Deck 68: Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome

Question 1

A patient with acute respiratory distress syndrome ( ARDS ) and acute renal failure has the following medications prescribed. Which medication should the nurse discuss with the health care provider before administration?

A) ranitidine ( Zantac ) 50 mg IV
B) gentamicin ( Garamycin ) 60 mg IV
C) sucralfate ( Carafate ) 1 g per nasogastric tube
D) methylprednisolone ( Solu-Medrol ) 40 mg IV

Answer 1

gentamicin ( Garamycin ) 60 mg IV

Question 2

To decrease the risk for ventilator-associated pneumonia, which action will the nurse include in the plan of care for a patient who requires intubation and mechanical ventilation?

A) Avoid use of positive end-expiratory pressure (PEEP).
B) Suction every 2 hours.
C) Elevate head of bed to 30 to 45 degrees.
D) Give enteral feedings at no more than 10 mL/hr.

Answer 2

Elevate head of bed to 30 to 45 degrees.

Question 3

While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's oxygen saturation (SpO₂) from 94% to 88%. The nurse will

A) increase the oxygen flow rate.
B) suction the patient's oropharynx.
C) assist the patient to cough and deep breathe.
D) help the patient to sit in a more upright position.

Answer 3

increase the oxygen flow rate.

Question 4

Which assessment finding by the nurse when caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased?

A) The patient has subcutaneous emphysema.
B) The patient has a sinus bradycardia with a rate of 52.
C) The patient's PaO₂ is 50 mm Hg and the SaO₂ is 88%.
D) The patient has bronchial breath sounds in both the lung fields.

Question 5

A patient with chronic obstructive pulmonary disease ( COPD ) arrives in the emergency department complaining of shortness of breath and dyspnea. Which assessment finding by the nurse is most important to report to the health care provider?

A) The patient has bibasilar lung crackles.
B) The patient is sitting in the tripod position.
C) The patient's respiratory rate has decreased from 30 to 10 breaths/min.
D) The patient's pulse oximetry indicates an O₂ saturation of 91%.

Question 6

The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider?

A) Cough that is productive of blood-tinged sputum
B) Scattered crackles throughout the posterior lung bases
C) Temperature of 101.5° F ( 38.6° C ) after 2 days of IV antibiotic therapy
D) Oxygen saturation ( SpO₂ ) has dropped to 90% with administration of 100% O₂ by non-rebreather mask.

Question 7

When admitting a patient in possible respiratory failure with a high PaCO₂, which assessment information will be of most concern to the nurse?

A) The patient is somnolent.
B) The patient's SpO₂ is 90%.
C) The patient complains of weakness.
D) The patient's blood pressure is 162/94.

Question 8

The nurse is caring for a 22-year-old patient who came to the emergency department with acute respiratory distress. Which information about the patient requires the most rapid action by the nurse?

A) Respiratory rate is 32 breaths/min.
B) Pattern of breathing is shallow.
C) The patient's PaO₂ is 45 mm Hg.
D) The patient's PaCO₂ is 34 mm Hg.

Question 9

A patient has a nursing diagnosis of ineffective airway clearance related to thick, secretions. Which action will be best for the nurse to include in the plan of care?

A) Encourage use of the incentive spirometer.
B) Offer the patient fluids at frequent intervals.
C) Teach the patient the importance of coughing.
D) Increase oxygen level to keep O₂ saturation >95%.

Question 10

To evaluate the effectiveness of prescribed therapies for a patient with ventilatory failure, which diagnostic test will be most useful to the nurse?

A) Chest x-rays
B) Pulse oximetry
C) Arterial blood gas (ABG) analysis
D) Pulmonary artery pressure monitoring

Question 11

After receiving change-of-shift report, which patient will the nurse assess first?

A) A patient with cystic fibrosis who has thick, green-colored sputum
B) A patient with pneumonia who has coarse crackles in both lung bases
C) A patient with emphysema who has an oxygen saturation of 91% to 92%
D) A patient with septicemia who has intercostal and suprasternal retractions

Question 12

When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective?

A) The patient's PaO₂ is 90 mm Hg, and the SaO₂ is 92%.
B) Endotracheal suctioning results in minimal mucous return.
C) Sputum and blood cultures show no growth after 24 hours.
D) The skin on the patient's back is intact and without redness.

Question 13

The nurse obtains the vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature 101.2° F, blood pressure 90/56 mm Hg, pulse 92, respirations 34. Which action should the nurse take next?

A) Administer the scheduled IV antibiotic.
B) Give the PRN acetaminophen (Tylenol) 650 mg.
C) Obtain oxygen saturation using pulse oximetry.
D) Notify the health care provider of the patient's vital signs.

Question 14

A patient with respiratory failure has a respiratory rate of 8 and an SpO₂ of 89%. The patient is increasingly lethargic. The nurse will anticipate assisting with

A) administration of 100% oxygen by non-rebreather mask.
B) endotracheal intubation and positive pressure ventilation.
C) insertion of a mini-tracheostomy with frequent suctioning.
D) initiation of bilevel positive pressure ventilation (BiPAP).

Question 15

The pulse oximetry for a patient with right lower lobe pneumonia indicates an oxygen saturation of 90%. The patient has rhonchi, a weak cough effort, and complains of fatigue. Which action is best for the nurse to take?

A) Position the patient on the right side.
B) Place a humidifier in the patient's room.
C) Assist the patient with staged coughing.
D) Schedule a 2-hour rest period for the patient.

Question 16

A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a pneumothorax. Which action will the nurse anticipate taking?

A) Lower the positive end-expiratory pressure (PEEP).
B) Increase the fraction of inspired oxygen (FIO₂).
C) Suction more frequently.
D) Increase the tidal volume.

Question 17

When the nurse is caring for an obese patient with left lower lobe pneumonia, gas exchange will be best when the patient is positioned

A) on the left side.
B) on the right side.
C) in the tripod position.
D) in the high-Fowler's position.

Question 18

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is correct?

A) "PEEP will prevent fibrosis of the lung from occurring."
B) "PEEP will push more air into the lungs during inhalation."
C) "PEEP allows the ventilator to deliver 100% oxygen to the lungs."
D) "PEEP prevents the lung air sacs from collapsing during exhalation."

Question 19

When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first?

A) Check pupil reaction to light.
B) Notify the health care provider.
C) Attempt to calm and reassure the patient.
D) Assess oxygenation using pulse oximetry.

Question 20

A patient develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with

A) inserting a pulmonary artery catheter.
B) obtaining a ventilation-perfusion scan.
C) drawing blood for arterial blood gases.
D) positioning the patient for a chest radiograph.

Question 21

A patient with ARDS who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation (SIMV) has settings of fraction of inspired oxygen (FIO₂) 80%, tidal volume 500, rate 18, and positive end-expiratory pressure (PEEP) 5 cm. Which assessment finding is most important for the nurse to report to the health care provider?

A) Oxygen saturation 99%
B) Patient respiratory rate 22 breaths/min
C) Crackles audible at lung bases
D) Apical pulse rate 104 beats/min

Question 22

Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) can the RN delegate to an experienced LPN/LVN working in the intensive care unit?

A) Assess breath sounds
B) Insert a retention catheter
C) Place patient in the prone position
D) Monitor pulmonary artery pressures