respiratory

You're providing care to a patient who was just transferred to your unit for the treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which results are expected during this early phase of acute respiratory distress syndrome that correlates with this diagnosis? A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23 B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26 C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29 D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19

The answer is A. This option demonstrates respiratory alkalosis. In the early stages of ARDS (exudative) the patient will start to enter in respiratory alkalosis. The patient starts to have tachypnea (the body's way of trying to increase the oxygen level but it can't). They will have a very low PaO2 level (normal PaO2 is 80 mmHg), the blood pH will become high (normal is 7.35-7.45) (alkalotic). In the late stage, the patient can enter into respiratory acidosis.

You're providing care to a patient who is being treated for aspiration pneumonia. The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is developing acute respiratory distress syndrome (ARDS)? 1. The patient is experiencing bradypnea. 2. The patient is tired and confused. 3. The patient's PaO2 remains at 45 mmHg. 4. The patient's blood pressure is 180/96.

The patient's PaO2 remains at 45 mmHg. A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the patient is STILL hypoxic. Option 3 is the answer because it states the patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60 mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants to know the HALLMARK sign and symptom.

which of the following is an important consideration when administering mechanical ventilation to a patient with acute respiratory distress syndrome (ARDS)? 1. assess for pneumothorax 2. assess for increased ICP 3. assess patient mobility 4. assess for CO2 toxicity 5. assessing liver enzymes 6. assess for thrill and bruit

assess for pneumothorax due to decreased lung compliance and high peak airway pressures, barotrauma or trauma to the lung(s) is common in ventilated patients with ARDS. To reduce the risk of injuring the lung, smaller tidal volumes should be used with these patients.

3. During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse you know this will lead to? A. bronchoconstriction B. atelectasis C. upper airway blockage D. pulmonary edema

atelectasis Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales (hence the sac won't collapse). If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue) when there is a decrease production in surfactant.

During your assessment of a patient with suspected acute respiratory distress syndrome (ARDS), which of the following findings is most likely to be seen? 1. pulmonary hypotension 2. refractory hyperoxia 3. bradypnea 4. atelectasis 5. skin rash 6. increased PaO2

atelectasis damage to alveolar cells causes decreased production of surfactant, the substance that functions to help keep alveoli open. This, in addition to accumulation of fluid in the alveoli, contribute to atelectasis

which of the following mechanism is the most likely caused of acute respiratory distress syndrome (ARDS)? 1. inhaled toxins 2. air enters pleural space, but can't exit 3. damaged alveolar-capillary membrane

damaged alveolar-capillary membrane damaged or injury to the alveolar-capillary membrane triggers the released of inflammatory mediators, eventually leading to increased membrane permeability. These changes in the lungs allow fluid from the interstitial space to enter and fill the alveoli. When this occurs, the alveoli can no longer function to oxygenate the blood that flows through the capillaries, causing impaired gas exchange.

During your assessment of a patient with suspected acute respiratory distress syndrome (ARDS), which of the following findings is most likely to b seen? 1. localized pulmonary infiltrates 2. skin rash 3. diarrhea 4. decreased PaO2 5. usually asymptomatic 6. increased PaO2

decreased PaO2 impaired gas exchange will cause a decreased in arterial oxygen levels in the blood, despite increasing oxygen concentrations used in oxygen therapy.

During your assessment of a patient with suspected acute respiratory distress syndrome (ARDS), which of the following findings is most likely to be seen? 1. diffuse pulmonary infiltrates 2. jaw claudication 3. refractory hyperoxia 4. skin rash 5. usually asymptomatic 6. diarrhea

diffuse pulmonary infiltrates an x-ray of healthy, air-filled lungs will appear black. However with ARDS, an x-ray of the patient's chest will reveal lungs that appear white, due to widespread infiltrates and minimal air spaces. it is often referred to as whiteout or white lung.

