critical care exam 1 respiratory practice question
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Critical Care exam 1: respiratory Practice
questions
:
A 64-year-old man with moderate chronic obstructive pulmonary disease presents to your
office complaining that for the past 5 days, he has been experiencing worsening shortness of
breath. He denies having fevers or chills, but he does report increasing purulent sputum
production. He visited his 6-year-old grandson this past weekend, and the child had
symptoms of an upper respiratory infection. The patient's vital signs are normal except that
oxygen saturation on room air is 88%. Examination reveals bilateral expiratory wheezing. A
chest radiograph is normal. Results of laboratory testing are as follows: white blood cell
count, 12,500/mm3; arterial blood gas pH, 7.35; arterial oxygen tension (PaO2), 65 mm Hg;
and carbon dioxide tension (PCO2), 60 mm Hg. You arrange for hospital admission.
Which of the following is the most appropriate step to take next for this patient after he is
admitted to the hospital?
a. - correct answer-c
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 - correct answer-a
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 - correct answer-a, c, d
,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 - correct answer-c
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.
a. Impaired mental status
b. Insulin resistance
c. Seizures
d. Persistent weight loss
e. Constipation - correct answer-a,b,c
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.
, a. Pulse oximetry of 94% on room air
b. A PaO2 level below 60 mmHg
c. An ABG pH level of 7.35
d. A pCO2 level over 50 mmHg
e. A respiratory rate of over 16/minute - correct answer-b, d
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?
a. Ineffective thermoregulation
b. Impaired urinary elimination
c. Ineffective tissue perfusion
d. Disturbed personal identity - correct answer-c
7. As the nurse, you know that acute respiratory distress syndrome (ARDS) can be caused
by direct or indirect lung injury. Select below all the INDIRECT causes of ARDS
A. Drowning
B. Aspiration
C. Sepsis
D. Blood transfusion
E. Pneumonia
F. Pancreatitis - correct answer-C, D, F
Indirect causes are processes that can cause inflammation OUTSIDE of the lungs....so the
issue arises somewhere outside the lungs
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?
a. Chest tube insertion on the left side.
b. Chest tube insertion on the right side.
c. Intubation
d. Tracheostomy - correct answer-a
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.
8) A 26-year-old patient is admitted to the hospital in severe respiratory distress. His oxygen
saturations are 80% despite supplemental oxygen provided by a facemask. The provider
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