RF ARDS nclex questions

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ARF/ARDS, Module 13: Resp. Failure ...

120 terms anniedang_9Preview ARDS n 33 terms alm 1) A nurse is caring for a patient with ARDS. The nurse views the ABG. What value should the nurse report to the physician?

pH: 7.35

PaCO2: 26mmhg

PaO2:95

HCO3: 22

a) PaCO2

b)pH c)HCO3 d)PaO2

• PaCO2

The normal range for PaCO2 is 35-45. This patient is experiencing a superimposed respiratory alkalosis likely due to hyperventilation. The nurse should report the PaCO2 to the physician.

2) A nurse must position the patient prone after his diagnosis of acute respiratory distress syndrome (ARDS). Which of the following is a benefit of using this position? Select all that apply.A)Decreased atelectasis B)Reduced need for endotracheal intubation c)Mobilization of secretions d)Decreased pleural pressure e)Increased response to corticosteroid therapy A)Decreased atelectasis C)Mobilization of secretions D)Decreased pleural pressure Decreased atelectasis", "Mobilization of secretions" and "Decreased pleural pressure" are correct. Prone positioning, or placing the patient face down with the head turned to the side, helps with pulmonary function in the patient diagnosed with ARDS. When the patient is placed in a prone position, the heart and diaphragm are not pressing against the lungs, which means that pleural pressure is reduced. When there is less pressure exerted on the lungs, atelectasis decreases. Studies have shown that many patients in the prone position have increased lung secretions, which improves oxygenation.-"Reduced need for endotracheal intubation" is incorrect. The prone position has not been shown to decrease the likelihood of intubation.-"Increased response to corticosteroid therapy" is incorrect because positioning does not change the body's response to steroid therapy.3) A 25-year-old patient in the ICU is being treated for acute respiratory distress syndrome (ARDS). The patient is on a ventilator and requires 80 percent FiO2. Which information would the nurse most likely need to report about the patient to the respiratory therapist working with her?a)The patient needs endotracheal suctioning b)The patient needs more oxygen because of his saturation c)The patient needs an arterial blood gas drawn d)The patient needs a hemoglobin level drawn

• the patient needs an arterial blood gas drawn

4) A patient who has recovered from ARDS in the ICU is now malnourished and has lost a significant amount of weight. The physician orders TPN to add nutrition for the patient, who then develops re-feeding syndrome. Which of the following signs or symptoms would the nurse expect to see with re-feeding syndrome? Select all that apply.

• Impaired mental status
• Insulin resistance
• Seizures
• Persistent weight loss
• Constipation
• Impaired mental status
• Insulin resistance
• Seizures

"impaired mental status", "Insulin resistance" and "Seizures" are correct. Re-feeding syndrome can occur as a response to nutrient reintroduction after a period of starvation. When an extremely malnourished patient receives TPN, the body has to adjust to receiving nutrients again, which can cause shifts in electrolytes in the body. These shifts in electrolytes can result in sudden and often fatal complications. Signs and symptoms of re-feeding syndrome include confusion and impaired mental status, insulin resistance, seizures, coma and death.-"Persistent weight loss" is incorrect because by the time a patient develops re-feeding syndrome, the onset of symptoms is so sudden that weight loss cannot be measured as part of the syndrome.-"Constipation" is incorrect, as it is not a symptom of refeeding syndrome.

5) A nurse is caring for a patient with ARDS. Which of the following clinical indicators would signify that this client is in respiratory failure? Select all that apply.

• Pulse oximetry of 94% on room air
• A PaO2 level below 60 mmHg
• An ABG pH level of 7.35
• A pCO2 level over 50 mmHg
• A respiratory rate of over 16/minute
• PaO2 level below 60 mmHg
• pCO2 level over 50 mmHg

Respiratory diseases can cause such compromise that the patient will suffer symptoms; however, there are certain clinical indicators that can clarify whether the patient is actually in respiratory failure. Clinical indicators of respiratory failure include pulse oximetry of less than 91% on room air, PaO2 level less than 60 mmHg, and a pCO2 level of over 50 mmHg.6) A nurse is caring for a patient who is in respiratory distress because of ARDS. Which of the following nursing diagnoses would most likely be associated with this condition?

• Ineffective thermoregulation
• Impaired urinary elimination
• Ineffective tissue perfusion
• Disturbed personal identity
• Ineffective tissue perfusion

7) A nurse walks into a client who is in respiratory distress. The client has a tracheal deviation to the right side. The nurse knows to prepare for which of the following emergent procedures?

• Chest tube insertion on the left side.
• Chest tube insertion on the right side.
• Intubation
• Tracheostomy
• Chest tube insertion on the left side.

Tracheal deviation indicates a pneumothorax, the direction of the deviation indicates the side the pneumothorax is on. If the trachea is deviating to the right, then the pneumo is on the left. The treatment for this is a chest tube on the side of trhe deflated lung.You're providing care to a patient who is being treated for aspiration pneumonia. The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is developing acute respiratory distress syndrome (ARDS)?

• The patient is experiencing bradypnea.
• The patient is tired and confused.
• The patient's PaO2 remains at 45 mmHg.
• The patient's blood pressure is 180/96.
• The patient's PaO2 remains at 45 mmHg.

A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen the patient is STILL hypoxic

You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding of this condition. Which statement by a new nurse demonstrates he understands the condition?

• "This condition develops because the exocrine glands start to work incorrectly leading to thick, copious mucous to collect in the alveoli

sacs."

• "ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the lungs."
• "Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has accumulated in the pleural space."
• "This condition develops because alveolar-capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."
• "This condition develops because alveolar-capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."

ARDS is a type of respiratory failure that occurs when the capillary membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse, you know this will lead to?

• bronchoconstriction
• atelectasis
• upper airway blockage
• pulmonary edema
• Atelectasis

Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales. If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse A patient has been hospitalized in the ICU for a near-drowning event. The patient's respiratory function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS?

• infiltrates only on the upper lobes
• enlargement of the heart with bilateral lower lobe infiltrates
• white-out infiltrates bilaterally
• normal chest x-ray
• white-out infiltrates bilaterally

Which patient below is at MOST risk for developing ARDS and has the worst prognosis?

• A 52-year-old male patient with a pneumothorax.
• A 48-year-old male being treated for diabetic ketoacidosis.
• A 69-year-old female with sepsis caused by a gram-negative bacterial infection.
• A 30-year-old female with cystic fibrosis.
• A 69-year-old female with sepsis caused by a gram-negative bacterial infection.