Deck 68: Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome

Question 1

The nurse will monitor for clinical manifestations of hypercapnia when a patient in the emergency department has

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 1

chest trauma and multiple rib fractures.

Question 2

When a patient is diagnosed with pulmonary fibrosis, the nurse will teach the patient about the risk for poor oxygenation because of

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.

Answer 2

decreased transfer of oxygen into the blood because of thickening of the alveoli.

Question 3

When admitting a patient in possible respiratory failure with a high PaCO?, which assessment information will be of most concern to the nurse?

A) The patient is somnolent.
B) The patient's SpO₂f.is 90%.
C) The patient complains of weakness.
D) The patient's blood pressure is 162/94.

Answer 3

The patient is somnolent.

Question 4

A patient is brought to the emergency department unconscious following a barbiturate overdose. Which potential complication will the nurse include when developing the plan of care?

A) Hypercapnic respiratory failure related to decreased ventilatory effort
B) Hypoxemic respiratory failure related to diffusion limitations
C) Hypoxemic respiratory failure related to shunting of blood
D) Hypercapnic respiratory failure related to increased airway resistance

Question 5

The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider?

A) The patient has a cough that is productive of blood-tinged sputum.
B) The patient has scattered crackles throughout the posterior lung bases.
C) The patient's temperature is 101.5° F after 2 days of IV antibiotic therapy.
D) The patient's SpO₂ has dropped to 90%, although the O₂ flow rate has been increased.

Question 6

A patient is diagnosed with a large pulmonary embolism. When explaining to the patient what has happened to cause respiratory failure, which information will the nurse include?

A) "Oxygen transfer into your blood is slow because of thick membranes between the small air sacs and the lung circulation."
B) "Thick secretions in your small airways are blocking air from moving into the small air sacs in your lungs."
C) "Large areas of your lungs are getting good blood flow but are not receiving enough air to fill the small air sacs."
D) "Blood flow though some areas of your lungs is decreased even though you are taking adequate breaths."

Question 7

When caring for a patient who developed acute respiratory distress syndrome (ARDS) as a result of a urinary tract infection (UTI), the nurse is asked by the patient's family how a urinary tract infection could cause lung damage. Which response by the nurse is appropriate?

A) "The infection spread through the circulation from the urinary tract to the lungs."
B) "The urinary tract infection produced toxins that damaged the lungs."
C) "The infection caused generalized inflammation that damaged the lungs."
D) "The fever associated with the infection led to scar tissue formation in the lungs."

Question 8

When the nurse is caring for an obese patient with left lower-lobe pneumonia, gas exchange will be best when the patient is positioned

A) on the left side.
B) on the right side.
C) in the high-Fowler's position.
D) in the tripod position.

Question 9

A finding indicating to the nurse that a 22-year-old patient with respiratory distress is in acute respiratory failure includes a

A) shallow breathing pattern.
B) partial pressure of arterial oxygen (PaO₂) of 45 mm Hg.
C) partial pressure of carbon dioxide in arterial gas (PaCO₂) of 34 mm Hg.
D) respiratory rate of 32/min.

Question 10

To evaluate both oxygenation and ventilation in a patient with acute respiratory failure, the nurse uses the findings revealed with

A) arterial blood gas (ABG) analysis.
B) hemodynamic monitoring.
C) chest x-rays.
D) pulse oximetry.

Question 11

All the following medications are ordered for a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) and acute renal failure. Which medication should the nurse discuss with the health care provider before administration?

A) IV ranitidine (Zantac) 50 mg IV
B) sucralfate (Carafate) 1 g per nasogastric tube
C) IV gentamicin (Garamycin) 60 mg
D) IV methylprednisolone (Solu-Medrol) 40 mg

Question 12

When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first?

A) Monitor the patient every 10 to 15 minutes.
B) Notify the patient's health care provider immediately.
C) Attempt to calm and reassure the patient.
D) Assess vital signs and pulse oximetry.

Question 13

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is correct?

A) "PEEP will prevent fibrosis of the lung from occurring."
B) "PEEP will push more air into the lungs during inhalation."
C) "PEEP allows the ventilator to deliver 100% oxygen to the lungs."
D) "PEEP prevents the lung air sacs from collapsing during exhalation."

