Lewis Chapter 67: Acute Respiratory Failure and ARDS NCLEX fully solved 2024

Lewis Chapter 67: Acute Respiratory Failure and ARDS NCLEXThe nurse is caring for a 27-yr-old man with multiple fractured ribs from a motor vehicle crash. Which clinical manifestation, if experienced by the patient, is an early indication that the patient is developing respiratory failure? A Tachycardia and pursed lip breathing B Kussmaul respirations and hypotension C Frequent position changes and agitation D Cyanosis and increased capillary refill time - correct answer C Frequent position changes and agitation (A change in mental status is an early indication of respiratory failure. The brain is sensitive to variations in oxygenation, arterial carbon dioxide levels, and acid-base balance. Restlessness, confusion, agitation, and combative behavior suggest inadequate oxygen delivery to the brain.) Arterial blood gas results are reported to the nurse for a 68-yr-old patient admitted with pneumonia: pH 7.31, PaCO2 49 mm Hg, HCO3 26 mEq/L, and PaO2 52 mm Hg. What order should the nurse complete first? A Administer albuterol inhaler prn. B Increase fluid intake to 2500 mL per 24 hours. C Initiate oxygen at 2 liters/minute by nasal cannula. D Perform chest physical therapy four times per day. - correct answer C Initiate oxygen at 2 liters/minute by nasal cannula. (The arterial blood gas results indicate the patient is in uncompensated respiratory acidosis with moderate hypoxemia. Oxygen therapy is indicated to correct hypoxemia secondary to V/Q mismatch. Supplemental oxygen should be initiated at 1 to 3 L/min by nasal cannula, or 24% to 32% by simple face mask or Venturi mask to improve the PaO2. Albuterol would be administered next if needed for bronchodilation. Hydration is indicated for thick secretions, and chest physical therapy is indicated for patients with 30 mL or more of sputum production per day.) A 72-yr-old woman with aspiration pneumonia develops severe respiratory distress. Her PaO2 is 42 mmHg and FIO2 is 80%. Which intervention should the nurse complete first? A Stat portable chest radiography B Administer lorazepam (Ativan) 1 mg IV push C Place the patient in a prone position on a rotational bed D Position the patient with arms supported away from the chest - correct answer D Position the patient with arms supported away from the chest (The nurse will first position the patient to facilitate ventilation. Additional oxygen support may be necessary. Refractory hypoxemia indicates the patient is not demonstrating acute lung injury but has now developed acute respiratory distress syndrome (ARDS). If the PaO2 is 42 mm Hg on 80% FIO2 (fraction of inspired oxygen; room air is 21% FIO2), then the PaO2/FIO2 ratio is 52.5, indicating ARDS (PaO2/FIO2 ratio < 200). Stat portable chest radiography may show worsening infiltrates or "white lung." A rotational bed placing the patient in prone position would be a strategy to use for select patients with ARDS. This patient's age, diagnosis, and comorbidities may indicate appropriateness for this treatment. Administration of lorazepam (Ativan) 1 mg may be harmful to this patient's oxygenation status. Further assessment would be needed to determine safety.) The nurse is caring for a 37-yr-old female patient with multiple musculoskeletal injuries who has developed acute respiratory distress syndrome (ARDS). Which intervention should the nurse initiate to prevent stress ulcers? A Observe stools for frank bleeding and occult blood. B Maintain head of the bed elevation at 30 to 45 degrees. C Begin enteral feedings as soon as bowel sounds are present. D Administer prescribed lorazepam (Ativan) to reduce anxiety. - correct answer C Begin enteral feedings as soon as bowel sounds are present. (Stress ulcers prevention includes early initiation of enteral nutrition to protect the gastrointestinal (GI) tract from mucosal damage. Antiulcer agents such as histamine (H2)-receptor antagonists, proton pump inhibitors, and mucosal protecting agents are also indicated to prevent stress ulcers. Monitoring for GI bleeding does not prevent stress ulcers. Ventilator-associated pneumonia related to aspiration is