Clinical Reasoning Cases in Nursing
7th EditionJulie S Snyder, Mariann M Harding
2,512 solutions
Clinical Reasoning Cases in Nursing
7th EditionJulie S Snyder, Mariann M Harding
2,512 solutions
Foundations for Population Health in Community and Public Health Nursing
5th EditionJeanette Lancaster, Marcia Stanhope
156 solutions
Medical Language Accelerated
2nd EditionAndrew Cavanagh, Steven Jones
568 solutions
1. unexplained or disproportionate dyspnea when
a) blood test normal
b) PFT normal
2. Assessment of the impact of intervention
a) certain therapies
b) lung transplants
c) lung volume reduction
3. determination of prognosis
a) survival rates in CF and CHF patients
4. Disability determination
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Egan's Chapters 54, 55, 56
Terms in this set (137)
All of the following are among the top common causes of death in the United States, except:
Cystic Fibrosis
All of the following are acceptable phrases for writing an educational objective except:
"At the end of the lesson, the patient will be able to understand..."
All of the following are learning domains except:
analytical
Teaching physical skills to patients is learning in what domain?
psychomotor
Teaching facts to patients involves learning in what domain?
cognitive
What type of information is associated with teaching in the affective domain?
motivation and attitude
The objective that states "Verbalize willingness to use oxygen properly and safely" falls in which domain?
affective
What concept will be MOST emphasized in teaching new skills to patients?
REPETITION (important)
Which of the following may be necessary with children before learning can take place?
reward system
Which of the following is used to evaluate cognitive objectives?
written exam
Which of the following is used to evaluate the affective and psychomotor domains?
performance checklist
Which of the following is the primary goal of health education?
change the behavior
Which of the following is the primary goal of health promotion?
change the lifestyle
All of the following factors are linked to one of the major causes of death in the United States except:
high-sodium diet
Which of the following is the goal of tertiary prevention?
to prevent acceleration of the disease process once it has occurred
Which of the following examples of health care represents tertiary prevention?
pulmonary rehabilitation
Which of the following are broad goals of Healthy People 2010?
To eliminate health disparities
To increase quality and years of healthy life
What percentage of smokers has been reported to want to stop the smoking habit?
70%
All of the following are involved in work site wellness activities performed by respiratory therapists except:
prescribing nicotine patches
Which of the following are verbs the respiratory therapist can use within the cognitive domain to educate patients?
cite
define
identify
recognize
When instructing children on asthma management, which factors should be considered in teaching children versus adults on such a topic?
motivated by external factors
directed by others
limited experience
Patients with chronic cardiopulmonary disorders all share an inability to do what?
cope effectively with their disease process
What is the term used to describe the restoration of individuals to the fullest possible medical, mental, emotional, social, and vocational potential?
rehabilitation
What are the overall goals of rehabilitation?
to minimize the disability's impact on the individual or family
to maximize the functional ability of the
individual
The principal objectives of pulmonary rehabilitation include which of the following?
to control and alleviate the symptoms
to restore functional capabilities as much as possible
to improve quality of life
Which of the following would you not expect to observe after a chronic obstructive pulmonary disease (COPD) patient completes a sound pulmonary rehabilitation program?
permanent increase in forced expiratory volume in 1 second (FEV1) and forced expiratory flow (FEF25%-75%)
Knowledge from the clinical sciences is used in pulmonary rehabilitation programming for mainly what purpose?
to quantify the extent of physiological impairment
to set expectations for reasonable outcomes
In which of the following ways does the body respond to increased levels of physical activity?
increased minute ventilation
neuroendocrine stimulation
Knowledge from the social sciences is used in pulmonary rehabilitation programming for mainly what purpose?
determine the impact of the disability on the patient or family
to establish was to improve the patient's quality of
life
During exercise, the point at which increased levels of lactic acid production result in an increased VCO2 and VE is referred to as what?
ventilatory threshold
Which of the following occur when the ventilatory threshold is exceeded during exercise?
metabolism becomes anaerobic
fatigue increases
To physically recondition a patient and increase exercise tolerance, which of the following must be accomplished?
