Question 1

The nurse explains the purpose of a tracheostomy tube for mechanical ventilation. Which patient statement indicates the need for additional teaching?

Accepted Answer

1. This statement would not indicate the need for additional teaching.
2. The tracheostomy reduces dead space, allowing the flow of air more easily into the airways, so there is a decreased resistance to airflow. This statement indicates that additional teaching is needed.
3. This statement would not indicate the need for additional teaching.
4. This statement would not indicate the need for additional teaching.

Question 2

Which setting on a ventilator would require a nursing intervention to improve the outcome for a 60-kg patient with acute lung injury (ALI)?

Accepted Answer

1. The patient with ALI needs supplemental oxygen to help maintain PaO₂. 2. V_T is the volume of gas delivered in one ventilatory cycle. VT is normally 7 mL/kg of body weight or around 500 mL. In mechanical ventilation, the volume is kept at 5-8 mL/kg in order to prevent trauma to lung tissues. In ALI, lower volumes are preferred. The nurse would need to discuss reducing the tidal volume with members of the multidisciplinary team. 3. No action is needed by the nurse. The rate is increased to allow the blow off of CO₂; therefore, a rate of 15 per minute is adequate for the patient with ALI. 4. It would not benefit the patient to alter the I:E ratio while the tidal volume for this patient is excessive.

Question 3

Arterial blood gas (ABG) results of an intubated, mechanically ventilated patient are as follows: pH 7.33; PaO₂ 50; PaCO 49; bicarbonate 27. What nursing action is a priority for this patient?

Accepted Answer

1. This patient is in respiratory acidosis due to inadequate ventilation. The correct action would be to increase rate and FiO₂. 2. Administering IV fluids would not be appropriate because this would interfere with oxygenation. 3. Positive end expiratory pressure is usually prescribed during the weaning process. This patient is not being weaned from the ventilator. 4. This would not improve the patient's ABG or respiratory status.

Question 4

What should the nurse expect to assess in a patient experiencing the fibrotic phase of acute lung injury?

Accepted Answer

1. This is not an assessment finding in the fibrotic phase of acute lung injury.
2. This is not an assessment finding in the fibrotic phase of acute lung injury.
3. This is not an assessment finding in the fibrotic phase of acute lung injury.
4. During the fibrotic phase (the final phase), there is altered healing that results from the development of fibrotic tissue in the alveolar capillary membrane. This disfigurement contributes to the decrease in lung compliance and worsening pulmonary hypertension; leukocytosis, continuing infiltrates, and fever occur.

Question 5

What should the nurse expect to assess in a patient with respiratory failure and hypoxemia?

Accepted Answer

1. This would not be assessed in a patient with respiratory failure and hypoxemia.
2. These are not symptoms of respiratory failure and hypoxemia.
3. Due to the hypoxia, the brain receives diminished oxygen, and personality, perception, and the levels of consciousness are altered. Decreased respiratory reserves lead to hypoxia of the heart, which also requires higher percentages of oxygen to function. The anginal pain is a result of cardiac hypoxia.
4. These are not symptoms of respiratory failure and hypoxemia.

Question 6

Which arterial blood gas result indicates the development of an acute lung injury?

Accepted Answer

1. This would be considered a normal blood gas.
2. This would be seen in the proliferative phase of acute lung injury.
3. This blood gas would be seen in the patient who has tachypnea and respiratory alkalosis with hypoxemia.
4. This blood gas would not occur in early acute lung injury.

Question 7

A patient is diagnosed with type I hypoxemic failure. The nurse should realize that this type of respiratory failure is linked to what?

Accepted Answer

1. Muscular failure to move the air into and out of the lungs is not linked to type I hypoxemic failure.
2. Failure of the neurological system to stimulate respirations is not linked to type I hypoxemic failure.
3. Skeletal alterations of the thoracic region that limit air movement are not linked to type I hypoxemic failure.
4. Type I hypoxemic failure is linked to a breakdown of oxygen transport from the alveolus to arterial flow.

