Question 1

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP)to the family members of a patient with ARDS is accurate?

Accepted Answer

A)   "PEEP will push more air into the lungs during inhalation."
B)   "PEEP prevents the lung air sacs from collapsing during exhalation."
C)   "PEEP will prevent lung damage while the patient is on the ventilator."
D)   "PEEP allows the breathing machine to deliver 100% oxygen to the lungs." B

Question 2

The nurse reviews the electronic medical record for a patient scheduled for a total hip replacement.Which assessment data shown in the accompanying figure increase the patient's risk for respiratory complications after surgery?

Accepted Answer

A)   Albumin level and recent weight loss
B)   Mild confusion and recent weight loss
C)   Age and recent arthroscopic procedure.
D)   Anemia and recent arthroscopic procedure A

Question 3

To evaluate the effectiveness of ordered interventions for a patient with ventilatory failure,which diagnostic test will be most useful to the nurse?

Accepted Answer

A)   Chest x-ray
B)   Oxygen saturation
C)   Arterial blood gas analysis
D)   Central venous pressure monitoring C

Question 4

When assessing a patient with chronic obstructive pulmonary disease (COPD),the nurse finds a new onset of agitation and confusion.Which action should the nurse take first?

Accepted Answer

A)   Notify the health care provider.
B)   Check pupils for reaction to light.
C)   Attempt to calm and reorient the patient.
D)   Assess oxygenation using pulse oximetry.

Question 5

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?

Accepted Answer

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.

Question 6

The nurse is caring for a 33-year-old patient who arrived in the emergency department with acute respiratory distress.Which assessment finding by the nurse requires the most rapid action?

Accepted Answer

A)   The patient's PaO2 is 45 mm Hg.
B)   The patient's PaCO2 is 33 mm Hg.
C)   The patient's respirations are shallow.
D)   The patient's respiratory rate is 32 breaths/minute.

Question 7

After receiving change-of-shift report on a medical unit,which patient should the nurse assess first?

Accepted Answer

A)   A patient with cystic fibrosis who has thick, green-colored sputum
B)   A patient with pneumonia who has crackles bilaterally in the lung bases
C)   A patient with emphysema who has an oxygen saturation of 90% to 92%
D)   A patient with septicemia who has intercostal and suprasternal retractions

Question 8

During change-of-shift report on a medical unit,the nurse learns that a patient with aspiration pneumonia who was admitted with respiratory distress has become increasingly agitated.Which action should the nurse take first?

Accepted Answer

A)   Give the prescribed PRN sedative drug.
B)   Offer reassurance and reorient the patient.
C)   Use pulse oximetry to check the oxygen saturation.
D)   Notify the health care provider about the patient's status.

Question 9

The nurse is caring for a 78-year-old patient who was hospitalized 2 days earlier with community-acquired pneumonia.Which assessment information is most important to communicate to the health care provider?

Accepted Answer

A)   Scattered crackles bilaterally in the posterior lung bases.
B)   Persistent cough that is productive of blood-tinged sputum.
C)   Temperature of 101.5° F (38.6° 
C)   after 2 days of IV antibiotic therapy.
D)   Decreased oxygen saturation to 90% with 100% O2 by non-rebreather mask.

Question 10

The nurse documents the vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature 101.2° F,blood pressure 90/56 mm Hg,pulse 92,respirations 34.Which action should the nurse take next?

Accepted Answer

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

Question 11

A patient with chronic obstructive pulmonary disease (COPD)arrives in the emergency department complaining of shortness of breath and dyspnea on minimal exertion.Which assessment finding by the nurse is most important to report to the health care provider?

Accepted Answer

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

Question 12

A patient with respiratory failure has a respiratory rate of 6 breaths/minute and an oxygen saturation (SpO2)of 88%.The patient is increasingly lethargic.Which intervention will 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 continuous positive pressure ventilation (CPAP)

Question 13

A patient with acute respiratory distress syndrome (ARDS)and acute kidney injury has the following medications ordered.Which medication should the nurse discuss with the health care provider before giving?

