Download Mechanical Ventilation Troubleshooting and more Exams Nursing in PDF only on Docsity!
TMC Practice Exam 1 questions with correct
answers
You note in the chart of a patient's who is receiving volume control ventilation that the plateau pressure has been increasing over the last 6 hours, while the PEEP levels remains constant. Which of the following would be the most likely cause of this change? Select one: A. development of pulmonary edema B. water accumulation in the ventilator circuit C. partial obstruction of the endotracheal tube D. development of bronchospasm Answer ✔✔ An increase in the plateau pressure relative to baseline (Pplat-PEEP) indicates a decrease in the patient's lung and/or thoracic compliance. Common causes of a decrease in lung compliance are pneumothorax, pulmonary edema, atelectasis and ARDS. Partial obstruction of the ET tube and development of bronchospasm would increase airway resistance and thus increase PIP and the PIP-Pplat pressure difference, but not affect Pplat. The correct answer is: development of pulmonary edema The difference between the mean arterial pressure (MAP) and intracranial pressure (ICP) is the: Select one: A. cerebral perfusion pressure B. cerebral vascular resistance C. blood-brain barrier pressure
D. jugular venous pressure Answer ✔✔ The difference between the mean arterial pressure (MAP) and intracranial pressure (ICP) is the cerebral perfusion pressure (CPP); CPP = MAP - ICP. As this equation makes clear, any factor that increases ICP and/or lowers MAP will decrease CPP and thus potentially cause brain damage or death. In general perfusion is adequate if the CPP can be maintained between 60 to 100 mm Hg. The correct answer is: cerebral perfusion pressure Which of the following would provide the best bedside assessment of the need for mechanical ventilation in a patient with Guillain-Barre syndrome? Select one: A. FRC B. VC C. airway resistance D. TLC Answer ✔✔ Guillain-Barre syndrome is a restrictive neuromuscular disorder that results in hypoventilation. Airway resistance measures are not useful in diagnosing restrictive ventilatory impairments. Restrictive ventilatory impairments are characterized by low lung volumes. Of the volumes listed, only the vital capacity (VC) can be measured at bedside The correct answer is: VC The normal range of adult blood pressure (systolic/diastolic) is about: Select one: A. 80-100/40-70 mm Hg B. 100-140/60-90 mm Hg
A. 0.1 - 0.4 L/cm H2O B. 0.4 - 0.8 L/cm H2O C. 10 - 15 L/cm H2O D. 15 - 20 L/cm H2O Answer ✔✔ Normal compliance of the adult lung ranges from 0.1 to 0.4 L/cm H2O, with an average value of about 0.2 L/cm H2O. The volume component of the compliance is measured as the inhaled volume at any given pressure change. The pressure component represents the difference between the alveolar and pleural pressures (the transpulmonary pressure gradient). The correct answer is: 0.1 - 0.4 L/cm H2O Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal lungs should be able exhale what percent of the FVC? Select one: A. 35-50% of the FVC B. 50-70% of the FVC C. 70-83% of the FVC D. 84-93% of the FVC Answer ✔✔ The normal range for the FEV1 as a percent of the FVC (FEV1%) is 70-83%. Patients with obstructive pulmonary disease will show a reduction in timed FEV% values, while patients with restrictive disorders will generally exhibit normal (or sometimes high) FEV% values. The correct answer is: 70-83% of the FVC Which of the following clinical findings would increase the probability that a patient with some perfusion defects on a V/Q scan has a pulmonary embolism?