the body's overall O2 utilization must be improved
the patient's essential muscle groups must be strengthened
the cardiovascular response to exercise must be enhanced
Attrition in pulmonary rehabilitation programs is most associated with which of the following?
degree to which patients' psychosocial needs are met
Which of the following elements should be considered in most pulmonary rehabilitation programs?
individual needs
patient's education
patient's personality
patient's aptitudes
Common goals shared by most pulmonary rehabilitation programs include which of the following?
improvement in physical activity levels
control of respiratory infections
reduction in medical costs and hospitalizations
family education, counseling, and support
Which of the following is NOT a reasonable expectation for a pulmonary rehabilitation program?
reversal of the disease process
Specific patient objectives for a pulmonary rehabilitation program could include all of the following except:
improvement in the results of pulmonary function tests
What is the first step in evaluating patients for participation in a pulmonary rehabilitation program?
complete patient history
A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following test regimens would you recommend in order to ascertain the patient's cardiopulmonary status?
cardiopulmonary exercise evaluation
pulmonary function testings
A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following pulmonary function tests would you recommend be performed as a component of the preliminary evaluation?
Lung volumes including (FRC)
Diffusing capacity (DLCO)
Pre- and Post-bronchodilator flows
A cardiopulmonary exercise evaluation is conducted on a patient before participation in pulmonary rehabilitation for what purposes?
to quantify the patient's baseline exercise capacity
to develop an exercise prescription (inc target heart rate)
to
determine how much desaturation occurs with exercise
Absolute contraindications for conducting a cardiopulmonary exercise evaluation include all of the following except:
diastolic blood pressure greater than 110 mm Hg
Under which of the following conditions would you recommend ending a cardiopulmonary exercise evaluation?
electrocardiogram
indicating supraventricular tachycardia
10% fall from baseline oxyhemoglobin (HbO2) saturation
fall in systolic blood pressure of more than 20 mm Hg
request from the patient to terminate the test
While you are assisting in a treadmill cardiopulmonary stress test procedure, the patient complains to you of severe shortness of breath and some chest pain. Which of the following actions would you recommend at this time?
Terminate the procedure at once
All of the following should be monitored during a cardiopulmonary exercise evaluation except:
FEV1 and FVC
What are some relative contraindications for cardiopulmonary exercise testing?
severe pulmonary hypertension or cor pulmonale
known electrolyte disturbances (eg
hypokalemia)
SaO2/SpO2 <85% on room air
untreated or unstable asthma
To maximize patient safety during cardiopulmonary stress testing, which of the following precautions would you recommend?
immediate availability of a crash cart
staff training in emergency life support
presence of a physician throughout testing
patient physical exam or ECG before testing
In preparing an outpatient for a cardiopulmonary stress test to be conducted the next day, which of the following instructions would you provide?
the patient should fast for at least 8 hours before testing
the patient should wear loose-fitting clothing and sneakers
the patient should review the drugs with the physician
Which of the following patients are NOT good candidates for pulmonary rehabilitation?
unstable cardiovascular patients who require monitoring
patients with malignant neoplasms involving the lungs
Which of the following patients would benefit least from pulmonary rehabilitation?
patient with malignant lung cancer
Which of the following patients are good candidates for pulmonary rehabilitation?
Those with exercise limitations due to severe dyspnea
those with moderate to severe obstructive lung disease
Below what level of the predicted FEV1/FVC are patients with irreversible airway obstruction considered good candidates for pulmonary rehabilitation?
60%
Which of the following pulmonary function tests are most useful in determining whether a patient with restrictive lung disease should be considered for pulmonary rehabilitation?
DLCO
total lung capacity (TLC)
For which of the following patients would you recommend an open-ended format for a pulmonary rehabilitation program?
those with scheduling difficulties
those who require individual attention
those who are
self-directed
To increase the likelihood that positive patient results are lasting, what must pulmonary rehabilitation programs provide?
