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Acute Respiratory Questions Essay

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ACUTE RESPIRATORY STUDY QUESTIONS
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1.
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A client is in danger of respiratory arrest following the administration of an opioid analgesic. An arterial blood gas value is obtained. The nurse should expect the PaCO2 to be which value?
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a.
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15 mm Hg
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b.
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30 mm Hg
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c.
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40 mm Hg
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d.
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80 mm Hg
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2.
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A client’s arterial blood gas (ABG) results are as follows: pH, 7.16; PaCO2, 80 mm Hg; PaO2 46 mm Hg; HCO3-, 24 mEq/L; SaO2, 81%. These ABG results represent which condition?
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a.
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Metabolic acidosis
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b.
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Metabolic alkalosis
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c.
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Respiratory acidosis
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d.
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Respiratory alkalosis
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3.
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A firefighter was involved in extinguishing a house fire and is being treated for smoke inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. He most likely has developed which condition?
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a.
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Acute respiratory distress syndrome (ARDS)
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b.
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Atelectasis
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c.
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Bronchitis
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d.
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Pneumonia
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4.
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In a client with smoke inhalation who develops pulmonary edema, the nurse should expect to hear which breath sound?
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a.
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Crackles
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b.
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Decreased breath sounds
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c.
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Inspiratory and expiratory wheezing
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d.
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Upper airway rhonchi
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5.
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Which nursing diagnosis would be the priority for a client with acute respiratory distress syndrome (ARDS)?
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a.
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Ineffective breathing pattern
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b.
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Risk for infection
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c.
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Imbalanced nutrition: Less than body requirements
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d.
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Impaired skin integrity
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6.
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Which statement best describes what happens to the alveoli in acute respiratory distress syndrome (ARDS)?
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a.
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Alveoli are overexpanded.
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b.
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Alveoli increase perfusion.
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c.
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Alveolar spaces are filled with fluid.
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d.
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Alveoli improve gaseous exchange.
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7.
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A 69-year-old client develops acute shortness of breath and progressive hypoxia requiring mechanical ventilation after repair of a fractured right femur. The hypoxia was probably caused by which condition?
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a.
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Asthma attack
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b.
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Atelectasis
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c.
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Bronchitis
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d.
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Fat embolism
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8.
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A client with a fat embolism is receiving 100% FIO2 on a mechanical ventilator and continues to be hypoxic. Which measure can improve his oxygenation?
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a.
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Add positive end-expiratory pressure (PEEP).
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b.
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Give beta-adrenergic blockers.
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c.
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Give diuretics.
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d.
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Increase the FIO2 on the ventilator.
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ACUTE RESPIRATORY STUDY QUESTIONS, pg 2
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9.
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If a client with a fat embolism continues to be hypoxic following therapy with positive end-expiratory pressure, what can be done to reduce oxygen demand?
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a.
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Give diuretics.
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b.
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Give neuromuscular blockers.
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c.
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Put the head of the bed flat.
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d.
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Use bronchodilators.
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10.
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Positive end-expiratory pressure (PEEP) therapy has which initial effect on the heart?
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a.
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Bradycardia
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b.
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Tachycardia
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c.
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Increased blood pressure
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d.
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Reduced cardiac output
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11.
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Occasionally, clients with acute respiratory distress syndrome (ARDS) are placed in the prone position. How does this position help the client?
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a.
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It improves cardiac output.
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b.
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It makes the client more comfortable.
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c.
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It prevents skin breakdown.
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d.
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It recruits more alveoli.
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12.
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Which condition could lead to acute respiratory distress syndrome (ARDS)?
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a.
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Appendicitis
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b.
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Massive trauma
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c.
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Receiving conscious sedation
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d.
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Right meniscus injury
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13.
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Which indicators would show if the condition of a client with acute respiratory distress syndrome (ARDS) is improving?
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a.
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Arterial blood gas (ABG) values
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b.
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Bronchoscopy results
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c.
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Increased blood pressure
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d.
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Sputum culture and sensitivity results
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14.
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A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of breath. He reports that it started suddenly. The assessment should include which intervention?
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a.
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Auscultation of breath sounds
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b.
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Chest x-ray
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c.
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Echocardiogram
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d.
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Electrocardiogram (ECG)
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15.
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The client in the previous question has decreased-to-absent breath sounds on the right side, from the apex to the base. Which condition best explains this?
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a.
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Acute asthma
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b.
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Chronic bronchitis
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c.
