1. Which diagnostic test will provide the nurse with the most specific information to evaluate the effectiveness of interventions for a patient with ventilatory failure? Show ANS: C DIF: Cognitive Level: Apply (application) REF: 1614 2. While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's oxygen saturation (SpO2)
from 94% to 88%. Which action should the nurse take? ANS: B DIF: Cognitive Level: Apply (application) REF: 1609 3. 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? ANS: B DIF: Cognitive Level: Apply (application) REF: 1616 4. 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? ANS: B DIF: Cognitive Level: Apply (application) REF: 1616 5. A nurse is caring for an obese patient with right lower lobe pneumonia. Which position will be best to improve gas exchange? ANS: A DIF: Cognitive Level: Apply (application) REF: 1617 6. When admitting a patient with possible respiratory failure and a high PaCO2, which assessment information should be immediately reported to the health care provider? ANS: A DIF: Cognitive Level:
Analyze (analysis) REF: 1615 7. 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? ANS: A DIF: Cognitive Level: Apply (application) REF: 1623 8.
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 ANS: D DIF: Cognitive Level: Apply (application) REF: 1625 9. 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? ANS: B DIF: Cognitive Level: Apply (application) REF: 1623 10. Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the patient's caregiver is accurate?
ANS: B DIF: Cognitive Level: Understand (comprehension) REF: 1624 11. 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? ANS: A DIF: Cognitive Level: Apply (application) REF: 1625 12. 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? ANS: C DIF: Cognitive Level: Analyze (analysis) REF: 1620 13. 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? ANS: A DIF: Cognitive Level: Apply (application) REF: 1616 14. A patient admitted with acute respiratory failure has ineffective airway clearance related to thick secretions. Which nursing intervention would specifically address this patient problem? ANS: B DIF: Cognitive Level: Apply (application) REF: 1617 15. 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? ANS: D DIF: Cognitive Level: Apply (application) REF: 1624 16. After receiving change-of-shift report on a medical unit, which patient should the nurse assess first? ANS:
D DIF: Cognitive Level: Analyze (analysis) REF: 1622 17. 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? ANS: D DIF: Cognitive Level: Analyze (analysis) REF: 1610 18. 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? ANS: D DIF: Cognitive Level: Analyze (analysis) REF: 1611 19. 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? ANS: A DIF: Cognitive Level: Analyze (analysis) REF: 1611 20. 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? ANS: C DIF: Cognitive Level: Analyze (analysis) REF: 1622
21. 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? ANS: D DIF: Cognitive
Level: Apply (application) REF: 1615 22. 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? ANS: A DIF: Cognitive Level: Analyze (analysis) REF: 1616 23. Which information about a patient who is receiving cisatracurium (Nimbex) to prevent asynchronous breathing with the positive pressure ventilator
requires action by the nurse? ANS: A DIF: Cognitive Level: Apply (application) REF: 1619 24. 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? ANS: A DIF: Cognitive Level: Analyze (analysis) REF: 1623 25. 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? ANS: C DIF: Cognitive Level: Analyze (analysis) REF: 1610 DELETE26. 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 ANS: B DIF: Cognitive Level: Analyze (analysis) REF: 1615 MULTIPLE RESPONSE 1. Which actions should the nurse start to reduce the risk for ventilator-associated pneumonia (VAP) (select
all that apply)? ANS: B, C, D, E DIF: Cognitive Level: Apply (application) REF: 1623 LEWIS Practice Questions: End of chapter ANS: A, b, d 2. The O2 delivery system chosen for the patient in acute respiratory failure should a. always be a low-flow device, such as a nasal cannula or face mask. b. administer continuous positive airway pressure ventilation to prevent CO2 narcosis. c. correct the PaO2 to a normal level as quickly as possible using mechanical ventilation. d. maintain the PaO2 at greater than or equal to 60 mm Hg at the lowest O2 concentration possible. D The most common early clinical manifestation of ARDS that the nurse may observe are: ANS: a. dyspnea and tachypnea 4. Maintenance of fluid balance in the patient with ARDS invoves: ANS: c. fluid restriction and diuretics as necessary 5. Which intervention is most likely to prevent or limit barotrauma in the patient with ARDS who is mechannically ventilated: c. Use of permissive hypercapnia Question 6 of 15 A. Diffusion limitation A The patient with pulmonary fibrosis has a thickened alveolar-capillary interface that slows gas transport, and hypoxemia is more likely during exercise than at rest. Intrapulmonary shunt occurs when alveoli fill with fluid (e.g., acute respiratory distress syndrome, pneumonia). Alveolar hypoventilation occurs when there is a generalized decrease in ventilation (e.g., restrictive lung disease, central nervous system diseases, neuromuscular diseases). Ventilation-perfusion mismatch occurs when the amount of air does not match the amount of blood that the lung receives (e.g., chronic obstructive pulmonary disease, pulmonary embolus). Question 9 of 15 ANS: C. When explaining respiratory failure to the patient's family, what should the nurse use as an accurate description? c. Respiratory failure results when the transfer of oxygen Which descriptions are characteristic of hypoxemic respiratory failure (select all that apply)? a. Referred to as ventilatory failure B C E F Hypoxemic respiratory failure is often caused When teaching the patient about what was happening when
