CHAPTER 20: PULMONARY THERAPEUTIC MANAGEMENT {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 20: P ULMONARY T HERAPEUTIC
M ANAGEMENT
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. What is the preset positive pressure used to augment the patient’s
inspiratory effort known as?
a. Positive end-expiratory pressure (PEEP)
b. Continuous positive airway pressure (CPAP)
c. Pressure control ventilation (PCV)
d. Pressure support ventilation (PSV)



ANS: D



Preset positive pressure used to augment the patient’s inspiratory
efforts is known as pressure s upport ventilation. With continuous
positive airway pressure, positive pressure is applied during
spontaneous breaths; the patient controls rate, inspiratory flow, and
tidal volume. Positive end -expiratory pressure is positive pressure
applied at the end o f expiration of ventilator breaths.



PTS: 1 DIF: Cognitive Level: Understanding REF: p.
500 | Table 20 -5 OBJ: Nursing Process Step: Intervention
TOP: Pulmonary MSC: NC LEX: Physiologic Integrit y

,2. Which statement best describes the effects of positive -pressure ventilation
on cardiac output?
a. Positive-pressure ventilation increases intrathoracic pressure, which
increases venous return and cardiac output.
b. Positive-pressure ventilation decreases venous return, which
increases preload and cardiac output.
c. Positive-pressure ventilation increases venous return, which
decreases preload and cardiac output.
d. Positive-pressure ventilation increases intrathoracic pressure, which
decreases venous return and cardiac output.



ANS: D



Positive-pressure ventilation increas es 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.



PTS: 1 DIF: Cognitive Level: Understanding REF: p.
500 OBJ: Nursing Proces s Step: Intervention TOP:
Pulmonary MSC: NC LEX: Physiologic Integrit y



3. What nursing interventions should be included in the nursing management
of the patient receiving a neuromuscular blocking agent?
a. Withholding all sedation and narcotics
b. Protecting the patient from the environment
c. Keeping the patient supine
d. Speaking to the patient onl y when necessary



ANS: B

, Patient safet y 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.



PTS: 1 DIF: Cognitive Level: Understanding REF: p.
505 OBJ: Nursing Process Step: Intervention TOP:
Pulmonary MSC: NC LEX: Physiologic Integrit y



4. A patient with acute lung failure has been on a ventilator for 3 days and is
being considered for weaning. When entering the room, the ventilator
inoperative alarm sounds. What action should the nurse take FIRST?
a. Troubleshoot the ventilator until the problem is fo und.
b. Take the patient off the ventilator and manuall y ventilate.
c. Call the respiratory therapist for help.
d. Silence the ventilator alarms until the problem is resolved.



ANS: B



Ensure emergency equipment is at bedside at all times (e.g., manual
resuscitatio n bag connected to ox ygen, masks, suction equipment or
supplies), including preparations for power failures. If the ventilator
malfunctions, the patient should be removed from the ventilator and
ventilated manuall y with a manual resuscitation bag.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 492
OBJ: Nursing Process Step: Intervention TOP:
Pulmonary MSC: NC LEX: Physiologic Integrit y