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Pneumonia
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d.
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Spontaneous pneumothorax
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16.
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Which treatment should a nurse expect for a client with spontaneous pneumothorax?
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a.
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Antibiotics
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b.
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Bronchodilators
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c.
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Chest tube placement
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d.
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Hyperbaric chamber
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ACUTE RESPIRATORY STUDY QUESTIONS, pg 3
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17.
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A 60-year-old client was in a motor vehicle collision as an unrestrained driver. He’s now in the emergency department complaining of difficulty breathing and chest pain. On auscultation of his lung fields, no breath sounds are present in the left upper lobe. This client may have which condition?
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a.
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Bronchitis
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b.
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Pneumonia
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c.
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Pneumothorax
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d.
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Tuberculosis (TB)
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18.
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Which method is the best way to confirm the diagnosis of a pneumothorax?
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a.
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Auscultate for breath sounds.
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b.
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Have the client use an incentive spirometer.
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c.
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Take a chest x-ray.
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d.
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Stick a needle in the area of the decreased breath sounds.
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19.
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After a motor vehicle collision, a client has a chest tube inserted in the left upper chest. When the tube is inserted, it begins to drain a large amount of dark red fluid. Which explanation best describes what caused this?
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a.
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The chest tube was inserted improperly.
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b.
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This always happens when a chest tube is inserted.
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c.
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An artery was nicked when the chest tube was placed.
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d.
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The client had a hemothorax instead of a pneumothorax.
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20.
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A hospitalized client needs a central IV catheter inserted. The physician places the catheter in the subclavian vein. Shortly afterward, the client develops shortness of breath and appears restless. Which action should the nurse perform first?
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a.
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Administer a sedative.
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b.
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Advise the client to calm down.
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c.
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Auscultate for breath sounds.
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d.
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Check to see if the client can have medication.
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21.
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Which measure would be ordered for a client who recently had a central venous catheter inserted and who now appears short of breath and anxious?
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a.
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Chest x-ray
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b.
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Electrocardiogram
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c.
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Laboratory tests
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d.
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Sedation
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22.
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A client needs to have a chest tube inserted in the right upper chest. Which action is part of the nurse’s role?
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a.
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The nurse isn’t needed.
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b.
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Prepare the chest tube drainage system.
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c.
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Bring the chest x-ray to the client’s room.
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d.
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Insert the chest tube.
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23.
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Which result shows that a chest tube insertion was done correctly?
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a.
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Bronchial sounds heard at both bases
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b.
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Vesicular sounds heard over upper lung fields
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c.
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Bronchovesicular sounds heard over both lung fields
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d.
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Crackles heard on the affected side
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24.
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Which measure best determines that a chest tube is no longer needed for a client who had a pneumothorax?
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a.
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The drainage from the chest tube is minimal.
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b.
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Arterial blood gas (ABG) levels are obtained to ensure proper oxygenation.
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c.
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It’s removed and the client is assessed to see if he’s breathing adequately.
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d.
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No fluctuation in the water seal chamber occurs when no suction is applied.
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ACUTE RESPIRATORY STUDY QUESTIONS, pg 4
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25.
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Which intervention should be done before a chest tube is removed?
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a.
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Disconnect the drainage system from the tube.
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b.
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Obtain a chest x-ray to document reexpansion.
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c.
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Obtain an arterial blood gas level to document oxygen status.
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d.
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Sedate the client, and the physician will slip the tube out without warning the client.
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26.
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A client with a chest tube has accidentally removed it. What action should the nurse perform first?
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a.
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Position the client on his left side.
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b.
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Position the client on his right side.
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c.
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Apply an occlusive dressing over the site.
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d.
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Reinsert the chest tube that fell out.
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27.
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A 165-lb client with a pulmonary embolus is ordered to receive heparin 20 units/kg/hour by IV infusion. How many units of heparin should he receive each hour?
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a.
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1,000
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b.
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1,200
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c.
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1,500
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d.
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1,700
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28.
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Which source is the most common origin for a pulmonary embolism?
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a.
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Amniotic fluid
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b.
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Bone marrow
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c.
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Septic thrombi
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d.
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Venous thrombi
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29.
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Clients most at risk for pulmonary embolism are those with which condition?
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a.
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Arthritis
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b.
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Diabetes
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c.
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Pregnancy
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d.
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Trauma to the pelvis or lower extremities
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30.