During your assessment of a patient with suspected acute respiratory distress syndrome (ARDS), which of the following findings is most likely to be seen? 1. dyspnea 2. bradypnea 3. increased PaO2 4. diarrha 5. GI distress 6. localized pulmonary infiltrates

dyspnea changes in the lungs that interfere with gas exchange will cause patients with ARDS to become dyspneic. difficulty breathing and the feeling of not getting enough air will lead to tachypnea, and eventually, respiratory alkalosis.

which of the following is true of acute respiratory distress syndrome (ARDS)? 1. increased perinatal mortality only 2. high mortality rate 3. common in african americans 4. low mortality rate 5. more common in women 6. more common in men

high mortality rate the mortality rate for patients with ARDS is about 50%; however, prone positioning ahs shown to increase positive outcomes in some patients. when a patient is supine, fluid will pool in the dependent areas of the lungs, damaging alveoli, and interfering with gas exchange. placing the patient in prone position will allow previously dependent areas of the lungs to continue to receive the greatest blood flow, and alveoli will be allowed to reopen, due to the shifting of fluid to the anterior surface of the lungs

which of the following interventions is most likely indicated for a patient with acute respiratory distress syndrome (ARDS)? 1. sodium restriction 2. oxygen 3. promote self-monitoring 4. surgery 5. short-acting inhaled beta-agonist 6. stent

oxygen the goal of oxygen therapy is to correct hypoxemia and achieve a PaO2 of 60 mmHg or higher. Patients should be treated with the lowest concentration of oxygen possible to stay within the desired parameters.

During your assessment of a patient with suspected acute respiratory distress syndrome (ARDS), which of the following findings is most likely to be seen?

pulmonary hypertension the inflammatory process involved in ARDS will eventually cause destruction of the pulmonary vasculature and decreased lunch compliance. as this occurs, pulmonary vascular resistance will increase, and pulmonary hypertension may result. pulmonary hypertension is considered a late sign of decreased lung compliance.

During your assessment of a patient with suspected acute respiratory distress syndrome (ARDS), which of the following findings is most likely to be seen?

refractory hypoxemia in patient with ARDS, the lungs are being adequately perfused, but gas exchange is disrupted due to atelectasis and fluid in the alveoli. The results is a V/Q mismatch and an intrapulmonary shunt, which leads to hypoxemia. Hypoxemia in this situation is refractory to oxygen therapy.

4. A patient has been hospitalized in the ICU for a near drowning event. The patient's respiratory function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS? A. infiltrates only on the upper lobes B. enlargement of the heart with bilateral lower lobe infiltrates C. white-out infiltrates bilaterally D. normal chest x-ray

white-out infiltrates bilaterally This is a finding found in ARDS....pronounce white-out infiltrates bilaterally.

A nursing student is demonstrating to a client how to use the incentive spirometer (IS). Which of the following statements by the client indicates correct understanding of how to use the IS? 1. "I will breathe in slowly and deeply to maximize the volume of air in my lungs" 2. "I will breathe in as quickly as possible to get the maximum volume of air into my lungs" 3. "I will purse my lips and breathe out forcefully to maximize the air pressure in my lungs" 4. " I will breathe out completely to empty my lungs of as much CO2 as possible"

1. "I will breathe in slowly and deeply to maximize the volume of air in my lungs" This statement shows correct understanding of how to use the incentive spirometer. Breathing in slowly and deeply increases the volume of air in the lungs and causes alveoli to inflate.

A nurse should be most concerned about which of the following assessment findings? 1. High pitched stridorous breath sounds 2. Coarse crackles with cough and shortness of breath 3. Asthma attack with wheezing 4. Use of rescue inhaler every day

1. High pitched stridorous breath sounds All of these clients are having airway and breathing problems but anyone with stridor is experiencing an obstructed upper airway. This could be potentially from the airway closing, or something stuck in the airway, either way it is emergent and should be the most concerning finding.

During your assessment of a patient with suspected acute respiratory distress syndrome (ARDS), which of the following findings is most likely to be seen? 1. absent or restrict movement on affected side 2. obstructive sleep apnea 3. restless 4. bradypnea 5. myalgia 6. refractory hyperoxia

restlessness patients who are not getting enough oxygen will become restless, anxious, and diaphoretic. the body will attempt to compensate for the lack of oxygen by increasing heat rate, causing ARDS patient to become tachycardic.

