Priorities in Critical Care Nursing, Test 2 2024
1. The nurse performs inspection of the oral cavity as part of a focused
pulmonary assessment to assess for evidence of what condition?: Hypoxemia
A normal finding
3. What chest wall deformity is characterized by an increase in
anteroposterior (AP) diameter with displacement of the sternum forward and
the ribs outward?: Barrel chest
4. A patient is admitted in respiratory distress secondary to pneumonia.
The nurse knows that obtaining a history is very important.
What is the appropriate intervention at this time for obtaining this data?:
Curtail the history to just a few questions about the patient's chief complaint and
precipitating events.
5. While conducting a physical assessment on a patient with chronic
obstructive pulmonary disease (COPD), the nurse notes that the patient's
breathing is rapid and shallow. What is this type of breathing pattern called?:
Tachypnea
6. Which condition is an example of a disorder with increased tactile
fremitus?: Pneumonia
7. When auscultating a patient's lungs, the nurse hears sounds that
sound like popping in the small airways. What should the nurse document
under breath sounds in the patient's record?: Crackles
8. A patient is admitted with acute respiratory failure secondary to
emphysema. Percussion of the lung fields will predictably exhibit which
tone?: Hyperresonance
9. A patient is admitted with acute respiratory failure secondary to
pneumonia. Upon auscultation, the nurse hears creaking, leathery, coarse
breath sounds in the lower anterolateral chest area during inspiration and
expiration. This finding is indicative of what condition?: Pleural effusion
10. A patient just involved in a motor vehicle accident has sustained blunt
chest trauma as part of his injuries. The nurse notes absent breath sounds
on the left side. A left-sided pneumothorax is suspected and is further
validated when assessment of the trachea reveals what finding?: A shift to
the right
11. The nurse is caring for a patient with respiratory failure. The nurse notes
the patient's diaphragmatic excursing is 8 cm. What coexisting conditions
could account for this finding?: Atelectasis and pleural effusion
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, 12. The nurse is observing a new nurse listen to a patient's lungs. Which
action by the new nurse indicates a need to review auscultation skills?: The
nurse listens only during inspiration.
13. The patient's arterial blood gas (ABG) values on room air are PaO2, 70
mm Hg; pH, 7.31; PaCO2, 52 mm Hg; and HCO3-, 24 mEq/L. What is the
interpretation of the patient's ABG?: Uncompensated respiratory acidosis
14 On admission, a patient presents with a respiratory rate of 24 breaths/min,
pursed-lip breathing, heart rate of 96 beats/min in sinus tachycardia, and a
blood pressure of 110/68 mm Hg. The patient's arterial blood gas (ABG) values
on room air are PaO2 , 70 mm Hg; pH, 7.38; PaCO2 , 52 mm Hg; and HCO3 - ,
34 mEq/L. Which diagnoses would be most consistent with the above arterial
blood gas values?: Chronic obstructive pulmonary disease
15. The patient's arterial blood gas (ABG) values on room air are PaO2, 40 mm
Hg; pH, 7.10; PaCO2, 44 mm Hg; and HCO3-, 16 mEq/L. What is the
interpretation of the patient's ABG?: Uncompensated metabolic acidosis
16. A patient presents moderately short of breath and dyspneic. A chest
radiographic examination reveals a large right pleural effusion with
significant atelectasis. The practitioner would be most likely to prescribe
which procedure?: Thoracentesis
17. A patient with severe unilateral pneumonia has been admitted with
severe hypoxemia. The nurse suspects the underlying cause of the
hypoxemia is which pathophysiologic process?: Intrapulmonary shunting
18. For which situation does a patient with acute lung failure require a
bronchodilator?: Bronchospasms
19. Supplemental oxygen administration is usually effective in treating
hypoxemia related to which situation?: Ventilation/perfusion mismatching
20. Which nursing intervention should be used to optimize oxygenation and
ventilation in the patient with acute lung failure?: Provide adequate rest time
between procedures.
21. A patient has been admitted with the diagnosis of acute respiratory
distress syndrome (ARDS). Arterial blood gasses (ABGs) revealed an
elevated pH and decreased PaCO2 . The patient is becoming fatigued, and the
practitioner orders a repeat ABG. Which set of results would be indicative of
the patient's current condition?: Decreased pH and elevated PaCO2
22. The practitioner indicates in her notes that the patient has mild adult
respiratory distress syndrome (ARDS). The patient is requiring mechanical
ventilation and has a PEEP of 5 cm H2 O. The nurse would anticipate the
patient having which finding?: PaO2/FiO 2ratio of 220 mm Hg
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1. The nurse performs inspection of the oral cavity as part of a focused
pulmonary assessment to assess for evidence of what condition?: Hypoxemia
A normal finding
3. What chest wall deformity is characterized by an increase in
anteroposterior (AP) diameter with displacement of the sternum forward and
the ribs outward?: Barrel chest
4. A patient is admitted in respiratory distress secondary to pneumonia.
The nurse knows that obtaining a history is very important.
