Deck 67: Acute Respiratory Failure and Acute Respiratory Distress Syndrome

Question 1

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

A)gentamicin 60 mg IV
B)pantoprazole (Protonix) 40 mg IV
C)sucralfate (Carafate) 1 g per nasogastric tube
D)methylprednisolone (Solu-Medrol) 60 mg IV

Answer 1

gentamicin 60 mg IV

Question 2

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)positioning the patient for a chest x-ray.
D)insertion of a pulmonary artery catheter.

Answer 2

insertion of a pulmonary artery catheter.

Question 3

The nurse assesses vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature of 101.2° F,blood pressure of 90/56 mm Hg,pulse of 92 beats/min,and respirations of 34 breaths/min. 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.

Answer 3

Obtain oxygen saturation using pulse oximetry.

Question 4

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

Question 5

The nurse is caring for a 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/min.

Question 6

When prone positioning is used for 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 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 7

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 pulse oximetry indicates a 91% O₂ saturation.
D)The patient's respirations have dropped to 10 breaths/minute.

Question 8

Which diagnostic test will provide the nurse with the most specific information to evaluate the effectiveness of interventions for a patient with ventilatory failure?

A)Chest x-ray
B)O₂ saturation
C)Arterial blood gas analysis
D)Central venous pressure monitoring

Question 9

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

A)The patient is very 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 10

A patient admitted with acute respiratory failure has ineffective airway clearance related to thick secretions. Which nursing intervention would specifically address this patient problem?

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 above 93%.

Question 11

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP)to the patient's caregiver 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% O₂ to the lungs."

Question 12

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

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 4-hour rest period for the patient.

Question 13

While caring for a patient who has been admitted with a pulmonary embolism,the nurse notes a change in the patient's oxygen saturation (SpO?)from 94% to 88%. Which action should the nurse take?

A)Suction the patient's oropharynx.
B)Increase the prescribed O₂ flow rate.
C)Instruct the patient to cough and deep breathe.
D)Help the patient to sit in a more upright position.

Question 14

The nurse is caring for an older 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)Persistent cough of blood-tinged sputum.
B)Scattered crackles in the posterior lung bases.
C)Oxygen saturation 90% on 100% O₂ by nonrebreather mask.
D)Temperature 101.5° F (38.6° C) after 2 days of IV antibiotics.

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 beats/min.

Question 16

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 17

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)Observe for facial symmetry.
B)Notify the health care provider.
C)Attempt to calm and reorient the patient.
D)Assess oxygenation using pulse oximetry.

Question 18

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

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

Question 19

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

A)Administration of 100% O₂ 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 20

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 21

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

Question 22

Which actions should the nurse start to reduce the risk for ventilator-associated pneumonia (VAP)?

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

Question 23

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 24

The nurse reviews the electronic health 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)Older age and anemia
B)Albumin level and weight loss
C)Recent arthroscopic procedure
D)Confusion and disorientation to time

Question 25

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)of 80%,tidal volume of 450,rate of 16/minute,and positive end-expiratory pressure (PEEP)of 5 cm. Which assessment finding is most important for the nurse to report to the health care provider?

A)O₂ saturation of 99%
B)Heart rate 106 beats/minute
C)Crackles audible at lung bases
D)Respiratory rate 22 breaths/minute

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

A)No sedative has been ordered for the patient.
B)The patient does not respond to verbal stimulation.
C)There is no cough or gag reflex when the patient is suctioned.
D)The patient's oxygen saturation remains between 90% to 93%.