Clinical Seminar Group 4 Game Questions

The nurse cares for multiple patients on a critical care stepdown unit. Which of the following patients is at risk for developing nosocomial pneumonia?

• A. The mechanically ventilated patient

• B. The patient with a chest tube

• C. The patient admitted for COPD exacerbation

• D. The patient with a pneumothorax

Answer explanation

A client on mechanical ventilation has no gag reflex that keeps bacteria out of the lower respiratory tract putting them at risk for nosocomial infections.

What does a nurse expect to hear on a lung auscultation of a patient diagnosed with pneumonia?

• crackles

• stridor

• rhonchi

• wheezing

Answer explanation

Crackles are expected to be heard on a patient with pneumonia when they exhale.

What transmission precautions are implemented in a patient with SARS? Explain the appropriate PPE.

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Answer explanation

SARS spreads through droplet transmission. To prevent transmission, the appropriate PPE is dawning a mask and gloves upon entering the patient's room.

Which of the following are indications for emergency intubation?

• Respiratory failure and cool peripheries

• Respiratory failure and severe illness of any cause

• Respiratory failure and oliguria

• Respiratory failure and low intracranial pressure

Answer explanation

Emergency intubation may be needed for a patient who has respiratory failure and any additional severe illness, sufficient to compromise the patient's ability to maintain spontaneous respiration.

What pathological mechanism that occurs in the lungs allows pneumonia to occur?

• Atelectasis

• Effusion

• Bronchiectasis

• Inflammation

Answer explanation

A common feature of all types of pneumonia is an inflammatory reaction resulting from the offending agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the lung/airway. Effusion is an accumulation of fluid.

To verify correct placement of the endotracheal tube right after insertion, what should a nurse perform first?

• Use an end-tidal CO2 monitor

• Observe for respirations

• Auscultate breath sounds

• Chest x-ray

Answer explanation

An end-tidal Co2 monitor checks for placement in the trachea. This is recommended for rapid verification of placement. A chest x-ray is performed after the tube is secured.

The nurse walks into a patient room and sees the patient holding the endotracheal tube, what should the nurse do initially?

• Manually ventilate patient with 100% oxygen

• Call Rapid Response Team

• Reinsert the tube

• Scream for help

Answer explanation

The nurse should initially maintain oxygenation for the client. Calling the Rapid Response Team is appropriate after oxygenation is achieved. The nurse would call the provider to reinsert the tube. Screaming for help is not therapeutic for the patient and family that may be at the bedside.

What does the nursing care of a patient with an endotracheal tube look like? Give at least 3 answers.

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Answer explanation

Ensure patient is in high flower's; count patient's respirations for a full minute and compare to desired respirations and ventilator set rate; check ventilator settings every hour; assess temperature of patient's skin; assess patient for signs of anxiety

A 65 year old female presents to the clinic and is diagnosed with bacterial pneumonia. Which of the findings are consistent with this diagnosis?

• Tachycardia

• Dyspnea

• Temperature of 102

• Profuse sweating

• Persistent cough

Answer explanation

All of these findings are consistent with bacterial pneumonia.

Which of the following are potential complications associated with intubation?

• Hypotension.

• Raised intracranial pressure

• Aspiration.

• hypertension

Answer explanation

A side effect of the use of anesthetic agents required for intubation is hypotension. Once the patient has been anesthetized, there is a risk that gastric contents may be aspirated into the lungs. Laryngoscopy (the introduction of the laryngoscope blade into the larynx) in an inadequately anesthetized patient may stimulate an adrenergic response (adrenaline secretion). This can cause an increase in blood pressure and a raised intracranial pressure