Question 8

The nurse receives the following ABG result: pH = 7.00 PaCO₂ = 50 mm Hg PaO₂ = 89 mm Hg SaO₂ = 90% Based on the results, what should the nurse do first?

Accepted Answer

1. This can be done after the patient assessment is done. 2. Assess lung sounds and vital signs because patient assessment is always performed first before actions are implemented. Both the pH and PaCO₂ reflect respiratory acidosis caused by decreased respiratory effectiveness. Changes in breath sounds and vital signs can identify respiratory acidosis. 3. This can be done some other time. 4. Further assessment is needed before this is implemented.

Question 9

Which patients should the nurse identify as being at risk for developing type II hypoxemic hypercapneic failure? Select all that apply.

Accepted Answer

1. This is an example of type II hypoxemic hypercapneic failure because this condition interferes with the musculoskeletal or anatomical lung function.
2. The post-operative patient can develop atelectasis if respiratory hygiene is not done. Atelectasis is a transportation issue that diminishes the oxygen transportation by fluid accumulation and is not a type II hypoxemic hypercapneic failure.
3. This is an example of type II hypoxemic hypercapneic failure because this condition interferes with the musculoskeletal or anatomical lung function.
4. This is an example of type II hypoxemic hypercapneic failure because this condition interferes with the musculoskeletal or anatomical lung function.
5. Aspiration pneumonia is not an example of type II hypoxemic hypercapneic failure.

Question 10

When assessing a patient with type I hypoxemic failure, the nurse should evaluate for which contributing health problem? Select all that apply.

Accepted Answer

1. This health problem contributes to the development of type I hypoxemic failure.
2. Asthma does not contribute to the development of type I hypoxemic failure.
3. This health problem contributes to the development of type I hypoxemic failure.
4. This health problem contributes to the development of type I hypoxemic failure.
5. This health problem does not contribute to the development of type I hypoxemic failure.

Question 11

When caring for a patient with damage to the cerebral cortex, which change in respiration and ventilation should the nurse expect to observe?

Accepted Answer

1. This would not occur because of damage to the cerebral cortex.
2. This would not occur because of damage to the cerebral cortex.
3. The cerebral cortex regulates voluntary ventilatory effort. In the patient with an injury to the cerebral cortex, voluntary initiation of respirations will decrease.
4. This would not occur because of damage to the cerebral cortex.

Question 12

The nurse instructs a patient on the advantages of noninvasive mechanical ventilation (NIV). Which patient statement reflects a need for additional teaching?

Accepted Answer

1. This statement does not reflect the need for additional teaching.
2. This statement does not reflect the need for additional teaching.
3. This statement does not reflect the need for additional teaching.
4. Although the technique is not invasive, it can still be uncomfortable. In addition, admission to the ICU may be necessary for close and intensive respiratory management. This statement reflects the need for additional teaching.

Question 13

When planning care for a patient who is mechanically ventilated, the nurse should include interventions to address which potential complications? Select all that apply.

Accepted Answer

1. The patient who is mechanically ventilated is at risk for cardiovascular compromise.
2. The patient who is mechanically ventilated is not at risk for this type of pneumonia.
3. The patient who is mechanically ventilated is at risk for barotrauma.
4. The patient who is mechanically ventilated is at risk for volutrauma.
5. The patient who is mechanically ventilated is at risk for anxiety from lack of synchrony with the ventilator.

Question 14

Which statement made by a new graduate nurse about invasive mechanical ventilation techniques is incorrect and requires additional teaching?

Accepted Answer

1. It is the tidal volume that is set, not the total lung capacity. In addition, all ventilations, whether machine generated or spontaneous by the patient, will have the same tidal volume.
2. This is a correct statement and does not require additional teaching.
3. This is a correct statement and does not require additional teaching.
4. This is a correct statement and does not require additional teaching.

Question 15

Which patient should the nurse identify as benefiting from the use of noninvasive ventilation (NIV)?

