Question 1

To evaluate the effectiveness of prescribed therapies for a client with ventilatory failure, which of the following diagnostic tests will be most useful to the nurse?

Accepted Answer

A)  Chest x-rays
B)  Pulse oximetry
C)  Arterial blood gas (ABG)  analysis
D)  Pulmonary artery pressure monitoring C

Question 2

The nurse is caring for a client who has been admitted with a pulmonary embolism and notes a change in the client's oxygen saturation (SpO2) from 94% to 88%. Which of the following actions should the nurse implement?

Accepted Answer

A)  Increase the oxygen flow rate.
B)  Suction the client's oropharynx.
C)  Assist the client to cough and deep breathe.
D)  Help the client to sit in a more upright position. A

Question 3

The nurse is assessing a client with chronic lung disease and finds a sudden onset of agitation and confusion. Which of the following actions should the nurse take first?

Accepted Answer

A)  Check pupil reaction to light.
B)  Notify the health care provider.
C)  Attempt to calm and reassure the client.
D)  Assess oxygenation using pulse oximetry. D

Question 4

Which of the following assessment findings by the nurse when caring for a client with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased?

Accepted Answer

A)  The client has subcutaneous emphysema.
B)  The client has a sinus bradycardia with a rate of 52.
C)  The client's PaO2 is 50 mm Hg and the SaO2 is 88%.
D)  The client has bronchial breath sounds in both the lung fields.

Question 5

The nurse is caring for a client who was hospitalized 2 days earlier with aspiration pneumonia. Which of the following assessment information is most important to communicate to the health care provider?

Accepted Answer

A)  Cough that is productive of blood-tinged sputum
B)  Scattered crackles throughout the posterior lung bases
C)  Temperature of 38.6°C (101.5°
C)   after 2 days of IV antibiotic therapy
D)  Oxygen saturation (SpO2)  has dropped to 90% with administration of 100% O? by non-rebreather mask

Question 6

The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is intubated, receiving mechanical ventilation and has developed a pneumothorax. Which of the following actions will the nurse anticipate taking?

Accepted Answer

A)  Lower the positive end-expiratory pressure (PEEP) .
B)  Increase the fraction of inspired oxygen (FIO2) .
C)  Suction more frequently.
D)  Increase the tidal volume.

Question 7

The nurse obtains the vital signs for a client admitted 2 days ago with gram-negative sepsis: temperature 38.4°C (101.1°F), blood pressure 90/56 mm Hg, pulse 92 beats/minute, respirations 34/minute. Which of the following actions should the nurse take next?

Accepted Answer

A)  Administer the scheduled IV antibiotic.
B)  Give the PRN acetaminophen 650 mg.
C)  Obtain oxygen saturation using pulse oximetry.
D)  Notify the health care provider of the client's vital signs.

Question 8

The nurse is caring for a client who develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. To determine whether the client has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, thenursewill anticipate assisting with which of the following actions?

Accepted Answer

A)  Inserting a pulmonary artery catheter
B)  Obtaining a ventilation-perfusion scan
C)  Drawing blood for arterial blood gases
D)  Positioning the client for a chest radiograph

Question 9

Which of the following statements by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a client with ARDS is correct?

Accepted Answer

A)  "PEEP will prevent fibrosis of the lung from occurring."
B)  "PEEP will push more air into the lungs during inhalation."
C)  "PEEP allows the ventilator to deliver 100% oxygen to the lungs."
D)  "PEEP prevents the lung air sacs from collapsing during exhalation."

Question 10

The nurse is caring for a client who came to the emergency department with acute respiratory distress. Which of the following information requires the most rapid action by the nurse?

Accepted Answer

A)  Respiratory rate is 32 breaths/minute.
B)  Pattern of breathing is shallow.
C)  The client's PaO2 is 45 mm Hg.
D)  The client's PaCO2 is 34 mm Hg.

Question 11

The nurse is admitting a client who is in possible respiratory failure with a high PaCO2. Which of the following assessment information will be of most concern to the nurse?

Accepted Answer

A)  The client is somnolent.
B)  The client's SpO2 is 90%.
C)  The client complains of weakness.
D)  The client's blood pressure is 162/94 mmHg.

Question 12

The nurse is admitting a client with chronic obstructive pulmonary disease (COPD) who has shortness of breath and dyspnea. Which of the following assessment findings is most important to report to the health care provider?

Accepted Answer

A)  The client has bibasilar lung crackles.
B)  The client is sitting in the tripod position.
C)  The client's respiratory rate has decreased from 30 to 10 breaths/minute.
D)  The client's pulse oximetry indicates an O2  saturation of 91%.

Question 13

The nurse is caring for a client with respiratory failure who has a respiratory rate of 8/min and a SpO2 of 89%. The client is increasingly lethargic. Which of the following actions should the nurse anticipate?

Accepted Answer

A)  Administration of 100% oxygen by non-rebreather mask
B)  Endotracheal intubation and positive pressure ventilation
C)  Insertion of a mini-tracheostomy with frequent suctioning
D)  Initiation of bilevel positive pressure ventilation (BiPAP)

Question 14

The nurse is caring for an obese client with left lower lobe pneumonia. Which of the following positions should the nurse place the client in for optimal gas exchange?