The nurse is caring for a client with pneumonia. Upon assessment, the nurse notes crackles in the lungs. The client appears breathless and asks if his oxygen is turned on. The nurse checks the nasal cannula and flowmeter, confirming a rate of 5LPM per nasal cannula (FiO2 40%). Vital signs reflect the following: O2 81% on 5 LPM NC, BP 145/84, Pulse 110, RR 28. ABG values are as follows: pH 7.47, PaCO2 29, PaO2 49. What is this client's P/F ratio? 1. 49/0.4 2. 110/0.81 3. 29/40 4. 47/0.5

1. 49/0.4 The P/F ratio is an indicator of ARDS severity. This value corresponds to the PaO2/FiO2. This client's P/F ratio is 49/0.4, which is 122. This meets moderate ARDS criteria (P/F <200).

A client is recovering from surgery for an abdominal resection and has developed atelectasis after spending a significant period of time in bed. Atelectasis is best described as which of the following? 1. A collapse of the alveoli where gas exchange occurs 2. A tightening of the smooth muscles of the airways 3. A collection of air in the pleural space around the lung 4 A blood clot that lodges in one of the small vessels of the lungs

1. A collapse of the alveoli where gas exchange occurs A client recovering from surgery is at risk of developing atelectasis, which occurs when the alveoli of the lungs collapse. The alveoli are the points where exchange of carbon dioxide and oxygen occurs between the lungs and the bloodstream, so when these alveoli collapse, the pulmonary system does not create an adequate gas exchange.

A nurse is caring for a client with pulmonary edema. Which of the following factors can predispose a client to developing this condition? Select all that apply. 1. Acute respiratory distress syndrome 2. Hypothyroidism 3. Heart failure 4. Inhalation of toxic gases 5. Diabetes

1. Acute respiratory distress syndrome When a lung injury occurs that causes a physiological response like acute respiratory distress syndrome (ARDS), pulmonary edema can occur. 3. Heart failure Pulmonary edema occurs as a build up of fluid in the lungs, which causes shortness of breath. The condition is more likely to develop in situations where a client has excess fluid in the body. Heart failure is an example of a condition that can lead to pulmonary edema. 4. Inhalation of toxic gases Inhaling toxic gases causes pulmonary injury which can result in severe pulmonary edema.

Prior to taking a client to the operating room for total knee replacement surgery, the nurse teaches the client about incentive spirometry to prepare for the post-operative period. Which information would the nurse most likely include during this teaching? 1. After inhaling, the client should hold his breath for five seconds before breathing out 2. The incentive spirometry will have to be performed at least once a day 3. The client should breathe out and breathe in by taking a rapid, deep gasp of air 4. The incentive spirometry is only used the first day after surgery

1. After inhaling, the client should hold his breath for five seconds before breathing out Incentive spirometry (IS) is a simple tool that can be used to prevent pneumonia during the period following surgery when a client is more likely to be immobile. When using an incentive spirometer, the client inhales slowly to inflate the lungs, and holds the breath at maximum expansion for as long as possible. Three to five seconds is best to maximize alveoli opening. The client then exhales through pursed lips. A major surgery such as total knee replacement increases the risks of immobility and the nurse should teach the client about how to use incentive spirometry. This tool keeps air passages open and prevents collapse of alveoli that can lead to pneumonia.

A 63-year-old client was admitted for a pacemaker insertion and is being discharged to home. Which of the following information should the nurse provide to the client about home care of a cardiac pacemaker? 1. Carry a pacemaker identification card at all times 2. Replace the battery every 12 months 3. Check and record the pulse rate with every meal and activity 4. Do not bathe with the pacemaker; only showers are allowed

1. Carry a pacemaker identification card at all times A client who has had a pacemaker inserted requires significant teaching and education to best care for the device. Teaching should include when the batteries need to be changed, which is usually several years after placement. The client should also carry a card and wear a MedicAlert bracelet that indicates that he has a pacemaker so that caregivers will know his underlying condition and will take care not to damage the pacemaker. Additionally, the client with a pacemaker should take care around electrical devices and move 5 to 10 feet away and check their pulse if they have any unusual feelings around electrical devices. Cellphones should be used on the opposite side of the device.

A nurse is working with a client with a lung abscess who has an order for chest physiotherapy (CPT). The client requires positioning and chest percussion as part of CPT. Which of the following would be considered an absolute contraindication for performing percussion as part of CPT? 1. Chest incision 2. Hypotension 3. Empyema 4. Vasoactive drug administration

1. Chest incision Chest physiotherapy involves a process of loosening respiratory secretions and helping the client to eliminate them, whether by expectorating the secretions or by suctioning them. There are several contraindications for the percussion portion of CPT, which refers to tapping on various parts of the chest wall to loosen secretions. Contraindications include chest incisions, rib fractures or a history of pathological bone fractures, increased intracranial pressure, bronchospasm, and unstable vital signs.