Accepted Answer

1. Noninvasive ventilation is not used for an acute exacerbation of asthma.
2. A patient with sleep apnea would benefit from the use of noninvasive ventilation.
3. Noninvasive ventilation is not indicated in the treatment of acute myocardial infarction.
4. Noninvasive ventilation is not indicated in the treatment of sepsis.

Question 16

The nurse searches the health history of a patient diagnosed with an acute lung injury for a reason for the disease process. Which statement correctly identifies the cause for this type of lung injury?

Accepted Answer

1. This statement reflects indirect causes of acute lung injury.
2. This statement does not correctly identify the cause of acute lung injury.
3. This statement does not correctly identify the cause of acute lung injury.
4. This statement does not correctly identify the cause of acute lung injury.

Question 17

The nurse is suctioning an intubated, mechanically ventilated patient. For which complication should the nurse assess this client?

Accepted Answer

1. Dysrhythmias can occur as a side effect of suctioning due to hypoxia.
2. Hyperthermia is not a side effect of suctioning.
3. Hematuria is not a side effect of suctioning.
4. Decreased urinary output is not a consequence of suctioning.

Question 18

Which nursing action optimizes overall oxygenation and ventilation in the patient with acute respiratory distress syndrome (ARDS)?

Accepted Answer

1. This allows the oxygen supply and demand to stay balanced. Too much activity can lower supply too quickly and result in hypoxemia. Spacing out nursing activities and care is less stressful to the patient and decreases oxygen consumption. 2. This procedure lowers O₂ supply and increases O₂ demand. 3. Sedation will allow the patient to rest but does not directly balance oxygen supply and demand. 4. This activity actually decreases supply and increases demand.

Question 19

Which assessment findings should indicate to the nurse that a patient is experiencing respiratory distress? Select all that apply.

Accepted Answer

1. This symptom would be present in a patient in respiratory distress.
2. This symptom would be present in a patient in respiratory distress.
3. This symptom would be present in a patient in respiratory distress.
4. The patient in respiratory distress would have rapid respirations.
5. Jugular vein distention is not a symptom of respiratory distress.

Question 20

A patient with ARDS is on a mechanical ventilator and is becoming increasingly restless with a heart rate of 128 bpm. The SaO₂ is 88% and the ventilator settings are FiO₂ 50%; PEEP 8 cm; AC 10 with a total respiratory rate of 30; and a tidal volume of 700 mL. There are coarse rhonchi audible in all lung fields. Which action should the nurse take?

Accepted Answer

1. The patient needs to be suctioned as evidenced by the symptoms of hypoxia-low SaO₂ and tachycardia. The presence of rhonchi is most likely obstructing the airway. 2. Paralyzing the patient is not appropriate because there are indications suctioning needs to be done. Paralyzing agents are used for ventilator synchrony. 3. Changing ventilator settings are not indicated at this time. 4. Sedation or changing the PEEP is not appropriate.

Quiz 3: Care of the Patient With Respiratory Failure

The nurse explains the purpose of a tracheostomy tube for mechanical ventilation. Which patient statement indicates the need for additional teaching?

Which setting on a ventilator would require a nursing intervention to improve the outcome for a 60-kg patient with acute lung injury (ALI) ?

Arterial blood gas (ABG) results of an intubated, mechanically ventilated patient are as follows: pH 7.33; PaO₂ 50; PaCO 49; bicarbonate 27. What nursing action is a priority for this patient?

What should the nurse expect to assess in a patient experiencing the fibrotic phase of acute lung injury?

What should the nurse expect to assess in a patient with respiratory failure and hypoxemia?

Which arterial blood gas result indicates the development of an acute lung injury?

A patient is diagnosed with type I hypoxemic failure. The nurse should realize that this type of respiratory failure is linked to what?

The nurse receives the following ABG result: pH = 7.00 PaCO₂ = 50 mm Hg PaO₂ = 89 mm Hg SaO₂ = 90% Based on the results, what should the nurse do first?

