Skills questions cpts 23-24-25 Flashcards
Which of the following are signs and symptoms of a tension pneumothorax? (Select all that apply.) A) Distended neck veins B) Hypotension C) Hypertension D) Tachycardia
A,B,D
Distended neck veins, hypotension, and tachycardia are cardinal signs of a tension pneumothorax. Option “C,” hypertension, is not normally seen in a tension pneumothorax. (REF: p. 610)
Use of noninvasive positive-pressure ventilation (CPAP or BiPAP) has the potential to cause carbon dioxide retention in selected patients. Patients with which of the following underlying diagnoses are at greatest risk for carbon dioxide retention? A) Heart failure B) Pulmonary fibrosis C) Chronic obstructive pulmonary disease D) Pulmonary edema
C
Patients diagnosed with COPD who have ventilatory failure are at risk to retain carbon dioxide. Patients with heart failure, pulmonary fibrosis, or pulmonary edema are at greatest risk for oxygen failure. (REF: p. 602)
A patient with pulmonary edema had BiPAP started 30 minutes ago. The nurse should inform the patient that he will undergo which diagnostic test shortly? A) Arterial blood gas B) Chest X-ray C) Pulmonary function test D) Pulse oximetry reading
A
When a patient is placed on noninvasive positive-pressure ventilation (BiPAP), it is necessary to evaluate the oxygenation and ventilation status of the patient. Although an arterial blood gas is an invasive procedure, it is important to know the patient’s oxygen and carbon dioxide levels. Chest X-ray will provide information on fluid overload, and a pulmonary function test is inappropriate when a patient is acutely ill. A pulse oximetry reading would yield information on oxygenation. (REF: p. 602)
The low-pressure alarm has sounded on a patients ventilator. The nurse should check for which of the following situations?
A) The ventilator circuit has a leak.
B) The patient coughed during the inspiratory cycle.
C) The airway needs suctioning.
D) The patient is biting on the endotracheal tube.
A
The two most common causes for the low-pressure alarm sounding (indicating a sudden drop in pressure) are a leak in the ventilate circuit or the patient tube becoming disconnected from the ventilator. Patient coughing or biting on the ET tube may cause the high pressure alarm to sound. Secretions building up in the airway may cause a decrease in the pressure but not a sudden drop. Suctioning is the correct way to address that situation when identified. (REF: p. 606, 610)
A patient is to be placed on a ventilator. Which nursing action has been found to be most effective in reducing ventilator-associated pneumonia?
A) Performing mouth care at least four times a day
B) Repositioning the patient every 2 to 3 hours
C) Assessing lung sounds every shift
D) Performing range-of-motion exercises three times a day
A
Studies have shown that frequent mouth care decreases the incidence of ventilator-associated pneumonia. The other procedures are important to do, but they do not affect the incidence of ventilator-associated pneumonia. (REF: p. 609 )
Which of the following are necessary to prepare the patient for postural drainage? (Select all that apply.)
A) Encourage fluid intake of 1500 to 2000 mL.
B) Explain the procedure and positioning techniques.
C) Schedule treatment 1 to 2 hours after meals.
D) Coordinate treatments with other respiratory or
A,B,C,D
Coordinating therapy around a patients meals and activities reduces the risks for aspiration, conflict with other therapies, and fatigue. In addition, adequate fluid intake helps to liquefy secretions so the patient can easily clear them. As always, informing patients of any therapy promotes cooperation and decreases anxiety. (REF: p. 617)
Which of the following CPT maneuvers can be delegated? (Select all that apply.) A) Postural drainage B) Acapella device C) Vibration D) Shaking
A,B,C,D,
All of these maneuvers may be delegated to assistive personnel. However, the nurse is responsible for performing respiratory assessment, reviewing the chest X-ray when appropriate, and determining that the patient is stable for the procedure. (REF: p. 615)
Before discharge, the nurse designs a patient teaching plan to help the patient and family correctly perform chest physiotherapy. Why is this teaching an important aspect of patient safety?
A) Reduces readmission to a health care facility
B) Decreases the amount of medical equipment needed in the home care setting
C) Because patients and families need to know changes or effects associated with chest PT and when to notify the health care provider
D) Decreases anxiety of the family caregiver
C
The patient and the caregiver need to know and recognize changes in the patients respiratory or physiologic status to determine the effectiveness of therapy and to know when they should inform the health care provider of the need for additional therapy. (Ref: p. 619)
A patient is receiving chest physiotherapy in the home setting. The home health nurse observes the session and notes that the patient is not tolerating the procedure well. Which of the following is the best choice for modifying care?
A) Reduce treatments by 2 per day.
B) Suggest using an Acapella device.
C) Let the patient select when treatment is given.
D) Administer a bronchodilator therapy.
B
An Acapella device in conjunction with CPT maneuvers provides airway vibration and assists in clearing the airways. Reducing treatment sessions at all is not acceptable because the patient needs the therapy. The nurse may shorten the session if the patient is able to clear the airway with a shorter session. Administering a bronchodilator requires an order from the health care provider; this would take some time, and the nurse can institute other therapies. Letting the patient select when to have CPT therapy may not be appropriate in that these therapies may have to be scheduled at specific time periods. (REF: p. 620)
Which of the following skills can safely be delegated routinely to an NAP?
A) Oropharyngeal suctioning
B) Airway suctioning using a closed method
C) Endotracheal tube care
D) Tracheostomy care
A
Although an NAP may routinely handle oropharyngeal suctioning, the other skills require the training and judgment of an RN. The nurse is responsible for cardiopulmonary assessment and evaluation of the patient during the skill performance. Only in cases of a permanent tracheostomy or a well-established artificial airway in a stable patient may the skill of suctioning be delegated to an NAP. (REF: pp. 626, 630, 639, 645)
Why is it important to assess a patient’s understanding of a procedure?
A) Encourages cooperation of the patient during and after the procedure
B) Minimizes risks to the patient
C) Identifies teaching needs
D) All of the above
D
All of these outcomes are applicable to assessing patient knowledge of the procedure. If the patient understands what will happen to him during a procedure and why this is important for his health, he tends to cooperate during and after the procedure. If the patient understands the procedure and what he needs to do afterward to remain safe and free of complications, risks will be minimized. Also, by discussing the procedure with the patient, the nurse can identify teaching needs. (REF: p. 627)
If a patient is accidentally extubated, which of the following actions are appropriate?
A) Remain with the patient.
B) Assist respirations with bag-valve mask as needed.
C) Assess patient for airway patency, spontaneous breathing, and vital signs.
D) Prepare for reintubation.
E) All of the above
E
All of the listed interventions are appropriate for unexpected extubation. The nurse should stay with the patient until assistance arrives to continually assess respiratory status and the need for any of the listed interventions. (REF: p. 644)
Several factors affect the volume and consistency of endotracheal secretions. Which of the following causes an increase in the amount and thickness of secretions? (Select all that apply.) A) Fluid intake B) Infection C) Respiratory rate D) Humidification
B
Patients with respiratory infection, such as pneumonia, are prone to increased secretions that are thicker and sometimes are more difficult to expectorate. Fluid intake increases the amount of secretions but will thin them. Humidity loosens secretions, facilitating airway suctioning when the patient cannot clear secretions effectively. Rate of respirations will not effect the amount or viscosity of secretions. (REF: p. 631)
