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ACNP II Test I (Acute Respiratory): Questions & Detailed Solutions
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ACNP II Test I (Acute Respiratory): Questions & Detailed Solutions
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ACNP II Test I (Acute Respiratory): Questions &Detailed Solutions
Decrease in FEV-1 & FVC are indicitive of Right Ans - obstructive
pulmonary disease
Diet considerations for pt's with elevated pCO2 Right Ans - high
carbohydrates will further increase CO2 making levels rise. can consider
Pulmacare instead of Ensure to boost nutrition
pt with COPD & presumed pneumonia-tx Right Ans - o2 (ie: venturi mask
@ 28% fio2), vs q4h, ANTIBIOTICS: fluoroquinolone (moxifloxacin 400 mg
daily) & macrolide (azithromycin 500mg first dose, then 250 mg daily), albut
& atrovent 2 puffs q 4h, solumedrol IV 0.5mg/kg IV q6h x 3 days
Care plan (non medication) for pt with pneumonia + COPD (activity,
interventions, diet) Right Ans - bed rest* (decrease workload, decrease
energy expenditure & respiratory effort), CPT, 2 gm Na+ diet (r/t HTN), *don't
forget DVT prophylaxis when pt on bedrest
Albuterol (extra info) Right Ans - Short acting beta 2 agonist, leads to
bronchiolar smooth muscle relaxation & dilation, decreased airway resistance,
& increased TV & vital capacity. Inhibited by NS beta blockers. Adverse
effects= tremors, Tachycardia, Hypokalemia, CP in CAD pt.
Atrovent (extra info) Right Ans - Anticholinergic-bronchial dilation &
decreased mucus secretion. Caution in pts with glaucoma, BPH
Theophylline caution Right Ans - Theophylline increases respiratory
muscle function & has some bronchodilatory effects. Best used with beta-
agonists. **Third line, narrow therapeutic range. Blood levels 10-20mcg/mL--
can cause CNS changes & dysrhythmias
Cor Pulmonale (def.) Right Ans - Right sided HF secondary to prolonged
hypoxemia
, Cor Pulmonale patho Right Ans - Hypoxemia-> vasoconstriction of
pulmonary bed whch increases pulmonary vascular resistance. Increase in
pulmonary vascular resistance increases RV workload
s/s of cor pulmonale (3) Right Ans - peripheral edema, JVD, hepatomegaly
Hypoxemic vasoconstriction (shunting) physiology Right Ans - purpose is
to match blood flow to ventilated alveoli; however, blood is diverted to alveoli
that still have decreased diffusion (due to COPD reduction in functional
surface area). As a result, PCo2 rises & Po2 is low.
Paradoxical diaphragmatic function indicates Right Ans - respiratory
fatigue
Rationale for treating a temperature/ tx plan Right Ans - Co2 & o2
consumption increases by 10% for each degree rise in body temp. tylenol 650
mg PR.
Caution, if Sao2 <90% po2 ____; if Sao2 <80% increased r/f ____ Right Ans -
When Sao2 <90%, Po2 declines rapidly; when Sao2 <80%, pt is at high risk for
lethal arrythmias.
** Sao2/Po2 relationship Right Ans - Sao2: 60, 75, 90 correlates with pO2:
30, 40, 60(*goal)
Goals when intubating/ventilating pt Right Ans - maintain patent airway,
reduce work of breathing, oxygenate (improve V/Q relationship, reverse
hypoxemia-goal for this pt pO2 55-60)
Advantage to elective intubation vs waiting for respiratory arrest Right Ans
- resp arrest increases r/f cardiopulmonary arrest, aspiration, compromised
weaning
% of intubated pts who develop VAP; mortality rate of VAP Right Ans - 10-
40% of intubated pts develop VAP; mortality rat is 30-70%
Chronic Bronchitis (def) Right Ans - Chronic cough & sputum production x
at least 3 consecutive months for @ least 2 years
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