Midterm Exam:NR572\/ NR 572 (2023\/ 2024 Latest Update) Advanced Acute Care Management Exam Review |Week 1-4| Questions and Verified Answers| 100% Correct- Chamberlain<\/p>\n\n\n\n
Midterm Exam:NR572\/ NR 572 (2023\/ 2024
Latest Update) Advanced Acute Care
Management Exam Review |Week 1-4|
Questions and Verified Answers| 100%
Correct- Chamberlain
Q: A 63-year-old male with a history of chronic obstructive pulmonary disease presents to the
emergency department with increasing shortness of breath, productive cough with yellow-green
sputum, and fever. Vital signs are as follows: temperature: 38.2\u00b0c; heart rate: 100; respiratory
rate: 28; blood pres- sure: 110\/68; oxygen saturation: 90 %. On examination, the nurse
practitioner (NP) notes that the client has difficulty completing his sentences and has an
increased work of breathing. Bilateral crackles and wheezes are auscultated in the lower lobes.
Posterior anterior (PA) & lateral chest x-ray and serum labs are pending, however, the arterial
blood gas reveals pH 7.30; PCO2 68 mm Hg; HCO3 28 mmol\/L; and PaO2 60 mm Hg. What is
the correct interpretation by the NP?
a. uncompensated respiratory acidosis
b. partially compensated respiratory acidosis c. uncompensated metabolic acidosis
d. partially compensated metabolic acidosis
Answer:
partially compensated respiratory acidosis (Correct answer)
pH=low acidosis PCO2= high acidosis HCO3= high alkalosis
The HCO3 is elevated indicating that the body is trying to compensate for the
elevated PCO2, but the pH is not yet within range. The client has respiratory acidosis resulting
from an acute exacerbation of chronic obstructive pulmonary disease with partial compensation.
Q: Tx of pneumothorax (conservative tx)
Answer:
Conservative treatment for asymp- tomatic clients with airspace < 20% of the pleural cavity can
be managed with serial chest x-rays every 24-72 hours. Resolution usually occurs within two
weeks. Ambulatory clients should be instructed to follow-up in the Emergency Department if
symptoms recur or worsen.<\/p>\n\n\n\n
Q: Tx of pneumothorax
Answer:
In non-urgent situations, a chest tube is usually inserted for symptomatic clients with > 20%
involvement to expand the lung. When evidence of a tension pneumothorax exists, emergency
intervention by needle decompression should be performed followed by chest tube insertion.
Q: Where do you insert a chest tube?
Answer:
4th or 5th intercostal space at the midclav- icular lin
Q: A hallmark s\/s of a pneumothorax includes:
Answer:
recalled using the acronym
P-THORAX:
P Pleuritic Pain
T Tracheal Deviation to the Opposite Side
H Hyperresonance on the affected side
O Onset Sudden
R Reduced Breath Sounds (& Dyspnea) A Absent Fremitus
X X-ray Findings
Additional findings may include dyspnea, fatigue, tachycardia, tachypnea, and dry cough.
Q: In examining pleural fluid, which of the following characteristics suggest an exudative
effusion?
-Pleural\/serum protein ratio greater than 0.5
-Pleural pH of 7.40
-Pleural\/serum LDH ratio less than 0.1
-white blood count (WBC) content of 6000
Answer:
Pleural\/serum protein ratio greater than 0.5 (Correct answer)<\/p>\n\n\n\n
Rationale: The requirements for exudative effusion include: ratio of pleural fluid protein to
serum protein is greater than 0.5; ratio of pleural fluid LDH and serum LDH is greater than 0.6;
pleural fluid LDH >2\/3 serum LDH
Q: Which of the following is a late finding in a client with tension pneumoth- orax?
Increased heart rate
Hypertension
Tracheal deviation
Decreased breath sounds
Answer:
tracheal deviation
Rationale: A late finding of the client with a tension pneumothorax is tracheal deviation
indicating mediastinal structure shifting due to the increased pressure.
Q: Which of the following exam findings would be expected in percussing the chest of a client
with a pneumothorax?
Hyper-resonance Hypo-resonance Normal sounds
Crepitus
Answer:
hyper-resonance
Rationale: Air in the pleural space will result in hyper-resonance with percussion of the chest.
Fluid in the pleural space would cause hypo-resonance.
Q: The client is undergoing a thoracentesis for pleural effusion. After the procedure, the client
should be monitored for the development of which of the following:
Pulmonary Embolism Pneumothorax Coagulopathy
Pulmonary Contusion
Answer:
Pneumothorax
Rationale: A complication associated with thoracentesis is a pneumothorax. This complication
can be minimized by performing the procedure under ultrasound guidance.<\/p>\n\n\n\n
Q: pleural fluid analysis consist of
Answer:
protein lactate dehydrogenase level (LDH)
gram stain culture cytology pH level
Q: A pleural effusion is likely exudative if at least one of the following exists :-
Answer:
the ratio of pleural fluid protein to serum protein is greater than 0.5 the ratio of pleural fluid
LDH and serum LDH is greater than 0.6 pleural fluid LDH >2\/3 serum LDH
Q: Type 1 respiratory failure
Answer:
Type I respiratory failure involves low oxygenation and a normal or low carbon dioxide level.
hypoxia without hypercapnia
Q: Type 2 respiratory failure
Answer:
Type II respiratory failure involves low oxygen, with high carbon dioxide (CO2).
hypoxia with hypercapnia
Q: pericardial effusion
Answer:
a collection of fluid between the pericardial sac and the myocardium
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