Exam 2 Medsurg Pulm
(5).webp "Exam 2 Medsurg Pulm - Quiz")
- 1.
Which vital signs are associated with hypoxia (decreased oxygen at the tissues). Choose all 3 that apply)
- A.
Decreased heart rate
- B.
Increased respiratory rate
- C.
Decreased BP
- D.
Decreased respiratory rate
- E.
Increased heart rate
- F.
Increased BP
Correct Answer(s)
B. Increased respiratory rate
E. Increased heart rate
F. Increased BPExplanation
Hypoxia, or decreased oxygen at the tissues, can lead to compensatory mechanisms in the body. One of these mechanisms is an increased respiratory rate, as the body tries to take in more oxygen. Another mechanism is an increased heart rate, which helps to circulate the oxygenated blood more quickly. Additionally, increased blood pressure can occur as the body tries to maintain adequate blood flow to the tissues. Therefore, the correct answers are increased respiratory rate, increased heart rate, and increased blood pressure.Rate this question:
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- 2.
Which is a classic EARLY clinical presentation of asthma?
- A.
Increased respirations, expiratory wheezing.
- B.
Decreased respirations, fatigue
- C.
Decreased respirations, diminished or absent breath sounds.
- D.
Cough, elevated BP.
Correct Answer
A. Increased respirations, expiratory wheezing.Explanation
A classic early clinical presentation of asthma is characterized by increased respirations and expiratory wheezing. This is because asthma is a chronic inflammatory disease of the airways that causes the airways to become narrow and inflamed, making it difficult for air to flow in and out of the lungs. This leads to increased effort in breathing and the production of wheezing sounds during expiration.Rate this question:
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- 3.
Which of the following is NOT a normal value? (yes, use your cards)
- A.
O2 saturation of 96%.
- B.
PH of 7.4
- C.
PaO2 of 70.
- D.
End tidal CO2 of 42.
- E.
Option 5
Correct Answer
C. PaO2 of 70.Explanation
The normal value for PaO2 (partial pressure of oxygen in arterial blood) is typically between 75-100 mmHg. A value of 70 mmHg is slightly lower than the normal range, indicating a mild decrease in oxygen levels in the blood. Therefore, PaO2 of 70 is not a normal value.Rate this question:
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- 4.
Which of the following patients would be on droplet precautions?
- A.
The patient with impaired immunity due to HIV infection.
- B.
The patient with the Flu.
- C.
The patient with tuberculosis
- D.
The patient with suspected measles who has not been vaccinated.
Correct Answer
B. The patient with the Flu.Explanation
The patient with the Flu would be on droplet precautions because the flu is primarily spread through respiratory droplets when an infected person coughs, sneezes, or talks. Droplet precautions are necessary to prevent the transmission of respiratory infections that are spread by droplets larger than 5 microns in size. This includes wearing a mask, practicing proper hand hygiene, and maintaining a safe distance from others. Patients with impaired immunity due to HIV infection, tuberculosis, and suspected measles would require different precautions based on the specific mode of transmission for each of these diseases.Rate this question:
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- 5.
Which patient has a positive skin test reaction for TB?
- A.
A patient with an immunosuppressive condition/ illness (post-transplant/HIV infection) with an induration of 2mm or greater.
- B.
Any adult with an induration of 5mm after 24 hours.
- C.
An IV drug abuser with an induration of 5mm or greater.
- D.
A resident of a high risk setting (prison/shelter) with an induration >10mm after 48 hours.
Correct Answer
D. A resident of a high risk setting (prison/shelter) with an induration >10mm after 48 hours.Explanation
A resident of a high-risk setting (prison/shelter) with an induration greater than 10mm after 48 hours is considered to have a positive skin test reaction for TB. This is because individuals in high-risk settings are more likely to be exposed to TB, and a larger induration size indicates a stronger immune response to the TB antigen, suggesting a higher likelihood of TB infection.Rate this question:
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- 6.
Which patient is most at risk for atelectasis?
- A.
The patient with Asthma.
- B.
The post-operative patient who has not been out of bed in the first 12-24 hours post op.
- C.
The patient who is NPO.
- D.
The patient with heart failure and increased preload
Correct Answer
B. The post-operative patient who has not been out of bed in the first 12-24 hours post op.Explanation
The post-operative patient who has not been out of bed in the first 12-24 hours post op is most at risk for atelectasis. Atelectasis is the collapse or closure of the lung resulting in reduced or absent gas exchange. Post-operative patients who remain in bed for an extended period of time are more susceptible to atelectasis due to decreased lung expansion and decreased coughing and deep breathing. Early mobilization and ambulation are important in preventing atelectasis in post-operative patients.Rate this question:
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- 7.
Which of the following is true regarding a community acquired pneumonia?
- A.
It includes pneumonia that develops in long term care.
- B.
All of these are true.
- C.
It is ALWAYS viral.
- D.
It is diagnosed within 48 hours of hospital admission.
