NUR 430 NCLEX QUESTIONS EXAM 2 WITH
ACCURATE ANSWERS
Which manifestation is not associated with the exudative phase of acute lung
injury?
A) Increased airway resistance and work of breathing
B) Cellular granulation and deposits of collagen in the capillary membrane
C) Loss of surfactant, resulting in alveolar collapse
D) Development of interstitial edema - ANSWER B) Cellular granulation and
deposits of collagen in the capillary membrane
All are pathophysiologic manifestations of the exudative phase except cellular
granulation and deposits of collagen in the capillary membrane, which occurs
during the fibroproliferative phase as healing begins.
Mr. D, a 28-year-old man, has been admitted to the intensive care unit for
monitoring after a motor vehicle accident (MVA). Your physical assessment
reveals multiple abrasions and bruising across the chest but an otherwise
healthy young man. Suddenly, Mr. D complains of difficulty breathing. You
quickly perform an assessment of his respiratory status and observe that his O2
saturation has dropped dramatically, there are decreased breath sounds on the
left, and it appears that there is some tracheal deviation. What would be your
next logical action?
A) Notify Mr. D's physician and prepare for a stat V/Q scan.
B) Start Mr. D on O2 at 4 L/min nasal cannula and prepare an aminophylline drip.
C) Call the rapid response team and prepare for emergency insertion of a chest
tube.
D) Notify Mr. D's physician of these changes. - ANSWER C) Call the rapid
response team and prepare for emergency insertion of a chest tube.
The signs and symptoms Mr. D is experiencing are classic indications of
development of a pneumothorax. The characteristics that particularly
differentiate this diagnosis are the bruising on the chest after MVA and the
deviated trachea.
Risk factors for pulmonary thromboembolism include the following predisposing
factors except:
A) ischemia.
B) injury to the endothelial lining of blood vessels.
C) hypercoagulable states.
D) venous stasis. - ANSWER A) ischemia.
,Risk factors for pulmonary thromboembolism include the following predisposing
factors: venous stasis such as in atrial fibrillation, decreased cardiac output,
and immobility; injury to the vascular endothelium, such as in local vessel injury,
infection, and atherosclerosis; and hypercoagulability, such as in polycythemia.
Which statement is true regarding status asthmaticus?
A) Initial arterial blood gas levels indicate severe hypoxemia and respiratory
acidosis.
B) Low-flow oxygen therapy should be used cautiously in patients with asthma.
C) Small, frequent doses of bronchodilators should be started immediately.
D) Corticosteroids, although useful in the treatment of status asthmaticus,
usually require 6 to 8 hours to take effect. - ANSWER D) Corticosteroids,
although useful in the treatment of status asthmaticus, usually require 6 to 8
hours to take effect.
The onset of action of corticosteroids is 6 to 8 hours. A patient in status
asthmaticus often initially presents with alkalosis caused by tachypnea and
hyperventilation, but as fatigue sets in, hypoventilation and hypercapnia result
in acidosis. These patients often require high-flow oxygen therapy and high-
dose bronchodilators.
Ms. H has been in the MICU for 3 days now with a diagnosis of pneumonia. She is
being treated with antibiotics, 50% oxygen, and vigorous pulmonary toilet.
Despite your best efforts, her condition continues to get worse. Which of the
following would indicate the development of acute respiratory distress
syndrome (ARDS)?
A) Initially, the Paco2 is elevated on arterial blood gas analysis.
B) Arterial blood gas analysis reveals a low Pao2 despite increases in
supplemental oxygen.
C) Chest radiography shows evidence of pulmonary hypertension.
D) Respiratory acidosis is present initially on arterial blood gas analysis. -
ANSWER B) Arterial blood gas analysis reveals a low Pao2 despite increases in
supplemental oxygen.
Arterial blood gas analysis reveals a low Pao2 despite increases in
supplemental oxygen administration (refractory hypoxemia). Initially, the Paco2
is low as a result of hyperventilation, but eventually, the Paco2 increases as the
patient fatigues. The pH is high initially but decreases as respiratory acidosis
develops. Initially, the chest radiography findings may be normal because
changes in the lungs do not become evident for up to 24 hours. As the
pulmonary edema becomes apparent, diffuse, patchy interstitial and alveolar
infiltrates appear. This progresses to multifocal consolidation of the lungs,
which appears as a "whiteout" on the chest radiographs.
