Ch 15 - Acute Respiratory Failure

The nurse is concerned that a patient is at increased risk of developing a pulmonary embolus and develops a plan of care for prevention to include which intervention? a. antiseptic oral care b. bed rest with head of bed elevated c. coughing and deep breathing d. mobility

d. mobility

Which statement is true regarding venous thromboembolism (VTE) and pulmonary embolus (PE)? a. PE should be suspected in any patient who has unexplained cardiorespiratory complaints and risk factors for VTE b. bradycardia and hyperventilation are classic symptoms of PE c. dyspnea, chest pain, and hemoptysis occur in nearly all patients with PE d. most critically ill patients are at low risk for VTE and PE and do not require prophylaxis

a. PE should be suspected in any patient who has unexplained cardiorespiratory complaints and risk factors for VTE

The nurse's caring for a client with cystic fibrosis and understands that treatment consists of which of the following? (select all that apply) a. airway clearance therapies b. antibiotic therapy c. nutritional support d. tracheostomy e. cardiac monitoring

a. airway clearance therapies b. antibiotic therapy c. nutritional support

The etiology of noncardiogenic pulmonary edema in ARDS is related to form of damage? a. alveolar-capillary membrane b. left ventricle c. mainstem bronchus d. trachea

a. alveolar-capillary membrane

What are the diagnostic criteria for ARDS? (select all that apply) a. bilateral infiltrates on chest x ray study b. decreased cardiac output c. PaO2/FiO2 ratio less than 200 d. pulmonary artery occlusion pressure (PAOP) of more than 18 e. acute onset within 7 days of clinical insult

a. bilateral infiltrates on chest x ray study c. PaO2/FiO2 ratio less than 200

The patient diagnosed with acute respiratory distress syndrome (ARDS) would exhibit which symptom? a. decreasing PaO2 levels despite increased FiO2 administration b. elevated alveolar surfactant levels c. increased lung compliance with increased FiO2 administration d. respiratory acidosis associated with hyperventilation

a. decreasing PaO2 levels despite increased FiO2 administration

The nurse is caring for mechanically ventilated patient prepares to include which strategies to prevent ventilator-associated pneumonia should be into the patients plan of care? (select all that apply) a. drain condensate from the ventilator tubing away from patient b. elevate HOB to 30-45 degrees c. instill normal saline as part of the suctioning procedure d. perform regular oral care with chlorhexidine e. administer antibiotic therapy as prescribed

a. drain condensate from the ventilator tubing away from patient b. elevate HOB to 30-45 degrees d. perform regular oral care with chlorhexidine

What strategies are appropriate from preventing deep vein thrombosis (DVT) and pulmonary embolus (PE) in an at-risk patient? (select all that apply) a. graduated compression stockings b. heparin or low-molecular weight heparin c. sequential compression devices d. strict bed rest e. providing education regarding compression ultrasound

a. graduated compression stockings b. heparin or low-molecular weight heparin c. sequential compression devices

The nurse is caring for patient in acute respiratory failure and understands that the patient should be positioned? (select all that apply) a. high fowlers b. side lying with head of bed elevated c. sitting in a chair d. supine with the bed flat e. prone with face turned to left

a. high fowlers b. side lying with head of bed elevated c. sitting in a chair

Which of the following are physiological effects of positive end-expiratory (PEEP) used in the treatment of ARDS? (select all that apply) a. increase functional residual capacity b. prevent collapse of unstable alveoli c. improve arterial oxygenation d. open collapsed alveoli e improve venous oxygenation

a. increase functional residual capacity b. prevent collapse of unstable alveoli c. improve arterial oxygenation d. open collapsed alveoli