Periodic follow-up and reinforcement
The physical reconditioning component of a pulmonary rehabilitation program usually includes which of the following?
aerobic exercises for the
extremities
timed walking exercise
ventilatory muscle training
Which of the following exercises are useful for reconditioning the lower extremities of patients undergoing pulmonary rehabilitation?
walking on a flat surface for a specified period of time
walking on a treadmill for a specified distance or time
pedaling on a stationary bicycle for a specified distance
A patient in your pulmonary rehabilitation program has an orthopedic disability that precludes her from walking or using a stationary bicycle. Which of the following activities would you recommend to help recondition the lower extremities?
aquatic exercises
Which of the following exercises are useful for reconditioning the upper extremities of patients undergoing pulmonary rehabilitation?
using a rowing machine
using arm ergometer
using free hand weights
Reconditioning the inspiratory muscles of patients undergoing pulmonary rehabilitation is accomplished through which of the following methods?
performing inspiratory resistive breathing exercises
Which of the following is/are true about the flow-resistor breathing exerciser?
Exhaled gas flows unimpeded out a one-way valve
Resistance is created by a variable-size orifice
Imposed load varies with the rate of flow
During inspiratory resistive exercises, the desired load should be about what percentage of the maximum inspiratory pressure?
30%
Which of the following educational topics covered in a typical pulmonary rehabilitation program are most suitable for presentation by a respiratory care practitioner?
diaphragmatic and pursed-lip breathing techniques
respirator structure, function, and disease
Which of the following health professionals would be best for conducting a pulmonary rehabilitation session on methods of relaxation and stress management?
clinical psychologist
Which of the following health professionals would be best for conducting a pulmonary rehabilitation session on recreation and vocational counseling?
occupational therapist
Which of the following topics should be covered in a rehabilitation education session on respiratory home care?
self-administration of therapy
care of home equipment
safe use of home care equipment
Appropriate topical areas to be covered in a rehabilitation education session on nutrition include which of the following?
elements of a good diet
proper eating habits
foods to avoid
daily menu planning
A small-group discussion format for pulmonary rehabilitation educational sessions is recommended in order to foster which of the following?
group interaction
peer support
group identity
What is the ideal class size for pulmonary rehabilitation programs?
3-10
A small pulmonary rehabilitation program class size has which of the following beneficial effects?
it facilitates group interaction
it allows for more individualized attention
it helps to sustain participant motivation
it reduces the likleihood of attrition
Minimum equipment requirements for the physical reconditioning component of a pulmonary rehabilitation program include which of the following?
inspiratory resistive breathing devices
rowing machines
or upper extremity ergometers
pulse oximeters
stationary bicycles
To deal with incidents of hypoxemia, dyspnea, or airway hyperreactivity during physical reconditioning activities, which of the following should be available in the rehabilitation area?
bronchodilator agents
emergency oxygen
Which of the following is NOT a factor affecting the cost of a pulmonary rehabilitation program?
patient health insurance
By following the reimbursement guidelines for a comprehensive outpatient rehabilitative facility (CORF), Medicare will reimburse up to what percentage of the allowable charge for a rehabilitation program?
charge sessions as physical therapy exercises for COPD patients
charge sessions as office visits with
therapeutic exercises
What government programs can serve as a source for reimbursement for pulmonary rehabilitation?
comprehensive outpatient rehabilitative facility (CORF)
Veterans Administration benefits
Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS)
Which of the following outcome measures is considered a major predictor for improvement in a COPD patient's health-related quality of life?
frequent attendance in a maintenance program
For which of the following procedures pulmonary rehabilitation has become recognized as a prerequisite?
lung volume reduction surgery
Common cardiovascular hazards of physical reconditioning for patients with chronic lung disease include which of the following?
cardiac arrhythmias
systemic hypotension
muscle contractures
Where are most cardiac rehabilitation programs conducted?
hospital facilities
Which of the following are differences between cardiac and pulmonary rehabilitation?
Cardiac patients are
typically younger
Reimbursement is easier to obtain with cardiac rehabilitation
Breathing exercises are not essential to cardiac patients
What is the level of involvement of the respiratory therapist in cardiac rehabilitation?
significantly less than in pulmonary rehabilitation
Which of the following clinicians are commonly involved in the cardiac rehabilitation programs?
nurse specialist
cardiologist
Postacute care settings include all of the following except
Trauma centers
Which patients are better suited for subacute rather than for acute care?
