Question

Case Scenario #1

1. Ms. Smith is a 34 year old female that you have been asked to assess. She is 5 feet, 1 inch tall and weighs 220 lbs. She is a post-operative patient who had her gall bladder removed yesterday. She has received a lot of pain medication and is lethargic at the time of your assessment. You talk to her about her complaints and she states she is having difficulty breathing. You suspect atelectasis and recommend a chest x-ray. What would you expect to see on the chest x-ray?

a. Increased density (patchy infiltrates)

b. Interstitial pattern

c. Mediastinal shift to the opposite side

d. Deep sulcus sign

2. You show the chest x-ray to the physician and before he confirms the diagnosis of atelectasis, he wants more information. He asks you to assess the patient’s pulmonary status. Which of the following would you expect to find if she has atelectasis? (Choose as many as indicated).

a. Decreased tactile fremitus

b. Fine crackles

c. Hyperresonance to percussion

d. Decreased chest wall expansion

e. Dullness to percussion

3. After your assessment, you recommend that arterial blood gases be drawn to further assess her pulmonary status. The results of the ABGs show mild hypoxemia(PaO2 of 65 mmHg). What pathophysiologic changes are most likely causing the hypoxemia?

a. Pleural effusion

b. Deadspace effect

c. Empyema

d. Intrapulmonary or capillary shunting

4. The physician asks for your recommendation for treatment. Which of the following would you recommend? (C

Answer 1

1. The correct option is a) In X-RAY , radiological appearance of atelectasis is by increased density .

2. The correct option are b,d,e . On assessment , the nurse would find fine crackles at the end of expiration , idullness to percussion and decreased chest wall expansion .

3. The correct option is b) dead space effect . On expiration, the air in the dead space is expired first, before any of the air from the alveoli reaches the atmosphere. Therefore, the dead space is very disadvantageous for removing the expiratory gases from the lungs.