What is the appropriate intervention at this time for obtaining this data?:
Curtail the history to just a few questions about the patient's chief complaint and
precipitating events.
5. While conducting a physical assessment on a patient with chronic
obstructive pulmonary disease (COPD), the nurse notes that the patient's
breathing is rapid and shallow. What is this type of breathing pattern called?:
Tachypnea
6. Which condition is an example of a disorder with increased tactile
fremitus?: Pneumonia
7. When auscultating a patient's lungs, the nurse hears sounds that
sound like popping in the small airways. What should the nurse document
under breath sounds in the patient's record?: Crackles
8. A patient is admitted with acute respiratory failure secondary to
emphysema. Percussion of the lung fields will predictably exhibit which
tone?: Hyperresonance
9. A patient is admitted with acute respiratory failure secondary to
pneumonia. Upon auscultation, the nurse hears creaking, leathery, coarse
breath sounds in the lower anterolateral chest area during inspiration and
expiration. This finding is indicative of what condition?: Pleural effusion
10. A patient just involved in a motor vehicle accident has sustained blunt
chest trauma as part of his injuries. The nurse notes absent breath sounds
on the left side. A left-sided pneumothorax is suspected and is further
validated when assessment of the trachea reveals what finding?: A shift to
the right
11. The nurse is caring for a patient with respiratory failure. The nurse notes
the patient's diaphragmatic excursing is 8 cm. What coexisting conditions
could account for this finding?: Atelectasis and pleural effusion
1/7
, 12. The nurse is observing a new nurse listen to a patient's lungs. Which
action by the new nurse indicates a need to review auscultation skills?: The
nurse listens only during inspiration.
13. The patient's arterial blood gas (ABG) values on room air are PaO2, 70
mm Hg; pH, 7.31; PaCO2, 52 mm Hg; and HCO3-, 24 mEq/L. What is the
interpretation of the patient's ABG?: Uncompensated respiratory acidosis
14 On admission, a patient presents with a respiratory rate of 24 breaths/min,
pursed-lip breathing, heart rate of 96 beats/min in sinus tachycardia, and a
blood pressure of 110/68 mm Hg. The patient's arterial blood gas (ABG) values
on room air are PaO2 , 70 mm Hg; pH, 7.38; PaCO2 , 52 mm Hg; and HCO3 - ,
34 mEq/L. Which diagnoses would be most consistent with the above arterial
blood gas values?: Chronic obstructive pulmonary disease
15. The patient's arterial blood gas (ABG) values on room air are PaO2, 40 mm
Hg; pH, 7.10; PaCO2, 44 mm Hg; and HCO3-, 16 mEq/L. What is the
interpretation of the patient's ABG?: Uncompensated metabolic acidosis
16. A patient presents moderately short of breath and dyspneic. A chest
radiographic examination reveals a large right pleural effusion with
significant atelectasis. The practitioner would be most likely to prescribe
which procedure?: Thoracentesis
17. A patient with severe unilateral pneumonia has been admitted with
severe hypoxemia. The nurse suspects the underlying cause of the
hypoxemia is which pathophysiologic process?: Intrapulmonary shunting
18. For which situation does a patient with acute lung failure require a
bronchodilator?: Bronchospasms
19. Supplemental oxygen administration is usually effective in treating
hypoxemia related to which situation?: Ventilation/perfusion mismatching
20. Which nursing intervention should be used to optimize oxygenation and
ventilation in the patient with acute lung failure?: Provide adequate rest time
between procedures.
21. A patient has been admitted with the diagnosis of acute respiratory
distress syndrome (ARDS). Arterial blood gasses (ABGs) revealed an
elevated pH and decreased PaCO2 . The patient is becoming fatigued, and the
practitioner orders a repeat ABG. Which set of results would be indicative of
the patient's current condition?: Decreased pH and elevated PaCO2
22. The practitioner indicates in her notes that the patient has mild adult
respiratory distress syndrome (ARDS). The patient is requiring mechanical
ventilation and has a PEEP of 5 cm H2 O. The nurse would anticipate the
patient having which finding?: PaO2/FiO 2ratio of 220 mm Hg
2/7