Accepted Answer

A)   Pantoprazole (Protonix)  40 mg IV
B)   Gentamicin (Garamycin)  60 mg IV
C)   Sucralfate (Carafate)  1 g per nasogastric tube
D)   Methylprednisolone (Solu-Medrol)  60 mg IV

Question 14

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?

Accepted Answer

A)   Oxygen saturation 99%
B)   Respiratory rate 22 breaths/minute
C)   Crackles audible at lung bases
D)   Heart rate 106 beats/minute

Question 15

The nurse is caring for a patient who is intubated and receiving positive pressure ventilation to treat acute respiratory distress syndrome (ARDS).Which finding is most important to report to the health care provider?

Accepted Answer

A)   Blood urea nitrogen (BUN)  level 32 mg/dL
B)   Red-brown drainage from orogastric tube
C)   Scattered coarse crackles heard throughout lungs
D)   Arterial blood gases: pH 7.31, PaCO2 50, PaO2 68

Question 16

Which nursing interventions included in the care of a mechanically ventilated patient with acute respiratory failure can the registered nurse (RN)delegate to an experienced licensed practical/vocational nurse (LPN/LVN)working in the intensive care unit?

Accepted Answer

A)   Assess breath sounds every hour.
B)   Monitor central venous pressures.
C)   Place patient in the prone position.
D)   Insert an indwelling urinary catheter.

Question 17

Which actions should the nurse initiate to reduce the risk for ventilator-associated pneumonia (VAP)(select all that apply)?

Accepted Answer

A)   Obtain arterial blood gases daily.
B)   Provide a "sedation holiday" daily.
C)   Elevate the head of the bed to at least 30°.
D)   Give prescribed pantoprazole (Protonix) .
E)   Provide oral care with chlorhexidine (0.12%)  solution daily.

Question 18

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

Accepted Answer

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.

Question 19

Which information about a patient who is receiving cisatracurium (Nimbex)to prevent asynchronous breathing with the positive pressure ventilator requires immediate action by the nurse?

Accepted Answer

A)   Only continuous IV opioids have been ordered.
B)   The patient does not respond to verbal stimulation.
C)   There is no cough or gag when the patient is suctioned.
D)   The patient's oxygen saturation fluctuates between 90% to 93%.

Question 20

A patient with acute respiratory distress syndrome (ARDS)who is intubated and receiving mechanical ventilation develops a right pneumothorax.Which action will the nurse anticipate taking next?

Accepted Answer

A)   Increase the tidal volume and respiratory rate.
B)   Increase the fraction of inspired oxygen (FIO2) .
C)   Perform endotracheal suctioning more frequently.
D)   Lower the positive end-expiratory pressure (PEEP) .

Exam 64: Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is accurate?

The nurse reviews the electronic medical record for a patient scheduled for a total hip replacement.Which assessment data shown in the accompanying figure increase the patient's risk for respiratory complications after surgery?

To evaluate the effectiveness of ordered interventions for a patient with ventilatory failure,which diagnostic test will be most useful to the nurse?

When assessing a patient with chronic obstructive pulmonary disease (COPD) ,the nurse finds a new onset of agitation and confusion.Which action should the nurse take first?

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?

The nurse is caring for a 33-year-old patient who arrived in the emergency department with acute respiratory distress.Which assessment finding by the nurse requires the most rapid action?

After receiving change-of-shift report on a medical unit,which patient should the nurse assess first?

During change-of-shift report on a medical unit,the nurse learns that a patient with aspiration pneumonia who was admitted with respiratory distress has become increasingly agitated.Which action should the nurse take first?

The nurse is caring for a 78-year-old patient who was hospitalized 2 days earlier with community-acquired pneumonia.Which assessment information is most important to communicate to the health care provider?