A mechanically ventilated patient has a fever, P/F ratio of 230, and a pulmonary
artery occlusive pressure of 15 mm Hg. The patient is coughing and triggering
, the high-pressure alarm on the ventilator. The radiologist has notified the nurse
that the patient's feeding tube is in the right lung, and the patient has developed
bilateral infiltrates on the radiograph. The nurse is concerned that the patient is
developing:
A) acute pulmonary embolism.
B) acute lung injury.
C) pneumothorax.
D) inadequate nutrition. - ANSWER B) acute lung injury
The patient is showing signs of acute lung injury brought on by the direct lung
injury from the misplaced feeding tube. There is no evidence of a pulmonary
embolism. A pneumothorax would have shown up on the radiograph as a
unilateral problem, not a diffuse infiltrate. Nutrition is not the immediate concern
at this moment.
Which mode of ventilation uses low tidal volume in conjunction with normal
respiratory rates to limit the effects of barotraumas in patients with adult
respiratory distress syndrome (ARDS)?
A) Assist control (A/C) ventilation
B) Permissive hypercapnia
C) Pressure control ventilation (PCV)
D) Continuous positive airway pressure (CPAP) - ANSWER B) Permissive
hypercapnia
Permissive hypercapnia is the mode with "normal" rates (not increased) and
small tidal volumes to allow the CO2 levels to increase. A/C ventilation has a
preset tidal volume that the patient gets from the ventilator whether he or she
breathes extra or allows the machine to deliver all breaths. PCV sets an
inspiratory pressure rather than a tidal volume. CPAP delivers oxygen and a
pressure above baseline to keep the alveoli inflated and prevent atelectasis.
The sputum culture obtained on admission shows Streptococcus pneumonia in a
patient with a history of coronary artery disease and alcoholism. The nurse
reflects that the patient has:
A) hospital-acquired pneumonia (HAP).
B) community-acquired pneumonia (CAP).
C) bilateral pneumonia.
D) ventilator-associated pneumonia (VAP). - ANSWER B) community-acquired
pneumonia (CAP).
The patient has CAP. The culture was obtained on admission, S. pneumoniae is a
commonly acquired pathogen, and the patient has comorbidities that could lead
to CAP. The patient was not in the hospital longer than 48 hours or on the
ventilator, and there is no mention of the radiography report describing the
location of the pneumonia.
ACCURATE ANSWERS
Which manifestation is not associated with the exudative phase of acute lung
injury?
A) Increased airway resistance and work of breathing
B) Cellular granulation and deposits of collagen in the capillary membrane
C) Loss of surfactant, resulting in alveolar collapse
D) Development of interstitial edema - ANSWER B) Cellular granulation and
deposits of collagen in the capillary membrane
All are pathophysiologic manifestations of the exudative phase except cellular
granulation and deposits of collagen in the capillary membrane, which occurs
during the fibroproliferative phase as healing begins.
Mr. D, a 28-year-old man, has been admitted to the intensive care unit for
monitoring after a motor vehicle accident (MVA). Your physical assessment
reveals multiple abrasions and bruising across the chest but an otherwise
healthy young man. Suddenly, Mr. D complains of difficulty breathing. You
quickly perform an assessment of his respiratory status and observe that his O2
saturation has dropped dramatically, there are decreased breath sounds on the
left, and it appears that there is some tracheal deviation. What would be your
next logical action?
A) Notify Mr. D's physician and prepare for a stat V/Q scan.
B) Start Mr. D on O2 at 4 L/min nasal cannula and prepare an aminophylline drip.
C) Call the rapid response team and prepare for emergency insertion of a chest
tube.
D) Notify Mr. D's physician of these changes. - ANSWER C) Call the rapid
response team and prepare for emergency insertion of a chest tube.
The signs and symptoms Mr. D is experiencing are classic indications of
development of a pneumothorax. The characteristics that particularly
differentiate this diagnosis are the bruising on the chest after MVA and the
deviated trachea.
Risk factors for pulmonary thromboembolism include the following predisposing
factors except:
A) ischemia.
B) injury to the endothelial lining of blood vessels.
C) hypercoagulable states.
D) venous stasis. - ANSWER A) ischemia.
,Risk factors for pulmonary thromboembolism include the following predisposing
factors: venous stasis such as in atrial fibrillation, decreased cardiac output,
and immobility; injury to the vascular endothelium, such as in local vessel injury,
infection, and atherosclerosis; and hypercoagulability, such as in polycythemia.
Which statement is true regarding status asthmaticus?
