Question 1

Which patients should the nurse identify as being at risk for developing type II hypoxemic hypercapneic failure? Select all that apply.

Accepted Answer

A)  A 5-year-old male with a 5-year history of muscular dystrophy 
B)  A 34-year-old female patient who is 3 days' postoperative open cholecystectomy 
C)  A 24-year-old male newly admitted with possible Guillain-Barré syndrome 
D)  A 72-year-old female with kyphosis 
E)  An 85-year-old patient admitted with aspiration pneumonia

Question 2

Which statement made by a new graduate nurse about invasive mechanical ventilation techniques is incorrect and requires additional teaching?

Accepted Answer

A)  "Assist control mode refers to the patient receiving a set total lung capacity (TL
C) , but the rate can be modified by the patient's own rate of breathing." 
B)  "Total control mode controls both the rate and volume that are preset and delivered without the machine responding to any of the patient's own breaths." 
C)  "Synchronized intermittent mandatory ventilation (SIMV) refers to the patient setting an independent rate but limited tidal volume based on the patient's own strength. A minimum rate is also used as a backup to prevent hypoventilation." 
D)  "Continuous positive airway pressure will increase the residual capacity and keep the alveoli open. Rate and volume are controlled by the patient. This is one step in the weaning process."

Question 3

The nurse receives the following ABG result: pH = 7.00
PaCO2 = 50 mm Hg
PaO2 = 89 mm Hg
SaO2 = 90%
Based on the results, what should the nurse do first?

Accepted Answer

A)  Check the last dose of CNS depressant drug. 
B)  Assess lung sounds and vital signs. 
C)  Review the history for asthma or emphysema. 
D)  Apply oxygen per nasal cannula at 2 L/min.

Question 4

A patient is annoyed by a cough that occurs at change of seasons. What should the nurse explain to the patient about this symptom?

Accepted Answer

A)  "A cough is harmful and should be suppressed." 
B)  "A cough is a protective reflex to clear debris out of the lungs." 
C)  "A cough means that you are fighting an upper respiratory infection." 
D)  "A cough propels respiratory secretions into the upper airways for expulsion."

Question 5

The nurse searches the health history of a patient diagnosed with an acute lung injury for a reason for the disease process. Which statement correctly identifies the cause for this type of lung injury?

Accepted Answer

A)  Acute lung injury can be caused indirectly from sepsis, systemic inflammatory response syndrome, or pancreatitis. 
B)  Acute lung injury is a single organ dysfunction syndrome that has a chronic onset. 
C)  Acute lung injury is caused by few infiltrates on chest radiography. 
D)  Acute lung injury is caused by right ventricular failure.

Question 6

A patient with chronic obstructive pulmonary disease (COPD) experiences shortness of breath. What should the nurse explain to the patient about this symptom?

Accepted Answer

A)  "It is because you have excess fluid in your lungs." 
B)  "It is caused by excess mucus in your lung membranes." 
C)  "It's because you have excess carbon dioxide trapped in your lungs." 
D)  "It is because you have pneumonia that has not been treated correctly."

Question 7

A patient being mechanically ventilated is being considered for weaning. What intervention should the nurse take at this time? Select all that apply.

Accepted Answer

A)  Prepare the patient to be placed on CPAP for 2 hours. 
B)  Prepare the patient to be placed on a T-piece for 2 hours. 
C)  Measure rapid shallow breathing index after 2 hours on a T-piece. 
D)  Lower the ventilator settings. 
E)  Set the ventilator to synchronized intermittent mandatory ventilation.

Question 8

During multidisciplinary rounds, a discussion is held regarding the use of medications in acute respiratory distress syndrome (ARDS). Which statement is most accurate based upon published research findings?

Accepted Answer

A)  Corticosteroids are used for their anti-inflammatory property to manage the cytokine-mediated inflammatory response in ARDS. 
B)  Exogenous surfactant therapy is more beneficial to adult patients with ARDS than when it is given to neonates. 
C)  β-agonists reduce pulmonary edema and inflammation. 
D)  Inhaled nitric oxide promotes blood flow to ventilated areas of the lungs.

