Nclex Questions for Shock - Critical ...

NCLEX Acute Respiratory Failure and ARDS ScienceMedicineNursing EmSay Save Nclex Questions for Shock - Critical ...32 terms karmageniePreview

Lewis Chapter 67: Acute Respiratory ...

49 terms Forever_Aela5102 Preview Resp Failure & ARDS NCLEX 21 terms NurseLouPreview Ch. 5 H 30 terms

kim ANS: C

ABG analysis is most useful in this setting because ventilatory failure causes problems with CO2 retention, and ABGs provide information about the PaCO2 and pH. The other tests also may be done to help in assessing oxygenation or determining the cause of the patient's ventilatory failure.DIF: Cognitive Level: Application REF: 1752-1754 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity To evaluate the effectiveness of prescribed therapies for a patient with ventilatory failure, which diagnostic test will be most useful to the nurse?

• Chest x-rays
• Pulse oximetry
• Arterial blood gas (ABG) analysis
• Pulmonary artery pressure monitoring

ANS: A

Increasing oxygen flow rate usually will improve oxygen saturation in patients with ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with perfusion, actions that improve ventilation, such as deep-breathing and coughing, sitting upright, and suctioning, are not likely to improve oxygenation.DIF: Cognitive Level: Application REF: 1747-1749 | 1754 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 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%. The nurse will

• increase the oxygen flow rate.
• suction the patient's oropharynx.
• assist the patient to cough and deep breathe.
• help the patient to sit in a more upright position.

ANS: B

The patient's lethargy, low respiratory rate, and SpO2 indicate the need for mechanical ventilation with ventilator-controlled respiratory rate.Administration of high flow oxygen will not be helpful because the patient's respiratory rate is so low. Insertion of a mini-tracheostomy will facilitate removal of secretions, but it will not improve the patient's respiratory rate or oxygenation. BiPAP requires that the patient initiate an adequate respiratory rate to allow adequate gas exchange.DIF: Cognitive Level: Application REF: 1754-1756 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. The nurse will anticipate assisting with

• administration of 100% oxygen by non-rebreather mask.
• endotracheal intubation and positive pressure ventilation.
• insertion of a mini-tracheostomy with frequent suctioning.
• initiation of bilevel positive pressure ventilation (BiPAP).

ANS: C

The patient's assessment indicates that assisted coughing is needed to help remove secretions, which will improve oxygenation. A 2-hour rest period at this time may allow the oxygen saturation to drop further. Humidification will not be helpful unless the secretions can be mobilized.Positioning on the right side may cause a further decrease in oxygen saturation because perfusion will be directed more toward the more poorly ventilated lung.DIF: Cognitive Level: Application REF: 1754-1755 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity The pulse oximetry for a patient with right lower lobe pneumonia indicates an oxygen saturation of 90%. The patient has rhonchi, a weak cough effort, and complains of fatigue. Which action is best for the nurse to take?

• Position the patient on the right side.
• Place a humidifier in the patient's room.
• Assist the patient with staged coughing.
• Schedule a 2-hour rest period for the patient.

ANS: B

The patient should be positioned with the "good" lung in the dependent position to improve the match between ventilation and perfusion. The obese patient's abdomen will limit respiratory excursion when sitting in the high-Fowler's or tripod positions.DIF: Cognitive Level: Application REF: 1754-1755 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity When the nurse is caring for an obese patient with left lower lobe pneumonia, gas exchange will be best when the patient is positioned

• on the left side.
• on the right side.
• in the tripod position.
• in the high-Fowler's position.

ANS: A

Increasing somnolence will decrease the patient's respiratory rate and further increase the PaCO2 and respiratory failure. Rapid action is needed to prevent respiratory arrest. An SpO2 of 90%, weakness, and elevated blood pressure all require ongoing monitoring but are not indicators of possible impending respiratory arrest.DIF: Cognitive Level: Application REF: 1751 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity When admitting a patient in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the nurse?

• The patient is somnolent.
• The patient's SpO2 is 90%.
• The patient complains of weakness.
• The patient's blood pressure is 162/94.

ANS: B

Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other medications are appropriate for the patient with ARDS.DIF: Cognitive Level: Application REF: 1761-1762 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity A patient with acute respiratory distress syndrome (ARDS) and acute renal failure has the following medications prescribed. Which medication should the nurse discuss with the health care provider before administration?

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

ANS: A

Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will not help in differentiating cardiogenic from noncardiogenic pulmonary edema.DIF: Cognitive Level: Application REF: 1753-1754 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity A patient develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. 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

• inserting a pulmonary artery catheter.
• obtaining a ventilation-perfusion scan.
• drawing blood for arterial blood gases.
• positioning the patient for a chest radiograph.

ANS: A

The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not indications that PEEP should be reduced.DIF: Cognitive Level: Application REF: 1760-1761 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity Which assessment finding by the nurse when caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased?

• The patient has subcutaneous emphysema.
• The patient has a sinus bradycardia with a rate of 52.
• The patient's PaO2 is 50 mm Hg and the SaO2 is 88%.
• The patient has bronchial breath sounds in both the lung fields.

ANS: D

By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation. PEEP will not prevent the fibrotic changes that occur with ARDS, push more air into the lungs, or change the fraction of inspired oxygen (FIO2) delivered to the patient.DIF: Cognitive Level: Comprehension REF: 1761-1762 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 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?

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

ANS: A

The purpose of prone positioning is to improve the patient's oxygenation as indicated by the PaO2 and SaO2. The other information will be collected but does not indicate whether prone positioning has been effective.DIF: Cognitive Level: Application REF: 1762-1763 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 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?

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