Those who have a determined course of treatment
those who are recovering from an
acute illness
Where is most postacute respiratory care provided?
The home
Under which conditions is the home NOT the best setting for providing subacute care?
When the patient is unable to do self-care
When adequate caregiver support is unavailable
Respiratory home care contributes to achieving which of the following goals?
improving patients' physical and social well-being
ensuring cost-effective delivery of care
supporting and maintaining patients' lives
promoting patient and family self-sufficiency
For which of the following categories of disorders is respiratory home care NOT considered appropriate?
Acute restrictive disorders
Studies have shown that carefully selected home treatment regimens can play an important role in achieving which of the following
maintaining patients' lives
improving patients' quality of life
increasing patients' functional performance
reducing hospitilization costs
From where do standards for the delivery of subacute and home health care derive?
state licensing laws
private sector standards
federal regulations
What statutory regulations ensure that skilled nursing facilities and home health agencies meet minimum health and safety requirements?
Medicare provider certification program
State Health agency regulations
What agency is primarily responsible for voluntary accreditation of postacute care providers?
The Joint Commission (TJC) (formerly Joint Commission on Accreditation of Hospitals Organization [JCAHO])
Which of the following key features distinguish delivery of respiratory care services in alternative settings (subacute, long-term, and home care) from traditional acute care delivery?
1. reliance on outside vendors
for most lab and diagnostic testing
2. reliance mainly on portable equipment (oxygen [O2], suction, aerosol)
3. most work independently performed with minimal supervision
4. heavy reliance on assessment and documentation in care planning
5. intensive interaction with professional team and patient's family
Which of the following is NOT normally included as part of a good discharge plan?
confirming or securing financial resources
All of the following are components of the patient evaluation aspect of a good discharge plan except the patient's:
socioeconomic status and neighborhood characteristics
What are some desired outcomes of the discharge plan?
1. prevent hospital readmission due to poor planning
2. satisfactory
performance of all treatments by caregivers
3. caregivers' ability to assess the patient and solve problems
4. patient's and family's satisfaction
Which of the following is NOT normally part of the respiratory home care team?
pulmonary function
Establishing therapeutic objectives for home care is normally the responsibility of which member of the respiratory home care team?
Attending physician
Providing regular in-home follow-up visits and assessing the patient's overall progress is the responsibility of which member of the respiratory home care team?
respiratory care practitioner
Providing necessary home care equipment and supplies and handling any emergency situations involving delivery or equipment operation is the responsibility of which member of the respiratory home care team?
durable medical equipment (DME) company representative
Durable medical equipment (DME) companies usually provide which of the following respiratory home care services?
1. third-party insurance processing
2. most respiratory care modalities
3. 24-hours/7-days-a-week
service
4. home instruction and follow-up
Factors to consider when advising a patient on selection of durable medical equipment (DME) include all of the following except:
finder's fees
To determine if a home setting can support the equipment needs of a mechanically ventilated patient being considered for discharge, which of the following would you assess?
1. available space for equipment
2. amperage of power supply
3. number and location of grounded outlets
4. presence of hazardous appliances
Key environmental factors that should be assessed in considering discharge of a patient to the home care setting include all of the following except:
airborne pollutants
What is the most common home care modality?
O2 Therapy
Which of the following are acceptable indicators of hypoxemia for purposes of justifying home O2 therapy?
2. drop in Sao2 below 89% during ambulation
3. resting arterial SaO2 below 88% (room air)
Home O2 therapy can be justified in patients with PaO2 values greater than 55 mm Hg in all of the following conditions except:
peripheral vascular disease
Physical hazards associated with home O2 therapy equipment include all of the following except:
Gaseous explosions
Once the need for long-term home O2 therapy has been documented, why should repeated laboratory assessment (ABG or oximetry) be conducted?
1. to follow the course of the disease
2. to assess changes in clinical status
3. to facilitate changes in the prescription
CMS regulations require that prescriptions for home O2 therapy be based on:
documented hypoxemia
Which of the following is FALSE about home O2 therapy?
A PRN (as needed) prescription for O2 is acceptable.