Correct Answer
D. It is diagnosed within 48 hours of hospital admission.Explanation
Community-acquired pneumonia refers to pneumonia that is acquired outside of a healthcare setting, such as in the community or at home. It is typically diagnosed within 48 hours of hospital admission because if pneumonia is diagnosed after 48 hours of admission, it is considered to be a healthcare-associated pneumonia. This is an important distinction to make as the treatment and management of community-acquired pneumonia may differ from healthcare-associated pneumonia.Rate this question:
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- 8.
When do you recommend your patient with COPD and acute pneumonia be given his annual flu vaccine?
- A.
This should be reviewed and considered at discharge
- B.
This should be reviewed and considered on admission.
- C.
This should be routinely administered 24 hours after the start of antibiotics
- D.
Flu vaccination is not a recommendation in patients with COPD.
Correct Answer
A. This should be reviewed and considered at dischargeExplanation
The correct answer is "This should be reviewed and considered at discharge." This is because the patient with COPD and acute pneumonia should receive their annual flu vaccine before they are discharged from the hospital. This is important because patients with COPD are at a higher risk of developing complications from the flu, and the vaccine can help prevent this. By reviewing and considering the flu vaccine at discharge, healthcare providers can ensure that the patient receives the vaccine in a timely manner to protect their health.Rate this question:
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- 9.
Which patient has a positive TB test?
- A.
The patient with AIDS with an induration of 5mm after 48 hours.
- B.
The patient with pneumonia with an induration of 5mm after 48 hours.
- C.
The patient with no risk factors with an induration of 5mm after 72 hours.
- D.
All of the above
Correct Answer
A. The patient with AIDS with an induration of 5mm after 48 hours.Explanation
The correct answer is the patient with AIDS with an induration of 5mm after 48 hours. This is because a positive TB test is indicated by an induration of 5mm or more after 48-72 hours. The other options do not mention any risk factors or conditions that would increase the likelihood of having TB.Rate this question:
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- 10.
In a patient with copious sputum and a weak cough what is your priority nursing diagnosis?
- A.
Risk for altered nutrition and dehydration.
- B.
Risk for infection and for altered gas exchange.
- C.
Altered breathing patterns (actual).
- D.
Ineffective airway clearance (actual) and potential for altered gas exchange.
Correct Answer
D. Ineffective airway clearance (actual) and potential for altered gas exchange.Explanation
The priority nursing diagnosis in a patient with copious sputum and a weak cough would be "Ineffective airway clearance (actual) and potential for altered gas exchange." This is because the patient's weak cough and excessive sputum indicate a difficulty in clearing the airway, which can lead to ineffective breathing and potential complications such as altered gas exchange. It is important for the nurse to address this issue promptly to ensure proper oxygenation and prevent further respiratory complications.Rate this question:
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- 11.
In a patient in asthma, which of the following is the MOST concerning assessment finding?
- A.
Increasing wheezing on auscultation.
- B.
HR increasing from 90-110 with bronchodilator treatments.
- C.
Increasing oxygen requirements (from 2liters to 4 liters) to maintain an Spo2 >93%
- D.
Decreasing breath sounds
Correct Answer
D. Decreasing breath soundsExplanation
The most concerning assessment finding in a patient with asthma is decreasing breath sounds. This could indicate a worsening of the condition and potential airway obstruction. It is important to monitor breath sounds closely as they can provide important information about the patient's respiratory status. Increasing wheezing on auscultation, an increase in heart rate with bronchodilator treatments, and increasing oxygen requirements can also be concerning, but decreasing breath sounds should be the most concerning finding in this case.Rate this question:
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- 12.
Which of the following would increase the risk of fluid volume deficit in a patient with pneumonia? (choose all that apply)
- A.
Fever
- B.
Tachypnea.
- C.
Decreased PO intake.
- D.
Cough/Pain.
Correct Answer(s)
A. Fever
B. Tachypnea.
C. Decreased PO intake.Explanation
Fever, tachypnea, and decreased PO intake can all increase the risk of fluid volume deficit in a patient with pneumonia. Fever causes increased sweating and evaporation, leading to fluid loss. Tachypnea, or rapid breathing, can result in increased respiratory water loss. Decreased PO intake, or reduced oral fluid intake, can lead to dehydration and fluid volume deficit. Cough and pain, however, do not directly contribute to fluid volume deficit in this context.Rate this question:
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- 13.
In which patients would airborne precautions be necessary
- A.
In the patient with known corona virus who is in the grocery store
- B.
In the patient with an exposure to corona virus in the ER
- C.
In the patient with corona virus who is being intubated
- D.
In none of these patients
Correct Answer
C. In the patient with corona virus who is being intubatedExplanation
Airborne precautions are necessary when there is a risk of transmission of infectious agents through small particles suspended in the air. Intubation is a high-risk procedure that can generate aerosols, increasing the chances of spreading the virus. Therefore, in the patient with corona virus who is being intubated, airborne precautions are necessary to protect healthcare providers and prevent the spread of the virus to other patients and individuals in the vicinity.Rate this question:
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- 14.
Prone positioning is a nursing measure used in the treatment of ARDS (and currently in corona virus) to…
- A.
