Deck 28: Caring for the Patient With Complex Respiratory Disorders

Question 1

A patient being mechanically ventilated is receiving PEEP of 10 cm of H₂O. The nurse ensures that which intervention is performed for this patient?

A) Closed system suctioning
B) Oral care daily
C) Placement of a nasogastric tube
D) Daily measurement of vital signs

Answer 1

Closed system suctioning

Question 2

A patient being mechanically ventilated develops hypotension after the respiratory therapist implements the most recent physician orders. The nurse suspects which ventilator mode might be the cause?

A) PEEP
B) SIMV mode
C) Assist-control mode
D) Pressure-controlled settings

Answer 2

PEEP

Question 3

A patient is being mechanically ventilated with SIMV at a rate of 2

A) The rate could be too high for this mode.
B) The patient will be more comfortable with a different mode.
C) The patient is not receiving enough sedation.
D) SIMV is always used in combination with PEEP.
E) The nurse would question this order for which reason?

Answer 3

The rate could be too high for this mode.

Question 4

A patient being mechanically ventilated has the following ventilator settings: SIMV 16, PEEP 20 cm of H₂O, FiO₂ 45%, tidal volume .450 liters. What concerns will the nurse have for this patient?

A) Barotrauma
B) Volutrauma
C) Sinusitis
D) Oxygen toxicity

Question 5

A patient is admitted with pulmonary edema. Which portions of the admission assessment have priority? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Cardiac history
B) Pulmonary history
C) Renal history
D) Family history of genetic illnesses
E) Vaccination status

Question 6

Which instructions should the nurse include when providing discharge teaching to a patient recovering from acute respiratory distress syndrome ARDS)? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "You should avoid smoking and air pollution."
B) "Lifestyle modifications to decrease oxygen demands will be necessary."
C) "It is important for you to restrict fluid intake to avoid congestive failure."
D) "You and your family should get annual influenza immunizations."
E) "You must avoid large gatherings of people."

Question 7

The family of a mechanically ventilated patient receiving a chest tube asks why the tube is necessary. What is the nurse's most accurate response?

A) "The chest tube helps to decompress the lung and prevents further complications."
B) "The chest tube helps the patient breathe more easily when on a ventilator."
C) "The chest tube is an elective procedure that many physicians like to perform."
D) "The chest tube is required to provide PEEP to the patient."

Question 8

A patient requires endotracheal intubation. Which equipment should the nurse prepare? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Flexible stylet
B) Suction catheters
C) Petroleum-based lubricant
D) Sterile gloves
E) Irrigation tipped 5 mL syringe

Question 9

A patient who is intubated is demonstrating rhonchi and has a pulse oximeter reading of 92%, soft abdomen, heart rate 88 bpm, and blood pressure 98/54 mmHg. Which intervention is the nurse's first priority?

A) Suction the patient.
B) Contact the physician.
C) Increase the oxygen.
D) Start dopamine.

Question 10

A patient being ventilated mechanically develops respiratory alkalosis. The high-pressure alarm has sounded frequently for this patient. The nurse knows this is a common problem in patients with which ventilator settings?

A) Assist-control mode
B) SIMV mode with the set rate too low
C) Pressure-support mode
D) Pressure-control mode

Question 11

A patient diagnosed with sepsis suddenly develops dyspnea, crackles, hypertension, bounding pulses, agitation, and confusion. The nurse suspects that which condition has developed?

A) Noncardiogenic pulmonary edema
B) Right-sided heart failure
C) Left-sided heart failure
D) Constrictive pericarditis

Question 12

A patient being mechanically ventilated suddenly develops cardiac arrhythmias from increasingly higher PEEP. The patient most likely has which underlying physiologic issues?

A) Decreased cardiac output and acidosis
B) Increased cardiac output and alkalosis
C) Decreased cardiac output and renal failure
D) Increased cardiac output and electrolyte disturbance

Question 13

A patient is ready to begin weaning from mechanical ventilation. The nurse would prepare to assist respiratory therapy with which procedure?

A) Applying a T-tube set
B) Insertion of a short one-way valve
C) Tracheostomy insertion
D) Insertion of a new endotracheal tube

Question 14

The chest X-ray of a patient who was recently intubated shows the endotracheal tube located in the right bronchus. The nurse recognizes that which intervention should be implemented?

