Adult Respiratory

A client is intubated and receiving mechanical ventilation. The nurse reports to the client's room when the ventilator alarms. Which nursing action indicates that the ventilator was signaling a high-pressure alarm? 1 The nurse removes secretions by suctioning. 2 The nurse lowers the setting of the tidal volume. 3 The nurse checks that tubing connections are secure. 4 The nurse obtains a specimen for arterial blood gases (ABGs).

1

A postoperative client with a tracheostomy tube in place suddenly develops noisy, increased respirations and an elevated heart rate. The nurse would take which action immediately? 1 Suction the tracheostomy. 2 Change the tracheostomy tube. 3 Readjust the tracheostomy tube and tighten the ties. 4 Perform a complete respiratory assessment.

1

After surgery, a client reports sudden, severe chest pain and begins coughing. The nurse suspects the client has a pulmonary embolus based on which characteristic of the client's sputum? 1 Pink 2 Clear 3 Green 4 Yellow

1

Which blood gas value would the nurse expect in a ventilated client with an air leak and suspected alveolar hypoventilation? 1 pH of 7.32 2 Po2 of 95 mm Hg 3 Pco2 of 30 mm Hg 4 HCO3- of 20 mEq/L (20 mmol/L)

1

Which actions will the nurse take for a client with a suspected pulmonary embolus? Select all that apply. One, some, or all responses may be correct. 1 Administer oxygen at high flow rates. 2 Notify the Rapid Response Team. 3 Lower the head of the client's bed. 4 Place the client on a cardiac monitor. 5 Anticipate rapid administration of warfarin.

1, 2, 4

Pa02/Fi02 ratio to start weaning

150-200

A client develops bacterial pneumonia and is admitted to the emergency department. The client's initial PaO2 is 80 mm Hg. When the arterial blood gases are drawn again, the level is 65 mm Hg. Which action would the nurse take first? 1 Ensure that intubation equipment is available. 2 Increase the oxygen flow rate per facility protocol. 3 Notify the health care provider to request a chest x-ray. 4 Recheck the arterial blood gases to verify accuracy.

2

A client with a pulmonary embolus is intubated and placed on mechanical ventilation. Which nursing action is important when suctioning the endotracheal tube? 1. Applying negative pressure while inserting the suction catheter 2. Hyper-oxygenating with 100% oxygen before and after suctioning 3. Suctioning two to three times in succession to effectively clear the airway 4. Using rapid movements of the suction catheter to loosen secretions

2

When the nurse educator is observing a student performing tracheal suctioning of a client with thick secretions, which student action requires intervention? 1 Maintains a sterile field 2 Applies suction during insertion of the catheter 3 Preoxygenates with 100% oxygen for 1 minute 4 Tests suction pressure at 100 mm Hg before inserting catheter

2

Which change in the arterial blood gases would the nurse expect in a client with hyperventilation due to anxiety? 1 Respiratory acidosis 2 Respiratory alkalosis 3 Respiratory compensation 4 Respiratory decompensation

2

When taking the history for a client who is being treated for obstructive sleep apnea, which findings would the nurse expect? Select all that apply. One, some, or all responses may be correct. 1 Daytime hypoxemia 2 Chronic fatigue 3 Enlarged tonsils 4 Subcutaneous emphysema 5 Poor concentration

2, 3, 5

A client is admitted with metabolic acidosis. Which two body systems would the nurse assess for compensatory changes? 1 Skeletal and nervous 2 Circulatory and urinary 3 Respiratory and urinary 4 Muscular and endocrine

3

A client is receiving mechanical ventilation. The nurse suspects that the client is experiencing poor oxygenation based on which assessment finding? 1 PaO2 of 93 2 Skin warm and dry 3 Increased restlessness 4 No secretions when client is suctioned

3

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco2 of 45 mm Hg, HCO3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support which diagnosis? 1 Hypocapnia 2 Hyperkalemia 3 Metabolic alkalosis 4 Respiratory acidosis

