Deck 32: Care of Critically Ill Patients with Respiratory Problems

Question 1

A client is on intravenous heparin to treat a pulmonary embolism.The client's most recent partial thromboplastin time (PTT)was 25 seconds.What order should the nurse anticipate?

A) Decrease the heparin rate.
B) Increase the heparin rate.
C) No change to the heparin rate.
D) Stop heparin; start warfarin (Coumadin).

Answer 1

Increase the heparin rate.

Question 2

A client appears dyspneic,but the oxygen saturation is 97%.What action by the nurse is best?

A) Assess for other manifestations of hypoxia.
B) Change the sensor on the pulse oximeter.
C) Obtain a new oximeter from central supply.
D) Tell the client to take slow, deep breaths.

Answer 2

Assess for other manifestations of hypoxia.

Question 3

A nurse is assisting the health care provider who is intubating a client.The provider has been attempting to intubate for 40 seconds.What action by the nurse takes priority?

A) Ensure the client has adequate sedation.
B) Find another provider to intubate.
C) Interrupt the procedure to give oxygen.
D) Monitor the client's oxygen saturation.

Answer 3

Interrupt the procedure to give oxygen.

Question 4

A client is admitted with a pulmonary embolism (PE).The client is young,healthy,and active and has no known risk factors for PE.What action by the nurse is most appropriate?

A) Encourage the client to walk 5 minutes each hour.
B) Refer the client to smoking cessation classes.
C) Teach the client about factor V Leiden testing.
D) Tell the client that sometimes no cause for disease is found.

Question 5

A student nurse is preparing to administer enoxaparin (Lovenox)to a client.What action by the student requires immediate intervention by the supervising nurse?

A) Assessing the client's platelet count
B) Choosing an 18-gauge, 2-inch needle
C) Not aspirating prior to injection
D) Swabbing the injection site with alcohol

Question 6

A nurse is caring for a client on mechanical ventilation and finds the client agitated and thrashing about.What action by the nurse is most appropriate?

A) Assess the cause of the agitation.
B) Reassure the client that he or she is safe.
C) Restrain the client's hands.
D) Sedate the client immediately.

Question 7

A client is being discharged soon on warfarin (Coumadin).What menu selection for dinner indicates the client needs more education regarding this medication?

A) Hamburger and French fries
B) Large chef's salad and muffin
C) No selection; spouse brings pizza
D) Tuna salad sandwich and chips

Question 8

A client is on mechanical ventilation and the client's spouse wonders why ranitidine (Zantac)is needed since the client "only has lung problems." What response by the nurse is best?

A) "It will increase the motility of the gastrointestinal tract."
B) "It will keep the gastrointestinal tract functioning normally."
C) "It will prepare the gastrointestinal tract for enteral feedings."
D) "It will prevent ulcers from the stress of mechanical ventilation."

Question 9

An intubated client's oxygen saturation has dropped to 88%.What action by the nurse takes priority?

A) Determine if the tube is kinked.
B) Ensure all connections are patent.
C) Listen to the client's lung sounds.
D) Suction the endotracheal tube.

Question 10

A client has a pulmonary embolism and is started on oxygen.The student nurse asks why the client's oxygen saturation has not significantly improved.What response by the nurse is best?

A) "Breathing so rapidly interferes with oxygenation."
B) "Maybe the client has respiratory distress syndrome."
C) "The blood clot interferes with perfusion in the lungs."
D) "The client needs immediate intubation and mechanical ventilation."

Question 11

A client is hospitalized with a second episode of pulmonary embolism (PE).Recent genetic testing reveals the client has an alteration in the gene CYP2C19.What action by the nurse is best?

A) Instruct the client to eliminate all vitamin K from the diet.
B) Prepare preoperative teaching for an inferior vena cava (IVC) filter.
C) Refer the client to a chronic illness support group.
D) Teach the client to use a soft-bristled toothbrush.

Question 12

A client has been diagnosed with a very large pulmonary embolism (PE)and has a dropping blood pressure.What medication should the nurse anticipate the client will need as the priority?

A) Alteplase (Activase)
B) Enoxaparin (Lovenox)
C) Unfractionated heparin
D) Warfarin sodium (Coumadin)

Question 13

A client has been brought to the emergency department with a life-threatening chest injury.What action by the nurse takes priority?

A) Apply oxygen at 100%.
B) Assess the respiratory rate.
C) Ensure a patent airway.
D) Start two large-bore IV lines.

Question 14

A nurse is preparing to admit a client on mechanical ventilation from the emergency department.What action by the nurse takes priority?

A) Assessing that the ventilator settings are correct
B) Ensuring there is a bag-valve-mask in the room
C) Obtaining personal protective equipment
D) Planning to suction the client upon arrival to the room

Question 15

A client is on a ventilator and is sedated.What care may the nurse delegate to the unlicensed assistive personnel (UAP)?

A) Assess the client for sedation needs.
B) Get family permission for restraints.
C) Provide frequent oral care per protocol.
D) Use nonverbal pain assessment tools.