A) The tube needs to be withdrawn slightly.
B) The tube needs to be inserted further.
C) The tube is correctly placed.
D) The tube is incorrectly attached to the ventilator.

Question 15

An elderly postoperative patient without known respiratory or central nervous system disease cannot be extubated in the postanesthesia recovery unit due to abnormal ABG results. The patient does not respond to the nurse's commands and has a respiratory rate of 10. What ABG results might the nurse expect?

A) pH 7.28; PaO₂ 80 mmHg; PaCO₂ 55 mmHg; HCO₃ 22 mmHg; SaO₂ 92%
B) pH 7.35; PaO₂ 58mmHg; PaCO₂ 36 mmHg; HCO₃ 25 mmHg; SaO₂ 85%
C) pH 7.42; PaO₂ 52mmHg; PaCO₂ 45 mmHg; HCO₃ 26 mmHg; SaO₂ 82%
D) pH 7.44; PaO₂ 59mmHg; PaCO₂ 50 mmHg; HCO₃ 25 mmHg; SaO₂ 89%

Question 16

A patient being mechanically ventilated requires increasing PEEP for worsening ARDS. The order for PEEP is now at 20 cm of H₂O. The nurse will need to contact the physician immediately if which condition develops?

A) Lung sounds greater on one side than the other
B) Lung sounds with crackles
C) Diminished peripheral pulses
D) High-pressure alarm

Question 17

A patient being mechanically ventilated is demonstrating hypoxia, with a pulse oximeter reading of 88%. After ensuring the integrity of the ventilator tubing and assessing the patient, the nurse auscultates adventitious lung sounds. Which action should the nurse take next?

A) Suction the patient.
B) Contact the physician.
C) Turn the patient on the side.
D) Silence the alarm.

Question 18

Which physician's order should the nurse question for a patient who is intubated and being mechanically ventilated?

A) Endotracheal suctioning every hour
B) Endotracheal suctioning as needed
C) NPO status
D) Intake and output every 4 hours

Question 19

The nurse will assess for which complications in the patient who has a nasal endotracheal tube in place? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Tracheoesophageal fistula
B) Wound infection
C) Pressure necrosis of the nares
D) Sinusitis
E) Obstruction of the tube

Question 20

The family of an elderly patient diagnosed with pulmonary edema asks the nurse what the diagnosis means. How should the nurse respond?

A) "It is too much fluid in the lungs."
B) "It is a narrowing of the coronary vessels that causes the heart to stop working correctly."
C) "It is a disorder that rarely affects individuals older than 60."
D) "It is caused by working too hard when one is younger."

Question 21

A patient presents to the emergency department complaining of sudden onset of increased weakness and tingling of the lower extremities that has progressed to the upper arms. The patient is diagnosed with Guillain-Barré syndrome. The patient's respiratory rate is 8; blood pressure is 86/48. The patient is being prepared for intubation. What would the nurse anticipate the blood gases to reveal?

A) High pH
B) High PaCO₂
C) High HCO₃
D) Low PaCO₂

Question 22

A patient has just been diagnosed with acute respiratory distress syndrome ARDS). The nurse is aware that both acute lung injury ALI) and ARDS patients often require which priority intervention?

A) Placement on a mechanical ventilator
B) Preparation of a living will
C) Frequent hydration with ice chips
D) Frequent suctioning to keep the airway clear

Question 23

A patient was admitted 3 days ago with a myocardial infarction MI) and has developed pulmonary edema. How would the nurse explain this condition to the patient and family?

A) The pulmonary system has an excessive amount of fluid that has been building over the last several days, and now the heart is no longer able to keep up with the demands.
B) The cardiac muscle has been injured and is not able to efficiently pump the blood through the patient's system, resulting in an increased pressure in the pulmonary system.
C) The pulmonary system was injured first due to hypoxia, which caused the heart attack.
D) The cardiac muscle is working too hard to push fluids through the pulmonary system and there is fluid excess as a result.

Question 24

Which interventions should the nurse plan to help reduce a patient's risk of developing ventilator-associated pneumonia? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Brush the patient's teeth every 4 hours.
B) Regularly drain any accumulated water from ventilator tubing.
C) Place a nasogastric tube to keep the stomach decompressed.
D) Keep the head of the bed at 30 to 45 degrees.
E) Wash the hands before and after patient contact.