Question 14

While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's arterial oxyhemoglobin saturation (SpO₂) from 94% to 88%. The nurse will

A) assist the patient to cough and deep-breathe.
B) help the patient to sit in a more upright position.
C) suction the patient's oropharynx.
D) increase the oxygen flow rate.

Question 15

It will be most important for the nurse to check pulse oximetry for which of these patients?

A) A patient with emphysema and a respiratory rate of 16
B) A patient with massive obesity who is refusing to get out of bed
C) A patient with pneumonia who has just been admitted to the unit
D) A patient who has just received morphine sulfate for postoperative pain

Question 16

A patient with hypercapnic respiratory failure has a respiratory rate of 8 and an SpO₂ of 89%. The patient is increasingly lethargic. Which collaborative intervention will the nurse anticipate?

A) Administration of 100% oxygen by non-rebreather mask
B) Endotracheal intubation and positive pressure ventilation
C) Insertion of a mini-tracheostomy with frequent suctioning
D) Initiation of bilevel positive pressure ventilation (BiPAP)

Question 17

After prolonged cardiopulmonary bypass, a patient develops increasing shortness of breath and hypoxemia. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with

A) positioning the patient for a chest radiograph.
B) drawing blood for arterial blood gases.
C) obtaining a ventilation-perfusion scan.
D) inserting a pulmonary artery catheter.

Question 18

A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of acute respiratory distress. When monitoring the patient, which assessment by the nurse will be of most concern?

A) The patient is sitting in the tripod position.
B) The patient has bibasilar lung crackles.
C) The patient's pulse oximetry indicates an O₂ saturation of 91%.
D) The patient's respiratory rate has decreased from 30 to 10/min.

Question 19

A patient in acute respiratory failure as a complication of COPD has a PaCO₂ of 65 mm Hg, rhonchi audible in the right lung, and marked fatigue with a weak cough. The nurse will plan to

A) allow the patient to rest to help conserve energy.
B) arrange for a humidifier to be placed in the patient's room.
C) position the patient on the right side with the head of the bed elevated.
D) assist the patient with augmented coughing to remove respiratory secretions.

Question 20

Which information obtained by the nurse when assessing a patient with acute respiratory distress syndrome (ARDS) who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates a complication of ventilator therapy is occurring?

A) The patient has subcutaneous emphysema.
B) The patient has a sinus bradycardia, rate 52.
C) The patient's PaO₂ is 50 mm Hg and the SaO₂ is 88%.
D) The patient has bronchial breath sounds in both the lung fields.

Question 21

A patient with acute respiratory distress syndrome (ARDS) has progressed to the fibrotic phase. The patient's family members are anxious about the patient's condition and are continuously present at the hospital. In addressing the family's concerns, it is important for the nurse to

A) support the family and help them understand the realistic expectation that the patient's chance for survival is poor.
B) inform the family that home health nurses will be able to help them maintain the mechanical ventilation at home after patient discharge.
C) refer the family to social support services and case management to plan for transfer of the patient to a long-term care facility.
D) provide hope and encouragement to the family because the patient's disease process has started to resolve.

Question 22

The nurse obtains the vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature 101.2° F, blood pressure 90/56 mm Hg, pulse 92, respirations 34. Which action should the nurse take next?

A) Notify the health care provider of the patient's vital signs.
B) Obtain oxygen saturation using pulse oximetry.
C) Document the vital signs and continue to monitor.
D) Administer PRN acetaminophen (Tylenol) 650 mg.

Question 23

When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective?

A) The skin on the patient's back is intact and without redness.
B) Sputum and blood cultures show no growth after 24 hours.
C) The patient's PaO₂ is 90 mm Hg, and the SaO₂ is 92%.
D) Endotracheal suctioning results in minimal mucous return.

Question 24

Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) is most appropriate for the RN to delegate to an experienced LPN/LVN working in the intensive care unit?

A) Placing the patient in the prone position
B) Assessment of patient breath sounds
C) Administration of enteral tube feedings
D) Obtaining the pulmonary artery pressures