TESTBANK Chapter Title: Pulmonary Diagnostic Procedures Chapter #: 20

Questions 1-3 refer to the following situation. 1. On admission a patient presents as follows: pH 7.38; RR 24, regular, pursed lip breathing; PaO2 66; HR 112, sinus tachycardia; PaCO2 52; BP 110/68; HCO3- 30; SpO2 90% on O2 2 liters/min nasal cannula. These gases show: 1. compensated metabolic alkalosis. 2. compensated respiratory acidosis. 3. compensated metabolic acidosis. 4. compensated respiratory alkalosis.

Topic: Pulmonary Cognitive Level: Application Correct answer: 3 Rationale: The pH is closer to the acidic level, therefore the
primary disorder is acidosis. The increased PaCO2 is the cause of the acidosis, and the pH is normal (7.35-7.45) so this is compensated respiratory acidosis with metabolic alkalosis. Page Reference: 537-539

2. Which of the following diagnoses would be most consistent

with the above ABG values? 1. Acute pulmonary embolism 2. Acute myocardial infarction 3. Congestive heart failure 4. Chronic obstructive pulmonary disease

Topic: Pulmonary Cognitive Level: Application Correct answer: 4 Rationale: The fact that the HCO3- level has increased
enough to compensate for the increased pCO2 level indicates that this is not an acute condition because the kidneys can take several days to adjust. The other choices would present with a lower HCO3- level. Page Reference: 538

3. What treatment could you expect the physician to order for

this patient? 1. Increase O2 to 6 L/min. 2. Prepare for emergency intubation. 3. Administer 1 amp of sodium bicarbonate. 4. Repeat ABG in 4 hours.

Topic: Pulmonary Cognitive Level: Analysis Correct answer: 4 Rationale: Increasing the FiO2 on this patient could decrease
the respiratory rate and increase the severity of the patients CO2 retention. The patients ABG values do not warrant intubation at this time. Additional sodium bicarbonate is not indicated because this patient has a fully compensated pH. A repeat ABG may be ordered to assess the patients ongoing respiratory status. Page Reference: 540

4. A patients assessment data are as follows:

pH 7.10 RR 34 PaCO2 60 HR 128 PaO2 40 BP 180/92 HCO320 This is best described as: 1. uncompensated respiratory acidosis. 2. uncompensated metabolic acidosis. 3. compensated metabolic acidosis. 4. compensated respiratory acidosis. 5. Which of the following formulas represents the correct calculation of the anion gap? 1. Na+ (Cl- - HCO3-) 2. Na+ Cl- HCO33. (Cl- + HCO3-) Na+ 4. Na+ - (Cl- + HCO3-)

Topic: Pulmonary Cognitive Level: Application Correct answer: 1 Rationale: The pH is below normal range (7.35-7.45) so this
is an uncompensated acidosis. The PaCO2 is markedly elevated, and the HCO3- is normal. This indicates an uncompensated respiratory acidosis. Page Reference: 537-539

Topic: Pulmonary Cognitive Level: Knowledge Correct answer: 4 Rationale: The correct formula for calculating the anion gap
is extracellular fluid cations (Na+) minus extracellular fluid anions (Cl-) plus measured bicarbonate level (HCO-3). Page Reference: 541

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6. A patient presents with the following values: pH 7.20; pO2

106; pCO2 35; HCO3- 11. These values are most consistent with: 1. uncompensated respiratory acidosis. 2. uncompensated metabolic acidosis. 3. uncompensated metabolic alkalosis. 4. uncompensated respiratory alkalosis. 7. Which of the following symptoms would be most consistent with the previous values? 1. Diarrhea 2. Shortness of breath 3. Central cyanosis 4. Peripheral cyanosis

Topic: Pulmonary Cognitive Level: Application Correct answer: 2 Rationale: The pH indicates acidosis, and the HCO3- is
markedly decreased indicating a metabolic disorder. Page Reference: 537-539

Topic: Pulmonary Cognitive Level: Comprehension Correct answer: 1 Rationale: Diarrhea is one mechanism by which the body
can lose large amounts of HCO3-. The other choices are indications of hypoxia, which is not indicated with a pO2 of 106. Page Reference: 538

8. For which of the following conditions is bronchoscopy

indicated? 1. Pulmonary edema 2. Ineffective clearance of secretions 3. Upper GI bleed 4. Installation of surfactant

Topic: Pulmonary Cognitive Level: Comprehension Correct answer: 2 Rationale: Bronchoscopy visualizes the bronchial tree. If
secretions are present, they can be removed by suctioning and sent for culture to help adjust antibiotic therapy. Page Reference: 543

9. A patient presents moderately short of breath and dyspneic.

A chest x-ray examination reveals a large right pleural effusion with significant atelectasis. The physician is most likely to order which of the following procedures? 1. Thoracentesis 2. Bronchoscopy 3. V/Q scan 4. Repeat chest x-ray

Topic: Pulmonary Cognitive Level: Application Correct answer: 1 Rationale: A thoracentesis involves removal of excess
intrapleural fluid and is indicated for this patient. There is no evidence of a pulmonary emboli necessitating a V/Q scan. A bronchoscopy can not assist in fluid removal. There is no indication that there is a problem with this chest x-ray. Page Reference: 543