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Which measure to prevent pulmonary embolism after lower extremity surgery is the best?
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a.
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Early ambulation
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b.
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Frequent chest x-rays to find a pulmonary embolism
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c.
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Frequent lower extremity scans
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d.
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Intubation of the client
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31.
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Which physiologic effects of a pulmonary embolism would initially affect oxygenation?
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a.
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A blood clot blocks ventilation; perfusion is unaffected.
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b.
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A blood clot blocks ventilation, producing hypoxia despite normal perfusion.
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c.
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A blood clot blocks perfusion and ventilation, producing profound hypoxia.
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d.
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A blood clot blocks perfusion, producing hypoxia despite normal or hypernormal ventilation.
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32.
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Which statement best describes the ventilation-perfusion mismatch that occurs with a pulmonary embolism?
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a.
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The area of the lung being ventilated isn’t being perfused.
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b.
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The area of the lung being perfused isn’t being ventilated.
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c.
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The area of the lung being ventilated is also being perfused.
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d.
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The amount of ventilation occurring doesn’t equal perfusion.
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33.
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When a client has a pulmonary embolism, he develops chest pain caused by which condition?
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a.
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Costochondritis
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b.
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Myocardial infarction (MI)
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c.
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Inflammatory reaction
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d.
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Referred pain from the pelvis to the chest
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ACUTE RESPIRATORY STUDY QUESTIONS, pg 5
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34.
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A client with a pulmonary embolism frequently feels apprehension or a sense of “impending doom” because of which reason?
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a.
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Inflammatory reaction in the lung parenchyma
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b.
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Loss of chest expansion
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c.
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Loss of lung tissue
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d.
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Sudden reduction in adequate oxygenation
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35.
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Hemoptysis may be present in a client with a pulmonary embolism because of which reason?
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a.
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Alveolar damage in the infarcted area
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b.
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Involvement of major blood vessels where the clot formed
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c.
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Loss of lung parenchyma
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d.
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Loss of lung tissue
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36.
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A client with a massive pulmonary embolism will have an arterial blood gas analysis performed to determine the extent of hypoxia. The acid-base disorder that may be present is:
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a.
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metabolic acidosis.
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b.
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metabolic alkalosis.
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c.
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respiratory acidosis.
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d.
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respiratory alkalosis.
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37.
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A ventilation-perfusion (VQ) scan is commonly performed to diagnose a pulmonary embolism. This test provides what type of information?
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a.
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Amount of perfusion present in the lung
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b.
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Extent of the occlusion and amount of perfusion lost
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c.
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Location of the pulmonary embolism
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d.
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Location and size of the pulmonary embolism
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38.
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Which test can be used to definitively diagnose a pulmonary embolism?
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a.
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Arterial blood gas (ABG) analysis
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b.
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Chest x-ray
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c.
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Pulmonary angiogram
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d.
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Ventilation-perfusion (VQ) scan
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39.
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Which medication is prescribed after a pulmonary embolism is diagnosed?
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a.
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Warfarin (Coumadin)
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b.
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Heparin
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c.
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Streptokinase (Streptase)
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d.
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Urokinase (Abbokinase)
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40.
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IV Heparin is given to clients with pulmonary embolism for which reason?
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a.
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To dissolve the clot
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b.
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To break up the pulmonary embolism
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c.
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To slow the development of other clots
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d.
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To prevent clots from breaking off and embolizing to the lung
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41.
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A client with a pulmonary embolism is discharged but will remain on warfarin (Coumadin) therapy for up to 6 months to:
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a.
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prevent further embolism formation.
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b.
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minimize the growth of new or existing thrombi.
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c.
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continue to reduce the size of the pulmonary embolism.
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d.
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break up the existing pulmonary embolism until it’s totally gone.
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ACUTE RESPIRATORY STUDY QUESTIONS, pg 6
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42.
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The goal of oxygen therapy for a client with a pulmonary embolism is to obtain which value?
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a.
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PaCO2 greater than 40 mm Hg
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b.
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PaCO2 less than 40 mm Hg
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c.
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PaO2 greater than 60 mm Hg
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d.
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PaO2 less than 60 mm Hg
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43.
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A client may develop hypotension caused by a pulmonary embolism that produces which result?
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a.
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Pressure on the heart and reduced cardiac output
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b.
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Reduced blood flow to the lung, which causes hypotension
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c.
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Reduced blood return to the right side of the heart leading to lower blood pressure
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d.
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Increased pulmonary vascular resistance and reduced blood delivery to the left side of the heart
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44.
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A client with a pulmonary embolism typically has chest pain and apprehension, which can be treated by which method?
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a.
answer

