PULMONARY PRACTICE TEST
- A type of pressure mode that provides a continuous pressure throughout the entire respiratory cycle, helping to improve oxygenation in spontaneously breathing patients. This mode can be used for intubated patients or non-intubated patients via mask. This mode may be used to wean patients from mechanical ventilation and for nocturnal ventilation via mask for patients with sleep apnea.
A. Continuous Positive Airway Pressure (CPAP) Mode
B. Assist/Control (A/C) Mode
C. Synchronized Intermittent Mandatory Ventilation (SIMV)
D. Pressure Control Mode
A Rationale: is correct answer
B is incorrect
Rationale: A volume control mode where the ventilator will provide a set tidal volume for a set
rate. If the patient initiates additional breaths above the set rate the ventilator will
provide a tidal volume for those additional breaths (assisted breaths).
C is incorrect
Rationale: A volume control mode where the ventilator will provide a set tidal volume for a set
rate. If the patient initiates additional breaths above the set rate the ventilator will
not provide a tidal volume for those additional breaths (spontaneous breaths).
D is incorrect
Rationale: this mode delivers a set maximum peak inspiratory pressure (PIP). The PIP is the
maximum highest pressure allowed in the ventilator circuit (tubing). This mode does
not deliver a set tidal volume. The tidal volume varies per breath due to lung
compliance and airway resistance. This mode is used for patients that have
developed ARDS, and sedation is usually necessary in this mode.
- A patient on a ventilator with 5cm of H2O PEEP develops severe hypotension when disconnected from the ventilator. The nurse realizes that:
A. The patient cannot be removed from the ventilator when PEEP is used.
B. The patient is hypovolemic as a result of the PEEP setting.
C. The patient is anxious about being removed from the ventilator.
D. When the patient is removed from the ventilator and the AMBU is used it causes over inflation from the AMBU aggressive rates.
A is incorrect
Rationale: The patient can be removed from the ventilator for transport or for suctioning. It
does not matter if PEEP is on or not when being removed from ventilator for
transport or suctioning. Ventilation is provided by AMBU Bag.
B is incorrect
Rationale: PEEP does not have any correlation with hypovolemia.
C is incorrect
Rationale: this is not related to hypotension, anxiety usually causes hypertension.
D is Correct answer.
Rationale: Rationale: Most ventilated patients should have PEEP of at least 5 cm of H2O to prevent the pressure in the alveoli from dropping to zero at the end of expiration. The nurse can cause auto-PEEP with over aggressive rates with an air-mask-bag unit(AMBU). Rapid rates are used to bag the patient instead of the rate that was set on the ventilator. The patient might become hypotensive with the built up pressure in the lungs from "auto-PEEP". Treatment would involve disconnecting the patient from the AMBU or ventilator for a few seconds; this would allow the excess pressure to dissipate.
- The nurse is caring for a patient with non-cardiogenic pulmonary edema. The nurse should notify the physicianif the patient develops which of the following?
A. Heart rate 124 bpm
B. 3+ pulses in the lower extremities
C. B/P 152/88
D. PCWP > 30 mm Hg
A is incorrect
Rationale: this is an s/s of NCPE, the questions states patient already has NCPE
B is incorrect
Rationale: fluid overload may be present but not the best answer because an increase in PCWP is more indicative of developing CPE
C is incorrect
Rationale: this is an s/s of NCPE, the question states patient already has NCPE
D is correct answer
Rationale: Rationale: The patient with non-cardiogenic pulmonary edema will develop tachycardia, hypertension, bounding pulses, and a drop in PCWP. If the patient’s PCWP increases, the physician should be notified because this could indicate the development of cardiogenic pulmonary edema where the PCWP > 18 mmHg.
- A type of ventilator breath that the patient can initiate but the ventilator will still control volume or pressuredelivered. (Depending on Volume modes or Pressure modes) The ventilator will also control when expirationstarts after inspiration that was initiated by the patient.
A. Spontaneous Breath
B. Mandatory Breath
C. Assisted Breath
D. Apnea
A is incorrect
Rationale: breaths are controlled entirely by patient
B is incorrect
Rationale: breaths are controlled entirely by ventilator
C is correct answer
Rationale: patient initiates the breath but the ventilator assists with the breathing cycle (volume,
support and expiration cycle).
