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PCCN REVIEW - PULMONARY EXAM QUESTIONS AND ANSWERS
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PCCN REVIEW - PULMONARY EXAM QUESTIONS AND ANSWERS
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PCCN REVIEW - PULMONARY EXAM QUESTIONS ANDANSWERS
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.
Hypoxemia is best defined as:
-A decrease in O2 at the cellular level
-A decrease in O2 levels in arterial blood
-A decrease in O2 levels in venous blood
-A decrease in O2 levels from the brain - answer- A decrease in O2 levels in arterial
blood
Hypoxemia is a decrease in O2 levels in arterial blood or PaO2 < 80 mmHg.
Hypoxia is defined as a decreased oxygen level at the cellular level.
Decreased O2 levels within veins refer to PaO2 < 50mmHg
Decreased O2 levels within the brain refer to ScVO2 < 20
Sometimes the costal cartilage becomes calcified with age. Vertebrae develop
osteoporosis, and a degree of kyphosis can occur. Weight gain is common and posture
is affected. The chest wall compliance decreases, as does vital capacity. Residual
volume increases, PaO2 decreases, and PaCO2 increases.
The cells that are responsible for forming a barrier for alveoli are:
-Macrophages
-Type II alveolar epithelial cells
-Type I alveolar epithelial cells
-Cilia - answer- Type I alveolar epithelial cells
Type I cells line the outside of the alveoli. These cells, which maintain the blood-gas
interface, are easily inflamed by inhaled toxins or heated air.
Type II cells produce surfactant.
Anatomic dead space isreferred to as:
-Minute ventilation
-Wasted ventilation
-Physiologic dead space
-Conducting airways - answer- Conducting airways
Conducting airways are ventilated, but perfusion (gas exchange) does not occur.
, Wasted ventilation is the amount of ventilation that does not participate in gas
exchange.
The oxyhemoglobin dissociation curve is:
-A graphic representation showing the relationship between dissolving oxygen and the
affinity for oxygen by the hemoglobin molecule
-A graphic representation of carbon dioxide content verses oxygen content in arterial
blood
-A measure of methemoglobin
-A way to calculate gas transport across the alveoli - answer- A graphic representation
showing the relationship between dissolving oxygen and the affinity for oxygen by the
hemoglobin molecule
The oxyhemoglobin dissociation curve reflects physiological circumstances and their
effect on the hemoglobin's affinity for oxygen.
If the oxyhemoglobin curve shifts to the right, one factor that will affect this shift is:
-A decreased CO2
-A decreased pH
-A decrease in temperature
-A decrease in 2,3-DPG - answer- A decreased pH
A shift to the right means hemoglobin has less affinity for oxygen.
2,3-Diphosphoglyceride (2,3-DPG) is needed to help force O2 off the hemoglobin
molecule.
If 2,3-DPG levels decrease, the hemoglobin will hang onto O2.
If the temperature increases, the tissues need more O2.
If the PCO2 becomes elevated, the tissues need more O2.
If the oxyhemoglobin dissociation curve shifts to the left, which of the following would
precipitate this change?
-Increased temperature
-Increased PaCO2
-Increased 2,3-DPG
-Increased pH - answer- Increased pH
When the oxyhemoglobin dissociation curve shifts to the left, it means that hemoglobin
holds onto oxygen.
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