Administering analgesics
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b.
answer

Using guided imagery
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c.
answer

Positioning the client on his left side
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d.
answer

Providing emotional support
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45.
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A client with a pulmonary embolism may have an umbrella filter placed in the vena cava for which reason?
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a.
answer

The filter prevents further clot formation.
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b.
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The filter collects clots so they don’t go to the lung.
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c.
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The filter breaks up clots into insignificantly small pieces.
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d.
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The filter contains anticoagulants that are slowly released, dissolving any clots.
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46.
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A client with a pulmonary embolism may need an embolectomy, which involves which action?
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a.
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Removing an embolism in the lower extremity
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b.
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Sucking the embolism out of the lung by bronchoscopy
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c.
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Surgically removing the embolism source in the pelvis
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d.
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Surgically removing the embolism in the pulmonary vasculature
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47.
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Nursing management of a client with a pulmonary embolism focuses on which action?
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a.
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Assessing oxygenation status
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b.
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Monitoring the oxygen delivery device
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c.
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Monitoring other sources of clots
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d.
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Determining whether the client requires another ventilation-perfusion (VQ) scan
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48.
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How does positive end-expiratory pressure (PEEP) improve oxygenation?
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a.
answer

It provides more oxygen to the client.
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b.
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It opens up bronchioles and allows oxygen to get in the lungs.
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c.
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It opens up collapsed alveoli and helps keep them open.
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d.
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It adds pressure to the lung tissue, which improves gaseous exchange.
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49.
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Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic clients by which method?
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a.
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The mask provides 100% oxygen to the client.
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b.
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The mask provides continuous air that the patient can breathe.
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c.
answer

The mask provides pressurized oxygen so that the client can breathe more easily.
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d.
answer

The mask provides pressurized oxygen at the end of expiration to open collapsed alveoli.
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ACUTE RESPIRATORY STUDY QUESTIONS, pg 7
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50.
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Bi-level positive airway pressure (BiPAP) is delivered through a special oxygen mask that performs which function?
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a.
answer

The mask provides 100% oxygen at both inspiration and expiration.
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b.
answer

The mask provides pressurized oxygen so the client can breathe more easily.
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c.
answer

The mask provides pressurized oxygen at the end of expiration to open collapsed alveoli.
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d.
answer

The mask provides both continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) to provide optimal oxygenation and ventilation.
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51.
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After a motor vehicle collision, an 18-year-old client is admitted with a pneumothorax. The surgeon inserts a chest tube and attaches it to a chest drainage system. Bubbling soon appears in the water seal chamber. Which factor is the most likely cause of the bubbling?
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a.
answer

Air leak
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b.
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Adequate suction
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c.
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Inadequate suction
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d.
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Kinked chest tube
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52.
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A client’s arterial blood gas (ABG) analysis reveals a pH of 7.18, PaCO2 of 73 mm Hg, PaO2 of 77 mm Hg, and HCO3- of 24 mEq/L. What do these values indicate?
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a.
answer

Metabolic acidosis
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b.
answer

Respiratory alkalosis
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c.
answer

Metabolic alkalosis
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d.
answer

Respiratory acidosis
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53.
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An unrestrained passenger is thrown 20 feet (6.1 m) from a care. On admission to the emergency department, he has a heart rate of 130 beats/minute, shallow respirations at a rate of 32 breaths/minute, and a blood pressure of 90/60 mm Hg. His skin is pale and cool, and capillary refill is delayed. Breath sounds are diminished on the right side and paradoxical chest-wall movement appears on the right side. A chest x-ray reveals a right pneumothorax with multiple rib fractures (4th to 7th right ribs). Which diagnosis is the most probable?
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a.
answer

Tension pneumothorax
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b.
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Flail chest
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c.
answer

Ruptured diaphragm
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d.
answer

Massive hemothorax
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54.
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To obtain an arterial blood gas sample from a client’s radial artery, which action should the nurse perform first?
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a.
answer

Perform Allen’s test.
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b.
answer

Place a rolled towel under the client’s wrist.
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c.
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Clean the puncture site with an alcohol or povidone-iodine pad.
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d.
answer

Palpate the artery with the index and middle fingers of one hand.
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55.
answer

After experiencing an anxiety attack, a client comes to the emergency department complaining of dizziness and light-headedness. Arterial blood gas (ABG) analysis reveals a pH of 7.62, PaCO2 of 22 mm Hg, PaO2 of 96 mm Hg, and HCO3- of 24 mEq/L. Which action should the nurse take?
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a.
answer

Do nothing; these ABG values are normal.
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b.
answer