D is incorrect
Rationale: this is absence of breathing
- A type of ventilator breath that the patient initiates and controls the entire respiratory cycle. With these types ofbreaths the patient controls inspiratory, expiratory, volume and pressure.
A. Assisted Breath
B. Spontaneous Breath
C. Mandatory Breath
D. PEEP
A is incorrect
Rationale: this ventilator breath the patient initiates but the ventilator will still control either
volume or pressure and when expiration cycle will begin
B is correct answer
Rationale: this breath is initiated and controlled by the patient. these types of breaths are used
in weaning modes (CPAP) and in SIMV modes.
C is incorrect
Rationale: MandatoryBreath is controlled entirely by the ventilator
D is incorrect
Rationale: PEEP is a setting on the ventilator for continuous pressure at end expiration and
not a ventilator breath type
- A nurse is caring for an older adult client who is physically frail and who has been in bed for more than a week.Which of the following clinical manifestations indicates to the nurse that the client is developing pneumonia?
A. Chills
B. Cough
C. Confusion
D. Chest pain
A is incorrect
Rationale: Often with pneumonia, older adults do not have chills and fever but instead have
fatigue, weakness, lethargy, and anorexia.
B is incorrect
Rationale: Often with pneumonia, older adults do not cough but instead have fatigue,
weakness, lethargy, and anorexia.
C is correct answer
Rationale: The most common clinical indication of pneumonia in older adult clients is confusion as a result of hypoxia. Often with pneumonia, they do not have chills, fever, coughing, and chest pain, but instead have fatigue, weakness, lethargy, and anorexia.
D is incorrect
Rationale: Often with pneumonia, older adults do not have chest pain but instead have fatigue,
weakness, lethargy, and anorexia.
- A nurse is caring for a child with a suspected diagnosis of cystic fibrosis. Which of the following diagnostictests will the nurse prepare the child for to confirm the diagnosis?
A. Sweat chloride test
B. A sputum culture
C. A stool fat content analysis
D. Pulmonary function test
A is correct answer
Rationale: Clients with cystic fibrosis have an increase of sodium and chloride in both saliva
and sweat. Therefore, a sweat chloride test is a definitive diagnostic test to determine the diagnosis of cystic fibrosis.
B is incorrect
Rationale: A sputum culture will determine the organism infecting the lungs. However, it is not
a diagnostic test to determine the diagnosis of cystic fibrosis.
C is incorrect
Rationale: A stool fat content analysis will determine the amount of fat within a stool. However,
it is not the best diagnostic test to determine the diagnosis of cystic fibrosis.
D is incorrect
Rationale: Pulmonary function tests will determine the lung capability. However, it is not a
diagnostic test to determine the diagnosis of cystic fibrosis.
- A nurse is caring for a client who has an acute respiratory illness. The nurse should monitor the client forwhich of the following manifestations of impending airway obstruction. (Select all that apply.)
A. Tachycardia
B. Nausea
C. Retractions
D. Muscle tremors
E. Restlessness
A, C & E are correct
Rationale: Tachycardia is correct. Increases in pulse and respiratory rates are indications of impending airway obstruction. Nausea is incorrect. Gastrointestinal upset is not an indication of impending airway
obstruction. Retractions are correct. Substernal, suprasternal, and intercostal retractions and
flaring nares are indications of impending airway obstruction. Muscle tremors are incorrect. Muscle tremors are not an indication of impending airway obstruction. Restlessness is correct. Restlessness is an indication of impending airway obstruction.
- A ventilator setting for the percentage of oxygen in the air delivered to the patient. This setting is adjusted onthe ventilator to maintain a saturation of oxygen level of >90%. If this setting is adjusted to higher than 60% forlonger than 24hrs on the ventilator, the patient is at risk for oxygen toxicity and other strategies must beimplemented.