3

The nurse is caring for a client whose mechanical ventilator settings include the use of positive end-expiratory pressure (PEEP). This treatment improves oxygenation primarily through which mechanism of action? 1 Providing more oxygen to lung tissue 2 Forcing pressure into lung tissue, which improves gas exchange 3 Opening collapsed alveoli and keeping them open 4 Opening collapsed bronchioles, which allows more oxygen to reach lung tissue

3

The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? 1 Respiratory alkalosis 2 Poor oxygen perfusion 3 Normal acid-base balance 4 Compensated metabolic acidosis

3

The nurse is preparing to perform endotracheal suctioning on a client. Before beginning the procedure, which intervention would the nurse do? 1 Ask the client to take several deep breaths. 2 Instruct the client to cough before suctioning. 3 Administer 100% oxygen to the client. 4 Change the suctioning equipment to ensure sterility.

3

The nurse teaches the client about appropriate foods to consume when taking warfarin. The nurse evaluates that the client needs further teaching when the client makes which statement? 1 "Eggs provide a good source of iron, which is needed to prevent anemia." 2 "Yellow vegetables are high in vitamin A and should be included in the diet." 3 "Dark green leafy vegetables are high in vitamin K, so I should eat them more often." 4 "Milk and other high-calcium dairy products are necessary to counteract bone density loss."

3

When the nurse is reviewing a client's arterial blood gas results, which finding is consistent with respiratory alkalosis? 1 An elevated pH, elevated partial pressure of carbon dioxide (PCO2) 2 A decreased pH, elevated PCO2 3 An elevated pH, decreased PCO2 4 A decreased pH, decreased PCO2

3

Which action would the nurse anticipate implementing when caring for a client with acute respiratory distress syndrome who is intubated and on mechanical ventilation? 1 Deflate the endotracheal tube cuff hourly. 2 Schedule a change in ventilator tubing every 24 hours. 3 Determine need for suctioning based on client assessments. 4 Leave fraction of inspired oxygen (FiO2) at the highest setting as the client oxygenation improves.

3

Which action would the nurse take first when caring for a client with a possible pulmonary embolus? 1 Auscultate the chest. 2 Obtain the vital signs. 3 Elevate the head of the bed. 4 Notify the rapid response team.

3

Which diagnosis is a client most likely to have who has an arterial blood gas report indicating that pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L (20 mmol/L)? 1 Panic attack 2 Persistent vomiting 3 Diabetic ketoacidosis 4 Advanced emphysema

3

Which laboratory value would the nurse use to determine whether a client is receiving a therapeutic dose of intravenous heparin? 1 International normalized ratio (INR) is between 2 and 3 2 Prothrombin time (PT) is 2.5 times the control value 3 Activated partial thromboplastin time (APTT) is 70 seconds 4 Activated clotting time (ACT) is in the range of 70 to 120 seconds

3

Which nursing action is a priority before administering prescribed furosemide? 1 Weigh the client. 2 Assess skin turgor. 3 Review the potassium level results. 4 Check the 24-hour intake and output.

3

A client is experiencing severe acute respiratory distress. Which response would the nurse expect the client to exhibit? 1 Tremors 2 Anasarca 3 Bradypnea 4 Tachycardia

4

Endotracheal intubation and positive-pressure ventilation are instituted because of a client's deteriorating respiratory status. Which is an important nursing intervention? 1 Facilitate verbal communication. 2 Prepare the client for emergency surgery. 3 Maintain sterility of the ventilation system. 4 Assess the client's response to the mechanical ventilation.

4

The arterial blood gases for a client with acute respiratory distress are pH 7.30, PaO2 80 mm Hg (10.64 kPa), PaCO2 55 mm Hg (7.32 kPa), and HCO3 23 mEq/L (23 mmol/L). How would the nurse interpret these findings? 1 Hypoxemia 2 Hypocapnia 3 Compensated metabolic acidosis 4 Uncompensated respiratory acidosis

4

When caring for a client who has acute respiratory distress syndrome (ARDS), the nurse would implement which measure to promote effective airway clearance? 1 Administer sedatives as frequently as possible. 2 Turn the client every 4 hours. 3 Increase ventilator settings every 2 hours. 4 Suction as needed.