Encourage the client to breathe into a paper bag.
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c.
answer

Notify the physician and prepare to give sodium bicarbonate.
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d.
answer

Notify the physician and prepare to give supplemental oxygen.
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56.
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A physician places an order in the computer for a nurse to change a client’s chest drainage system from suction to gravity drainage. How should the nurse proceed?
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a.
answer

Detach the tubing from the suction to provide a vent.
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b.
answer

Clamp the client’s drainage tube.
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c.
answer

Question the physician’s order.
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d.
answer

Turn off the suction source and leave the tubing connected.
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ACUTE RESPIRATORY STUDY QUESTIONS, pg 8
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57.
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A client with acute respiratory failure is admitted to the intensive care unit with an arterial line for frequent measurement of arterial blood gas levels and continuous measurement of blood pressure. The nurse is evaluating the waveform. Identify the area that indicates that the aortic valve has closed.
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58.
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A client with a suspected pulmonary embolus is brought to the emergency department. He complains of shortness of breath and chest pain. Which other signs and symptoms would support this diagnosis? Select all that apply:
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a.
answer

Low-grade fever
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b.
answer

Thick green sputum
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c.
answer

Bradycardia
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d.
answer

Frothy sputum
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e.
answer

Tachycardia
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f.
answer

Blood-tinged sputum
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59.
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A nurse begins her shift by reading the following shift report note on a client.
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H.B. age 78
answer

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Hyperventilating, RR 36
answer

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bpm, c/o dizziness,
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shortness of breath,
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tingling in hands and feet,
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weakness. Anxious.
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ABG: pH 7.48
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PaCO2: 33 mm Hg
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Without further information, the nurse plans to reevaluate the client’s status for which problem?
answer

question

a.
answer

Metabolic acidosis
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b.
answer

Acute respiratory failure
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c.
answer

Respiratory alkalosis
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d.
answer

Anxiety reaction
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60.
answer

A 28-year-old client with human immunodeficiency virus (HIV) is admitted to the hospital with flulike symptoms. He has dyspnea and a cough. He’s placed on a 100% nonrebreather mask and arterial blood gases are drawn. Which result indicates the need for intubation?
question

a.
answer

PaO2, 90 mm Hg; PaCO2, 40 mm Hg
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b.
answer

PaO2, 85 mm Hg; PaCO2, 45 mm Hg
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c.
answer

PaO2, 80 mm Hg; PaCO2, 45 mm Hg
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d.
answer

PaO2, 70 mm Hg; PaCO2, 55 mm Hg
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ACUTE RESPIRATORY STUDY QUESTIONS, pg 9
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61.
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A client with acquired immunodeficiency syndrome is intubated, leaving him prone to skin breakdown from the endotracheal (ET) tube. Which intervention is best to prevent this?
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a.
answer

Use lubricant on the lips.
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b.
answer

Provide oral care every 2 hours.
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c.
answer

Suction the oral cavity every 2 hours.
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d.
answer

Reposition the ET tube every 24 hours.
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62.
answer

A 31-year-old client is admitted to the hospital with respiratory failure. He’s intubated in the emergency department, placed on 100% FiO2, and is coughing up copious secretions. Which intervention should be done first?
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a.
answer

Get and x-ray.
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b.
answer

Suction the client.
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c.
answer

Restrain the client.
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d.
answer

Obtain an arterial blood gas (ABG) analysis.
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63.
answer

A client with an endotracheal (ET) tube has copious, brown-tinged secretions. Which intervention is a priority?
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a.
answer

Use a trap to obtain a specimen.
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b.
answer

Instill saline to break up secretions.
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c.
answer

Culture the specimen with a culturette swab.
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d.
answer

Obtain an order for a liquefying agent for the sputum.
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64.
answer

An x-ray shows an endotracheal (ET) tube is 2 cm above the carina, and there are nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the x-ray is accurate?
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a.
answer

The x-ray is inconclusive.
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b.
answer

The client has a disease process going on.
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c.
answer

The ET tube needs to be advanced.
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d.
answer

The ET tube needs to be pulled back.
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65.
answer

A client has arterial blood gases drawn. The results are as follows: pH, 7.52; PaO2, 50 mm Hg; PaCO2, 28 mm Hg; HCO3-, 24 mEq/L. Which condition is indicated?
question

a.
answer

Metabolic acidosis
question

b.
answer

Metabolic alkalosis
question

c.
answer

Respiratory acidosis
question

d.
answer

Respiratory alkalosis