Question 9

A patient is diagnosed with type I hypoxemic failure. The nurse should realize that this type of respiratory failure is linked to what?

Accepted Answer

A)  Muscular failure to move the air into and out of the lungs 
B)  Failure of the neurological system to stimulate respirations 
C)  Skeletal alterations of the thoracic region that limit air movement 
D)  Breakdown of oxygen transport from the alveolus to arterial flow

Question 10

The nurse instructs a patient on the advantages of noninvasive mechanical ventilation (NIV). Which patient statement reflects a need for additional teaching?

Accepted Answer

A)  "I will not have to have a tube down my throat for it to work." 
B)  "I will probably recover faster, so I can get out of the hospital faster." 
C)  "I am more likely to have fewer complications such as pneumonia." 
D)  "Noninvasive ventilation is not uncomfortable, and I won't have to be admitted to ICU to use it."

Question 11

A patient with ARDS is on a mechanical ventilator and is becoming increasingly restless with a heart rate of 128 bpm. The SaO2 is 88% and the ventilator settings are FiO2 50%; PEEP 8 cm; AC 10 with a total respiratory rate of 30; and a tidal volume of 700 mL. There are coarse rhonchi audible in all lung fields. Which action should the nurse take?

Accepted Answer

A)  Hyperoxygenate with 100% oxygen and suction the patient. 
B)  Administer the ordered neuromuscular blockade medications. 
C)  Increase the FiO2 to 60% and tidal volume to 750 mL for 2 minutes. 
D)  Increase the PEEP to 10 cm and sedate the patient.

Question 12

A patient in the recovery phase of acute respiratory distress syndrome continues to experience difficulty with breathing. What should the nurse recognize as being the characteristics of this phase? Select all that apply.

Accepted Answer

A)  Development of fibrotic tissue in the alveolar capillary membrane resulting in alveolar disfigurement 
B)  Decreased lung compliance 
C)  Worsening pulmonary hypertension 
D)  Increased dead space ventilation 
E)  Formation of hyaline membranes

Question 13

The nurse is suctioning an intubated, mechanically ventilated patient. For which complication should the nurse assess this client?

Accepted Answer

A)  Dysrhythmias 
B)  Hyperthermia 
C)  Hematuria 
D)  Decreased urinary output

Question 14

Which arterial blood gas result indicates the development of an acute lung injury?

Accepted Answer

A)  pH 7.4, PaCO2 40 mm Hg, PaO2 96, HCO3 24 mEq, SaO2 94% 
B)  pH 7.31, PaCO2 50 mm Hg, PaO2 70 mm Hg, HCO3 20 mEq, SaO2 90% 
C)  pH 7.49, PaCO2 32 mm Hg, PaO2 75 mm Hg, HCO3 22 mEq, SaO2 90% 
D)  pH 7.29, PCO2 28 mm Hg, PaO2 97 mm Hg, HCO3, 16 mEq, SaO2 94%

Question 15

Which patient should the nurse identify as benefiting from the use of noninvasive ventilation (NIV)?

Accepted Answer

A)  A 55-year-old female with an acute exacerbation of asthma 
B)  A 57-year-old male with a history of sleep apnea 
C)  A 48-year-old female with an acute myocardial infarction 
D)  A 72-year-old male with sepsis

Question 16

The high-pressure alarm on a patient's mechanical ventilator is sounding. What action should the nurse take? Select all that apply.

Accepted Answer

A)  Assess if the patient needs to be suctioned. 
B)  Assess if the patient is biting the tube. 
C)  Assess if the patient has rolled onto the tube. 
D)  Assess for a mucous plug. 
E)  Assess for respiration synchrony with the ventilator.

Exam 3: Care of the Patient With Respiratory Failure

Which patients should the nurse identify as being at risk for developing type II hypoxemic hypercapneic failure? Select all that apply.

