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RNSG 2432 - Respiratory failure/ ARDS Questions With Complete Solutions
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RNSG 2432 - Respiratory failure/ ARDS Questions With Complete Solutions
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RNSG 2432 - Respiratory failure/ ARDS Questions WithComplete Solutions
A nurse is caring for a patient who is orally intubated and
receiving mechanical ventilation. To decrease the risk for
ventilator-associated pneumonia, which action will the nurse
include in the plan of care?
a. Elevate head of bed to 30 to 45 degrees.
b. Suction the endotracheal tube every 2 to 4 hours.
c. Limit the use of positive end-expiratory pressure.
d. Give enteral feedings at no more than 10 mL/hr. Correct
Answer ANS: A
Elevation of the head decreases the risk for aspiration. Positive
end-expiratory pressure is frequently needed to improve
oxygenation in patients receiving mechanical ventilation.
Suctioning should be done only when the patient assessment
indicates that it is necessary. Enteral feedings should provide
adequate calories for the patient's high energy needs.
A nurse is caring for a patient with acute respiratory distress
syndrome (ARDS) who is receiving mechanical ventilation
using synchronized intermittent mandatory ventilation (SIMV).
The settings include fraction of inspired oxygen (FIO2) 80%,
tidal volume 450, rate 16/minute, and positive end-expiratory
pressure (PEEP) 5 cm. Which assessment finding is most
important for the nurse to report to the health care provider?
a. Oxygen saturation 99%
b. Respiratory rate 22 breaths/minute
c. Crackles audible at lung bases
d. Heart rate 106 beats/minute Correct Answer ANS: A
,The FIO2 of 80% increases the risk for oxygen toxicity. Because
the patient's O2 saturation is 99%, a decrease in FIO2 is
indicated to avoid toxicity. The other patient data would be
typical for a patient with ARDS and would not need to be
urgently reported to the health care provider.
A nurse is caring for a patient with ARDS who is being treated
with mechanical ventilation and high levels of positive end-
expiratory pressure (PEEP). Which assessment finding by the
nurse indicates that the PEEP may need to be reduced?
a. The patient's PaO2 is 50 mm Hg and the SaO2 is 88%.
b. The patient has subcutaneous emphysema on the upper
thorax.
c. The patient has bronchial breath sounds in both the lung
fields.
d. The patient has a first-degree atrioventricular heart block with
a rate of 58. Correct Answer ANS: B
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 specific indications
that PEEP should be reduced.
A nurse is caring for an obese patient with right lower lobe
pneumonia. Which position will be best to improve gas
exchange?
a. On the left side
b. On the right side
c. In the tripod position
d. In the high-Fowler's position Correct Answer ANS: A
,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.
A nurse is weaning a 68-kg male patient who has chronic
obstructive pulmonary disease (COPD) from mechanical
ventilation. Which patient assessment finding indicates that the
weaning protocol should be stopped?
a. The patient's heart rate is 97 beats/min.
b. The patient's oxygen saturation is 93%.
c. The patient respiratory rate is 32 breaths/min.
d. The patient's spontaneous tidal volume is 450 mL. Correct
Answer ANS: C
Tachypnea is a sign that the patient's work of breathing is too
high to allow weaning to proceed. The patient's heart rate is
within normal limits, although the nurse should continue to
monitor it. An oxygen saturation of 93% is acceptable for a
patient with COPD. A spontaneous tidal volume of 450 mL is
within the acceptable range.
A patient admitted with acute respiratory failure has a nursing
diagnosis of ineffective airway clearance related to thick,
secretions. Which action is a priority for the nurse to include in
the plan of care?
a. Encourage use of the incentive spirometer.
b. Offer the patient fluids at frequent intervals.
c. Teach the patient the importance of ambulation.
d. Titrate oxygen level to keep O2 saturation >93%. Correct
Answer ANS: B
, Because the reason for the poor airway clearance is the thick
secretions, the best action will be to encourage the patient to
improve oral fluid intake. Patients should be instructed to use
the incentive spirometer on a regular basis (e.g., every hour) in
order to facilitate the clearance of the secretions. The other
actions may also be helpful in improving the patient's gas
exchange, but they do not address the thick secretions that are
causing the poor airway clearance
A patient develops increasing dyspnea and hypoxemia 2 days
after heart surgery. To determine whether the patient has acute
respiratory distress syndrome (ARDS) or pulmonary edema
caused by heart failure, the nurse will plan to assist with
a. obtaining a ventilation-perfusion scan.
b. drawing blood for arterial blood gases.
c. insertion of a pulmonary artery catheter.
d. positioning the patient for a chest x-ray. Correct Answer
ANS: C
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.
A patient is in acute respiratory distress syndrome as a result of
sepsis. Which of the following measures would most likely be
implemented to maintain cardiac output?
A. Administer crystalloid fluids or colloid solutions.
B. Position the patient in the Trendelenburg position.
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