10. A 75-kg, 58 patient is on the ventilator. The physician

tells you that he believes the patient may be ready for extubation. He orders the following tests: NIF and VC. Which of the following results best suggest that the patient is ready for extubation? 1. NIP 10, VC 4600 2. NIP 18, VC 4700 3. NIP 22, VC 4400 4. NIP 24, VC 4800 11. Ventilation/perfusion (V/Q) scans are ordered to evaluate the possibility of which of the following? 1. Pulmonary emboli 2. Acute myocardial infarction 3. Emphysema 4. Acute respiratory distress syndrome

Topic: Pulmonary Cognitive Level: Application Correct answer: 4 Rationale: These values indicate that the patient is taking a
strong enough and deep enough inspiration to have the best chance of tolerating extubation. Page Reference: 544

Topic: Pulmonary Cognitive Level: Knowledge Correct answer: 1 Rationale: This test is ordered for the evaluation of
pulmonary emboli. ECG or cardiac enzymes are ordered to evaluate for MI; ABG, CXR, and pulmonary function tests are ordered to evaluate for emphysema. CXR and hemodynamic monitoring are ordered for evaluation of ARDS. Page Reference: 544

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12. A patient presents with absent lung sounds in the left

lower lung fields, moderate SOB, and dyspnea. You suspect pneumothorax, and notify the physician who orders a STAT chest x-ray examination. Which of the following findings best supports your suspicions? 1. Blackness in the left lower lung area 2. Whiteness in the left lower lung area 3. Blunted costophrenic angles 4. Elevated left hemidiaphragm 13. A COPD patient requires intubation. After the physician intubates the patient you auscultate for breath sounds. You are not sure of the breath sounds in this patient. Which of the following would best assist in determining endotracheal tube placement in this patient? 1. STAT chest x-ray examination 2. End-tidal CO2 monitor 3. V/Q scan 4. Pulmonary artery catheter insertion

Topic: Pulmonary Cognitive Level: Comprehension Correct answer: 1 Rationale: Whitened areas on a CXR can indicate fluid or
blood accumulation. Blackness indicates lack of lung tissue, which would be present with a pneumothorax. The other choices are not related to the pneumothorax. Page Reference: 546

Topic: Pulmonary Cognitive Level: Comprehension Correct answer: 2 Rationale: Although a STAT chest x-ray examination would
be helpful, it has a long turn around time and the patients respiratory status can deteriorate quickly. An end-tidal CO2 monitor will give an immediate response and the tube can then be reinserted without delay if incorrectly placed. The other tests are not for ETT placement. Page Reference: 548

14. A patients pulse oximeter goes off. The monitor reads

82%. Which of the following suggests this value is incorrect? 1. Peripheral cyanosis 2. Non-pulsatile waveform 3. Severe SOB 4. Respiratory rate of 20

Topic: Pulmonary Cognitive Level: Comprehension Correct answer: 2 Rationale: Choices 1 and 3 are indications that the reading is
probably valid. Choice 4 does not exclude the value as valid. Since pulse oximetry readings are based on pulsatile flow, a non-pulsatile waveform would indicate that the value may not be valid. Page Reference: 548

15. Which of the following patients would be considered

hypoxemic? 1. A 70-year-old man with a PaO2 of 72 2. A 50-year-old woman with a PaO2 of 65 3. An 84-year-old man with a PaO2 of 96 4. A 68-year-old woman with a PaO2 of 80 16. Which blood gas parameter is the acid-base component that reflects kidney function? 1. pH 2. PaO2 3. PaCO2 4. HCO3-

Topic: Pulmonary Cognitive Level: Application Correct answer: 2 Rationale: Normal PaO2 is 80-100 mm Hg in persons under
the age of 60.

Page Reference: 537 Topic: Pulmonary Cognitive Level: Application Correct answer: 3 Rationale: pH 7.29 is below normal, reflecting acidosis. The
metabolic component (HCO3-) is low, indicating that the acidosis is metabolic in origin. Page Reference: 537-539

17. Which of the following arterial blood gas (ABG) values is

representative of uncompensated metabolic acidosis? 1. pH 7.29, PaCO2 57, and HCO3- 22 2. pH 7.36, PaCO2 33, and HCO3- 18 3. pH 7.22, PaCO2 42, and HCO3- 18 4. pH 7.52, PaCO2 38, and HCO3- 29

Topic: Pulmonary Cognitive Level: Knowledge Correct answer: 4 Rationale: The bicarbonate (HCO3-) is the acid-base
component that reflects kidney function. Page Reference: 538

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18. Which of the following ABG values reflects

compensation? 1. pH 7.26, PaCO2 55, and HCO3- 24 2. pH 7.30, PaCO2 32, and HCO3- 18 3. pH 7.48, PaCO2 30, and HCO3- 22 4. pH 7.38, PaCO2 58, and HCO3- 30 19. Determination of oxygenation status by oxygen saturation alone is inadequate. What other value must be known? 1. pH 2. PaCO2 3. HCO34. Hemoglobin