In addition to specifying the liter flow or concentration, which of the following must a physician include in a home O2 prescription?
2. appropriate medical diagnosis
3. laboratory evidence of hypoxemia
4. frequency of use of O2
5. duration of need for O2
Home O2 can be supplied by which of the following systems?
2. liquid O2 systems
3. O2 concentrators
What is the primary use of compressed O2 cylinders in alternative settings?
1. ambulation (small cylinders)
2. backup supply (large cylinders)
One cubic foot (1 cu/ft) of liquid O2 equals how many cu/ft of gaseous O2?
860.00
The gauge reading of a 50-lb home liquid O2 system indicates that the cylinder is a third full. What is the approximate duration of flow of this system at 2 L/min?
48 hours
An ambulatory home O2 therapy patient complains that the portable liquid (at 3 L/min) does not last long enough for a visit with the grandchildren. What might you recommend to overcome this limitation?
Use an O2-conserving device
Advantages of home liquid O2 systems include all of the following except they:
do not require an O2 service delivery company
Disadvantages of home liquid O2 systems include which of the following?
1. Oxygen is lost when not used (because of
venting).
2. The low temperature of liquid O2 can be a hazard.
3. Liquid O2 must be delivered when needed.
4. These systems cannot drive pneumatic equipment.
What is the most common O2 delivery system for long-term care?
nasal cannula
In setting up a home care chronic obstructive pulmonary disease patient for continuous low-flow O2 therapy through an O2 concentrator, which of the following additional equipment must you provide?
backup gas cylinder
Oxygen-conserving delivery systems include which of the following?
1. transtracheal catheter
2. reservoir cannula or pendant
3. pulse-dose
A home care patient using a reservoir cannula for long-term, low-flow O2 therapy objects to the cosmetic appearance of the device. Which of the following alternatives would you recommend to this patient's physician as capable of addressing the patient's concerns?
1. transtracheal catheter
Which O2 delivery system would you recommend for an active home care patient with low FIO2 needs who desires increased mobility?
conserving device used in conjunction with a portable liquid O2 system
Which of the following are good candidates for home mechanical ventilation?
1. a patient who cannot maintain adequate ventilation at night
2. a patient who requires continuous ventilation to survive
3. a terminally ill patient who requires ventilatory support
Conditions in which patient need for home mechanical ventilation is generally limited to daytime or nocturnal support include all of the following except:
high spinal cord injuries
Mechanical ventilation in the home setting can be provided by all of the following methods except:
positive pressure through an oral endotracheal tube
Which of the following are prerequisites to successful home-based mechanical ventilation?
1. presence of adequate professional support
2. willingness of family to accept responsibility
3. patient's condition, especially stability
4. overall viability of the home care plan
What is the first step in discharging a patient from an acute care facility who will require home-based mechanical ventilation?
The family is consulted about the feasibility
Which of the following conditions is an indication for application of noninvasive ventilation (NIV)?
The patient requires low concentrations of supplemental O2
Which of the following can benefit most from intermittent use of noninvasive ventilation?
patient with muscular dystrophy
Types of negative-pressure ventilators used in postacute care include all of the following except:
abdominal displacement device
You are conducting a routine visit to a ventilator-dependent patient in a home care setting. Which of the following would you be sure to perform while on this visit?
1. Carefully assess patient's status.
2. Administer prescribed
respiratory therapy.
3. Check and clean equipment (as needed).
4. Complete all appropriate documentation.
Which of the following evidence would support Medicare reimbursement for adult nasal CPAP equipment to treat sleep apnea?
polysomnograph confirming sleep apnea
Which of the following groups of hospitalized infants are frequently set up on apnea monitors?
those at risk for sudden infant death syndrome (SIDS)
Which of the following functions should a respiratory care practitioner perform when making a home care visit?
1. Identify any problem areas or concerns of the patient.
2. Assess the equipment (operation, cleanliness, supply needs).
3. Determine the patient's compliance with the therapy.
4. Assess the
patient (including pre- and post-treatment measures).
Which of the following is an additional goal of home care of the terminally ill patient near the end of life?
maximize comfort and well-being
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