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ACCS RESPIRATORY PRACTICE EXAM 1
Typology: Exams
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"Etomidate (Amidate)" is correct. Intubation is most often performed by inserting a tube into the mouth and passing it into the trachea in order to provide support for a patient's breathing. Most registered nurses do not perform endotracheal intubation, but they can assist the provider or respiratory therapist with placing the tube. The nurse may give medications to sedate the patient during the procedure, since it can be traumatic for the patient. Some medications given for sedation include etomidate, ketamine or midazolam. Midazolam (Versed) is used less often due to its need for titration based on weight, which is an extra step that is undesirable during rapid intubation. This extra step can cause delays and errors during intubation.
expiratory wheezing. A chest radiograph is normal. Results of laboratory testing are as follows: white blood cell count, 12,500/mm3; arterial blood gas pH, 7.35; arterial oxygen tension (PaO2), 65 mm Hg; and carbon dioxide tension (PCO2), 60 mm Hg. You arrange for hospital admission. Which of the following is the most appropriate step to take next for this patient after he is admitted to the hospital? a. - CORRECT-ANSWERS--c A 73-year-old man with hypertension, coronary artery disease, and diabetes mellitus presents to your office complaining of a cough and shortness of breath. He reports that for the past 3 or 4 days, he has been experiencing progressive dyspnea on exertion, and he now has mild dyspnea at rest. He also states that he has been having fevers, chills, and purulent sputum production over this period. He denies having come into contact with anyone who was sick. Results of physical examination are as follows: blood pressure, 124/87 mm Hg; heart rate, 95 beats/min; respiratory rate, 26 breaths/min; temperature, 101.3° F (38.5° C); and oxygen saturation on room air, 88%. The patient exhibits tachypnea without the use of accessory muscles. Bronchial breath sounds are noted over the right lower lung zones consistent with consolidation. A chest radiograph in the office confirms a right lower lobe infiltrate. You plan to admit the - CORRECT-ANSWERS--c You're providing care to a patient who is being treated for aspiration pneumonia. The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is developing acute respiratory distress syndrome (ARDS)?
D. "This condition develops because alveolar-capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs." - CORRECT-ANSWERS--D ARDS is a type of respiratory failure that occurs when the capillary membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse, you know this will lead to? A. bronchoconstriction B. atelectasis C. upper airway blockage D. pulmonary edema - CORRECT-ANSWERS--b Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales. If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse A patient has been hospitalized in the ICU for a near-drowning event. The patient's respiratory function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress syndrome. A STAT chest x- ray is ordered. What finding on the chest x-ray is indicative of ARDS?
A. infiltrates only on the upper lobes B. enlargement of the heart with bilateral lower lobe infiltrates C. white-out infiltrates bilaterally D. normal chest x-ray - CORRECT-ANSWERS--c. Which patient below is at MOST risk for developing ARDS and has the worst prognosis? A. A 52-year-old male patient with a pneumothorax. B. A 48-year-old male being treated for diabetic ketoacidosis. C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection. D. A 30-year-old female with cystic fibrosis. - CORRECT-ANSWERS--c
D. PEEP needs to be titrated to 15 mmHg of water - CORRECT-ANSWERS--A and C. Prone positioning helps improve PaO2 without actually giving the patient high concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting the V/Q mismatch). You're precepting a nursing student who is assisting you to care for a patient on mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the PEEP setting is at 10 mmHg. Your response is: A. "This pressure setting assists the patient with breathing in and out and helps improve airflow." B. "This pressure setting will help prevent a decrease in cardiac output and hyperinflation of the lungs." C. "This pressure setting helps prevent fluid from filling the alveoli sacs." D. "This pressure setting helps open the alveoli sacs that are collapsed during exhalation." - CORRECT-ANSWERS--d The Emergency Department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of pneumothorax? a. low respiratory rate b. diminished breath sounds c. presence of a barrel chest e. a sucking sound at the site of injury - CORRECT-ANSWERS--b.
