CHAPTER 19: PULMONARY DISORDERS {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 19: P ULMONARY D ISORDERS
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. Which finding confirms the diagnosis of a pulmonary embolism (PE)?
a. Low-probabilit y ventilation -perfusion (V/Q) scan
b. Negative pulmonary angiogram
c. High-probabilit y V/Q scan
d. Absence of vascular markings on the chest radiograph



ANS: C



A definitive diagnosis of a pulmonary embolism requires confirmation
by a high-probabilit y ventilation -perfusion (V/Q) scan, an abnormal
pulmonary angiogram or computed tomography scan, or strong clinical
suspicion coupled with abnormal findings on low er extremit y deep
venous thrombosis studies.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 473 |
p. 474 OBJ: Nursing Process Step: Assessment TOP:
Pulmonary MSC: NC LEX: Physiologic Integrit y



2. What condition develops when air enters the pleural space from the lung
on inhalation and cannot exit on exhalation?
a. Tension pneumothorax
b. Sucking chest wound

, c. Open pneumothorax
d. Pulmonary interstitial empyema



ANS: A



A tension pneumothorax develops when air enters the pleural space
from either the lung or the che st wall on inhalation and cannot escape
on exhalation. Open pneumothorax is a laceration in the parietal pleura
that allows atmospheric air to enter the pleural space; it occurs because
of penetrating chest trauma. Pulmonary interstitial emphysema is air i n
the pulmonary interstitial space.



PTS: 1 DIF: Cognitive Level: Understanding REF: p.
478 | Table 19 -6 OBJ: Nursing Process Step: Diagnosis
TOP: Pulmonary MSC: NC LEX: Physiologic Integrit y



3. What is the medical treatment for a pneumothorax greater t han 15%?
a. Systemic antibiotics to treat the inflammatory response
b. An occlusive dressing to equalize lung pressures
c. Interventions to evacuate the air from the pleural space
d. Mechanical ventilation to assist with re -expansion of the collapsed
lung



ANS: C



A pneumothorax greater than 15% requires intervention to evacuate the
air from the pleural space and facilitate re -expansion of the collapsed
lung. Interventions include aspiration of the air with a needle and
placement of a small -bore (12 to 20 Fr) or large -bore (24 to 40 Fr)
chest tube.

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



4. A patient was admitted after a left pneumonectom y. The patient is
receiving 40% ox ygen via a simple facemask. The morning chest
radiography study reveals right lower lobe pneumonia. After eating
breakfast, the patient suddenl y vomits and aspirates. What action should
the nurse take next?
a. Lavage the airway with normal saline.
b. Place the patient supine in a semi -Fowler position.
c. Manuall y ventilate the patient.
d. Suction the airway.



ANS: D



When aspiration is witnessed, emergency treatment should be instituted
to secure the airway and minimize pulmonary damage. The patient’s
head should be turned to the side, and the oral cavit y and upper airway
should be suctioned immediatel y to remove the gastric contents.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 484
OBJ: Nursing Process Step: Intervention TOP:
Pulmonary MSC: NC LEX: Phys iologic Integrit y



5. A patient was admitted in acute lung failure. The patient is receiving 40%
oxygen via a simple facemask. The morning chest radiography study
reveals right lower lobe pneumonia. Which test would the nurse expect the
practitioner to order to identify the infectious pathogen?