Deep venousthrombosis Recent history of cancer Prolonged immobilization A. Yes No Yes B. Yes Yes Yes C. No Yes Yes D. Yes Yes No Select one: A. A B. B C. C D. D Answer ✔✔ The accuracy of V/Q scans in diagnosing pulmonary embolism (PE) can be improved by combining a set of clinical risk factors with the V/Q results. These factors (known as the Wells criteria) include signs and symptoms of deep venous thrombosis (DVT), prior diagnosis of DVT or PE, tachycardia, immobilization for three or more days or surgery during the prior month, hemoptysis and recent history of cancer. The correct answer is: B During auscultation of a patient's chest, you hear intermittent "bubbling" sounds at the lung bases. Which of the following chart entries best describe this finding? Select one: A. "bronchial sounds heard at lung bases"
Select one: A. arterial blood gas analysis B. chest X-ray C. exhaled volume D. PETCO2 Answer ✔✔ While the PETCO2 can help determine lung vs esophageal placement of an ET tube, only a chest X-ray can confirm its proper placement in the trachea. On an adult A-P chest X-ray, the ET tube tip should be positioned about 4 to 6 cm above the carina or between T2 and T4. This position minimizes the chance of the tube moving down into the mainstem bronchi (endobronchial intubation) or up into the larynx (extubation). The correct answer is: chest X-ray In individuals with disorders causing an increased ELASTIC work of breathing, such as pulmonary fibrosis, which of the following breathing patterns results in the minimum work? Select one: A. slow and deep breathing B. slow and shallow breathing C. rapid and deep breathing D. rapid and shallow breathing Answer ✔✔ Individuals with disorders characterized by an increased elastic work of breathing, such as pulmonary fibrosis, tend to assume a rapid and shallow breathing pattern. For these patients, such a pattern results in the minimum mechanical work necessary to effectively ventilate the lungs. The correct answer is: rapid and shallow breathing
The most likely cause of bilateral fluffy infiltrates on a chest x-ray is: Select one: A. pulmonary edema B. neoplasm C. pleural effusion D. hemothorax Answer ✔✔ Bilateral infiltrates indicate a global (lung-wide) as opposed to local pulmonary problem. "Fluffy" infiltrates usually indicate an alveolar condition. Only pulmonary edema is a global condition affecting the alveolar region (fluid transudation). Typically neoplasms, effusions and hemothoraces are revealed as a localized areas of increased radiopacity. The correct answer is: pulmonary edema The normal apical impulse (PMI) usually is identified where? Select one: A. 3rd right intercostal space, left sternal border B. 3rd left intercostal space, anterior axillary line C. 5th right intercostal space, midclavicular line D. 5th left intercostal space, midclavicular line Answer ✔✔ The normal apical impulse is produced by the thrust of the contracting left ventricle and usually is identified near the midclavicular line in the left fifth intercostal space. This systolic thrust, referred to as the point of maximal impulse, or PMI, may be felt and visualized in most normal individuals. The correct answer is: 5th left intercostal space, midclavicular line
The correct answer is: right phrenic nerve paralysis On the physical assessment of a patient who appears acutely ill, you note the following: severely labored breathing, accessory muscle use, and stridor. These findings suggest: Select one: A. acute tension pneumothorax B. acute upper airway obstruction C. pneumonia with consolidation D. chronic airway obstruction Answer ✔✔ The patient with an acute upper airway obstruction is usually in acute distress and exhibits labored breathing. Accessory muscles commonly are used during inhalation. Breath sounds may be clear but can be difficult to discern through the characteristic stridor. The lungs may be normal to percussion and palpation. Since ventilation is at risk, the patient should not be left alone, and the assessment must be quick and accurate to allow proper treatment. The correct answer is: acute upper airway obstruction Which of the following methods could be used to assess the intensity of pain being experienced by an elderly, confused patient who is unable to express himself? Interview a family member Observe patient for grimacing Use a numeric rating scale A. No Yes Yes