A. FiO2%
B. Rate (f)
C. Tidal Volume (Vt)
D. Assist Control (A/C)
D is incorrect
Rationale: this is a volume controlled mode, not a setting
- During the assessment of a patient with a respiratory disorder, the nurse observes lower extremity edema.This finding is important in respiratory disorders because:
A. It will indicate the patient’s ability to ambulate.
B. Edema indicates the amount of fluid the patient can tolerate.
C. Edema indicates heart failure, a common finding in a patient with COPD.
D. It aids in determining if the patient will need assistance with activities of daily living.
Rationale: Rationale: Edema of the lower extremities is generally related to right heart or congestive heart failure. Right heart failure and combined left and right sided failure are common in patients with COPD. Right sided failure is caused by pulmonary hypertension. Chronic distention of the lower airways makes forward blood flow more difficult. The right heart hypertrophies in an attempt to increase force of blood through the pulmonary tree. The right heart fails and fluid unable to be accommodated is sequestered in dependent interstitial spaces and causes edema.
- A nurse is caring for a group of clients in an infectious disease unit. The nurse should wear an OSHA approvedN95 respirator mask when caring for a client with which of the following infectious diseases?
A. Pertussis
B. Mycoplasmal pneumonia
C. Tuberculosis
D. Respiratory syncytial virus
A is incorrect
Rationale: Pertussis is transmitted by large droplets and does not require the use of an
individually fitted N95 respirator mask. The nurse should wear a fluid resistant surgical mask when caring for a client who has Pertussis.
B is incorrect
Rationale: Mycoplasmal pneumonia is transmitted by large droplets and does not require the use of an N95 respirator mask. The nurse should wear a fluid resistant surgical mask when caring for a client who has mycoplasmal pneumonia.
C is correct answer
Rationale: Tuberculosis is transmitted by small droplets and requires the nurse to wear an individually fitted N95 respirator mask when caring for clients who have this disease.
D is incorrect
Rationale: Respiratory syncytial virus is transmitted by large droplets and does not require the use of an N95 respirator mask. The nurse should wear a fluid resistant surgical mask when caring for a client who is infected with the respiratory syncytial virus.
- A nurse is caring for a client who is having difficulty using an incentive spirometer. The nurse should suggestthat the client..
A. start slowly and increase volume over several sessions.
B. do regular deep-breathing exercises instead.
C. use another device because this one is might be faulty.
D. be much more vigorous in increasing increments.
Rationale: The best advice is to have the client should start very slowly and gradually increase the volume. It also helps to take several slow, deep breaths in between spirometer inhalations.
B is incorrect.
Rationale: Other deep breathing exercises are important, but they should not replace spirometer use. They can help enhance it.
C is incorrect
Rationale: Unless the device is obviously damaged or does not work at all, not even minimally, there is no reason to suspect that it is faulty.
D is incorrect
Rationale: Increasing vigor increases fatigue and might further discourage the client from using
the spirometer.
- A volume control mode where the ventilator will provide a set tidal volume for a set rate. If the patient initiatesadditional breaths above the set rate the ventilator will not provide a tidal volume for those additional breaths(spontaneous breaths).
A. Pressure Support
B. Assist Control (A/C)
C. Synchronized Intermittent Mandatory Ventilation (SIMV)
D. Pressure Control Mode
C is correct answer
A is incorrect
Rationale: A type of pressure mode that augments or assists spontaneous breathing efforts by delivering a high flow of gas to a selected pressure level early in inspiration (to overcome tube resistance) and maintains this pressure level throughout the inspiratory phase. By meeting the patient's inspiratory flow demand throughout the inspiratory phase, patient effort is reduced and comfort is increased. This mode can also be used in combination with other modes and used as a weaning technique.
B is incorrect
Rationale: A type of volume control mode that will provide an assisted breath if the patient initiates a breath. Each breath taken whether initiated by the patient or not will have the pre-set tidal volume delivered. (breaths are mandatory or assisted).
D is incorrect
Rationale: In this ventilator mode a selected gas pressure is delivered to the patient and sustained throughout the phase of ventilation. This mode does not have a set tidal volume. When the ventilator delivers a breath, it continues delivering the volume until the pre-set pressure limit is reached. When this mode of ventilation is used the tidal volume with each breath varies due to lung compliance.
