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Clinical Manifestations and Assessment of Respiratory Disease > Chapter 21 Pulmonary vascular disease and 22 Flail Chest > Flashcards

Chapter 21 Pulmonary vascular disease and 22 Flail Chest Flashcards

1
Q

The death of lung tissue that may result from an obstruction of the pulmonary artery is called a:

A

pulmonary infarction.

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2
Q

Bronchospasm may happen after a pulmonary embolism. Which of the following can lead to this bronchospasm?

  1. Localized hypoxemia
  2. Localized hypercapnia
  3. Localized hypocapnia
  4. Release of cellular mediators from platelets
A

1, 3, 4

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3
Q

A pulmonary embolism causes which of the following major pathologic and structural changes in the lungs?

  1. Alveolar consolidation
  2. Mucosal edema
  3. Alveolar atelectasis
  4. Pleural friction rub
A

1, 3

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4
Q

All of the following are associated with the formation of a deep vein thrombosis (DVT) EXCEPT:

a. blood vessel injury.
b. age greater than 40 years.
c. hypercoagulability.
d. venous stasis.

A

age greater than 40 years

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5
Q

Predisposing factors of pulmonary emboli include:

  1. varicose veins.
  2. smoking.
  3. obesity.
  4. congestive heart failure
A

1, 2, 3, 4

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6
Q

The sudden onset of which of the following signs and symptoms indicates a pulmonary embolism?

  1. Wheezing
  2. Coughing out blood-streaked sputum
  3. Cyanosis
  4. Sudden shortness of breath
A

1, 2, 3, 4

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7
Q

The best test for diagnosing a suspected pulmonary embolism is a(n):

A

spiral computerized tomography scan

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8
Q

A pulmonary angiogram is usually ordered:

A

when other tests for a pulmonary embolism are inconclusive

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9
Q

A patient’s D-dimer blood test results show a value of 250 ng/mL. How should these results be interpreted?

A

The patient does not have a pulmonary embolism

D-dimer value of greater than 500 ng/mL is considered positive for a pulmonary embolism.

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10
Q

The duplex venous ultrasonography test is used to:

A

diagnose a blood clot behind the knee or thigh.

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11
Q

Which of the following fibrinolytic agents are used to treat a pulmonary embolism?

  1. Urokinase
  2. Vitamin K
  3. Heparin
  4. Streptokinase
A

1, 4

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12
Q

All of the following are preventive measures taken with patients at high risk for thromboembolic disease EXCEPT:

a. Drink lots of water.
b. Dangle your legs over the edge of the bed before getting up.
c. Walk frequently.
d. Wear compression stockings.

A

Dangle your legs over the edge of the bed before getting up.

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13
Q

Which of the following is/are major mechanism(s) that contribute to the pulmonary hypertension commonly seen in a patient with a pulmonary embolism?

  1. Decreased cross-section area of the pulmonary vascular system
  2. Vasoconstriction induced by alveolar hypoxia
  3. Reflexes from the aortic and carotid sinus baroreceptors
  4. Vasoconstriction induced by humoral agents
A

1, 2, 4

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14
Q

The respiratory therapist is listening to the heart sounds of a patient with a suspected pulmonary embolus. The therapist could expect to hear all of the following EXCEPT:

a. increased second heart Sound (S2).
b. increased splitting of the second heart sound (S2).
c. third heart sound (S3).
d. fourth heart sound (S4).

A

fourth heart sound (S4).

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15
Q

In order to prevent pulmonary emboli, a filter may be placed into which of the following vessels to prevent clots from being carried into the pulmonary circulation?

A

Inferior vena cava

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16
Q

All of the following medications may be used to prevent pulmonary emboli EXCEPT:

a. enoxaparin.
b. dalteparin.
c. tinzaparin.
d. reteplase.

A

reteplase.