experiencing an intrapulmonary shunt, which a. This occurs when an obstruction impairs the flow of blood to the ventilated areas of the lung. C Intrapulmonary shunt occurs when blood flows through When the V/Q lung scan result returns with a mismatch ratio that is greater than 1, which condition should be suspected? C There will be more ventilation than perfusion (V/Q Which physiologic mechanism of hypoxemia occurs with pulmonary fibrosis? a. Anatomic shunt B Diffusion limitation in pulmonary fibrosis is caused by Which patient with the following manifestations is most likely to develop hypercapnic respiratory failure? a. Rapid, deep respirations in response to pneumonia B Hypercapnic respiratory failure is associated with alveolar Which arterial blood gas (ABG) results would most likely indicate acute respiratory failure in a patient with chronic a. PaO2 52 mm Hg, PaCO2 56 mm Hg, pH 7.4 b. PaO2 46 mm Hg, PaCO2 52 mm Hg, pH 7.36 c. PaO2 48 mm Hg, PaCO2 54 mm Hg, pH 7.38 d. PaO2 50 mm Hg, PaCO2 54 mm Hg, pH 7.28 D In a patient with normal lung function, respiratory The patient is being admitted to the intensive care unit (ICU) with hypercapnic respiratory failure. Which C D E F Morning headache, respiratory acidosis, the use
Which assessment finding should cause the nurse to suspect the early onset of hypoxemia? A Because the brain is very sensitive to a decrease in Which changes of aging contribute to the increased risk for respiratory failure in older adults (select all that apply)? A D E F Changes from aging that increase the older The nurse assesses that a patient in respiratory distress is developing respiratory fatigue and the risk of respiratory a. Cannot breathe unless he is sitting upright D The increase in respiratory rate required to blow off A patient has a PaO2 of 50 mm Hg and a PaCO2 of 42 mm Hg because of an intrapulmonary shunt. Which therapy is a. Positive pressure ventilation A patients with a V/Q mismatch because the alveoli are filled with fluid, which prevents gas exchange. Hypoxemia A patient with a massive hemothorax and pneumothorax has absent breath sounds in the right lung. To promote A When there is impaired function of one lung, the patient A patient in hypercapnic respiratory failure has a nursing diagnosis of ineffective airway clearance related to a. Inserting an oral airway B The patient with a history of heart failure and acute respiratory failure has thick secretions that she is having a. Administer more IV fluid by aerosol mask C For the patient with a history of heart failure, current After endotracheal intubation and mechanical ventilation have been started, a patient in A It is most important to assess the patient for the cause What is the primary reason that hemodynamic monitoring is instituted in severe respiratory failure? a. To detect V/Q mismatches D Hemodynamic monitoring with a pulmonary artery Patients with acute respiratory failure will have drug therapy to meet their individual needs. Which drugs will meet A B C Morphine and nitroglycerin (e.g., Tridil) will In caring for a patient in acute respiratory failure, the nurse recognizes that noninvasive positive pressure ventilation a. Is comatose and has high oxygen requirements D Noninvasive positive pressure ventilation (NIPPV) The patient progressed from acute lung injury to acute respiratory distress syndrome (ARDS). He is on the ventilator a. A sedation holiday A A sedation holiday is needed to assess the patient's Although ARDS may result from direct lung injury or indirect
lung injury as a result of systemic inflammatory response a. sepsis. A Although ARDS may occur in the patient who has What are the primary pathophysiologic changes that occur in the injury or exudative phase of ARDS (select all a. Atelectasis A C D he injury or exudative phase is the early phase of In patients with ARDS who survive the acute phase of lung injury, what manifestations are seen when they progress a. Chronic pulmonary edema and atelectasis C In the fibrotic phase of ARDS, diffuse scarring and In caring for the patient with ARDS, what is the most characteristic sign the nurse would expect the patient to exhibit? a. Refractory hypoxemia A Refractory hypoxemia, hypoxemia that does not respond The nurse suspects the early stage of ARDS in any seriously ill patient who manifests what? a. Develops respiratory acidosis C Early signs of ARDS are insidious and difficult to A patient with ARDS has a nursing diagnosis of risk for infection. To detect the presence of infections commonly B Ventilator-associated pneumonia (VAP) is one of the The best patient response to treatment of ARDS occurs when initial management includes what? a. Treatment of the
underlying condition A Because ARDS is precipitated by a physiologic insult, When mechanical ventilation is used for the patient with ARDS, what is the rationale for applying positive end- A Positive end-expiratory pressure (PEEP) used with The nurse suspects that a patient with PEEP is experiencing negative effects of this ventilatory maneuver when B PEEP increases intrathoracic and intrapulmonic Prone positioning is considered for a