During shift report, the oncoming nurse is told that an assigned client has atelectasis. The nurse knows this could be caused by which of the following? Select all that apply. 1. Collapsed lung 2. Intubation during general anesthesia 3. Ventricular tachycardia 4. Brain aneurysm 5. Deep vein thrombosis

1. Collapsed lung 2. Intubation during general anesthesia A person with a collapsed lung will have atelectasis in the affected area. When a client is intubated, a machine breathes for the client. Normally a person's diaphragm contracts, which increases the space in the chest cavity and causes air to enter the lungs. When intubated, a machine forces air into the lungs, which is the opposite mechanism for lung inflation than normal, and can cause a certain measure of obstruction. Clients who are intubated nearly always have some amount of atelectasis afterward.

While checking vital signs on an adult client admitted to the hospital from home, the nurse notes that the client's oxygen saturation level is 95% on room air. Which action of the nurse is most appropriate? 1. Continue to monitor and assess for changes 2. Place the client in the Trendelenburg position 3. Administer 100 percent oxygen by facemask 4. Provide heated and humidified oxygen via nasal cannula

1. Continue to monitor and assess for changes A desirable oxygen saturation level is between 95 and 100 percent for an adult. If the client has an oxygen saturation of 95 percent on room air, the nurse should continue to monitor for changes in respiratory status.

The nurse is assessing a client with atelectasis. Which of the following are expected findings? Select all that apply. 1. Diminished breath sounds 2. Fever 3. Low SpO2 4. Epistaxis 5. Flank pain

1. Diminished breath sounds 2. Fever 3. Low SpO2 When atelectasis occurs, air exchange is impaired. This leads to diminished breath sounds in the area or lobe of the lung where atelectasis is present. Atelectasis is often correlated with a fever. This is an expected finding. Gas exchange is impaired when a client has atelectasis, so low SpO2 would be an expected finding. A nosebleed is not correlated. Flank pain can indicate kidney stone, UTI, or bleeding. Not related to atelectasis.

The nurse is assessing a client who presented to the emergency room for shortness of breath. The client states, "I just cannot breath deeply, it feels like there is someone holding my ribs tight." What is the priority for this client? 1. Get an EKG (ECG) 2. Check the client's airway 3. Call a rapid response 4. Tell the client to take a deep breath

1. Get an EKG (ECG) Chest pressure can indicate a myocardial infarction. This client is able to speak a complete sentence, so the client has an airway and is breathing. The nurse will need to contact the provider for an EKG (ECG) right away.

The nurse is caring for a client with asthma who must receive regular breathing treatments. Which of the following are adverse drug reactions for bronchodilators? Select all that apply. 1. Headache 2. Tachycardia 3. Sneezing 4. Back pain 5. Palpitations

1. Headache 2. Tachycardia 5. Palpitations Common adverse reactions for bronchodilators include allergic reactions such as a rash, hives or itching, headache, tachycardia, restlessness, and palpitations.

A nurse needs to assess posterior lung sounds in a client. In which position would it be most appropriate to place this client? 1. High Fowler's 2. Semi-Fowler's 3. Dorsal recumbent 4. Sims' position

1. High Fowler's To assess the back and listen to posterior lung sounds, the nurse should place the client in the high Fowler's position. In this position, the client is sitting up with the head of the bed at a 90-degree angle. The high Fowler's position is used for performing an assessment that would require the client to sit up, such as the face and head, chest, and back.

A nurse is teaching a client how to take a deep breath and cough during postoperative care after abdominal surgery. The nurse has helped the client to a sitting position. What step should the nurse have the client perform next? 1. Inhale slowly through the nose 2. Breathe out quickly and hold it 3. Hold the breath for 2 to 3 seconds 4. Take a rapid initial breath and then breathe normally

1. Inhale slowly through the nose Deep breathing and coughing techniques help expand the lungs postoperatively. This is important to allow the alveoli to expand, because atelectasis occurs with general anesthesia, and can lead to pneumonia if not addressed. The nurse would instruct the client to inhale slowly at first, because coughing will ensue which is uncomfortable for the post-op client. Inhaling slowly also allows maximum time for the lungs to re-inflate, and more time allows for more alveoli to be inflated when the client moves air in slowly.