- A ventilator setting that is the pressure that is maintained in the lungs at the end of expiration. This setting isadjusted to maintain lung compliance by maintaining the alveoli in an open position.
A. Synchronized Intermittent mandatory Ventilation (SIMV)
B. Assist Control (A/C) Mode
C. Pressure Support
D. Positive End Expiratory Pressure (PEEP)
A is incorrect
Rationale: this is a volume control mode that delivers a mandatory breath intermittently with
spontaneous breaths
B is incorrect
Rationale: this is a volume control mode that delivers a set tidal volume with each breath
C is incorrect
Rationale: this setting (or mode) gives a high flow of gas at the beginning of the inspiratory
cycle to overcome tube or airway resistance.
D is correct answer
Rationale: this is a ventilator setting that can be used in all ventilator modes, it increases
oxygenation by opening up alveoli and not allowing them to collapse
- A patient is over breathing the ventilator at a very high rate, the nurse knows that this may cause "stackingbreaths" and will cause the ventilator to alarm high pressures. The nurse knows this type of complication isassociated most with which ventilator mode?
A. Synchronized Intermittent Mandatory Ventilation (SIMV) with Pressure Support
B. Assist Control Mode (A/C)
C. Continuous Positive Airway Pressure Mode (CPAP)
D. Synchronized Intermittent Mandatory Ventilation
A is incorrect
Rationale: Same as SIMV over breathing is encouraged, but with PS that decreases patient
effort in overcoming tube resistance.
B is correct answer
Rationale: Patient can become hypoxic by attempt to breathe faster, stacking breaths. At high
respiratory rates – air trapping may occur and cause high pressures and the high
pressure to alarm on the ventilator.
C is incorrect
Rationale: The patient sets their own rate, pressure and volumes in this mode. (i.e. All breaths are spontaneous). If the patient over breaths the ventilator it will not cause air trapping since patient controls
D is incorrect
Rationale: It is desirable for the patient to "over breath" the ventilator in this mode.
- While caring for a patient on a ventilator, the nurse notes that the patient is experiencing acute distress with adecrease in oxygen saturation to 82%. The nurse’s initial intervention would be to:
A. Call the respiratory therapist stat to assess the problem.
B. Remove the patient from the ventilator and use the AMBU bag with 100% oxygen.
C. Call the physician stat regarding the patient’s drop in oxygen saturation.
D. Administer a sedative per physician’s orders to reduce the patient’s anxiety.
A is incorrect
Rationale: It is with the scope of the registered nurse to provide this intervention.
B is correct answer
Rationale: Rationale: When the patient is experiencing hypoxia, it is imperative that the nurse remove the patient from the mechanical ventilator and administer 100 % oxygen until the problem can be detected. Once the oxygenation returns to an acceptable range the nurse should continue the assessment process. It is also important that the nurse listen anteriorly and posteriorly in all lung fields. The importance of this exam cannot be overemphasized. When listening, the nurse should compare right against left lung and never listen through clothing or other material. The clinician should listen laterally in order to appreciate certain lung segments that can be heard in this position.
C is incorrect
Rationale: This will take too long, most intubated patients have standing orders to keep sats above 90%. It is within the scope of practice to ambu bag patient to return saturations to above physician ordered parameters till other remedies can be initiated by the physician.
D is incorrect
Rationale: This is contraindicated. Patient's oxygenation status is being compromised, sedation is not an intervention that will help this patient.
- A patient with community-acquired pneumonia is being discharged. Which of the following should the nurseinclude in this patient’s discharge plan of care?
A. Take the prescribed antibiotics until the coughing stops.
B. Limit fluid intake to reduce secretions.
C. Avoid smoking or environments with smoke.
D. Resume normal activity level.
A is incorrect
Rationale: The patient should also be taught about all medications that will be continued at home. Medications should be taken as directed until the prescribed dose is gone, not only until symptoms disappear.
B is incorrect.
Rationale: Instructions should include ways to maintain resistance to infection with proper nutrition and adequate fluid intake. Fluids should be increased to help loosen secretions and encourage a productive cough.
C is correct answer
Rationale: The incidence of community-acquired pneumonia is highest in winter months, with smoking being an important risk factor.