A) Initial arterial blood gas levels indicate severe hypoxemia and respiratory
acidosis.
B) Low-flow oxygen therapy should be used cautiously in patients with asthma.
C) Small, frequent doses of bronchodilators should be started immediately.
D) Corticosteroids, although useful in the treatment of status asthmaticus,
usually require 6 to 8 hours to take effect. - ANSWER D) Corticosteroids,
although useful in the treatment of status asthmaticus, usually require 6 to 8
hours to take effect.
The onset of action of corticosteroids is 6 to 8 hours. A patient in status
asthmaticus often initially presents with alkalosis caused by tachypnea and
hyperventilation, but as fatigue sets in, hypoventilation and hypercapnia result
in acidosis. These patients often require high-flow oxygen therapy and high-
dose bronchodilators.
Ms. H has been in the MICU for 3 days now with a diagnosis of pneumonia. She is
being treated with antibiotics, 50% oxygen, and vigorous pulmonary toilet.
Despite your best efforts, her condition continues to get worse. Which of the
following would indicate the development of acute respiratory distress
syndrome (ARDS)?
A) Initially, the Paco2 is elevated on arterial blood gas analysis.
B) Arterial blood gas analysis reveals a low Pao2 despite increases in
supplemental oxygen.
C) Chest radiography shows evidence of pulmonary hypertension.
D) Respiratory acidosis is present initially on arterial blood gas analysis. -
ANSWER B) Arterial blood gas analysis reveals a low Pao2 despite increases in
supplemental oxygen.
Arterial blood gas analysis reveals a low Pao2 despite increases in
supplemental oxygen administration (refractory hypoxemia). Initially, the Paco2
is low as a result of hyperventilation, but eventually, the Paco2 increases as the
patient fatigues. The pH is high initially but decreases as respiratory acidosis
develops. Initially, the chest radiography findings may be normal because
changes in the lungs do not become evident for up to 24 hours. As the
pulmonary edema becomes apparent, diffuse, patchy interstitial and alveolar
infiltrates appear. This progresses to multifocal consolidation of the lungs,
which appears as a "whiteout" on the chest radiographs.
A mechanically ventilated patient has a fever, P/F ratio of 230, and a pulmonary
artery occlusive pressure of 15 mm Hg. The patient is coughing and triggering
, the high-pressure alarm on the ventilator. The radiologist has notified the nurse
that the patient's feeding tube is in the right lung, and the patient has developed
bilateral infiltrates on the radiograph. The nurse is concerned that the patient is
developing:
A) acute pulmonary embolism.
B) acute lung injury.
C) pneumothorax.
D) inadequate nutrition. - ANSWER B) acute lung injury
The patient is showing signs of acute lung injury brought on by the direct lung
injury from the misplaced feeding tube. There is no evidence of a pulmonary
embolism. A pneumothorax would have shown up on the radiograph as a
unilateral problem, not a diffuse infiltrate. Nutrition is not the immediate concern
at this moment.
Which mode of ventilation uses low tidal volume in conjunction with normal
respiratory rates to limit the effects of barotraumas in patients with adult
respiratory distress syndrome (ARDS)?
A) Assist control (A/C) ventilation
B) Permissive hypercapnia
C) Pressure control ventilation (PCV)
D) Continuous positive airway pressure (CPAP) - ANSWER B) Permissive
hypercapnia
Permissive hypercapnia is the mode with "normal" rates (not increased) and
small tidal volumes to allow the CO2 levels to increase. A/C ventilation has a
preset tidal volume that the patient gets from the ventilator whether he or she
breathes extra or allows the machine to deliver all breaths. PCV sets an
inspiratory pressure rather than a tidal volume. CPAP delivers oxygen and a
pressure above baseline to keep the alveoli inflated and prevent atelectasis.
The sputum culture obtained on admission shows Streptococcus pneumonia in a
patient with a history of coronary artery disease and alcoholism. The nurse
reflects that the patient has:
A) hospital-acquired pneumonia (HAP).
B) community-acquired pneumonia (CAP).
C) bilateral pneumonia.
D) ventilator-associated pneumonia (VAP). - ANSWER B) community-acquired
pneumonia (CAP).
The patient has CAP. The culture was obtained on admission, S. pneumoniae is a
commonly acquired pathogen, and the patient has comorbidities that could lead
to CAP. The patient was not in the hospital longer than 48 hours or on the
ventilator, and there is no mention of the radiography report describing the
location of the pneumonia.
