MED SURG III - EXAM #3

Which type of ventilator has a preset volume of air to be delivered with each inspiration?

• Negative Pressure

• Time-Cycled

• Pressure Cycled

• Volume Cycled

Answer explanation

Rationale:With volume-cycled ventilation, the volume of air to be delivered with each inspiration is preset. Negative-pressure ventilators exert a negative pressure on the external chest. Time-cycled ventilators terminate or control inspiration after a preset time. When the pressure-cycled ventilator cycles on, it delivers a flow of air (inspiration) until it reaches a preset pressure, and then cycles off, and expiration occurs passively.

Which is an accurate statement regarding cancer of the esophagus?

• It is seen more frequently in European Americans than in African Americans.

• It is three times more common in women than men in the United States .

• It usually occurs in the fourth decade of life.

• Chronic irritation of the esophagus is a known risk factor.

Answer explanation

Rationale:In the United States, cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco. In the United States, carcinoma of the esophagus occurs more than three times more often in men than in women. It is seen more frequently in African Americans than in European Americans. It usually occurs in the fifth decade of life.

The nurse is caring for a client being weaned from a mechanical ventilator. Which findings would require the weaning process to be terminated?

• PaO2 greater than 60 mm Hg with an FiO2 less than 40%

• Heart rate less than100 bpm

• Vital capacity of 12 mL/kg

• Blood pressure increase of 20 mm Hg from baseline

Answer explanation

Rationale:In collaboration with the primary provider, the nurse would terminate the weaning process if adverse reactions occur, including:

a heart rate increase of 20 beats/min, systolic blood pressure increase of 20 mm Hg, a decrease in oxygen saturation to less than 90%, respiratory rate less than 8 or greater than 20 breaths/min, ventricular dysrhythmias, fatigue, panic, cyanosis, erratic or labored breathing, and paradoxical chest movement.

A vital capacity of 10 to 15 mL/kg, maximum inspiratory pressure (MIP) at least –20 cm H2O, tidal volume of 7 to –9 mL/kg, minute ventilation of 6 L/min, and a rapid/shallow breathing index below 100 breaths/min/L;

PaO2 greater than 60 mm Hg with FiO2 less than 40% are criteria that indicate a client is ready to be weaned from the ventilator. A normal vital capacity is 10 to 15 mL/kg.

Which characteristic is seen with a healthy stoma?

• Painful

• Bleeding when Cleansing the Stoma

• Pink Color

• Dry in appearance

Answer explanation

Rationale:Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.

Which is a potential complication of a low pressure in the endotracheal tube cuff?

• Aspiration Pneumonia

• Pressure Necrosis

• Tracheal Bleeding

• Tracheal Ischemia

Answer explanation

Rationale:Low pressure in the cuff can increase the risk for aspiration pneumonia. High pressure in the cuff can cause tracheal bleeding, ischemia, and pressure necrosis.

The most common symptom of esophageal disease is

• Dysphagia

• Nausea

• Vomiting

• Odynophagia

Answer explanation

Rationale:This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing. Nausea is the most common symptom of gastrointestinal problems in general. Vomiting is a nonspecific symptom that may have a variety of causes. Odynophagia refers specifically to acute pain upon swallowing.

A nurse is working in an oncology treatment center. Which clinical manifestation when reported by a client would the nurse know may be related to metastasis from prostate cancer?

• Large amounts of dilute urine when voiding

• Weight gain of 3 pounds in 1 month

• Frequent nighttime urination

• Constant hip aching and discomfort

Answer explanation

Rationale:Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, oliguria, weight loss, weakness, nausea, and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.

Which is a correct endotracheal tube cuff pressure?

• 19 mm Hg

• 16 mm Hg

• 22 mm Hg

• 13 mm Hg

Answer explanation

Rationale:Cuff pressures should be checked with a calibrated aneroid manometer device every 6 to 8 hours to maintain cuff pressures between 20 and 25 mm Hg. The other values are not within the normal range for adequate cuff pressure.

The nurse is caring for a client in the ICU who is receiving mechanical ventilation. Which nursing measure is implemented in an effort to reduce the client's risk of developing ventilator-associated pneumonia (VAP)?

• Cleaning the client's mouoth with chlorhexidine daily

• Ensuring that the client remains sedated while intubated

• Turning and repositioning the cloent every 4 hours

• Maintaining the client in a high Fowler's position

Answer explanation

Rationale:The five key elements of the VAP bundle include elevation of the head of the bed (30 to 45 degrees [semi-Fowler's position)], daily "sedation vacations," and assessment of readiness to extubate; peptic ulcer disease prophylaxis (with histamine-2 receptor antagonists); deep venous thrombosis prophylaxis; and daily oral care with chlorhexidine (0.12% oral rinses). The client should be turned and repositioned every 2 hours to prevent complications of immobility and atelectasis and to optimize lung expansion.

A client is admitted to the hospital with suspected bladder cancer. The nurse assesses the client for which early signs and symptoms of the disease?

• Proteinuria and dysuria

• Hematuria and absence of pain

• Painful urination and hematuria

• Pyuria and palpable abdominal mass

Answer explanation

The most common earliest manifestation of bladder cancer is hematuria that is not accompanied by pain. The hematuria is intermittent at first. Later signs and symptoms include hematuria with dysuria and frequency because of bladder irritation. Pyuria and proteinuria are not part of the clinical picture. A mass usually is not palpable.