Question 1

Identify diagnostic criteria for ARDS.(Select all that apply.)

Accepted Answer

Diagnostic criteria for ARDS include bilateral infiltrates,or "white out," on chest x-ray study and a low PaO₂/FiO₂ ratio.Decreased cardiac output and a high PAOP are seen in pulmonary edema associated with cardiac causes.The PAOP description was deleted from the current definition.

Question 2

Which of the following statements is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP)? (Select all that apply.)

Accepted Answer

A comprehensive oral care protocol is an intervention for preventing VAP.It includes oral suction,brushing teeth every 12 hours,and swabbing.Chlorhexidine gluconate has been effective in patients who have undergone cardiac surgery.Actual toothbrushing is vital to the VAP bundle.

Question 3

The nurse is caring for a patient with cystic fibrosis (CF)and understands that treatment consists of which of the following? (Select all that apply.)

Accepted Answer

The three cornerstones of care for a patient with CF are antibiotic therapy,airway clearance,and nutritional support.Lung transplant is a treatment modality for those who can get a match and who do not have current respiratory failure.A tracheostomy is not a standard treatment for CF.

Question 4

From the following illustrations of the alveolar-capillary membrane,select the image that demonstrates shunting.

Accepted Answer

Figure C shows a shunt.A is a normal alveolar-capillary unit.B is hypoventilation with increased PaCO₂ and decreased PaO₂.D is a ventilation/perfusion mismatch.E is a diffusion defect.

Question 5

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS)is related to damage to the

Accepted Answer

Damage to the alveolar-capillary membrane results in noncardiogenic pulmonary edema.None of the other responses apply.

Question 6

The nurse calculates the PaO₂/FiO₂ ratio for the following values: PaO₂ is 78 mm Hg; FiO₂ is 0.6 (60%).

Accepted Answer

78/0.60 = 130,which meets the criteria for ARDS.

Question 7

Which of the following are components of the Institute for Healthcare Improvement's (IHI's)ventilator bundle? (Select all that apply.)

Accepted Answer

Options A,B,C,and D are components of the IHI ventilator bundle.Oral care with chlorhexidine has recently been added to the IHI bundle.Swabbing alone provides comfort care.

Question 8

The nurse is caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome.The nurse understands that the priority nursing concern for this patient is which of the following?

Accepted Answer

All are important,but protection of the airway is the most important intervention if the patient is placed in the prone position.

Question 9

During rounds,the provider alerts the team that proning is being considered for a patient with acute respiratory distress syndrome.The nurse understands that proning is

Accepted Answer

Proning is considered to improve ventilation by shifting perfusion from the posterior bases of the lung to the anterior portion.The patient is not responding to treatment,and all options should be considered.The patient remains at risk for skin breakdown due to immobility; during proning,the risk is in the dependent areas,such as the face.Proning is a labor-intensive procedure,and the nurse needs help from team members to ensure a safe turn,including protection of the airway.Continuous lateral rotation is a therapy done in the supine position with a specialized bed.

Question 10

Which of the following are physiological effects of positive end-expiratory pressure (PEEP)used in the treatment of ARDS? (Select all that apply.)

Accepted Answer

Ventilatory support for ARDS typically includes PEEP to restore functional residual capacity,open collapsed alveoli,prevent collapse of unstable alveoli,and improve arterial oxygenation.PEEP does not improve CO₂ retention.

Question 11

Which of the following treatments may be used to dissolve a thrombus that is lodged in the pulmonary artery?

Accepted Answer

Thrombolytics are useful in the management of pulmonary embolus and are given to dissolve the clot.Heparin will prevent further clot formation,but it will not dissolve the clot.Aspirin is not a thrombolytic agent.An embolectomy is a surgical procedure to remove the clot.

Question 12

The nurse is assessing a patient with acute respiratory distress syndrome.An expected assessment is

Accepted Answer

A normal PAOP with hypoxemia is an expected assessment finding in ARDS although this has been deleted from the most current definition.Cardiac output of 10 L/min and low systemic vascular resistance are expected findings in sepsis.PAOP of 20 mm Hg and cardiac output of 3 L/min are expected findings in heart failure.PAOP of 5 mm Hg and high systemic vascular resistance are expected findings in hypovolemic shock.

Question 13

The nurse is caring for a patient in acute respiratory failure and understands that the patient should be positioned (Select all that apply.)

Accepted Answer

Patients in respiratory distress are unable to tolerate a flat position.Trendelenburg would also be contraindicated as the weight of the organs on the lungs would inhibit movement.High Fowler's is appropriate.Side lying with head of bed elevated,sitting in a chair,and high Fowler's position are all appropriate ways to position the patient to facilitate gas exchange and comfort.