Question 16

A client in the emergency department has several broken ribs.What care measure will best promote comfort?

A) Allowing the client to choose the position in bed
B) Humidifying the supplemental oxygen
C) Offering frequent, small drinks of water
D) Providing warmed blankets

Question 17

A nurse is caring for a client on mechanical ventilation.When double-checking the ventilator settings with the respiratory therapist,what should the nurse ensure as a priority?

A) The client is able to initiate spontaneous breaths.
B) The inspired oxygen has adequate humidification.
C) The upper peak airway pressure limit alarm is off.
D) The upper peak airway pressure limit alarm is on.

Question 18

A nurse is teaching a client about warfarin (Coumadin).What assessment finding by the nurse indicates a possible barrier to self-management?

A) Poor visual acuity
B) Strict vegetarian
C) Refusal to stop smoking
D) Wants weight loss surgery

Question 19

A nurse is caring for four clients on intravenous heparin therapy.Which laboratory value possibly indicates that a serious side effect has occurred?

A) Hemoglobin: 14.2 g/dL
B) Platelet count: 82,000/L
C) Red blood cell count: 4.8/mm³
D) White blood cell count: 8.7/mm³

Question 20

A nurse answers a call light and finds a client anxious,short of breath,reporting chest pain,and having a blood pressure of 88/52 mm Hg on the cardiac monitor.What action by the nurse takes priority?

A) Assess the client's lung sounds.
B) Notify the Rapid Response Team.
C) Provide reassurance to the client.
D) Take a full set of vital signs.

Question 21

A nurse is caring for a client who is on mechanical ventilation.What actions will promote comfort in this client? (Select all that apply.)

A) Allow visitors at the client's bedside.
B) Ensure the client can communicate if awake.
C) Keep the television tuned to a favorite channel.
D) Provide back and hand massages when turning.
E) Turn the client every 2 hours or more.

Question 22

When working with women who are taking hormonal birth control,what health promotion measures should the nurse teach to prevent possible pulmonary embolism (PE)? (Select all that apply.)

A) Avoid drinking alcohol.
B) Eat more omega-3 fatty acids.
C) Exercise on a regular basis.
D) Maintain a healthy weight.
E) Stop smoking cigarettes.

Question 23

The nurse caring for mechanically ventilated clients knows that older adults are at higher risk for weaning failure.What age-related changes contribute to this? (Select all that apply.)

A) Chest wall stiffness
B) Decreased muscle strength
C) Inability to cooperate
D) Less lung elasticity
E) Poor vision and hearing

Question 24

The nurse caring for mechanically ventilated clients uses best practices to prevent ventilator-associated pneumonia.What actions are included in this practice? (Select all that apply.)

A) Adherence to proper hand hygiene
B) Administering anti-ulcer medication
C) Elevating the head of the bed
D) Providing oral care per protocol
E) Suctioning the client on a regular schedule

Question 25

A student nurse asks for an explanation of "refractory hypoxemia." What answer by the nurse instructor is best?

A) "It is chronic hypoxemia that accompanies restrictive airway disease."
B) "It is hypoxemia from lung damage due to mechanical ventilation."
C) "It is hypoxemia that continues even after the client is weaned from oxygen."
D) "It is hypoxemia that persists even with 100% oxygen administration."

Question 26

A client is brought to the emergency department after sustaining injuries in a severe car crash.The client's chest wall does not appear to be moving normally with respirations,oxygen saturation is 82%,and the client is cyanotic.What action by the nurse is the priority?

A) Administer oxygen and reassess.
B) Auscultate the client's lung sounds.
C) Facilitate a portable chest x-ray.
D) Prepare to assist with intubation.

Question 27

A nurse is caring for a client on the medical stepdown unit.The following data are related to this client:

What action by the nurse is most appropriate?

A) Call respiratory therapy for a breathing treatment.
B) Facilitate a STAT pulmonary angiography.
C) Prepare for immediate endotracheal intubation.
D) Prepare to administer intravenous anticoagulants.

Question 28

A client with a new pulmonary embolism (PE)is anxious.What nursing actions are most appropriate? (Select all that apply.)

A) Acknowledge the frightening nature of the illness.
B) Delegate a back rub to the unlicensed assistive personnel (UAP).
C) Give simple explanations of what is happening.
D) Request a prescription for antianxiety medication.
E) Stay with the client and speak in a quiet, calm voice.

Question 29

A 242-pound client is being mechanically ventilated.To prevent lung injury,what setting should the nurse anticipate for tidal volume? (Record your answer using a whole number.)___ mL

Question 30

A nurse is caring for five clients.For which clients would the nurse assess a high risk for developing a pulmonary embolism (PE)? (Select all that apply.)

A) Client who had a reaction to contrast dye yesterday
B) Client with a new spinal cord injury on a rotating bed
C) Middle-aged man with an exacerbation of asthma
D) Older client who is 1-day post hip replacement surgery
E) Young obese client with a fractured femur