Chapter 15: Pulmonary Disorders

Chapter 15: Pulmonary Disorders

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. Which of the following causes of hypoxemia is the result of blood passing through unventilated portions of the lungs?

ANS:  C

Hypoxemia is the result of impaired gas exchange and is the hallmark of acute respiratory failure. Hypercapnia may be present, depending on the underlying cause of the problem. The main causes of hypoxemia are alveolar hypoventilation, ventilation/perfusion (V/Q) mismatching, and intrapulmonary shunting. Intrapulmonary shunting occurs when blood passes through a portion of a lung that is not ventilated. Drug overdose is an extrapulmonary cause that affects the brain.

2. A patient with acute respiratory failure may require a bronchodilator if which of the following occurs?

ANS:  B

Bronchodilators aid in smooth muscle relaxation and are of particular benefit to patients with airflow limitations. Mucolytics and expectorants are no longer used because they have been found to be of no benefit in this patient population.

3. Supplemental oxygen administration is usually effective in treating hypoxemia related to

ANS:  D

Supplemental oxygen administration is effective in treating hypoxemia related to alveolar hypoventilation and ventilation/perfusion mismatching. When intrapulmonary shunting exists, supplemental oxygen alone is ineffective. In this situation, positive pressure is necessary to open collapsed alveoli and facilitate their participation in gas exchange. Positive pressure is delivered via invasive and noninvasive mechanical ventilation. If the patient is also experiencing hypercapnia, the PaCO₂ will be greater than 45 mm Hg. In patients with chronically elevated PaCO₂ levels, these criteria must be broadened to include a pH less than 7.35.

4. Which of the following nursing interventions should be used to optimize oxygenation and ventilation in the patient with acute respiratory failure?

ANS:  A

Providing adequate rest and recovery time between various procedures prevents desaturation and optimizes oxygenation. In acute lung failure, the goal of positioning is to place the least affected area of the patient’s lung in the most dependent position. Patients with unilateral lung disease should be positioned with the healthy lung in a dependent position. Hyperventilate the patient before suctioning; suction patients as needed.

5. A patient has been admitted to the critical care unit with the diagnosis of acute respiratory distress syndrome (ARDS). Arterial blood gasses (ABGs) revealed an elevated pH and decreased PaCO₂. The patient is becoming fatigued, and the health care provider orders a repeat ABG. The nurse anticipates the following results

ANS:  D

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.