The nurse instructs a client to use the pursed lip method of breathing and evaluates the teaching by asking the client about the purpose of this type of breathing. The nurse determines that the client understands if the client states that the primary purpose of pursed-lip breathing is to promote? a. promote oxygen intake b. strengthen the diaphragm c. strengthen the intercostal muscles d. promote carbon dioxide elimination - CORRECT-ANSWERS--d The nurse is caring for a client after a bronchoscopy and biopsy. Which of the following findings should be reported immediately? a. dry cough b. hematuria c. bronchospasm e. blood-streaked sputum - CORRECT-ANSWERS--c The nurse is suctioning a client via an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. which of the following interventions is appropriate? a. continue to suction b. notify the health care provider immediately c. stop the procedure and reoxygenate the client
a. bilateral wheezing b. inspiratory crackles c. intercostal retractions d. increased respiratory rate - CORRECT-ANSWERS--d The nurse is discussing the techniques of chest physiotherapy and postural drainage to a client having expectoration problems because of chronic thick, tenacious mucus production in the lower airway. the nurse explains that after the client is positioned for postural drainage the nurse will perform which action to loosen secretions? a. palpation and clubbing b. percussion and vibration c. hyperoxygenation and suctioning d. administer bronchodilator and monitor peak flow - CORRECT-ANSWERS-- b A client has experienced pulmonary embolism. the nurse should assess for which symptom, which is most commonly reported> a. hot, flushed feeling b. sudden chills and fever c. chest pain that occurs suddenly d. dyspnea when deep breaths occur - CORRECT-ANSWERS--c
An oxygen delivery system is prescribed for a client with copd to deliver a precise oxygen concentration. which oxygen delivery system would the nurse prepare for the client? a. face tent b. venturi mask c. aerosol mask d. tracheostomy collar - CORRECT-ANSWERS--b The low-pressure alarm sounds on a ventilator. the nurse assesses the client and then attempts to determine the cause of the alarm. If unsuccessful in determining the cause of the alarm, the nurse should take what initial action? a. administer oxygen b. check the client's vital signs c. ventilate the client manually d. start cardiopulmonary resuscitation - CORRECT-ANSWERS--c Mechanical ventilation corrects profoundly impaired ventilation, evidenced by hypoxia, respiratory distress. Requirements are: - CORRECT-ANSWERS-- pH <7. PaO2 < PaCO2 > despite therapy
D. Limit each suctioning pass to 10 seconds or less. - CORRECT-ANSWERS--D You should routinely suction a patient who is intubated? A. True B. False - CORRECT-ANSWERS--False Always assess first. The ventilator low-pressure alarm is sounding. What action(s) should you do first? A. Silence the alarm and suction the patient. B. Disconnect the patient and manually ventilate. C. Assess breath sounds and hyperventilate the patient. D. Check all tube connections. - CORRECT-ANSWERS--D The patient with chronic obstructive pulmonary disease (COPD) is intubated and on a mechanical ventilator. What sign or symptom requires immediate intervention? A. Urine output of 400 mL in 8 hours B. Absent breath sounds on one side C. Pitting edema of 1+
D. Gastric distention - CORRECT-ANSWERS--b When planning care for a patient on a mechanical ventilator, you understand that the application of positive end-expiratory pressure (PEEP) to the ventilator settings has which therapeutic effect? A. Increased FIO2 administration B. Increased inflation of the lungs C. Prevention of barotrauma to the lung tissue D. Prevention of alveolar collapse during expiration - CORRECT-ANSWERS-- d The purpose of adding PEEP to positive-pressure ventilation is to? A. increase functional residual capacity and improve oxygenation. B. increase FIO2 in an attempt to wean the patient and avoid O2 toxicity. C. determine whether the patient is in synchrony with the ventilator or needs to be paralyzed. D. determine whether the patient is able to be weaned and avoid the risk of pneumomediastinum. - CORRECT-ANSWERS--A. increase functional residual capacity and improve oxygenation. PEEP is a ventilatory maneuver in which positive pressure is applied to the airway during exhalation. This increases functional residual capacity (FRC) and often improves oxygenation, with the restoration of lung volume that normally remains at the end of passive exhalation.