Question 14

The nurse is caring for a mechanically ventilated patient.The nurse understands that strategies to prevent ventilator-associated pneumonia include which of the following? (Select all that apply.)

Accepted Answer

Condensate should be drained away from the patient to avoid drainage back into the patient's airway.Prevention guidelines recommend elevating the head of bed at 30 to 45 degrees.Regular antiseptic oral care,with an agent such as chlorhexidine,reduces oropharyngeal colonization.Daily "sedation holidays" help determine the need to continue mechanical ventilation.Normal saline is not recommended as part of the suctioning procedure,and it may increase the risk for infection.

Question 15

The nurse is assessing a patient.Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS)?

Accepted Answer

Increased peak inspiratory pressures are often early indicators of ARDS.Oxygen saturation decreases in ARDS.Chest x-ray study will show progressive infiltrates.In ARDS,a PaO₂/FiO₂ ratio of less than 200 is a criterion.

Question 16

Select the strategies for preventing deep vein thrombosis ( DVT )and pulmonary embolus ( PE ).(Select all that apply.)

Accepted Answer

Graduated compression stockings,sequential compression devices,and anticoagulation can reduce the risk for DVT.Physical activity can also reduce the risk; bed rest increases the risk.Leg massage is not recommended.

Quiz 15: Acute Respiratory Failure

Identify diagnostic criteria for ARDS.(Select all that apply.)

Which of the following statements is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP) ? (Select all that apply.)

The nurse is caring for a patient with cystic fibrosis (CF) and understands that treatment consists of which of the following? (Select all that apply.)

From the following illustrations of the alveolar-capillary membrane,select the image that demonstrates shunting.

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to damage to the

The nurse calculates the PaO₂/FiO₂ ratio for the following values: PaO₂ is 78 mm Hg; FiO₂ is 0.6 (60%) .

Which of the following are components of the Institute for Healthcare Improvement's (IHI's) ventilator bundle? (Select all that apply.)

The nurse is caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome.The nurse understands that the priority nursing concern for this patient is which of the following?

During rounds,the provider alerts the team that proning is being considered for a patient with acute respiratory distress syndrome.The nurse understands that proning is

Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of ARDS? (Select all that apply.)

Which of the following treatments may be used to dissolve a thrombus that is lodged in the pulmonary artery?

The nurse is assessing a patient with acute respiratory distress syndrome.An expected assessment is

The nurse is caring for a patient in acute respiratory failure and understands that the patient should be positioned (Select all that apply.)

The nurse is caring for a mechanically ventilated patient.The nurse understands that strategies to prevent ventilator-associated pneumonia include which of the following? (Select all that apply.)

The nurse is assessing a patient.Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS) ?

Select the strategies for preventing deep vein thrombosis ( DVT ) and pulmonary embolus ( PE ) .(Select all that apply.)

Quiz 15: Acute Respiratory Failure

Identify diagnostic criteria for ARDS.(Select all that apply.)

Which of the following statements is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP) ? (Select all that apply.)

The nurse is caring for a patient with cystic fibrosis (CF) and understands that treatment consists of which of the following? (Select all that apply.)

From the following illustrations of the alveolar-capillary membrane,select the image that demonstrates shunting.

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to damage to the

The nurse calculates the PaO2/FiO2 ratio for the following values: PaO2 is 78 mm Hg; FiO2 is 0.6 (60%) .

Which of the following are components of the Institute for Healthcare Improvement's (IHI's) ventilator bundle? (Select all that apply.)

The nurse is caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome.The nurse understands that the priority nursing concern for this patient is which of the following?

During rounds,the provider alerts the team that proning is being considered for a patient with acute respiratory distress syndrome.The nurse understands that proning is

Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of ARDS? (Select all that apply.)

Which of the following treatments may be used to dissolve a thrombus that is lodged in the pulmonary artery?

The nurse is assessing a patient with acute respiratory distress syndrome.An expected assessment is

The nurse is caring for a patient in acute respiratory failure and understands that the patient should be positioned (Select all that apply.)

The nurse is caring for a mechanically ventilated patient.The nurse understands that strategies to prevent ventilator-associated pneumonia include which of the following? (Select all that apply.)

The nurse is assessing a patient.Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS) ?

Select the strategies for preventing deep vein thrombosis ( DVT ) and pulmonary embolus ( PE ) .(Select all that apply.)

The nurse calculates the PaO₂/FiO₂ ratio for the following values: PaO₂ is 78 mm Hg; FiO₂ is 0.6 (60%) .