Which statement made by a new graduate nurse about invasive mechanical ventilation techniques is incorrect and requires additional teaching?

The nurse receives the following ABG result: pH = 7.00 PaCO₂ = 50 mm Hg PaO₂ = 89 mm Hg SaO₂ = 90% Based on the results, what should the nurse do first?

A patient is annoyed by a cough that occurs at change of seasons. What should the nurse explain to the patient about this symptom?

The nurse searches the health history of a patient diagnosed with an acute lung injury for a reason for the disease process. Which statement correctly identifies the cause for this type of lung injury?

A patient with chronic obstructive pulmonary disease (COPD) experiences shortness of breath. What should the nurse explain to the patient about this symptom?

A patient being mechanically ventilated is being considered for weaning. What intervention should the nurse take at this time? Select all that apply.

During multidisciplinary rounds, a discussion is held regarding the use of medications in acute respiratory distress syndrome (ARDS) . Which statement is most accurate based upon published research findings?

A patient is diagnosed with type I hypoxemic failure. The nurse should realize that this type of respiratory failure is linked to what?

The nurse instructs a patient on the advantages of noninvasive mechanical ventilation (NIV) . Which patient statement reflects a need for additional teaching?

A patient in the recovery phase of acute respiratory distress syndrome continues to experience difficulty with breathing. What should the nurse recognize as being the characteristics of this phase? Select all that apply.

The nurse is suctioning an intubated, mechanically ventilated patient. For which complication should the nurse assess this client?

Which arterial blood gas result indicates the development of an acute lung injury?

Which patient should the nurse identify as benefiting from the use of noninvasive ventilation (NIV) ?

The high-pressure alarm on a patient's mechanical ventilator is sounding. What action should the nurse take? Select all that apply.

Exam 3: Care of the Patient With Respiratory Failure

Which patients should the nurse identify as being at risk for developing type II hypoxemic hypercapneic failure? Select all that apply.

Which statement made by a new graduate nurse about invasive mechanical ventilation techniques is incorrect and requires additional teaching?

The nurse receives the following ABG result: pH = 7.00 PaCO2 = 50 mm Hg PaO2 = 89 mm Hg SaO2 = 90% Based on the results, what should the nurse do first?

A patient is annoyed by a cough that occurs at change of seasons. What should the nurse explain to the patient about this symptom?

The nurse searches the health history of a patient diagnosed with an acute lung injury for a reason for the disease process. Which statement correctly identifies the cause for this type of lung injury?

A patient with chronic obstructive pulmonary disease (COPD) experiences shortness of breath. What should the nurse explain to the patient about this symptom?

A patient being mechanically ventilated is being considered for weaning. What intervention should the nurse take at this time? Select all that apply.

During multidisciplinary rounds, a discussion is held regarding the use of medications in acute respiratory distress syndrome (ARDS) . Which statement is most accurate based upon published research findings?

A patient is diagnosed with type I hypoxemic failure. The nurse should realize that this type of respiratory failure is linked to what?

The nurse instructs a patient on the advantages of noninvasive mechanical ventilation (NIV) . Which patient statement reflects a need for additional teaching?

A patient in the recovery phase of acute respiratory distress syndrome continues to experience difficulty with breathing. What should the nurse recognize as being the characteristics of this phase? Select all that apply.

The nurse is suctioning an intubated, mechanically ventilated patient. For which complication should the nurse assess this client?

Which arterial blood gas result indicates the development of an acute lung injury?

Which patient should the nurse identify as benefiting from the use of noninvasive ventilation (NIV) ?

The high-pressure alarm on a patient's mechanical ventilator is sounding. What action should the nurse take? Select all that apply.

The nurse receives the following ABG result: pH = 7.00 PaCO₂ = 50 mm Hg PaO₂ = 89 mm Hg SaO₂ = 90% Based on the results, what should the nurse do first?