TESTBANK Chapter Title: Pulmonary Therapeutic Management
Chapter #: 22
1. Which of the following arterial blood gas values would
indicate a need for oxygen therapy?
1. PaO2 80 mm Hg
2. PaCO2 35 mm Hg
3. HCO3- 24 mEq
4. SaO2 87%
2. Which of the following oxygen administration devices can
deliver oxygen concentrations of 90%?
1. Nonrebreathing mask
2. Nasal cannula
3. Partial rebreathing mask
4. Simple mask
3. The most accurate and reliable control of FiO2 can be
achieved through the use of a:
1. simple mask.
2. nonrebreathing circuit (closed).
3. air-entrainment mask (AEM).
4. nonrebreathing mask.
Topic: Pulmonary
Cognitive Level: Application
Correct answer: 4
Rationale: The amount of oxygen required should provide a
PaO2 of 60-90 mm Hg and an SaO2 > 90.
Page Reference: 587
Topic: Pulmonary
Cognitive Level: Knowledge
Correct answer: 1
Rationale: With an FiO2 of 55%-70%, a nonrebreathing mask
with a tight seal over the face can deliver 90%-100% oxygen.
Page Reference: 586
Topic: Pulmonary
Cognitive Level: Knowledge
Correct answer: 2
Rationale: The most reliable and accurate means of delivering
a prescribed concentration of oxygen is through the use of a
nonrebreathing circuit (closed).
Page Reference: 586
4. Use of oxygen therapy in the patient who is hypercapnic may Topic: Pulmonary
result in:
Cognitive Level: Comprehension
1. oxygen toxicity.
Correct answer: 3
2. absorption atelectasis.
Rationale: In patients with severe COPD, carbon dioxide
3. carbon dioxide retention.
retention may occur as a result of administering oxygen in
4. pneumothorax.
higher concentrations.
Page Reference: 587
5. The correct procedure for the insertion of an oropharyngeal Topic: Pulmonary
airway is:
Cognitive Level: Application
1. placing it on the side of the mouth and sweeping it to the Correct answer: 4
midline.
Rationale: An oral airway is placed by inserting a tongue
2. using a laryngoscope for proper visualization and
depressor into the patient’s mouth to displace the tongue
insertion.
3. lubricating it with a water-soluble lubricant and inserting
it midline.
4. displacing the tongue downward and then slipping the
airway over the tongue.
6. The finding of normal breath sounds on the right side of the
chest and absent breath sounds on the left side of the chest in the
newly intubated patient is probably due to a:
1. right mainstem intubation.
2. left pneumothorax.
3. right hemothorax.
4. gastric intubation.
downward and then passing the airway into the patient’s mouth,
slipping it over the patient’s tongue. The tip of the airway
should lie above the epiglottis at the base of the tongue.
Page Reference: 588
Topic: Pulmonary
Cognitive Level: Application
Correct answer: 1
Rationale: The finding of normal breath sounds on the right
side of the chest and absent breath sounds on the left side of the
chest in the newly intubated patient is probably due to a right
mainstem intubation.
Page Reference: 589
Copyright © 2003, Elsevier Science (USA). All rights reserved.
2
7. Long-term ventilator management over 21 days is best
handled through use of a(n):
1. oropharyngeal airway.
2. esophageal obturator airway.
3. tracheostomy tube.
4. endotracheal intubation.
8. Which of the following statements is correct concerning
endotracheal tube cuff management?
1. The cuff should be deflated every hour to minimize
pressure on the trachea.
2. A small leak should be heard on inspiration if the cuff has
been inflated using the minimal leak technique.
3. Cuff pressures should be kept between 40 to 50 mm Hg to
ensure an adequate seal.
4. Cuff pressure monitoring should be done once every 24
hours.
9. Nursing interventions to limit the complications of
suctioning include:
1. inserting the suction catheter no more than 5 inches.
2. premedicating the patient with atropine.
3. hyperoxygenating the patient with 100% oxygen.
4. increasing the suction to 150 mm Hg.
10. Which of the following interventions would you perform
first following an unintentional extubation?
1. Open the patient’s airway.
2. Check the patient’s pulse.
3. Notify the patient’s physician.
4. Encourage the patient to cough.
11. The ventilator variable that causes inspiration is called the:
1. cycle.
2. trigger.
3. flow.
4. pressure.
12. The assist-control mode of ventilation functions in the
following manner.
1. It delivers gas at preset volume, at a set rate, and in
response to the patient's inspiratory efforts.
2. It delivers gas at a preset volume, allowing the patient to
breathe spontaneously at his or her own volume.
3. It applies positive pressure during both ventilator breaths
and spontaneous breaths.
4. It delivers gas at preset rate and tidal volume regardless of
the patient's inspiratory efforts.
Topic: Pulmonary
Cognitive Level: Knowledge
Correct answer: 3
Rationale: A tracheostomy tube is the preferred method of
airway maintenance in the patient requiring intubation for more
than 21 days.
Page Reference: 590
Topic: Pulmonary
Cognitive Level: Application
Correct answer: 2
Rationale: A small leak should be heard on inspiration if the
cuff has been inflated using the minimal leak technique. The
other statements are incorrect.
Page Reference: 595
Topic: Pulmonary
Cognitive Level: Application
Correct answer: 3
Rationale: Nursing interventions to limit the complications of
suctioning include hyperoxygenating the patient with 100%
oxygen.
Page Reference: 595
Topic: Pulmonary
Cognitive Level: Application
Correct answer: 1
Rationale: In the event of unintentional extubation, the
patient’s airway should be opened with the head-tilt/chin lift
maneuver and maintained with an oropharyngeal or
nasopharyngeal airway.