Improve venous return, thereby decreasing the risks from high volume and high pressure ventilation.
- B.
Increase oxygenation by improving V-Q ratio and decreasing shunt.
- C.
Decrease the risk of skin breakdown often associated with this debilitating condition.
- D.
Ncrease surfactant production and decrease the production of inflammatory mediators.
Correct Answer
B. Increase oxygenation by improving V-Q ratio and decreasing shunt.Explanation
Prone positioning is a nursing measure used in the treatment of ARDS (and currently in corona virus) to increase oxygenation by improving V-Q ratio and decreasing shunt. By placing the patient in a prone position, the ventilation-perfusion (V-Q) ratio is improved, meaning that more oxygen can be delivered to the alveoli and more carbon dioxide can be eliminated. This helps to improve oxygenation and decrease the shunt, which is the portion of blood that bypasses the alveoli without participating in gas exchange.Rate this question:
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- 15.
The patient has a pH of 7.32, a C02 of 50, and a bicarb of 23. You should:
- A.
Explain to the patient that he has an uncompensated respiratory acidemia
- B.
Assess the patient’s breathing—this ABG indicates acute hypoventilation (decreased breathing)—assess for cause.
- C.
Begin CPR
- D.
Assess the patient for anxiety and hypoxia—the most likely causes of this acute respiratory complication (associated with over breathing).
Correct Answer
B. Assess the patient’s breathing—this ABG indicates acute hypoventilation (decreased breathing)—assess for cause.Explanation
The patient's ABG results show a pH of 7.32, a CO2 level of 50, and a bicarb level of 23. These values indicate an uncompensated respiratory acidemia, which means that there is an excess of carbon dioxide in the blood due to decreased breathing (hypoventilation). Therefore, it is important to assess the patient's breathing and determine the cause of this acute hypoventilation. This will help in identifying the underlying problem and providing appropriate treatment.Rate this question:
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- 16.
A patient is restless and confused, RR is 32 and shallow, O2 saturation is 90%, patient’s breathing pattern is paradoxical, BP and HR are elevated. Your priority of care—would be to…
- A.
Conduct a head to toe assessment
- B.
Place the patient in a position of comfort, increase Oxygen to the highest level you have an order for, stay with the patient ask for the physician to be called.
- C.
Place patient on 100% non-rebreather mask, attach ecg leads, call for a chest xray.
- D.
Go for help
Correct Answer
B. Place the patient in a position of comfort, increase Oxygen to the highest level you have an order for, stay with the patient ask for the physician to be called.Explanation
The correct answer is to place the patient in a position of comfort, increase oxygen to the highest level you have an order for, stay with the patient, and ask for the physician to be called. This is the priority of care because the patient is showing signs of respiratory distress, such as shallow and rapid breathing, low oxygen saturation, and paradoxical breathing pattern. Placing the patient in a position of comfort and increasing oxygen can help alleviate respiratory distress, while staying with the patient and calling the physician ensures that appropriate medical intervention can be provided.Rate this question:
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- 17.
Your patient has a left upper and lower lobe pneumonia. To optimize his oxygenation (and to improve V/Q matching) you would place him
- A.
Bolt upright in bed
- B.
Supine
- C.
On his left side with his head at 30 degrees
- D.
On his right side with his head at 30 degrees
Correct Answer
D. On his right side with his head at 30 degreesExplanation
Placing the patient on his right side with his head at 30 degrees would be the optimal position to improve oxygenation and V/Q matching in a patient with left upper and lower lobe pneumonia. This position helps to improve ventilation and perfusion in the affected lung areas by allowing gravity to assist with drainage and reducing the risk of aspiration. The right side position also helps to minimize compression of the left lung and facilitate better expansion of the right lung. Additionally, elevating the head at 30 degrees helps to reduce the risk of aspiration and improve lung function.Rate this question:
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- 18.
Long acting inhaled bronchodilators.. reduce exacerbations, hospitalzitionis, and improve symptoms and health status.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Long-acting inhaled bronchodilators are known to be effective in reducing exacerbations, hospitalizations, and improving symptoms and health status in patients with respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). These medications provide long-lasting relief by relaxing the muscles in the airways, allowing for easier breathing. By reducing exacerbations and hospitalizations, they can significantly improve the overall quality of life for individuals with these conditions. Therefore, the statement "long-acting inhaled bronchodilators reduce exacerbations, hospitalizations, and improve symptoms and health status" is true.Rate this question:
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- 19.
Pnemonia= increased HR increased RR
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Increased heart rate (HR) and increased respiratory rate (RR) are common physiological responses to pneumonia. Pneumonia is an infection that affects the lungs, causing inflammation and fluid buildup. As a result, the body tries to compensate by increasing the heart rate to pump more oxygen-rich blood to the affected areas. Additionally, the respiratory rate increases to facilitate faster breathing and oxygen exchange. Therefore, it is true that pneumonia can lead to increased HR and RR.Rate this question:
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- 20.
Pnemonia is not droplet
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
it is droplet.Rate this question:
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Apr 24, 2023Quiz Edited by
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Apr 03, 2020Quiz Created by
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