
-respiratory assessments (lung sounds, pulse ox, how do they look)
-symptom management (fever reducers, nebs, cough medicine, pain relief)
✔✔does your pt need to be intubated? - ✔✔clinical signs: tachypnea, accessory muscle
use, anxiety, air hunger, inability to clear seretions, labored breathing
labs: low PaO2, elevated or low CO2
✔✔COPD - ✔✔bronchitis and emphysema
progressive disease, most commonly caused by cigarette smoke
less air flows in and out of airways because: alveoli lose their elasticity, lining of airways
becomes thick and inflamed, excess mucous is produced
✔✔COPD exacerbation s/s - ✔✔productive cough, SOB, wheezing, chest tightness
tachypnea, dyspnea, orthopneic, barrel chest
,✔✔COPD exacerbation treatment - ✔✔-bronchodilators (open airway)
-steroids (decrease inflammation of airways)
-antibiotics (if needed depending on cause of exacerbation)
-CPAP or BiPAP (positive pressure ventilation)
✔✔steroids nursing considerations - ✔✔hyperglycemia, adrenal function, hypokalemia
✔✔pneumothorax - ✔✔accumulation of air in the pleural space
can be caused by trauma, surgery, or idiopathic
✔✔spontaneous pneumothorax - ✔✔pneumothorax that occurs when a weak area on
the lung ruptures in the absence of major injury, allowing air to leak into the pleural
space
✔✔tension pneumothorax - ✔✔a type of pneumothorax in which air that enters the
chest cavity is prevented from escaping
✔✔hemothorax - ✔✔blood in the pleural cavity
✔✔pneumothorax s/s - ✔✔-dyspnea
-tachypnea
-pleuritic chest pain
-tachycardia
-restlessness
-decreased chest wall movement
-progressive cyanosis
-absent breath sounds unilaterally
✔✔pneumothorax treatment - ✔✔-supplemental O2
-evacuation of the air from the pleural space w/ large bore needle decompression
-chest tube insertion 2nd intercostal space, mid-clavicular line. placed to chest drainage
system that provides water-seal and suction
✔✔ARDS - ✔✔-hypoxemia within 7 days of pulmonary insult
-alveoli fill with fluid and may collapse
-bilateral opacities that isn't explained by pleural effusions, pneumothorax, or pulmonary
nodules
-respiratory failure not attributed to volume overload
-mild, moderate or severe P/F ratios in presence of PEEP
✔✔distinguish ARDS from CHF - ✔✔check BNP and edema which may indicate CHF is
the cause
, look at lung films and for a pulmonary insult within the last 7 days which may indicate
ARDS
✔✔ARDS severity - ✔✔look at P/F ratio
mild: 200-300
moderate: 100-200
severe: <100
✔✔injury to alveoli - ✔✔-causes release of proinflammatory cytokines
-cytokines recruit neutrophils to the lungs
-neutrophils become active and release toxic mediators
-damage to capillary endothelium and alveolar epithelium
-proteins leak out from vascular space
-normal oncotic gradient, fluid doesn't stay where it should. gets into airways and
interstitial spaces
✔✔ARDS s/s - ✔✔-hypoxemia after pulmonary insult
-bilateral opacities
-crackly lungs
-diaphoresis
-chest pain
-cough
-accessory muscle use
-rapid deterioration
-increasing demand for supplemental oxygen
✔✔ARDS treatment - ✔✔-treat underlying cause
-prevent progression of lung injury
-promote gas exchange
-high pressure ventilation (PEEP)
-high level O2 therapy to keep PaO2 >60
-support tissue oxygenation
-prevent complications
✔✔ARDS management strategies - ✔✔-low tidal volume ventilation
-recruit PEEP
-monitor plateau pressure
-pulmonary vasodilatos
-neuromuscular blockers
-proning
-ECMO
✔✔low tidal volume ventilation - ✔✔goal is <6mL/kg to prevent over distending alveoli.