Page Reference: 594
Topic: Pulmonary
Cognitive Level: Knowledge
Correct answer: 2
Rationale: The variable that causes inspiration is called the
trigger.
Page Reference: 598
Topic: Pulmonary
Cognitive Level: Comprehension
Correct answer: 1
Rationale: Assist-control ventilation delivers gas at a preset
tidal volume in response to the patient’s inspiratory efforts and
will initiate breaths if the patient fails to do so within a preset
time.
Page Reference: 599
Copyright © 2003, Elsevier Science (USA). All rights reserved.
3
13. Preset positive pressure used to augment the patient’s
inspiratory effort is known as:
1. positive end-expiratory pressure (PEEP).
2. constant positive airway pressure (CPAP).
3. pressure control ventilation (PCV).
4. pressure support ventilation (PSV).
14. Which of the following statements best describes the
effects of positive-pressure ventilation on cardiac output?
1. Positive-pressure ventilation increases intrathoracic
pressure, which increases venous return and cardiac output.
2. Positive-pressure ventilation decreases venous return,
which increases preload and cardiac output.
3. Positive-pressure ventilation increases venous return,
which decreases preload and cardiac output.
4. Positive-pressure ventilation increases intrathoracic
pressure, which decreases venous return and cardiac output.
15. Nursing management of the patient receiving a
neuromuscular blocking agent should include:
1. withholding all sedation and narcotics.
2. protecting the patient from the environment.
3. keeping the patient supine.
4. speaking to the patient only when necessary.
Topic: Pulmonary
Cognitive Level: Comprehension
Correct answer: 4
Rationale: Preset positive pressure used to augment the
patient’s inspiratory efforts is known as pressure support
ventilation.
Page Reference: 599
Topic: Pulmonary
Cognitive Level: Comprehension
Correct answer: 4
Rationale: Positive-pressure ventilation increases
intrathoracic pressure, which decreases venous return to the
right side of the heart. Impaired venous return decreases
preload, which results in a decrease in cardiac output.
Page Reference: 599
Topic: Pulmonary
Cognitive Level: Application
Correct answer: 2
Rationale: Patient safety is a major concern for the patient
receiving a neuromuscular blocking agent because these
patients are unable to protect themselves from the environment.
Special precautions should be taken to protect the patient at all
times.
Page Reference: 606
16. Questions 16-19 refer to the following situation. Ms. B. is a Topic: Pulmonary
73-year-old woman with acute respiratory failure. She has been Cognitive Level: Application
on a ventilator for several days and is being considered for
Correct answer: 2
weaning. The ventilator high pressure alarm keeps going off.
Rationale: If the ventilator malfunctions, the patient should
When you enter the room, the ventilator inoperative alarm
sounds.
Which of the following actions should be taken first?
1. Troubleshoot the ventilator until the problem is found.
2. Take Ms. B. off the ventilator and manually ventilate her.
3. Call the respiratory therapist for help.
4. Silence the ventilator alarms until the problem is resolved.
be removed from the ventilator and ventilated manually with a
manual resuscitation bag.
Page Reference: 602
17. All of the following conditions may set the high pressure
Topic: Pulmonary
Cognitive Level: Application
Correct answer: 1
Rationale: A leak in the endotracheal tube cuff will set the
alarm off on the ventilator except:
1. a leak in Ms B.’s endotracheal tube cuff.
2. Ms. B. biting the tube.
3. Ms. B. coughing.
4. increased secretions in Ms B.’s airway.
low exhaled volume alarm off, not the high pressure alarm.
Page Reference: 600
Copyright © 2003, Elsevier Science (USA). All rights reserved.
4
18. Which of the following criteria would indicate that Ms. B.
is ready to be weaned?
1. FiO2 > 50%
2. Respiratory rate > 30 breaths/minute
3. Minute ventilation > 10 L/min
4. Vital capacity (VC) /kg greater than or equal to 15 ml
Topic: Pulmonary
Cognitive Level: Application
Correct answer: 2
Rationale: Two strong predictors for weaning readiness are
vital capacity (VC) /kg greater than or equal to 15 ml and
negative inspiratory pressure (NIP) of -30 cm H2O or less.
Other weaker predictors of weaning readiness include
spontaneous minute volume greater than or equal to 10 L/min,
maximum voluntary ventilation (MVV) equal to at least twice
the minute ventilation (VE), PaO2 of 50 mm Hg or greater, low
mean arterial pressure, arterial pH greater than 7.35, respiratory
rate (f) less than 25 breaths/min, tidal volume (VT) greater than
300 ml (rapid, shallow breathing index), inspiratory work per
minute (WT/min) less than or equal to 1.6 kg-m, and inspiratory
work per liter of minute ventilation (WI/L) less than or equal to
0.14 kg-m (work of breathing indices).
Page Reference: 601
19. Which of the following criteria would indicate that Ms. B is Topic: Pulmonary
not tolerating weaning?
Cognitive Level: Application
1. A decrease in heart rate from 92 to 80 beats/min
Correct answer: 3
2. A SpO2 of 92%
Rationale: Weaning intolerance indicators include: a decrease
3. An increase in respiratory rate from 22 to 38 breaths/min in level of consciousness; diastolic blood pressure >100 mm
4. Spontaneous tidal volumes of 300 to 350 ml
Hg; a fall in systolic blood pressure; heart rate >100 beats/min
or >20 beats/min increase over baseline; f >30/min or >10/min
increase over baseline; VT <250-300 ml; pH level <7.35;
PaCO2 level increased by 8 mm Hg; premature ventricular
contractions >6 per minute or salvos; changes in ST segment;
and ventricular conduction changes.
Page Reference: 602
Copyright © 2003, Elsevier Science (USA). All rights reserved.