NUR 425 Exam 3 Latest Update -

NUR 425 Exam 3 Latest Update - Actual Exam 350 Questions and 100% Verified Correct Answers Guaranteed A+

2 Types of PPV - CORRECT ANSWER: Volume targeted ventilation

Pressure targeted ventilation

• Classifications of respiratory failure: - CORRECT ANSWER: Failure of ventilation

Failure of oxygenation

Failure of BOTH ventilation and oxygenation

• Primary Acid-Base Disturbances

All of the uncompensated states! - CORRECT ANSWER: Uncompensated Respiratory

Acidosis

Uncompensated Metabolic Acidosis

Uncompensated Respiratory Alkalosis

Uncompensated Metabolic Alkalosis

• pH is abnormal
• One system is causing the disturbance (abnormal)
• One system is doing nothing/not compensating (normal)

A 55 year old male with a brain tumor is hypoxic and hypercarbic (high CO2), what is he

at risk for? - CORRECT ANSWER: Increased ICP due to cerebral vasodilation

A 61 year old male is receiving Pancuronium, Fentanyl, and Propofol while on the ventilator. You assess the patient's Train of Four and see the patient's hand twitch four times. Which of the following is the most appropriate nursing action?

• Turn down the Pancuronium

• Turn up the Pancuronium

• Turn off the Pancuronium

4. Leave the Pancuronium at this rate - CORRECT ANSWER: 2

• the purpose of pancuronium is to paralyze our patient. 1 / 4

• We want them to be appropriately paralyzed by showing us 2 twitches in response to

receiving four impulses.

• However, this patient has just twitched in response to all of the impulses- he is not

paralyzed enough and we need to titrate the pancuronium up according to protocol

A 61 year old male is receiving Pancuronium, Fentanyl, and Propofol while on the ventilator. You walk in the room and the patient's BP is 200/130, heart rate is 154, and the patient is diaphoretic. You look at the ventilator screen and see no issues, you see that the patient's oxygen saturations are 98%. What is the most appropriate nursing action?

• Turn up the Pancuronium

• Turn down the Pancuronium

• Turn up the Propofol

4. Turn down the Propofol - CORRECT ANSWER: 3

• your patient is having a sympathetic response- he is panicking
• It is likely that he is paralyzed but too awake
• Increasing his sedation is a key humane comfort measure in this case

A nurse is assessing a female client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute respiratory distress syndrome?

• Bilateral wheezing
• Inspiratory crackles
• Intercostal retractions

D. Increased respiratory rate - CORRECT ANSWER: D

A patient has the following ABG results: pH 7.48, PaO2 86 mm Hg, PaCO2 44 mm Hg, HCO3− 29 mEq/L. When assessing the patient, the nurse would expect the patient to have

• Muscle cramping

• Warm, flushed skin

• Respiratory rate of 36

• Blood pressure of 94/52 - CORRECT ANSWER: Answer: a

Rationale:

• The patient is experiencing metabolic alkalosis (elevated pH and elevated HCO3− ). 2 / 4

• Clinical manifestations of metabolic alkalosis include hypertonic muscles and cramping

and reduced respiratory rate.

• Hypotension and warm, flushed skin may occur with respiratory acidosis

A patient with an acid-base imbalance has an altered potassium level. The nurse recognizes that the potassium level is altered because

• Potassium is returned to extracellular fluid when metabolic acidosis is corrected.

• Hyperkalemia causes an alkalosis that results in potassium being shifted into the

cells.

• Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the

cells.

• In alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate.
• CORRECT ANSWER: Answer: c

Rationale:

• Changes in pH (hydrogen ion concentration) will affect potassium balance.
• In acidosis, hydrogen ions accumulate in the intracellular fluid (ICF), and potassium

shifts out of the cell to the extracellular fluid to maintain a balance of cations across the cell membrane.

• In alkalosis, ICF levels of hydrogen diminish, and potassium shifts into the cell.
• If a deficit of H+ occurs in the extracellular fluid, potassium will shift into the cell.
• Acidosis is associated with hyperkalemia, and alkalosis is associated with

hypokalemia

A patient with severe chronic lung disease is hospitalized with respiratory distress.Which finding would suggest to the nurse that the patient has developed rapid decompensation?

• An SpO2 of 86%

• A blood pH of 7.33

• Agitation or confusion

• PaCO2 increases from 48 to 55 mm Hg - CORRECT ANSWER: Answer: C

Rationale:

• It is especially important to monitor specific and nonspecific signs of respiratory failure

in patients with chronic lung disease because a small change can cause significant decompensation.

• Immediately report any change in mental status, such as agitation, combative

behavior, confusion, or decreased level of consciousness. 3 / 4

A patient's ABG results include pH 7.31, PaCO2 50 mm Hg, PaO2 51 mm Hg, and HCO3 28 mEq/L. Oxygen is administered at 2 L/min, and the patient is placed in high- Fowler's position. An hour later, the ABGs are repeated with results of pH 7.36, PaCO2 40 mm Hg, PaO2 60 mm Hg, and HCO3 24 mEq/L. What is most important for the nurse to do?

• Increase the oxygen flow rate to 4 L/min.

• Document the findings in the patient's record.

• Reposition the patient in a semi-Fowler's position.

• Prepare the patient for endotracheal intubation and mechanical ventilation. -

CORRECT ANSWER: Answer: A

Rationale:

• The initial arterial blood gas (ABG) report indicates partially compensated respiratory

acidosis with moderate hypoxemia.

• The next ABG results indicate improvement, but the hypoxemia continues (Pao2

remains low).

• The patient should receive a higher concentration of oxygen to treat hypoxemia.

ABG reads:

pH: 7.28

PaCO2: 52

HCO3: 25 - CORRECT ANSWER: "Respiratory Acidosis"

• 7.28 is out of normal range not "fully compensated" by kidneys because...
• HCO3 is normal didn't try to compensate

("uncompensated")

-> "Uncompensated Respiratory Acidosis"

ABG reads:

pH: 7.50

PaCO2: 38

HCO3: 28 - CORRECT ANSWER: "Metabolic Alkalosis"

• 7.50 is out of normal range not "fully compensated" by lungs because...
• CO2 is normal didn't try to compensate

("uncompensated")

-> "Uncompensated Metabolic Alkalosis"

ABG results are as follows:

pH 7.20 PaCO2 28 mm Hg

• / 4