Question 25

A patient who is being mechanically ventilated also has a pleural chest tube. The nurse becomes concerned that the chest tube is not functioning correctly. Which actions should the nurse take? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Look for tidaling in the tube.
B) Look for tidaling in the diagnostic fluid chamber.
C) Clamp the chest tube and monitor patient response.
D) Disconnect the suction source.
E) Increase the suction

Question 26

Which patient should the nurse assess first?

A) Patient with a chest tube complaining of difficulty breathing
B) Patient with a tracheostomy who is on oxygen via trach mask
C) Patient preparing for discharge following a lengthy hospital stay for ARDS
D) Patient complaining of incisional pain

Question 27

A patient presents with PaO₂ of 54 mmHg and an arterial oxygen saturation of 80%. The nurse assesses for which most likely cause of this type of acute respiratory failure?

A) Cervical spinal cord injury
B) Pneumothorax
C) Obesity
D) Oversedation

Question 28

Arterial blood gases reveal that a patient's PaO₂ is 84% on room air. The patient's FaO₂/FiO₂ ratio is ______.

Question 29

The health care team plans to begin weaning a patient diagnosed with sepsis from the mechanical ventilator. The nurse would review the medical record to assess for achievement of which criteria? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The patient's hemoglobin is over 8 mg/dL.
B) Sepsis has improved.
C) The patient is hemodynamically stable on a moderate dose of vasopressor.
D) The patient is able to initiate inspiratory effort.
E) The patient is quiet and sleeps most of the time.

Question 30

A patient who was in a motor vehicle accident 1 day ago has been diagnosed with lung contusions. The patient develops increasing respiratory distress. The nurse recognizes that which factor will differentiate a diagnosis of acute lung injury ALI) from a diagnosis of acute respiratory distress syndrome ARDS)?

A) ALI patients have fewer injuries than ARDS patients.
B) ARDS patients have a lower respiratory rate than ALI patients.
C) ARDS and ALI differ only in the extent of hypoxemia.
D) ALI patients have more inflammation than ARDS patients.

Question 31

The nurse is concerned that an intubated patient is experiencing a cuff leak. Which assessment data would support the nurse's concern? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Increased temperature
B) The patient saying, "My neck hurts"
C) Edema of the upper extremities
D) A hissing sound heard over the trachea on expiration
E) Bubbling secretions at the corner of the patient's mouth

Question 32

A patient who has cardiogenic pulmonary edema is receiving intravenous dopamine at a rate of 195 mcg/min. The patient weighs 65 kg. The nurse would increase surveillance for tachycardia and dysrhythmias if the dopamine rate must be increased to a rate greater than ________ mcg/min.

Question 33

A patient who is septic is restless and agitated. The chest X-ray results indicate bilateral patchy infiltrates. As the patient's condition continues to deteriorate, which finding would raise the nurse's concern that the patient is developing ARDS?

A) Hypertension
B) Hyperventilation
C) Decreasing HCO₃
D) Refractory hypoxemia

Question 34

The nurse is giving a report to the oncoming ICU shift for the most recent admission. The nurse indicates the patient is hypotensive, has an S₃ heart sound, has crackles, has pink frothy sputum, and the skin is diaphoretic and cool. The oncoming shift recognizes which differences between cardiogenic pulmonary edema CPE) and noncardiogenic pulmonary edema NCPE)?

A) NCPE patients are hypotensive, have an S₃ heart sound, and have a cough.
B) CPE patients are hypotensive, have an S₃ heart sound, and have dry skin.
C) NCPE patients are hypertensive, have bounding pulses, and have jugular vein distension JVD).
D) CPE patients are hypotensive, have an S₃ heart sound, and are cool and diaphoretic.

Question 35

A student is accompanying the nurse today. A newly admitted ICU patient with a diagnosis of pulmonary edema has an elevated jugular vein distension JVD) and an S₃. Based on these assessment findings, the nurse indicates to the student that this is which type of pulmonary edema?

A) Neurogenic
B) Cardiogenic
C) High altitude
D) Excessive IV fluid administration