Which patients should the nurse identify as being at risk for developing type II hypoxemic hypercapneic failure? Select all that apply.

When assessing a patient with type I hypoxemic failure, the nurse should evaluate for which contributing health problem? Select all that apply.

When caring for a patient with damage to the cerebral cortex, which change in respiration and ventilation should the nurse expect to observe?

The nurse instructs a patient on the advantages of noninvasive mechanical ventilation (NIV) . Which patient statement reflects a need for additional teaching?

When planning care for a patient who is mechanically ventilated, the nurse should include interventions to address which potential complications? Select all that apply.

Which statement made by a new graduate nurse about invasive mechanical ventilation techniques is incorrect and requires additional teaching?

Which patient should the nurse identify as benefiting from the use of noninvasive ventilation (NIV) ?

The nurse searches the health history of a patient diagnosed with an acute lung injury for a reason for the disease process. Which statement correctly identifies the cause for this type of lung injury?

The nurse is suctioning an intubated, mechanically ventilated patient. For which complication should the nurse assess this client?

Which nursing action optimizes overall oxygenation and ventilation in the patient with acute respiratory distress syndrome (ARDS) ?

Which assessment findings should indicate to the nurse that a patient is experiencing respiratory distress? Select all that apply.

Quiz 3: Care of the Patient With Respiratory Failure

The nurse explains the purpose of a tracheostomy tube for mechanical ventilation. Which patient statement indicates the need for additional teaching?

Which setting on a ventilator would require a nursing intervention to improve the outcome for a 60-kg patient with acute lung injury (ALI) ?

Arterial blood gas (ABG) results of an intubated, mechanically ventilated patient are as follows: pH 7.33; PaO2 50; PaCO 49; bicarbonate 27. What nursing action is a priority for this patient?

What should the nurse expect to assess in a patient experiencing the fibrotic phase of acute lung injury?

What should the nurse expect to assess in a patient with respiratory failure and hypoxemia?

Which arterial blood gas result indicates the development of an acute lung injury?

A patient is diagnosed with type I hypoxemic failure. The nurse should realize that this type of respiratory failure is linked to what?

The nurse receives the following ABG result: pH = 7.00 PaCO2 = 50 mm Hg PaO2 = 89 mm Hg SaO2 = 90% Based on the results, what should the nurse do first?

Which patients should the nurse identify as being at risk for developing type II hypoxemic hypercapneic failure? Select all that apply.

When assessing a patient with type I hypoxemic failure, the nurse should evaluate for which contributing health problem? Select all that apply.

When caring for a patient with damage to the cerebral cortex, which change in respiration and ventilation should the nurse expect to observe?

The nurse instructs a patient on the advantages of noninvasive mechanical ventilation (NIV) . Which patient statement reflects a need for additional teaching?

When planning care for a patient who is mechanically ventilated, the nurse should include interventions to address which potential complications? Select all that apply.

Which statement made by a new graduate nurse about invasive mechanical ventilation techniques is incorrect and requires additional teaching?

Which patient should the nurse identify as benefiting from the use of noninvasive ventilation (NIV) ?

The nurse searches the health history of a patient diagnosed with an acute lung injury for a reason for the disease process. Which statement correctly identifies the cause for this type of lung injury?

The nurse is suctioning an intubated, mechanically ventilated patient. For which complication should the nurse assess this client?

Which nursing action optimizes overall oxygenation and ventilation in the patient with acute respiratory distress syndrome (ARDS) ?

Which assessment findings should indicate to the nurse that a patient is experiencing respiratory distress? Select all that apply.

Arterial blood gas (ABG) results of an intubated, mechanically ventilated patient are as follows: pH 7.33; PaO₂ 50; PaCO 49; bicarbonate 27. What nursing action is a priority for this patient?

The nurse receives the following ABG result: pH = 7.00 PaCO₂ = 50 mm Hg PaO₂ = 89 mm Hg SaO₂ = 90% Based on the results, what should the nurse do first?