The nurse is caring for a client who is post-op day 1 following abdominal surgery. The nurse notes that the client is taking shallow breaths and is guarding the incision site. The client has a temperature of 38.5 C, pulse 80, O2 88%, respirations 20, BP 110/86, and a WBC count of 10. The nurse assesses the client's incision site and notes no redness or warmth. Which of the following interventions is most appropriate? 1. Instruct the client on use of the incentive spirometer 2. Position the client prone to decrease the work of breathing 3. Check the client's intake and output record 4. Obtain supplies to place a dressing over the wound

1. Instruct the client on use of the incentive spirometer When a client develops a fever between post op days 1-3, it is likely due to atelectasis progressing to pneumonia. Since the client does not have other signs of infection and is a relatively fresh post-op, this client is likely experiencing post-op atelectasis. The nurse would check to see if the client was given an incentive spirometer and if so, make sure they are using it 5-10 times per hour while awake. If no IS is present at the bedside, the nurse will need to provide one and instruct the client on how to use it.

A client who had a bronchospasm was given ipratropium for treatment. The client asks the nurse how the medication works. Which of the following responses is accurate? 1. It reverses the action of acetylcholine, causing smooth muscle relaxation 2. It increases the production of cAMP, causing bronchodilation 3. It causes coughing, which brings up sputum, opening up the bronchial tree 4. It decreases inflammation in the bronchial tree

1. It reverses the action of acetylcholine, causing smooth muscle relaxation Ipratropium is an anticholinergic bronchodilator, which reverses the action of acetylcholine. This causes airway smooth muscle relaxation.

A nurse is caring for a client who is in respiratory distress because of ARDS. Which of the following conditions would most likely be present in this client? 1. Lack of tissue perfusion 2. Anuria 3. Disturbed personal identity 4. Problems with thermoregulation

1. Lack of tissue perfusion Acute respiratory distress syndrome (ARDS) is a life-threatening condition that affects the lungs and prevents the client from getting enough oxygen. This client will most likely be unable to effectively perfuse the tissues because decreased oxygen from lung disease prevents adequate oxygen from reaching the bloodstream and therefore peripheral tissues.

A nurse is caring for a client who is receiving chest physiotherapy (CPT). Which of the following is the desired outcome of this treatment? 1. Loosen secretions and re-inflate alveoli 2. Reduce intrapulmonary pressure 3. Drain fluid from the pleural space 4. Reduce alveolar pressure

1. Loosen secretions and re-inflate alveoli CPT involves using vibrations to loosen secretions. It may be in the form of cupping, using a vest that vibrates, or activating the bed setting (on certain beds) to vibrate. Once mobilized, the client can expel the secretions and inhale deeply to re-inflate the alveoli.

A female client presents to the ER reporting difficulty breathing. Upon assessment, the client reports "it feels like it's squeezing all around my ribs when I try to take a deep breath and it's making me nauseous." What is the priority nursing intervention for this patient? 1. Obtain a 12-lead EKG 2. Apply oxygen 3. Auscultate lung sounds 4. Check a blood pressure

1. Obtain a 12-lead EKG The priority will be to obtain a 12-lead EKG. Because female clients tend to report atypical cardiac symptoms when having a myocardial infarction, it is imperative to rule out MI in this client.

A nurse in the ICU is caring for a client that has been ventilated for 2 weeks due to Acute Respiratory Distress Syndrome (ARDS). The client's FiO2 has been at 60% for the last 48 hours. What is the nurse's immediate priority concern at this time? 1. Oxygen toxicity 2. Fluid retention 3. Risk for sepsis 4. Ventilator associated pneumonia

1. Oxygen toxicity Clients with ARDS require high levels of oxygen. Levels above 50% FiO2 for prolonged periods of time can cause oxygen toxicity. This is why the SpO2 goal for these clients tends to be approximately 92-94%. If a client has an SpO2 of 100%, the FiO2 needs to be decreased!

