Deck 70: Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome

Question 1

The nurse suspects the possible onset of ARDS in a susceptible patient who develops which of the following symptoms?

A) Dyspnea,restlessness,and mild hypoxemia
B) Tachypnea and hypertension with elevated PaO₂
C) Diffuse crackles and rhonchi on chest auscultation
D) Cough with blood-tinged sputum and respiratory alkalosis

Answer 1

Dyspnea,restlessness,and mild hypoxemia

Question 2

The nurse anticipates the possibility of hypercapnic respiratory failure when the patient has which of the following problems?

A) Chest trauma and multiple rib fractures
B) Carbon monoxide poisoning after a house fire
C) Left-sided ventricular failure and acute pulmonary edema
D) Tachypnea and acute respiratory distress syndrome (ARDS)

Answer 2

Chest trauma and multiple rib fractures

Question 3

A patient is brought to the emergency department unconscious following a barbiturate overdose.The nurse recognizes that the patient is at risk for which of the following conditions?

A) Hypercapnic respiratory failure related to ventilatory failure
B) Hypoxemic respiratory failure related to diffusion limitations
C) Hypoxemic respiratory failure related to shunting of blood from underventilated alveoli
D) Hypercapnic respiratory failure related to V/Q mismatch due to increased airway resistance

Answer 3

Hypercapnic respiratory failure related to ventilatory failure

Question 4

A patient in acute respiratory failure as a complication of COPD has a PaCO₂ of 65 mm Hg;adventitious lung sounds,especially in the right lung;and marked fatigue with an ineffective cough.To promote gas exchange in the patient,what should the nurse do?

A) Arrange for a humidifier to be placed in the patient's room.
B) Position the patient on the right side with the head of the bed elevated.
C) Assist the patient with augmented coughing to help remove respiratory secretions.
D) Schedule assessments and treatments to allow rest periods to help conserve the patient's energy.

Question 5

The nurse would assess pulse oximetry in which of the following patients?

A) A patient with chronic obstructive pulmonary disease (COPD)
B) A patient with pneumonia
C) A patient with massive obesity
D) A patient with postoperative anaesthetic depression

Question 6

Following a coronary artery bypass graft performed with cardiopulmonary bypass,a patient develops pulmonary edema.The nurse anticipates that differentiation between ARDS and pulmonary edema of cardiogenic origin will be made by which of the following diagnostic tests?

A) A chest X-ray film
B) ABG analysis
C) A V/Q lung scan
D) Pulmonary artery wedge pressures (PAWPs)

Question 7

When caring for a patient with pulmonary fibrosis,the nurse understands that the patient is at risk for hypoxemic respiratory failure as a result of which of the following conditions?

A) Too rapid movement of blood flow through the pulmonary blood vessels
B) Incomplete filling of the alveoli with air because of reduced respiratory ability
C) Decreased transfer of oxygen into the blood because of thickening of the alveoli
D) Mismatch between lung ventilation and blood flow through the blood vessels of the lung

Question 8

Which of the following findings indicates to the nurse that a patient with acute respiratory distress who has no history of chronic lung disease is in acute respiratory failure?

A) pH of 7.34
B) Arterial partial pressure of oxygen (PaO₂)of 45 mm Hg
C) Arterial partial pressure of carbon dioxide (PaCO₂)of 50 mm Hg
D) Evidence of respiratory muscle fatigue

Question 9

To evaluate both oxygenation and ventilation in a patient with acute respiratory failure,the nurse uses the findings revealed with which of the following monitoring methods?

A) Chest X-ray films
B) Pulse oximetry
C) Arterial blood gas (ABG)analysis
D) Hemodynamic monitoring

Question 10

A patient with severe chronic lung disease is hospitalized in respiratory distress.When monitoring the patient,which nursing assessment will be of most concern?