4

Which arterial blood gas result for a client who is receiving mechanical ventilation using the pressure support ventilation mode indicates that the client is hyperventilating? 1 pH 7.28 2 Bicarbonate (HCO3) 24 mEq/L (24 mmol/L) 3 Partial pressure of oxygen (PaO2) 60 mm Hg (7.98 kPa) 4 Partial pressure of carbon dioxide (PaCO2) 30 mm Hg (3.99 kPa)

4

Which medical intervention would the nurse anticipate will be included in the management of a client with acute respiratory distress syndrome (ARDS)? 1 Chest tube insertion 2 Aggressive diuretic therapy 3 Administration of beta-blockers 4 Positive end-expiratory pressure (PEEP)

4

PEDS: children will be on vent or ET tube for ~____days after resolution before trach placement

5

PEDS: respiratory distress RR

<10 or >40-60

PEDS: severity ranges in asthma Mild: Moderate: Severe:

>95% 90-95% <90%

A patient has been fasting and has ketones in their urine. What acid-base imbalance would the nurse expect to assess? a. Metabolic acidosis b. Respiratory alkalosis c. Metabolic alkalosis d. respiratory acidosis

A

For patient safety, which technique is best for the nurse to use when suctioning the client with a tracheostomy tube? a. Hyperoxygenation before and after suctioning b. Apply suction during insertion of the tube c. Repeat suctioning until the tube is clear d. Suction for 30 seconds

A

What is the rationale for using CPAP to treat sleep apnea a. Positive air pressure holds the airway open b. Negative air pressure holds the airway open c. Delivery of oxygen facilitates respiratory effort d. Alternating waves of air stimulate breathing

A

Patient admitted for sudden onset of severe abdominal pain. Which ABG value would the nurse suspect to see with this patient? a. PaCO2 48 b. HCO3 18 c. pH 7.32 d. SaO2 90

B

The low tidal volume alarm on a clients ventilator keeps sounding. What is the nurse's first action? a. Put air into the endotracheal tube cuff b. Check ventilation connections c. Manually ventilate the client d. Call the physician

B

The nurse reviews the ABG results of a patient and notes: pH of 7.45, PCO2 of 30, and HCO3 of 20. what does the patient have? a. Metabolic acidosis, compensated b. Respiratory alkalosis, compensated c. Metabolic alkalosis, uncompensated d. Respiratory acidosis, uncompensated

B

Which statement by the nurse is accurate when explaining the purpose of PEEP to family members of patients with ARDS? a. PEEP will prevent fibrosis of the lung from occurring b. PEEP prevents the lung air sacs from collapsing during exhalation c. PEEP will push more air into the lungs during inhalation d. PEEP allows the ventilator to deliver 100% oxygen to the lungs

B

A client has a PE and is started on oxygen. After a few minutes, their 02 sat has not significantly improved. Why? a. Breathing so rapidly interferes with oxygenation b. The blood clot interferes with perfusion in the lungs c. Maybe the client has respiratory distress syndrome d. He/she needs immediate intubation and mechanical ventilation

B (high VQ mismatch)

A client admitted to the hospital after vomiting for 3 days. Which ABG result would the nurse expect? a. pH 7.30, PaCO2 50, HCO3 27 b. pH 7.47, PaCO2 43, HCO3 28 c. pH 7.34, PaCO2 50, HCO3 28 d. pH 7.34, PaCO2 30, HCO3 23

B (metabolic alkalosis)

PEDS: meds for asthma

Bronchodilator Corticosteroids (flovent/QVAR) Antihistamines

PEDS: medication management for CF

Bronchodilator (albuterol) Mucolytic (Dornase Alfa) Antibiotic (prophylactic) NSAID (ibuprofen) Vitamins, enzymes, contraceptives

A nurse is caring for a patient who is receiving IV heparin. He vomits blood and heparin is stopped. What is the antidote? a. Vitamin K (phytonadione) b. Atropine c. Protamine d. Calcium gluconate