Accepted Answer

A)  Left lateral
B)  Right lateral
C)  Tripod position.
D)  High Fowler's position

Question 15

When prone positioning is used in the care of a client with acute respiratory distress syndrome (ARDS), which of the following information obtained by the nurse indicates that the positioning is effective?

Accepted Answer

A)  The client's PaO2 is 90 mm Hg, and the SaO2 is 92%.
B)  Endotracheal suctioning results in minimal mucous return.
C)  Sputum and blood cultures show no growth after 24 hours.
D)  The skin on the client's back is intact and without redness.

Question 16

After receiving change-of-shift report, which of the following clients should the nurse assess first?

Accepted Answer

A)  A client with cystic fibrosis who has thick, green-coloured sputum
B)  A client with pneumonia who has coarse crackles in both lung bases
C)  A client with emphysema who has an oxygen saturation of 91% to 92%
D)  A client with septicemia who has intercostal and suprasternal retractions

Question 17

The nurse is caring for a client with hypoxemia and a PaO2/FiO2 ratio of 170 while being administered oxygen 8 L/minute via mask. Which of the following information is accurate in relation to the client's situation?

Accepted Answer

A)  Is at risk for ARDS
B)  Also has an increased PaCO2 level
C)  Should be prepared for mechanical ventilation
D)  Requires packed red cells as soon as possible

Question 18

To decrease the risk for ventilator-associated pneumonia, which of the following actions should the nurse include in the plan of care for a client who requires intubation and mechanical ventilation?

Accepted Answer

A)  Avoid use of positive end-expiratory pressure (PEEP) .
B)  Suction every 2 hours.
C)  Elevate head of bed to 45 degrees.
D)  Give enteral feedings at no more than 10 mL/hour.

Question 19

A client with ARDS who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation (SIMV) has settings of fraction of inspired oxygen (FIO2) 80%, tidal volume 500, rate 18, and positive end-expiratory pressure (PEEP) 5 cm.Whichof the following assessment findings is most important for the nurse to report to the health care provider?

Accepted Answer

A)  Oxygen saturation 99%
B)  Client respiratory rate 22 breaths/minute
C)  Crackles audible at lung bases
D)  Apical pulse rate 104 beats/minute

Question 20

Chest physiotherapy is indicated for which of the following clients?

Accepted Answer

A)  Takes a bronchodilator
B)  Produces 40 mL of sputum per 24 hours
C)  Has an increased PCO2 level
D)  Is taking vancomycin

Exam 70: Nursing Management Respiratory Failure and Acute Respiratory Distress Syndrome

To evaluate the effectiveness of prescribed therapies for a client with ventilatory failure, which of the following diagnostic tests will be most useful to the nurse?

The nurse is caring for a client who has been admitted with a pulmonary embolism and notes a change in the client's oxygen saturation (SpO₂) from 94% to 88%. Which of the following actions should the nurse implement?

The nurse is assessing a client with chronic lung disease and finds a sudden onset of agitation and confusion. Which of the following actions should the nurse take first?

Which of the following assessment findings by the nurse when caring for a client with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased?

The nurse is caring for a client who was hospitalized 2 days earlier with aspiration pneumonia. Which of the following assessment information is most important to communicate to the health care provider?

The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is intubated, receiving mechanical ventilation and has developed a pneumothorax. Which of the following actions will the nurse anticipate taking?

The nurse obtains the vital signs for a client admitted 2 days ago with gram-negative sepsis: temperature 38.4°C (101.1°F) , blood pressure 90/56 mm Hg, pulse 92 beats/minute, respirations 34/minute. Which of the following actions should the nurse take next?

Which of the following statements by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a client with ARDS is correct?

The nurse is caring for a client who came to the emergency department with acute respiratory distress. Which of the following information requires the most rapid action by the nurse?

The nurse is admitting a client who is in possible respiratory failure with a high PaCO₂. Which of the following assessment information will be of most concern to the nurse?

The nurse is admitting a client with chronic obstructive pulmonary disease (COPD) who has shortness of breath and dyspnea. Which of the following assessment findings is most important to report to the health care provider?

The nurse is caring for a client with respiratory failure who has a respiratory rate of 8/min and a SpO₂ of 89%. The client is increasingly lethargic. Which of the following actions should the nurse anticipate?

The nurse is caring for an obese client with left lower lobe pneumonia. Which of the following positions should the nurse place the client in for optimal gas exchange?

When prone positioning is used in the care of a client with acute respiratory distress syndrome (ARDS) , which of the following information obtained by the nurse indicates that the positioning is effective?

After receiving change-of-shift report, which of the following clients should the nurse assess first?

The nurse is caring for a client with hypoxemia and a PaO₂/FiO₂ ratio of 170 while being administered oxygen 8 L/minute via mask. Which of the following information is accurate in relation to the client's situation?

To decrease the risk for ventilator-associated pneumonia, which of the following actions should the nurse include in the plan of care for a client who requires intubation and mechanical ventilation?

Chest physiotherapy is indicated for which of the following clients?