A) Bibasilar lung crackles
B) Sitting in the tripod position
C) Oxygen saturation of 91%
D) Decrease in respiratory rate from 30 breaths/min to 10 breaths/min

Question 11

A patient with hypercapnic respiratory failure is lethargic and has the following vital signs: blood pressure 84/50 mm Hg,pulse 120 beats/min,respiration 8 breaths/min,and SpO₂ of 89%.Which collaborative intervention will the nurse anticipate?

A) Administration of 100% oxygen by mask
B) Endotracheal intubation with mechanical ventilation
C) Insertion of a mini-tracheostomy tube to facilitate suctioning
D) Use of noninvasive PPV

Question 12

A patient is diagnosed with a large pulmonary embolism.In explaining to the patient what has happened to cause respiratory failure,what does the nurse understand is the mechanism involved?

A) Diffusion limitations because the blood gas membrane is thickened
B) Alveolar hypoventilation because of the obstruction in the small airways
C) Shunting because the blood perfuses large areas of underventilated alveoli
D) Ventilation-perfusion (V/Q)mismatch because of ventilation to areas where blood flow is decreased

Question 13

While performing an admission assessment of a patient in hypercapnic respiratory failure due to COPD,what symptoms would the nurse expect the patient to report?

A) Confusion
B) Cyanosis
C) Anxiety and restlessness
D) A morning headache and dyspnea

Question 14

When caring for a patient who developed ARDS as a result of a gram-negative urinary infection that became systemic,the nurse is asked by the patient's family how a urinary tract infection could cause lung damage.What is the best response to the family members?

A) The lungs have become massively infected by the spread of infection from the urinary tract to the lungs.
B) Failure of the kidneys causes toxins to accumulate in the blood,which are damaging to other tissues,such as the lungs.
C) Serious infections may cause stimulation of the body's inflammatory and immune systems,which,in turn,react abnormally with lung tissue.
D) The lungs become damaged when infections are carried in the blood and microorganisms clump together,blocking the blood supply to vital organs.

Question 15

To improve V/Q match and facilitate secretion removal in the patient with left lower lobe pneumonia,how should the nurse position the patient?

A) On the left side
B) On the right side
C) In high-Fowler's position
D) Sitting and leaning over the overbed table

Question 16

Which assessment finding would the nurse expect in a patient with hypoxemia?

A) Apnea
B) Decreased respiratory rate
C) Increased SpO₂
D) Prolonged expiration

Question 17

A patient admitted 2 days ago with gram-negative sepsis has the following assessment data: temperature 38.3°C,blood pressure 90/56 mm Hg,pulse 92 beats/min,respiration 34 breaths/min.Which action should the nurse take first?

A) Obtain oxygen saturation using pulse oximetry.
B) Document the vital signs,and continue to monitor.
C) Administer as-needed acetaminophen (Tylenol)650 mg.
D) Notify the physician of the patient's assessment data findings.

Question 18

Which of the following is a predisposing factor for the development of acute respiratory failure?

A) Malnutrition
B) Morbid obesity
C) A 10-pack-a-year smoking history
D) Allergy to pet hair

Question 19

Which of the following areas has the highest regional ventilation-perfusion ratio?

A) Apex of lung
B) Midpoint of lung
C) Base of lung
D) Right lung

Question 20

While caring for a patient with a pulmonary embolism,the nurse notes a change in the patient's arterial oxygen saturation by pulse oximetry (SpO₂)from 94% to 88%.The nurse recognizes that management of this patient's hypoxemia usually requires which of the following treatments?

A) Positive pressure ventilation (PPV)
B) Drugs that relieve bronchospasm
C) Removal of respiratory secretions
D) Administration of supplemental oxygen

Question 21

Which of the following is a late nonspecific manifestation of a patient with hypoxemia respiratory failure?

A) Agitation
B) Hypotension
C) Tachycardia
D) Fatigue

Question 22

Which assessment finding would the nurse expect in a patient with hypercapnia?

A) Increased tidal volume
B) Increased minute ventilation
C) Dyspnea
D) Bradycardia