Deck 64: Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome

Question 1

The nurse is caring for a 78-year-old patient who was hospitalized 2 days earlier with community-acquired pneumonia.Which assessment information is most important to communicate to the health care provider?

A) Scattered crackles bilaterally in the posterior lung bases.
B) Persistent cough that is productive of blood-tinged sputum.
C) Temperature of 101.5° F (38.6° C) after 2 days of IV antibiotic therapy.
D) Decreased oxygen saturation to 90% with 100% O₂ by non-rebreather mask.

Answer 1

Decreased oxygen saturation to 90% with 100% O₂ by non-rebreather mask.

Question 2

When assessing a patient with chronic obstructive pulmonary disease (COPD),the nurse finds a new onset of agitation and confusion.Which action should the nurse take first?

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

Answer 2

Assess oxygenation using pulse oximetry.

Question 3

A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery.To determine whether the patient has acute respiratory distress syndrome (ARDS)or pulmonary edema caused by heart failure,the nurse will plan to assist with

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

Answer 3

insertion of a pulmonary artery catheter.

Question 4

The oxygen saturation (SpO₂)for a patient with left lower lobe pneumonia is 90%.The patient has rhonchi,a weak cough effort,and complains of fatigue.Which action is a priority for the nurse to take?

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

Question 5

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

A) Chest x-ray
B) Oxygen saturation
C) Arterial blood gas analysis
D) Central venous pressure monitoring

Question 6

The nurse is caring for a 33-year-old patient who arrived in the emergency department with acute respiratory distress.Which assessment finding by the nurse requires the most rapid action?

A) The patient's PaO₂ is 45 mm Hg.
B) The patient's PaCO₂ is 33 mm Hg.
C) The patient's respirations are shallow.
D) The patient's respiratory rate is 32 breaths/minute.

Question 7

A patient with acute respiratory distress syndrome (ARDS)is placed in the prone position.When prone positioning is used,which information obtained by the nurse indicates that the positioning is effective?

A) The patient's PaO₂ is 89 mm Hg, and the SaO₂ is 91%.
B) Endotracheal suctioning results in clear mucous return.
C) Sputum and blood cultures show no growth after 48 hours.
D) The skin on the patient's back is intact and without redness.

Question 8

After receiving change-of-shift report on a medical unit,which patient should the nurse assess first?

A) A patient with cystic fibrosis who has thick, green-colored sputum
B) A patient with pneumonia who has crackles bilaterally in the lung bases
C) A patient with emphysema who has an oxygen saturation of 90% to 92%
D) A patient with septicemia who has intercostal and suprasternal retractions

Question 9

A patient with acute respiratory distress syndrome (ARDS)and acute kidney injury has the following medications ordered.Which medication should the nurse discuss with the health care provider before giving?

A) Pantoprazole (Protonix) 40 mg IV
B) Gentamicin (Garamycin) 60 mg IV
C) Sucralfate (Carafate) 1 g per nasogastric tube
D) Methylprednisolone (Solu-Medrol) 60 mg IV

Question 10

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 accurate?

A) "PEEP will push more air into the lungs during inhalation."
B) "PEEP prevents the lung air sacs from collapsing during exhalation."
C) "PEEP will prevent lung damage while the patient is on the ventilator."
D) "PEEP allows the breathing machine to deliver 100% oxygen to the lungs."

Question 11

A patient with chronic obstructive pulmonary disease (COPD)arrives in the emergency department complaining of shortness of breath and dyspnea on minimal exertion.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 respirations have decreased from 30 to 10 breaths/minute.
D) The patient's pulse oximetry indicates an O₂ saturation of 91%.

Question 12

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%.Which action should the nurse take next?

A) Increase the oxygen flow rate.
B) Suction the patient's oropharynx.
C) Instruct the patient to cough and deep breathe.
D) Help the patient to sit in a more upright position.

Question 13

A patient with respiratory failure has a respiratory rate of 6 breaths/minute and an oxygen saturation (SpO₂)of 88%.The patient is increasingly lethargic.Which intervention will the nurse anticipate?

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 continuous positive pressure ventilation (CPAP)

Question 14

A patient admitted with acute respiratory failure has a nursing diagnosis of ineffective airway clearance related to thick,secretions.Which action is a priority 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 ambulation.
D) Titrate oxygen level to keep O₂ saturation >93%.