C

A patient with ARF has a RR of 8 and a SPO2 of 85%. They are becoming increasingly lethargic. You anticipate assisting with what? a. Administration of 100% oxygen by nonrebreather mask b. Insertion of a tracheostomy with frequent suctioning c. Endotracheal intubation and positive pressure ventilation d. Initiation of bilateral positive pressure ventilation (BiPAP)

C

Patient admitted with an acid-base imbalance. ABG results are pH 7.33, PaCO2 49, HCO3 28. interpret these results. a. Uncompensated respiratory acidosis b. Metabolic alkalosis, uncompensated c. Partially compensated respiratory acidosis d. Partially compensated metabolic acidosis

C

Signs and symptoms of sleep apnea include which of the following? a. Difficulty falling asleep b. Headache in the evening c. Loud snoring d. Nighttime sleeplessness

C

The patient is being weaned from a ventilator. Assessment reveals a RR of 32, 02 of 88% with use of accessory muscles a. The Fi02 will be increased b. Weaning will continue c. The client will be places back on full ventilation d. The patient will be extubated

C

A patient has the following lab values: pH 7.55, HCO3 22, PCO2 30. what should the nurse do? a. Perform Allen's test b. Prepare the client for dialysis c. Encourage the client to slow down breathing d. Administer insulin as needed

C (metabolic alkalosis from hyperventilation)

In a state of respiratory alkalosis, which of the following additional laboratory values would the nurse note? a. Magnesium 2.4 b. Phosphorus 4.0 c. Potassium 3.2 d. Sodium 145

C (normal: 3.5-5)

PEDS: Top 3 interventions for RSV

Check 02, epi nebulizer, steroids

Fine noises on inspiration

Crackles

A patient who is found unresponsive has ABGs drawn and the results are pH of 7.12, PCO2 of 90, and HCO3 of 22. What does the patient have? a. Metabolic acidosis, compensated b. Respiratory acidosis, compensated c. Metabolic acidosis, uncompensated d. Respiratory acidosis, uncompensated

D

The nurse is taking the social history of a patient diagnosed with SCLC (small cell lung cancer). Which information is significant for this disease? a. Worked with asbestos for a short time many years ago b. Has no family history of this type of lung cancer c. Has numerous tattoos on upper and lower arms d. Has smoked 2 packs of cigarettes a day for 20 years

D

To prevent accidental decannulation of a tracheostomy tube, what does the nurse do? a. Allow some flexibility in motion of the tube while coughing b. Instruct the patient to hold the tube with a tissue while coughing c. Obtain an order for continuous upper extremity restraints d. Secure the tube in place using ties or fabric fasteners

D

PEDS: pan creative enzymes will be taken after ______ in cystic fibrosis patients

Every meal

PEDS: CF diet

High calorie, high fat (150% calorie, 40% fat)

PEDS: babies are obligatory ____ breathers

Nose

PEDS: a barky cough is indecisive of ____

RSV

Low pitched sound through respiration

Rhonchi

High pitched sound on inspiration

Stridor

PEDS: top symptom of respiratory distress progressing to failure

Tripod/sniffing position

Stages of development: Infant: 0-18 mo Toddler: 18mo-3yr Pre-school: 3-5yr Grade-school: 5-13yr Teen: 13-21yr Young adult: 21-39yr Middle adult: 40-65yr Older adult: 65yr+

Trust vs mistrust Autonomy vs shame & doubt Initiative vs guilt Industry vs inferiority Identity vs role confusion Intimacy vs isolation Generatively vs stagnation Integrity vs despair

PEDS: the most common cause for asthma attack is a ______

Viral infection (flu, covid, RSV)

High pitch musical sound through respiration

Wheezing

A patient has severe diarrhea. The nurse understands that the patient is at risk for developing which acid-base disorder? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

a

high VQ mismatch

air is entering, blood is blocked

low VQ mismatch

blood is entering, air is blocked

causes for low pressure alarms

cuff leak leak in vent circuit patient stops breathing

Causes for high pressure alarms

secretions biting the ETT pneumothorax PT is anxious kink in tubing water collecting in tubing