B. Yes No Yes C. Yes Yes No D. Yes Yes Yes Select one: A. A B. B C. C D. D Answer ✔✔ A numeric rating scale is not useful for young children or patients who are confused or unable to express themselves. As an alternative, interviewing family members may help provide information about pain history, typical behaviors when the patient has pain, and activities that may cause or aggravate pain. Lacking such information, the health professional may have to rely on overt patient behaviors (e.g., groaning/moaning, 'doubling over,' etc.) and/or facial expressions indicative of severe pain (e.g., grimacing, eye tearing, etc). The correct answer is: C During an interview, a patient complains about coughing. What further information would you seek regarding this symptom? Onset (e.g. what brings it on?) Characteristics (e.g. productive?) Course (e.g. progress over time) A. No Yes Yes B. Yes No Yes C. Yes Yes Yes
Select one: A. A B. B C. C D. D Answer ✔✔ Observations during inspection of the extremities that indicate poor peripheral circulation include peripheral cyanosis (acrocyanosis) or pallor, slow capillary refill, pitting edema and cool skin temperature. Digital clubbing is associated with a variety of clinical conditions, including bronchiectasis, pulmonary fibrosis, cyanotic congenital heart disease, lung cancer, and cirrhosis of liver. However, clubbing does not indicate poor peripheral circulation. The correct answer is: D Which of the following observations indicate that an infant's work of breathing may be abnormally high? Select one: A. palor B. digital clubbing C. acrocyanosis D. nasal flaring Answer ✔✔ Tachypnea, nasal flaring, grunting, and chest wall retractions are the most common signs of increased work of breathing in infants. Pallor or acrocyanosis are associated with circulatory problems insufficiency. Digital clubbing is associated with a variety of clinical conditions, including bronchiectasis, pulmonary fibrosis, cyanotic congenital heart disease, lung cancer, and cirrhosis of liver. However, clubbing does not indicate increased work of breathing.
The correct answer is: nasal flaring While performing a maximal expiratory pressure (MEP) test using a valved T- piece, the patient blows out against the manometer, but no positive pressure is registered. What should be done to troubleshoot this problem? Select one: A. make sure both the inspiratory and expiratory valves are blocked B. make sure the inspiratory valve is patent and the expiratory valve is blocked C. make sure the inspiratory valve is blocked and the expiratory valve is patent D. make sure both the inspiratory and expiratory valves are patent Answer ✔✔ To measure the maximal expiratory pressure (MEP) with a valved T-piece, the inspiratory valve should be open/patent (allowing the patient to inhale to TLC), while the expiratory valve should be blocked (allowing air to move only from the patient to the measuring manometer). The correct answer is: make sure the inspiratory valve is patent and the expiratory valve is blocked The primary indication for apnea monitoring is to: Select one: A. prevent sudden infant death syndrome (SIDS) B. identify life-threatening events in neonates C. warn of ventilator disconnection or malfunction D. assess neonates for obstructive sleep apnea Answer ✔✔ The primary indication for apnea monitoring is to identify life-threatening events in neonates at risk of recurrent apnea, bradycardia and hypoxemia. Prevention of sudden infant death
A. local anesthetic B. anticoagulant C. sterile gloves D. lancet Answer ✔✔ Equipment needed to obtain an arterial puncture includes a syringe, anticoagulant, transport container with label (and ice if not analyzed immediately), antiseptic swabs, tape, clean exam gloves, and a sterile gauze or bandage. A local anesthetic is optional. A lancet is used for capillary sampling, not arterial puncture. The correct answer is: anticoagulant Which of the following describes the correct procedure for performing a modified Allen's test? Select one: A. compress both the radial and ulnar arteries then release the radial artery B. compress both the radial and ulnar arteries then release the ulnar artery C. compress both the radial and ulnar arteries then release both arteries at once D. compress the brachial artery only and observe circulation to the hand Answer ✔✔ To perform the modified Allen's test, 1) the patient clenches his hand into a tight fist while you apply pressure to both the radial and ulnar arteries; 2) the patient then opens his hand without fully extending it (the palm and fingers are blanched); 3) you maintain pressure on the radial artery while removing pressure on the ulnar artery. At this point you should observe flushing of the entire hand, indicating the presence of collateral circulation. The correct answer is: compress both the radial and ulnar arteries then release the ulnar artery