The nurse receives report on a client who presented to the emergency department the day before following a near-drowning incident. Upon presentation to the ED, the emergency responders stated that the client's oxygen needs increased from 6 LPM to 8 LPM on a simple face mask while en-route. The client is now at 12 LPM. Based on this information, which of the following findings will most likely lead the nurse to suspect ARDS? 1. P/F ratio 120 2. Ground glass opacities on chest X-ray 3. O2 saturation 84% 4. Rales upon auscultation of lungs

1. P/F ratio 120 A P/F ratio of 120 indicates moderate refractory hypoxemia, which means the client is not able to exchange adequate oxygen despite an increased FiO2. This is a classic sign of ARDS. The P/F ratio is found by dividing the PaO2 by the FiO2. The lower the number, the more severe the ARDS.

A 23-year-old client requires chest physiotherapy while in the hospital for treatment for cystic fibrosis. The nurse assists the respiratory therapist by helping the client with postural drainage. Which of the following actions best describes this process? 1. Place the client in Trendelenburg position 2. Assist the client to sit up in bed at a 90-degree angle 3. Teach the client how to clap or percuss the affected area 4. Encourage the client to cough and deep breathe

1. Place the client in Trendelenburg position Chest physiotherapy involves working with the client to loosen and expectorate secretions in the respiratory system. Postural drainage involves placing the client into a position in which the trachea is lower than the affected area of the lung so the secretions will drain. The client remains in this position for a period of time to allow secretions to drain into the main bronchus and the trachea and then the secretions are removed through suctioning or expectoration.

A client is admitted to the emergency room and the nurse is performing an assessment and notes there to be decreased breath sounds to one side of the chest. The nurse knows this is indicative of which of the following? 1. Pneumothorax 2. Lower abdominal injury 3. Tracheobronchial injury 4. Pericardial tamponade

1. Pneumothorax As air fills the thoracic cavity, it causes compression of the lung on the affected side causing diminished lung sounds.

A 47-year-old client has been brought to the emergency department after falling from a roof. He has absent breath sounds on his right side, crepitus, and sharp chest pain with tracheal deviation to the left. Which of the following nursing interventions is appropriate? 1. Prepare client for chest tube placement 2. Immediately place the client in Trendelenburg position 3. Instruct the client in the proper use of a peak flow meter 4. Instruct the client to self splint the chest

1. Prepare client for chest tube placement This client has the assessment findings of a pneumothorax. This occurs when the client's intrapleural space is compromised, either from a blunt chest injury or an opening in the chest wall. Intrathoracic pressure rises, and the affected lung collapses. For this condition, the nurse will administer oxygen, place the client in Fowler's position, and prepare for chest tube placement.

A client with chest trauma has ABGs drawn. The nurse anticipates which scenario upon ABG analysis? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

1. Respiratory acidosis Chest trauma usually correlates with breathing difficulties. The nurse would anticipate respiratory acidosis upon analysis of the client's ABG results.

A nurse is caring for a client with pneumonia who has just had their endotracheal tube removed. Which of the following breath sounds would be the MOST concerning at this time? 1. Stridor 2. Crackles 3. Rhonchi 4. Wheezing

1. Stridor Hearing Stridor is always an urgent situation, but especially after extubation. This could indicate an obstructed or narrowed upper airway, possibly caused by trauma and swelling from the extubation. This requires immediate intervention - often the client will need to be re-intubated.

A preceptor asks a student nurse where carbon dioxide and oxygen exchange occurs in the lungs. Which response is correct? 1. The alveoli 2. The atrium 3. The alveolar ducts 4. The pulmonary veins

1. The alveoli Gas exchange occurs in the alveoli. The alveoli are the functional unit of the lungs.

A nurse is working with a client who requires a mechanical ventilator for breathing support. The client uses SIMV ventilation at a rate of 16, PEEP 6, PSV 10. In this example, the PEEP is described as which of the following? 1. The increase in end-expiration volumes to prevent atelectasis 2. Extra air added when the client takes a breath 3. Some assisted breaths for the client and some that the client takes independently 4. Full pressure support added to the client breaths for a certain period of time

1. The increase in end-expiration volumes to prevent atelectasis When using assistive devices that administer oxygen, PEEP refers to positive end expiratory pressure, which is the volume of air in the lungs after exhalation. PEEP settings prevent the alveoli from collapsing and causing atelectasis, which can worsen respiratory symptoms. The PEEP setting on most adult ventilators may range from approximately 5 to 20 cm H2O.