17
Q

A patient is on warfarin therapy for the prevention of deep venous thrombosis (DVT). The respiratory therapist should advise the patient to avoid eating all of the following EXCEPT:

a. broccoli.
b. spinach.
c. liver.
d. grapefruit.
e. orange juice.

A

e. orange juice.

18
Q

A pulmonary embolus produces which of the following / abnormalities?

A

True dead space

19
Q

While assessing a patient who was involved in a serious car crash and hit his steering wheel, the respiratory therapist observes that a section of his left anterior chest wall sinks inward during inspiration. What is the most likely cause?

A

Flail chest

20
Q

What is the most common finding at the site of the flail portion of a flail chest?

A

Pulmonary contusion

21
Q

Which of the following accurately describes a flail chest?

a. Double fractures of 2 adjacent ribs
b. Double fractures of 3 adjacent ribs
c. Single fracture of 3 adjacent ribs
d. Triple fractures of 2 adjacent ribs

A

Double fractures of 3 adjacent ribs

22
Q

Which of the following are pathologic changes associated with a flail chest?

  1. Pneumothorax
  2. Secondary pneumonia
  3. Pleural effusion
  4. Elevated diaphragms
A
  1. Pneumothorax

2. Secondary pneumonia

23
Q

All of the following are causes of a flail chest EXCEPT:

a. blast injury.
b. motor vehicle accident.
c. split sternum for open heart surgery.
d. fall from heights.

A

split sternum for open heart surgery

24
Q

Which of the following would be recommended for the management of an adult with a severe flail chest?

  1. Continuous positive airway pressure (CPAP)
  2. Pain management
  3. Mechanical ventilation
  4. Positive end-expiratory pressure (PEEP)
A
  1. Pain management
  2. Mechanical ventilation
  3. Positive end-expiratory pressure (PEEP)
25
Q

How many days of ventilatory support are anticipated for a patient with a flail chest to allow sufficient time for bone healing?

A

5 to 10 days

26
Q

What is the primary cause of hypoxemia in a patient with a severe flail chest?

A

Alveolar atelectasis

27
Q

Which of the following statements is TRUE regarding paradoxical chest movement?

a. With inspiration, the flail section moves outward.
b. The trachea deviates away from the flail side of the chest.
c. During inspiration, the flail section moves inward.
d. During exhalation, the flail area moves inward.

A

During inspiration, the flail section moves inward.

28
Q

When a patient has a flail chest, what happens during the ventilatory cycle?

A

Air is shunted from one lung to the other.

29
Q

A patient with a flail chest is experiencing pendelluft. Which of the following would be expected in a patient with a flail chest with pendelluft?

  1. Hypoventilation
  2. Hypertension
  3. Cyclical deeper and then more shallow breathing
  4. Rebreathing dead-space gas
30
Q

Which breath sounds would be expected to be heard when auscultating the chest of a patient with a flail chest?

A

Diminished over both lungs

31
Q

Which of the following chest radiograph findings would be expected for a patient with a flail chest?

  1. Increased opacity
  2. Rib fractures
  3. Decreased opacity
  4. Tracheal deviation
A
  1. Rib fractures

3. Decreased opacity

32
Q

What is the term for abnormal gas movement from one lung to the other?

A

Pendelluft

33
Q

Which of the following can stimulate an increased respiratory rate when a flail chest is present?

  1. Activation of deflation receptors
  2. Activation of irritant receptors
  3. Stimulation of J receptors
  4. Pain and anxiety
A
  1. Activation of deflation receptors
  2. Activation of irritant receptors
  3. Stimulation of J receptors
  4. Pain and anxiety
34
Q

Which of the following initial blood gas results would a respiratory therapist expect to find in a patient with a mild flail chest?

a. Elevated pH and elevated SaO2
b. Decreased pH and decreased SaO2
c. Increased pH and decreased SaO2
d. Decreased pH and increased SaO2

A

Increased pH and decreased SaO2

Clinical Manifestations and Assessment of Respiratory Disease (4 decks)

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