A patient is receiving volume controlled ventilation at a rate of 10/min. The percent inspiratory time (%I) control is set at 25%. What is the inspiratory time? Select one: A. 1.00 sec B. 1.25 sec C. 1.50 sec D. 1.75 sec Answer ✔✔ Given the rate (f) and percent inspiratory time (%I), the inspiratory time (I) is computed as:I = %I x (I + E)In this case (I + E) = 60/10 = 6 sec; I = 0.25 x 6 = 1.50 sec The correct answer is: 1.50 sec Sputum induction is performed on a trach patient to gather a sample for microbiological identification. The sample is collected using a Lukens trap. When applying suction after entering the airway, the mucus should Select one: A. pass into the trap and then move on into the collection jar B. pass through the wall tubing and then into the Lukens trap C. pass through the suction catheter and then enter the Lukens trap D. pass into the Lukens trap and then enter the suction catheter Answer ✔✔ A Lukens trap is used to collect sputum samples during suctioning or bronchoscopy. To use the trap, the therapist places it between the suction catheter and the suction system's connecting tubing, while maintaining its internal sterility. When suction is applied, secretions should then pass through the suction catheter and enter the Lukens trap. After gathering the desired specimen, the trap is sealed (with its own connecting tubing) and processed for laboratory study.
titrated upward in 1 L/min increments until the nighttime SpO2 consistently exceeds 88% and no further desaturation events occur. The correct answer is: titrate the patient's nocturnal O2 flow upward until the SpO remains above 88% You are gathering a sputum specimen from a patient in isolation. In addition to applying appropriate transmission-based precautions, which of the following procedures should be followed in processing this specimen? Select one: A. mix the specimen with a fixative before sending it to the lab B. place the specimen cup in a sturdy container with a secure lid C. leave the specimen cup at the nursing station for transport D. have the specimen undergo sterilization before processing Answer ✔✔ In addition to applying appropriate transmission-based precautions, when gathering a sputum specimen, great care should be taken to prevent external contamination of the container. If the outside of the container gets contaminated, it must be disinfected or placed in an bag. To minimize leakage during transport, specimens should always be placed in a sturdy container with a secure lid. When a specimen comes from a patient in isolation, the container should be placed in an impervious bag and labeled before removal from the room. Fixing or sterilizing the specimen makes no sense because it would prevent valid laboratory analysis. The correct answer is: place the specimen cup in a sturdy container with a secure lid To validate patient readings obtained from a transcutaneous blood gas monitor, you should:
Select one: A. measure and compare the PtcO2 and PtcCO2 at three or more different sites B. compare the monitor's readings to a concurrent pulse oximetry reading C. compare the monitor's readings to those obtained via a concurrent ABG sample D. compare the patient reading to those obtained when calibrating the sensor Answer ✔✔ Once properly set-up, the clinician should compare the transcutaneous blood gas monitor's readings to those obtained via a concurrent arterial blood gas. Good consistency between values validates monitor performance under the existing conditions. The correct answer is: compare the monitor's readings to those obtained via a concurrent ABG sample A patient breathing 100% at sea level has a PaO2 of 350 torr and a PaCO2 of 40 torr. What is her A-a gradient or P(A-a)O2? Select one: A. 663 torr B. 360 torr C. 563 torr D. 313 torr Answer ✔✔ Sea-level PB = 760 mm Hg. PAO2 = 1.0 (760 - 47) - 1. × 40 = 663 mm Hg (torr). P(A-a)O2 = 663 - 350 = 313 mm Hg (torr). The correct answer is: 313 torr An adult male patient on ventilatory support has just been intubated with a 7.0 mm oral endotracheal tube equipped with a high residual volume low pressure cuff. When sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45 cm H2O. What is the most likely problem?
