Pulmonary & Cardiac Quiz (Week 7) Flashcards
Your patient has had a RUL lobectomy & is now returning from the recovery room. The fluid in the chest tube water seal has stopped fluctuating. The nurse most appropriately interprets this assessment to indicate:
a.) The tubing may be kinked.
b.) All the fluid & air has been removed.
c.) The lungs have re-expanded.
d.) The suction is set too low.
a.) The tubing may be kinked
It is expected in this early post-operative period that a fluctuation would occur with each respiration. The nurse should first investigate the entire length of the tubing from the collection device to the patient for patency.
A patient has just returned to the unit after a right pneumonectomy. How should the nurse should position the patient?
a.) On the left side only.
b.) Prone.
c.) Slightly toward the right side.
d.) On the other side.
c.) Slightly toward the right side.
Current theory states that either the back or slightly toward the operative side are both appropriate positions. After a pneumonectomy, the operative side should be slightly dependent so that fluid in the pleural space remains below the level of the bronchial stump, & the inoperative side can fully expand. However, it is believed that if the patient is positioned completely on the operative side, this may put pressure on the bronchial stump.
A college basketball player collapses during a game & is revived with an external defibrillator. The patient is admitted to the coronary care unit & diagnosed with Long Q-T syndrome (LQTS). Because of this diagnosis, the nurse includes a discussion with the patient and the patient’s parents education about which of the following?
a.) Potential for corrective open-heart surgery.
b.) Genetic basis of this syndrome.
c.) Use of steroids to control dysrhythmias.
d.) Need for a low potassium diet.
b.) Genetic basis of this syndrome
Long Q-T syndrome is inherited in an autosomal-dominant pattern of inheritance with most individuals inheriting the gene from an affected parent. The diagnosis of this condition in one child in a family means that all other individuals in the family should be tested for the presence of this life-threatening arrhythmia & is most successfully managed with beta blocker medication.
The emergency room nurse admits a patient with multiple injuries following a motor vehicle accident. The patient’s respirations are shallow & labored. The patient is intubated & placed on a ventilator. Which of the following is the first action the nurse knows to take immediately following intubation?
a.) Obtaining a chest x-ray to verify endotracheal tube placement.
b.) Securing the endotracheal tube.
c.) Listening for bilateral breath sounds.
d.) Suctioning the endotracheal tube to clear secretions.
c.) Listening for bilateral breath sounds
The nurse needs to listen for bilateral breath sounds immediately folowing intubation. If breath sounds are absent on the left chest, this may indicate that the endotracheal tube could be in the right main-stem bronchus. If breath sounds are audible in the stomach, the endotracheal tube may be malpositioned in the esophagus. Once breath sounds are determined to be equal bilaterally, the endotracheal tube needs to be secured & a chest x-ray should be obtained to confirm proper placement. Although the endotracheal tube needs to be secured to protect against dislodgment, the immediate action following intubation, prior to securing the tube, is to check for bilateral breath sounds.
An elderly patient is admitted to the emergency room. The patient states, “I didn’t take my heart pill or my water pill this morning because I was sick to my stomach”. The patient’s records show that the patient has been taking dignoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 20 mg every morning. Laboratory values obtained on admission to the ER show a potassium level of 3.1 mEq/L. The nurse places the patient on a cardiac monitor, which shows a heart rate of 52 & frequent premature ventricular contractions (PVCs). Which action does the nurse take when the patient states a desire to urinate?
a.) Assist the patient to the bathroom
b.) Insert a foley catheter in the patient.
c.) Tell the patient to urinary on the incontinency pad.
d.) Obtain a bedside commode or urinal for the patient.
d.) Obtain a bedside commode or urinal for the patient.
THIS COULD BE A TYPICAL NCLEX QUESTION TO ASSESS YOUR KNOWLEDGE OF CARDIAC DYSRHYTHMIAS.