patient with ARDS who has not responded to other measures to increase PaO2 a. increase the mobilization of pulmonary secretions. D To verify the correct placement of an oral endotracheal tube (ET) after insertion, the best initial action by the nurse is to ANS: B DIF: Cognitive Level: Analyze (analysis) The nurse notes premature ventricular contractions (PVCs) while suctioning a patient's endotracheal tube. Which next action by the nurse is indicated? ANS: D DIF: Cognitive Level: Apply (application) The nurse notes thick, white secretions in the endotracheal tube (ET) of a patient who is receiving mechanical ventilation. Which
intervention will most directly treat this finding? ANS: C DIF: Cognitive Level: Apply (application) The nurse responds to a ventilator alarm and finds the patient lying in bed gasping and holding the endotracheal tube (ET) in her hand. Which
action should the nurse take next? ANS: D DIF: Cognitive Level: Analyze (analysis) The nurse notes that a patient's endotracheal tube (ET), which was at the 22-cm mark, is now at the 25-cm mark, and the patient is anxious and restless. Which action should the nurse take next? ANS: C DIF: Cognitive Level: Analyze (analysis) The nurse educator is evaluating the care that a new registered nurse (RN) provides to a patient receiving mechanical ventilation. Which action by the new RN indicates the need for more education? ANS: D DIF: Cognitive Level: Apply (application) When assisting with oral intubation of a patient who is having respiratory distress, in which order will the nurse take these actions? (Put a comma and a space between
each answer choice [A, B, C, D, E].) ANS: The patient is pre-oxygenated with a bag-valve-mask system for 3 to 5 minutes before intubation and then placed in a supine position. After the intubation, the cuff on the endotracheal tube is inflated to occlude and protect the airway. Tube placement is assessed first with an end-tidal CO2 sensor and then with chest x-ray examination. DIF: Cognitive Level: Analyze (analysis) Which assessment finding obtained by the nurse when caring for a patient receiving mechanical ventilation indicates the need for suctioning? ANS: C DIF: Cognitive Level: Apply (application) Four hours after mechanical ventilation is initiated, a patient's arterial blood gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg, and HCO3- of 23 mEq/L (23 mmol/L). The
nurse will anticipate the need to ANS: D DIF: Cognitive Level: Analyze (analysis) A patient with respiratory failure has arterial pressure-based cardiac output (APCO) monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 12 cm H2O. Which information indicates that a change in the ventilator settings may be required?
ANS: A DIF: Cognitive Level: Apply (application) A nurse is weaning a 68-kg patient who has chronic obstructive pulmonary disease (COPD) from mechanical ventilation. Which patient assessment
finding indicates that the weaning protocol should be stopped? ANS: C DIF: Cognitive Level: Apply (application) A patient who is orally intubated and receiving mechanical ventilation is anxious and is "fighting" the ventilator. Which action should the nurse take next? ANS: A DIF: Cognitive Level: Analyze (analysis) The nurse educator is evaluating the performance of a new registered nurse (RN) who is providing care to a patient who is receiving mechanical ventilation with 15 cm H2O of peak end-expiratory pressure (PEEP). Which action indicates that the new RN is safe? ANS: B DIF: Cognitive Level: Apply (application) The nurse is caring for a patient with a subarachnoid hemorrhage who is intubated and placed on a mechanical ventilator with 10 cm H2O of peak
end-expiratory pressure (PEEP). When monitoring the patient, the nurse will need to notify the health care provider immediately if the patient develops ANS: D DIF: Cognitive Level: Apply (application) A patient who is receiving positive pressure ventilation is scheduled for a spontaneous breathing trial (SBT). Which finding by the nurse is most likely to result in postponing the SBT? ANS: A DIF: Cognitive Level: Apply (application) Which of the following is the most common cause of ARDS quizlet?The most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream. Inhalation of harmful substances.
Which is the most important intervention for the patient with ARDS?The most common treatment for ARDS is oxygen therapy. This involves delivering extra oxygen to patients, through a mask, nasal cannula (two small tubes that enter the nose), or a tube inserted directly into the windpipe. Ventilator support: All patients with ARDS need oxygen therapy, as noted above.
What is the goal of nursing care for a patient who has ARDS?The goal of care for ARDS patients is to maximize perfusion in the pulmonary capillary system by increasing oxygen transport between the alveoli and pulmonary capillaries. To achieve the goal, you need to increase fluid volume without overloading the patient.
What are the most common early clinical manifestations of ARDS?The first symptom of ARDS is usually shortness of breath. Other symptoms of ARDS are low blood oxygen, rapid breathing, and clicking, bubbling, or rattling sounds in the lungs when breathing. ARDS can develop at any age.
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Which nursing activity is least effective for the person experiencing ARDS Quizlet
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