The nurse documents the vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature 101.2° F,blood pressure 90/56 mm Hg,pulse 92,respirations 34.Which action should the nurse take next?

A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of shortness of breath and dyspnea on minimal exertion.Which assessment finding by the nurse is most important to report to the health care provider?

A patient with respiratory failure has a respiratory rate of 6 breaths/minute and an oxygen saturation (SpO₂) of 88%.The patient is increasingly lethargic.Which intervention will the nurse anticipate?

A patient with acute respiratory distress syndrome (ARDS) and acute kidney injury has the following medications ordered.Which medication should the nurse discuss with the health care provider before giving?

The nurse is caring for a patient who is intubated and receiving positive pressure ventilation to treat acute respiratory distress syndrome (ARDS) .Which finding is most important to report to the health care provider?

Which nursing interventions included in the care of a mechanically ventilated patient with acute respiratory failure can the registered nurse (RN) delegate to an experienced licensed practical/vocational nurse (LPN/LVN) working in the intensive care unit?

Which actions should the nurse initiate to reduce the risk for ventilator-associated pneumonia (VAP) (select all that apply) ?

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

Which information about a patient who is receiving cisatracurium (Nimbex) to prevent asynchronous breathing with the positive pressure ventilator requires immediate action by the nurse?

A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a right pneumothorax.Which action will the nurse anticipate taking next?

Exam 64: Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is accurate?

The nurse reviews the electronic medical record for a patient scheduled for a total hip replacement.Which assessment data shown in the accompanying figure increase the patient's risk for respiratory complications after surgery?

To evaluate the effectiveness of ordered interventions for a patient with ventilatory failure,which diagnostic test will be most useful to the nurse?

When assessing a patient with chronic obstructive pulmonary disease (COPD) ,the nurse finds a new onset of agitation and confusion.Which action should the nurse take first?

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?

The nurse is caring for a 33-year-old patient who arrived in the emergency department with acute respiratory distress.Which assessment finding by the nurse requires the most rapid action?

After receiving change-of-shift report on a medical unit,which patient should the nurse assess first?

During change-of-shift report on a medical unit,the nurse learns that a patient with aspiration pneumonia who was admitted with respiratory distress has become increasingly agitated.Which action should the nurse take first?

The nurse is caring for a 78-year-old patient who was hospitalized 2 days earlier with community-acquired pneumonia.Which assessment information is most important to communicate to the health care provider?

The nurse documents the vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature 101.2° F,blood pressure 90/56 mm Hg,pulse 92,respirations 34.Which action should the nurse take next?

A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of shortness of breath and dyspnea on minimal exertion.Which assessment finding by the nurse is most important to report to the health care provider?

A patient with respiratory failure has a respiratory rate of 6 breaths/minute and an oxygen saturation (SpO2) of 88%.The patient is increasingly lethargic.Which intervention will the nurse anticipate?

A patient with acute respiratory distress syndrome (ARDS) and acute kidney injury has the following medications ordered.Which medication should the nurse discuss with the health care provider before giving?

The nurse is caring for a patient who is intubated and receiving positive pressure ventilation to treat acute respiratory distress syndrome (ARDS) .Which finding is most important to report to the health care provider?

Which nursing interventions included in the care of a mechanically ventilated patient with acute respiratory failure can the registered nurse (RN) delegate to an experienced licensed practical/vocational nurse (LPN/LVN) working in the intensive care unit?

Which actions should the nurse initiate to reduce the risk for ventilator-associated pneumonia (VAP) (select all that apply) ?

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

Which information about a patient who is receiving cisatracurium (Nimbex) to prevent asynchronous breathing with the positive pressure ventilator requires immediate action by the nurse?

A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a right pneumothorax.Which action will the nurse anticipate taking next?

A patient with respiratory failure has a respiratory rate of 6 breaths/minute and an oxygen saturation (SpO₂) of 88%.The patient is increasingly lethargic.Which intervention will the nurse anticipate?