Low potassium levels & possible digoxin toxicity have caused the patient to experience increased cardiac irritability. The patient needs continuous cardiac monitoring until the potassium level is stabilized & PVCs resolve. Either a male or female patient can be safely & hygienically assisted in voiding in bed (on a bedpan or with a urinal), or, if the patient’s condition permits, on a commode at the side of the bed.
NCLEX TEST WRITERS CONSIDER ASSISTING THE PATIENT TO THE BATHROOM AS UNSAFE.
Match the clinical problem with the physical assessment finding:
a.) Refractory hypoxemia, delayed x-ray findings, shunting
b.) Hyperressonance, decreased breath sounds
c.) Subcutaneous emphysema
d.) Decreased breath sounds on the left
1.) Barotrauma
2.) Tension pneumothorax
3.) Right main stem intubation
4.) ARDS
a-4.) ARDS = refractory hypoxemia, delayed x-ray findings, & shunting
b-2.) Tension Pneumothorax = hyperressonance & decreased breath sounds
c-1.) Barotrauma = subcutaneous emphysema
d-3.) Right main stem intubation = decreased breath sounds on the left
Match the respiratory pattern with the clinical condition:
a.) Increased intracranial pressure
b.) Congestive Heart Failure (CHF)
c.) Transtentorial herniation
d.) Metabolic acidosis
1.) Cheyne-Stokes breathing
2.) Sudden cessation of breathing
3.) Respiratory alkalosis
4.) Central neurogenic hyperventilation
a-4.) Increased intracranial pressure = central neurogenic hyperventilation
b-1.) Congestive Heart Failure (CHF) = Cheyne-Stokes breathing
c-2.) Transtentorial herniation = sudden cessation of breathing
d-3.) Metabolic acidosis = respiratory alkalosis
Your assessment of the patient receiving mechanical ventilation is critical for the prevention & early detection of problems. What problems might the impact of mechanical ventilation include?
a.) Decreased intrathoracic pressure.
b.) Stabilization of alveolar capillary membrane with high FIO2.
c.) Gastric distension.
d.) Emotional well-being.
c.) Gastric distension
- Increased intrathoracic pressure from positive pressure ventilation may decrease cardiac output, especially in patients who are hypovoleic or have low ejection fraction.
- High FIO2 for sustained periods will cause oxygen toxicity.
- The patient on mechanical ventilation may need a nasogastric (NG) tube to prevent or treat gastric distension.
- These patients will need emotional support, enhanced communication, & potentially sedatives.
Match the acid base disorders with the clinical condition or situation:
a.) Heroin overdose
b.) Recent diuretic use
c.) Diabetic ketoacidosis (DKA)
d.) Mechanical ventilation for head injury
1.) Respiratory alkalosis
2.) Respiratory acidosis
3.) Metabolic alkalosis
4.) Metabolic acidosis
a-2.) Heroin overdose = respiratory acidosis
b-3.) Recent diuretic use = metabolic alkalosis
c-4.) Diabetic ketoacidosis (DKA) = metabolic acidosis
d-1.) Mechanical ventilation for head injury = respiratory alkalosis
Match the values with the acid-base disorder.
a.) pH = 7.1 & HCO3 = 8
b.) pH = 6.9 & HCO3 = 24
c.) pH = 7.6 & PCO2 = 40
d.) pH = 7.54 & HCO3 = 24
1.) Respiratory acidosis
2.) Respiratory alkalosis
3.) Metabolic acidosis
4.) Metabolic alkalosis
a-3.) pH of 7.1 & HCO3 of 8 = metabolic acidosis
b-1.) pH of 6.9 & HCO3 of 24 = respiratory acidosis
c-4.) pH of 7.6 & PCO2 of 40 = metabolic alkalosis
d-2.) pH of 7.54 & HCO3 of 24 = respiratory alkalosis
Normal pH = 7.35 - 7.45
Normal PCO2 = 35 - 45
Normal HCO3 = 22-26