Topic: Pulmonary Cognitive Level: Application Correct answer: 4 Rationale: The pH is within normal limits, and both the
PaCO2 and the HCO3- are abnormal. Page Reference: 538-539

Topic: Pulmonary Cognitive Level: Application Correct answer: 4 Rationale: The oxygen saturation measures the amount of
oxygen bound to hemoglobin. If the hemoglobin is 7.0 g, an SaO2 reading may still be 98%. The 7.0 g Hgb is not adequate to meet tissue oxygen demands. Therefore the Hgb level in conjunction with the SaO2 is necessary to make an adequate assessment. Page Reference: 539-540

20. Your patient is intubated, and a sputum for culture and

sensitivity is ordered. Which of the following is important for obtaining the best specimen? 1. Once the specimen is in the container, dilute thick secretions with sterile water. 2. Apply suction when the catheter is advanced to obtain secretions from within the endotracheal tube. 3. Do not apply suction while the catheter is being withdrawn because this can contaminate the sample with sputum left in the endotracheal tube. 4. Do not clear the endotracheal tube of all local secretions prior to obtaining the specimen. 21. Preprocedural medications for a bronchoscopy may include: 1. aspirin for anticoagulation. 2. vecuronium to inhibit breathing. 3. codeine to decrease the cough reflex. 4. cimetidine to decrease hydrochloric acid secretion.

Topic: Pulmonary Cognitive Level: Application Correct answer: 3 Rationale: To prevent contamination of secretions in the
upper portion of the endotracheal tube, do not apply suction while the catheter is being withdrawn. Page Reference: 542

Topic: Pulmonary Cognitive Level: Application Correct answer: 3 Rationale: Narcotics, such as meperidine (Demerol) or
codeine, may be given before a bronchoscopy to depress laryngeal reflexes, induce slower and deeper respirations, and prevent coughing during the procedure. Page Reference: 543

22. Severe coughing and shortness of breath during a

thoracentesis are indicative of which of the following complications? 1. Reexpansion pulmonary edema 2. Pleural infection 3. Pneumothorax 4. Hemothorax

Topic: Pulmonary Cognitive Level: Application Correct answer: 1 Rationale: Reexpansion pulmonary edema can occur when a
large amount of fluid is removed from the pleural space. Removal of the fluid increases the negative intrapleural pressure, which can lead to edema when the lung does not reexpand to fill the space. The patient experiences severe coughing and shortness of breath. Page Reference: 543

23. A static lung compliance of 40 ml/cm H2O is indicative of

which of the following disorders? 1. Pneumonia 2. Bronchospasms 3. Pulmonary emboli 4. Upper airway obstruction

Topic: Pulmonary Cognitive Level: Comprehension Correct answer: 1 Rationale: Normal static compliance is approximately 50
ml/cm H2O. It decreases with any decrease in lung compliance, such as occurs with pneumothorax, atelectasis, pulmonary edema, and chest wall restrictions. Page Reference: 544

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24. A patient is admitted to rule out a pulmonary embolus.

The diagnostic test most conclusive to determine this diagnosis is a(n): 1. arterial blood gas. 2. bronchoscopy. 3. pulmonary function test. 4. ventilation/perfusion scan. 25. Which of the following chest x-ray findings is consistent with a left pneumothorax? 1. Flattening of the diaphragm 2. Shifting of the mediastinum to the right 3. Presence of a gastric air bubble 4. Increased radiolucency of the left lung field 26. Questions 26-27 refer to the following situation. Ms. H. is a 76-year-old woman with acute respiratory failure secondary to pneumonia. She smoked two packs of cigarettes a day for 25 years, stopping 10 years ago. Her ABG values on the current ventilator settings are pH 7.37, PaCO2 50, and HCO327. Her chest x-ray reveals a large right pleural effusion. Ms. H. should be placed in which of the following positions for a right thoracentesis? 1. Left lateral Sims 2. Reverse Trendelenburg 3. Right lateral decubitus 4. High Fowlers 27. Which of the following is the correct interpretation of Ms. H.s ABG values? 1. Compensated respiratory acidosis 2. Compensated metabolic alkalosis 3. Uncompensated respiratory alkalosis 4. Uncompensated metabolic acidosis

Topic: Pulmonary Cognitive Level: Knowledge Correct answer: 4 Rationale: A ventilation/perfusion scan is the most
conclusive test for a pulmonary embolus. Page Reference: 544

Topic: Pulmonary Cognitive Level: Application Correct answer: 2 Rationale: Shifting of the mediastinal structures away from
the area of involvement is a sign of a pneumothorax. Page Reference: 545

Topic: Pulmonary Cognitive Level: Application Correct answer: 3 Rationale: For a thoracentesis the patient on a ventilation
should be placed in the lateral decubitus position with the affected side down. Page Reference: 543

Topic: Pulmonary Cognitive Level: Application Correct answer: 1 Rationale: The ABG values reflect a compensated
respiratory acidosis. Page Reference: 538

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