helps sustain surfactant production
AND SOLUTIONS RATED A+
✔✔P/F ratio - ✔✔tells us the degree of sickness of our pt's lungs, and helps assess
oxygenation
PaO2/FiO2
normal is 300-500
✔✔pneumonia - ✔✔inflammation of the lungs due to presence of infection. alveoli fill
with sludge, leading to poor ventilation and oxygenation
✔✔types of pneumonia - ✔✔-Community Acquired: onset in the community
-Hospital Acquired: 48 hrs or longer after hospital admission
-Ventilator associated: within 48-72 hrs of intubation
-Aspiration: breathing in food or liquid
✔✔pneumonia s/s - ✔✔-cough, likely productive
-fatigue
-fever/chills
-chest pain with respirations
-SOB
✔✔pneumonia treatment - ✔✔-antibiotic therapy based on culprit organism (sputum
sample)
-respiratory cares (cough/deep breathe, incentive spirometry, mobilization)
-respiratory assessments (lung sounds, pulse ox, how do they look)
-symptom management (fever reducers, nebs, cough medicine, pain relief)
✔✔does your pt need to be intubated? - ✔✔clinical signs: tachypnea, accessory muscle
use, anxiety, air hunger, inability to clear seretions, labored breathing
labs: low PaO2, elevated or low CO2
✔✔COPD - ✔✔bronchitis and emphysema
progressive disease, most commonly caused by cigarette smoke
less air flows in and out of airways because: alveoli lose their elasticity, lining of airways
becomes thick and inflamed, excess mucous is produced
✔✔COPD exacerbation s/s - ✔✔productive cough, SOB, wheezing, chest tightness
tachypnea, dyspnea, orthopneic, barrel chest
,✔✔COPD exacerbation treatment - ✔✔-bronchodilators (open airway)
-steroids (decrease inflammation of airways)
-antibiotics (if needed depending on cause of exacerbation)
-CPAP or BiPAP (positive pressure ventilation)
✔✔steroids nursing considerations - ✔✔hyperglycemia, adrenal function, hypokalemia
✔✔pneumothorax - ✔✔accumulation of air in the pleural space
can be caused by trauma, surgery, or idiopathic
✔✔spontaneous pneumothorax - ✔✔pneumothorax that occurs when a weak area on
the lung ruptures in the absence of major injury, allowing air to leak into the pleural
space
✔✔tension pneumothorax - ✔✔a type of pneumothorax in which air that enters the
chest cavity is prevented from escaping
✔✔hemothorax - ✔✔blood in the pleural cavity
✔✔pneumothorax s/s - ✔✔-dyspnea
-tachypnea
-pleuritic chest pain
-tachycardia
-restlessness
-decreased chest wall movement
-progressive cyanosis
-absent breath sounds unilaterally
✔✔pneumothorax treatment - ✔✔-supplemental O2
-evacuation of the air from the pleural space w/ large bore needle decompression
-chest tube insertion 2nd intercostal space, mid-clavicular line. placed to chest drainage
system that provides water-seal and suction
✔✔ARDS - ✔✔-hypoxemia within 7 days of pulmonary insult
-alveoli fill with fluid and may collapse
-bilateral opacities that isn't explained by pleural effusions, pneumothorax, or pulmonary
nodules
-respiratory failure not attributed to volume overload
-mild, moderate or severe P/F ratios in presence of PEEP
✔✔distinguish ARDS from CHF - ✔✔check BNP and edema which may indicate CHF is
the cause
, look at lung films and for a pulmonary insult within the last 7 days which may indicate
ARDS
✔✔ARDS severity - ✔✔look at P/F ratio
mild: 200-300
moderate: 100-200
severe: <100
✔✔injury to alveoli - ✔✔-causes release of proinflammatory cytokines
-cytokines recruit neutrophils to the lungs
-neutrophils become active and release toxic mediators
-damage to capillary endothelium and alveolar epithelium
-proteins leak out from vascular space
-normal oncotic gradient, fluid doesn't stay where it should. gets into airways and
interstitial spaces
✔✔ARDS s/s - ✔✔-hypoxemia after pulmonary insult
-bilateral opacities
-crackly lungs
-diaphoresis
-chest pain
-cough
-accessory muscle use
-rapid deterioration
-increasing demand for supplemental oxygen
✔✔ARDS treatment - ✔✔-treat underlying cause
-prevent progression of lung injury
-promote gas exchange
-high pressure ventilation (PEEP)
-high level O2 therapy to keep PaO2 >60
-support tissue oxygenation
-prevent complications
✔✔ARDS management strategies - ✔✔-low tidal volume ventilation
-recruit PEEP
-monitor plateau pressure
-pulmonary vasodilatos
-neuromuscular blockers
-proning
-ECMO
✔✔low tidal volume ventilation - ✔✔goal is <6mL/kg to prevent over distending alveoli.
helps sustain surfactant production