Question 15

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

A) The patient's PaO₂ is 50 mm Hg and the SaO₂ is 88%.
B) The patient has subcutaneous emphysema on the upper thorax.
C) The patient has bronchial breath sounds in both the lung fields.
D) The patient has a first-degree atrioventricular heart block with a rate of 58.

Question 16

When admitting a patient with possible respiratory failure with a high PaCO₂,which assessment information should be immediately reported to the health care provider?

A) The patient is somnolent.
B) The patient complains of weakness.
C) The patient's blood pressure is 164/98.
D) The patient's oxygen saturation is 90%.

Question 17

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

A) Increase the tidal volume and respiratory rate.
B) Increase the fraction of inspired oxygen (FIO₂).
C) Perform endotracheal suctioning more frequently.
D) Lower the positive end-expiratory pressure (PEEP).

Question 18

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

Question 19

A nurse is caring for a patient who is orally intubated and receiving mechanical ventilation.To decrease the risk for ventilator-associated pneumonia,which action will the nurse include in the plan of care?

A) Elevate head of bed to 30 to 45 degrees.
B) Suction the endotracheal tube every 2 to 4 hours.
C) Limit the use of positive end-expiratory pressure.
D) Give enteral feedings at no more than 10 mL/hr.

Question 20

A nurse is caring for an obese patient with right lower lobe pneumonia.Which position will be best to improve gas exchange?

A) On the left side
B) On the right side
C) In the tripod position
D) In the high-Fowler's position

Question 21

The nurse reviews the electronic medical record for a patient scheduled for a total hip replacement.Which assessment data shown in the accompanying figure increase the patient's risk for respiratory complications after surgery?

A) Albumin level and recent weight loss
B) Mild confusion and recent weight loss
C) Age and recent arthroscopic procedure.
D) Anemia and recent arthroscopic procedure

Question 22

Which information about a patient who is receiving cisatracurium (Nimbex)to prevent asynchronous breathing with the positive pressure ventilator requires immediate action by the nurse?

A) Only continuous IV opioids have been ordered.
B) The patient does not respond to verbal stimulation.
C) There is no cough or gag when the patient is suctioned.
D) The patient's oxygen saturation fluctuates between 90% to 93%.

Question 23

A nurse is caring for a patient with acute respiratory distress syndrome (ARDS)who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation (SIMV).The settings include fraction of inspired oxygen (FIO₂)80%,tidal volume 450,rate 16/minute,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) Respiratory rate 22 breaths/minute
C) Crackles audible at lung bases
D) Heart rate 106 beats/minute

Question 24

Which nursing interventions included in the care of a mechanically ventilated patient with acute respiratory failure can the registered nurse (RN)delegate to an experienced licensed practical/vocational nurse (LPN/LVN)working in the intensive care unit?

A) Assess breath sounds every hour.
B) Monitor central venous pressures.
C) Place patient in the prone position.
D) Insert an indwelling urinary catheter.

Question 25

The nurse is caring for a patient who is intubated and receiving positive pressure ventilation to treat acute respiratory distress syndrome (ARDS).Which finding is most important to report to the health care provider?

A) Blood urea nitrogen (BUN) level 32 mg/dL
B) Red-brown drainage from orogastric tube
C) Scattered coarse crackles heard throughout lungs
D) Arterial blood gases: pH 7.31, PaCO₂ 50, PaO₂ 68

Question 26

During change-of-shift report on a medical unit,the nurse learns that a patient with aspiration pneumonia who was admitted with respiratory distress has become increasingly agitated.Which action should the nurse take first?

A) Give the prescribed PRN sedative drug.
B) Offer reassurance and reorient the patient.
C) Use pulse oximetry to check the oxygen saturation.
D) Notify the health care provider about the patient's status.

Question 27

Which actions should the nurse initiate to reduce the risk for ventilator-associated pneumonia (VAP)(select all that apply)?

A) Obtain arterial blood gases daily.
B) Provide a "sedation holiday" daily.
C) Elevate the head of the bed to at least 30°.
D) Give prescribed pantoprazole (Protonix).
E) Provide oral care with chlorhexidine (0.12%) solution daily.