Which of the following are components of the Institute for Healthcare Improvements (IHIs) ventilator bundle? (select all that apply) a. interrupt sedation each day to assess readiness to extubate b. maintain head of bed at least 30 degrees elevation c. provide deep vein thrombosis prophylaxis d. provide prophylaxis for peptic ulcer disease e. swab the mouth with foam swabs every 2 hours

a. interrupt sedation each day to assess readiness to extubate b. maintain head of bed at least 30 degrees elevation c. provide deep vein thrombosis prophylaxis d. provide prophylaxis for peptic ulcer disease

during rounds, the PCP alerts the team that proving is being considered for a patient with ARDS. The nurse should have what understanding about the benefit of proning? a. it is an optional treatment if the PaO2/FiO2 ratio is less than 100 b. it presents less of a risk for skin breakdown because the patient is face down c. it is possible with minimal help from co-workers d. it is used to provide continuous lateral rotational turning

a. it is an optional treatment if the PaO2/FiO2 ratio is less than 100

The nurse is caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome. The nurse understands that the priority nursing concern for this patient is which of the following? a. management and protection of the airway b. prevention of gastric aspiration c. prevention of skin breakdown and nerve damage d. psychological support to patient and family

a. management and protection of the airway

The nurse is discharging a patient home following treatment for community-acquired pneumonia. As part of the discharge teaching, the nurse should provide instruction? a. "if you get the pneumococcal vaccine, you'll never get pneumonia again" b. "it is important for you to get an annual influenza shot to reduce your risk of pneumonia" c. "stay away from cold, drafty places because that increases your risk of pneumonia when you get home" d. "since you have been treated for pneumonia, you now have immunity from getting it in the future"

b. "it is important for you to get an annual influenza shot to reduce your risk of pneumonia"

The nurse calculates the PaO2/FiO2 ration for the following values: PaO2 78 mm Hg; FiO2 0.6 (60%). what is the outcome and the relationship to the ARDS diagnosis criteria? a. 46.8; meets criteria for ARDS b. 130: meets criteria for ARDS c. 468; normal lung function d. not enough data to compute ratio

b. 130: meets criteria for ARDS (78 / 0.6 = 130, which meets criteria)

The nurse assessing a patient diagnosed with acute respiratory distress expects what assessment finding? a. cardiac output of 10 L/min and low systemic vascular resistance b. PAOP of 10mmHg and PaO2 of 55 c. PAOP of 20mmHg and cardiac output of 3 L/min d. PAOP of 5mmHg and high systemic vascular resistacnce

b. PAOP of 10mmHg and PaO2 of 55 (normal PAOP with hypoxemia is expected in ARDS)

What is themes common cause of a pulmonary embolus? a. an amniotic fluid embolus b. a deep vein thrombosis from Lower extremities c. a fat embolus from a long bone fracture d. vegetation that dislodges from an infected central venous Cath

b. a deep vein thrombosis from Lower extremities

The nurse is caring for a post patient with chronic obstructive pulmonary disease. Which assessment would be a cue to the patient developing post pneumonia? a. bradycardia b. change in sputum characteristics c. hypoventilation and respiratory acidosis d. pursed lip breathing

b. change in sputum characteristics

When fluid is present in the alveoli what is the result? a. alveoli collapse and atelectasis occurs b. diffusion of oxygen and carbon dioxide is impaired c. hypoventilation occurs d. the patient is in heart failure

b. diffusion of oxygen and carbon dioxide is impaired

The nurse assesses a patient who is admitted for an overdose of sedatives. The nurse expects to find which acid-base alteration? a. hyperventilation and respiratory acidosis b. hypoventilation and respiratory acidosis c. hypoventilation and respiratory alkalosis d. respiratory acidosis and normal oxygen levels

b. hypoventilation and respiratory acidosis

Which statement is true regarding oral care for the prevention of ventilator-associated pneumonia? (select all that apply) a. tooth brushing is performed every 2 hours for the greatest effect b. implementing a comprehensive oral care program is an intervention for preventing VAP c. oral care protocols should include oral suctioning and brushing teeth d. protocols that include chlorhexidine gluconate have been effective in preventing VAP e. avoid brushing teeth for 2 hours after chlorhexidine use

b. implementing a comprehensive oral care program is an intervention for preventing VAP c. oral care protocols should include oral suctioning and brushing teeth d. protocols that include chlorhexidine gluconate have been effective in preventing VAP

Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS) in a patient admitted with respiratory distress? a. increased oxygen saturation via pulse oximetry b. increased peak inspiratory pressure on the ventilator c. normal chest radiograph with enlarged cardiac structures d. PaO2/FiO2 ratio >300

b. increased peak inspiratory pressure on the ventilator

What is the treatment for an acute exacerbation of asthma? a. corticosteroids and theophylline by mouth b. inhaled bronchodilators and intravenous corticosteroids c. prone positioning or continuous lateral rotation d. sedation and inhaled bronchodilators

b. inhaled bronchodilators and intravenous corticosteroids

A patient at high risk for pulmonary embolism is receiving enoxaprin. The nurse should provide the patient with what explanation? a. im going to contact the pharmacist to see if you can take this medication by mouth b. this injection is being given to prevent blood clots from forming c. this medication will dissolve any blood clots you might get d. I will contact your primary care provider to discuss why you are getting this medication

b. this injection is being given to prevent blood clots from forming

Intrapulmonary shunting refers to what outcome? a. alveoli that are not perfused b. blood that is shunted from left side of the heart to the right and causes heart failure c. blood that is shunted from right side of the heart to the left without oxygenation d. shunting of blood supply to only one lung

c. blood that is shunted from right side of the heart to the left without oxygenation

what is the basic underlying pathophysiology of acute respiratory distress syndrome? a. a decrease in the number of white blood cells available b. damage to the right mainstem bronchus c. damage to the type II pneumocystis, which produce surfactant d. decreased capillary permeability

c. damage to the type II pneumocystis, which produce surfactant

What diagnostic procedure is required to make a definitive diagnosis of pulmonary embolism? a. arterial blood gas analysis b. chest x ray examination c. high resolution multi detector CT angiogram d. ventilation perfusion scanning

c. high resolution multi detector CT angiogram

What is a strategy for preventing thromboembolism in patients at risk who cannot take anticoagulants? a. administration of two aspirin tablets every 4 hours b. infusion of thormbolytics c. insertion of a vena cava filter d. subcutaneous heparin administration every 12 hours

c. insertion of a vena cava filter

The nurse is caring for a patient with acute respiratory distress syndrome who is hypoxemic despite mechanical ventilation. The primary care physician orders a nontraditional ventilator mode as part of the treatment. Despite sedation and analgesia, the patient remains restless and appears to be in discomfort. The nurse informs the PCP of this assessment and anticipates what order? a. continuous lateral rotation therapy b. guided imagery c. neuromuscular blockade d. prone positioning

c. neuromuscular blockade

A patient presents to the emergency department in acute respiratory failure secondary to community acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease. The nurse anticipates which treatment to facilitate ventilation? a. emergency tracheostomy and mechanical ventilation b. mechanical ventilation via an endotracheal tube c. noninvasive positive pressure ventilation (NPPV) d. oxygen at 100% via bag-valve-mask device

c. noninvasive positive pressure ventilation (NPPV)

Which acid-base disturbances commonly occurs with the hyperventilation and impaired gas exchange seen in severe exacerbation of asthma? a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis

c. respiratory acidosis

The nurse is discharging a patient diagnosed with asthma instructs the patient to prevent exacerbation by taking what action? a. obtaining an appointment for follow-up pulmonary function studies 1 week after discharge b. limiting activity until patient is able to climb two flights of stairs c. taking all asthma medications as prescribed d. taking medication on the PRN basis according to symptoms

c. taking all asthma medications as prescribed

The nurse is caring for a patient diagnosed with acute respiratory failure identifies "risk for ineffective airway clearance" as a nursing diagnosis. What nursing intervention is relevant to this diagnosis? a. elevate head of bed to 30 degrees b. obtain order for venous thromboembolism prophylaxis c. provide adequate sedation d. reposition patient every 2 hours

d. reposition patient every 2 hours

In assessing a patient, the nurse understands that what symptomology is an early sign of hypoxemia? a. clubbing of nail beds b. cyanosis c. hypotension d. restlessness

d. restlessness

Which treatment can be used to dissolve a thrombus that is lodged in the pulmonary artery? a. aspirin b. embolectomy c. heparin d. thrombolytics

d. thrombolytics