PCCN Review - Pulmonary
questions as given by the
AACN questions and answers
Your patient had an exacerbation of COPD. The rapid response team was called
and is currently intubating the patient and preparing him for transfer to ICU.
When the family visits, they are shocked to see the people working with the
patient. No one had told them the patient had deteriorated and required
intubation. After the patient is intubated and is being wheeled past them, family
members try to communicate verbally with the patient, but he does not respond
except to gesture. The nurse should tell the family members:
-They must leave the area because they are exciting the patient.
-The tube used for breathing prevents the patient from speaking
-They must speak with the doctor, who will explain why the patient cannot speak
-The patient is very ill and may die. - ANSWER-The tube used for breathing
prevents the patient from speaking
This is a case where communication is clearly the problem. The family should have
been informed by someone that the patient needed assistance with breathing and
that they should expect a transfer. It should also have been mentioned how the
patient might look in the ICU. In addition, it could have been communicated about
the patient's inability to speak.
,The other ANSWERs are all non-theraputic responses. The family is clearly
distressed, so a simple explaination in best.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was
intubated for a time because of his ARDs. On arrival to your unit, you note that he
is tachycardic and restless. Ben states, "I can't be here now. What if something like
this happens to me again?" The nurse's best response would be:
-The nurses in our unit can take care of you
-We are not very far away at the nurses' station
-Your insurance will not cover another day there
-You sound concerned about leaving the ICU - ANSWER-You sound concerned
about leaving the ICU
Theraputic communication occurs when the patient's feelings are validated. This
response allows for the patient to express the concerns he has about the transfer.
The other ANSWERs are closed and judgmental and do not allow for any
expression of feeling from the patient.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was
intubated for a time because of his ARDs. On arrival to your unit, you note that he
is tachycardic and restless. A set of blood gases drawn just prior to his transfer
show:
pH 7.52, PaCO2 31, HCO3 22, PaO2 87.
,These results would indicate:
-Respiratory acidosis
-Respiratory alkalosis
-Metabloic acidosis
-Metabolic alkalosis - ANSWER-Respiratory alkalosis
Ben was quite anxious and tachycardic. His RR probably was increased because of
both anxiety and his condition.
He would blow off CO2.
His pH is below normal, so it is uncompensated.
The HCO3 is low, indicating alkalosis
The interpretation would be:
Uncompensated Respiratory Alkolosis
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was
intubated for a time because of his ARDs. On arrival to your unit, you note that he
is tachycardic and restless. Ben is finally released from the hospital. He plans to
visit his family in Denver. Part of the patient teaching for Ben should include
information on the effects of high altitude on his ability to oxygenate effectively.
Which of the following changes would be expected on his blood gas results?
-The pH would decrease
-No effect
, -The O2 saturation would decrease
-The PaO2 would increase - ANSWER-The O2 saturation would decrease
At higher altitudes, there is decreased atmospheric pressure to force oxygen into
the lungs. To compensate for the lower pressure, the person must breathe faster.
The percentage of oxygen remains the same, but the partial pressure of the
oxygen decreases. Aterial PaO2 decreases, as does O2 saturation. The rapid
breathing will result in hyperventillation, raising the pH and lowering the PaCO2
level.
SaO2 values account for what % of O2 carreid within the bloodstream?
-2-3%
-10-24%
-97-98%
-100% - ANSWER-97-98%
The % of total oxygen carried within the bloodstream attributed to the SaO2 is 97-
98%.
SaO2 is the arterial saturation of hemoglobin. The % corresponds to the % of
hemoglobin on the red blood cells that carries O2. Typically this % is documented
as normal when within 93-99%.
PaO2 is the % of O2 within the bloodstream that is free or dissolved in the plasma.
This value is documented in mmHg and is considered normal when within the
range of 80-100 mmHg.
questions as given by the
AACN questions and answers
Your patient had an exacerbation of COPD. The rapid response team was called
and is currently intubating the patient and preparing him for transfer to ICU.
When the family visits, they are shocked to see the people working with the
patient. No one had told them the patient had deteriorated and required
intubation. After the patient is intubated and is being wheeled past them, family
members try to communicate verbally with the patient, but he does not respond
except to gesture. The nurse should tell the family members:
-They must leave the area because they are exciting the patient.
-The tube used for breathing prevents the patient from speaking
-They must speak with the doctor, who will explain why the patient cannot speak
-The patient is very ill and may die. - ANSWER-The tube used for breathing
prevents the patient from speaking
This is a case where communication is clearly the problem. The family should have
been informed by someone that the patient needed assistance with breathing and
that they should expect a transfer. It should also have been mentioned how the
patient might look in the ICU. In addition, it could have been communicated about
the patient's inability to speak.
,The other ANSWERs are all non-theraputic responses. The family is clearly
distressed, so a simple explaination in best.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was
intubated for a time because of his ARDs. On arrival to your unit, you note that he
is tachycardic and restless. Ben states, "I can't be here now. What if something like
this happens to me again?" The nurse's best response would be:
-The nurses in our unit can take care of you
-We are not very far away at the nurses' station
-Your insurance will not cover another day there
-You sound concerned about leaving the ICU - ANSWER-You sound concerned
about leaving the ICU
Theraputic communication occurs when the patient's feelings are validated. This
response allows for the patient to express the concerns he has about the transfer.
The other ANSWERs are closed and judgmental and do not allow for any
expression of feeling from the patient.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was
intubated for a time because of his ARDs. On arrival to your unit, you note that he
is tachycardic and restless. A set of blood gases drawn just prior to his transfer
show:
pH 7.52, PaCO2 31, HCO3 22, PaO2 87.
,These results would indicate:
-Respiratory acidosis
-Respiratory alkalosis
-Metabloic acidosis
-Metabolic alkalosis - ANSWER-Respiratory alkalosis
Ben was quite anxious and tachycardic. His RR probably was increased because of
both anxiety and his condition.
He would blow off CO2.
His pH is below normal, so it is uncompensated.
The HCO3 is low, indicating alkalosis
The interpretation would be:
Uncompensated Respiratory Alkolosis
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was
intubated for a time because of his ARDs. On arrival to your unit, you note that he
is tachycardic and restless. Ben is finally released from the hospital. He plans to
visit his family in Denver. Part of the patient teaching for Ben should include
information on the effects of high altitude on his ability to oxygenate effectively.
Which of the following changes would be expected on his blood gas results?
-The pH would decrease
-No effect
, -The O2 saturation would decrease
-The PaO2 would increase - ANSWER-The O2 saturation would decrease
At higher altitudes, there is decreased atmospheric pressure to force oxygen into
the lungs. To compensate for the lower pressure, the person must breathe faster.
The percentage of oxygen remains the same, but the partial pressure of the
oxygen decreases. Aterial PaO2 decreases, as does O2 saturation. The rapid
breathing will result in hyperventillation, raising the pH and lowering the PaCO2
level.
SaO2 values account for what % of O2 carreid within the bloodstream?
-2-3%
-10-24%
-97-98%
-100% - ANSWER-97-98%
The % of total oxygen carried within the bloodstream attributed to the SaO2 is 97-
98%.
SaO2 is the arterial saturation of hemoglobin. The % corresponds to the % of
hemoglobin on the red blood cells that carries O2. Typically this % is documented
as normal when within 93-99%.
PaO2 is the % of O2 within the bloodstream that is free or dissolved in the plasma.
This value is documented in mmHg and is considered normal when within the
range of 80-100 mmHg.