A nurse works on an interdisciplinary team to provide care for a client with lung cancer. The client is unable to effectively clear their airway. The nurse should ensure that which interdisciplinary team member is present to provide professional input? 1. The respiratory therapist 2. The pharmacist 3. The social worker 4. The provider

1. The respiratory therapist An interdisciplinary team is composed of various disciplines that can all offer their expertise within their chosen field of practice. Although all of the disciplines listed are important members of the team, a respiratory therapist would be included in this case because of the client's respiratory status and medical diagnosis.

A nursing student observes a nurse performing cupping on a client. The student correctly understands which of the following as the reason for this? 1. To loosen secretions and fluids 2. To expand the lungs and inflate the alveoli 3. To hydrate the client in order to thin mucus 4. To dilate the airways to facilitate greater air movement

1. To loosen secretions and fluids Cupping is the action of rhythmic percussion, or hitting the chest to loosen secretions and fluids. It forces these substances to move from smaller to larger airways where they can be expelled.

A nursing student is assessing a client with atelectasis. The client asks the student about the purpose of turning, coughing, and deep breathing. Which response is correct? 1. To mobilize secretions and inflate the alveoli 2. To expel pathogens from the lungs to prevent pneumonia 3. To prevent post-op fever due to surgical site infection 4. To assist with skin integrity and circulation

1. To mobilize secretions and inflate the alveoli When a client turns from one side to another, this mobilizes secretions in the lungs. Coughing and deep breathing assist to expel secretions and inflate the alveoli.

A nurse is caring for a client who is 68-years-old and has been diagnosed with chronic lung disease. The client already has a diagnosis of heart failure and has been in the hospital for breathing difficulties. The nurse wants to gather an interdisciplinary team to talk about this client's care. In this situation, the most likely reason for meeting with an interdisciplinary team is which of the following? 1. To shift the focus from acute care to ongoing care 2. To help the nurse feel a sense of professional satisfaction 3. To motivate other staff members to focus on their jobs 4. To make the best use of the client's time in the hospital

1. To shift the focus from acute care to ongoing care Part of the work of an interdisciplinary team is to coordinate efforts for care when the client has a chronic illness that will need to be managed after receiving acute care in the hospital. The focus of this team's interventions should be to determine the best plan of action to prepare the client for ongoing management of heart failure.

A nurse is caring for a 35-year-old client who suffered a pulmonary embolism (PE) an hour after she delivered a baby. The nurse knows that a pulmonary embolism is the result of a clot that lodges in the pulmonary artery after breaking off from a thrombus in another location. Which of the following are the most common sites of formation of the initial thrombus? 1. Veins in the lower extremities 2. Subclavian and jugular veins 3. Superior vena cava 4. Pulmonary veins

1. Veins in the lower extremities A pulmonary embolism (PE) occurs when a portion of a blood clot breaks off and travels through the bloodstream to lodge in one of the vessels of the pulmonary system. It causes pain, dyspnea, cough, and lung crackles. A pulmonary embolism can be life threatening due to the blockage of blood flow into the lungs. The most common sites of the initial thrombus formation are in the veins of the lower leg (DVT) or in the case of a postpartum PE, a uterine or other pelvic vein.

An ambulance arrives at the emergency department with a client who has audible sucking noises on both inspiration and expiration and diminished breath sounds on one side. Which of the following procedures should the nurse anticipate? 1. Chest tube insertion 2. Humidified O2 3. Arterial blood gas draw 4. Rapid fluid infusion

1. chest tube insertion These signs and symptoms are consistent with an open pneumothorax. The client needs an occlusive dressing to stop airflow at the site of the sucking sound, and will require placement of a chest tube to reinflate the lung on the affected side.

A client is ventilated with acute respiratory distress syndrome following infections of COVID-19. which of the following are priority actions by the nurse? select all that apply. 1. frequently oral care 2. elevating the HOB 3. placing the client supine 4. clear liquid diet 5. flutter valve as needed

1. frequent oral care 2. elevating the HOB Frequent oral care should be performed on the client, because this helps prevent ventilator-associated pneumonia. When the client is supine, the head of bed should be elevated >30 degrees, and ideally 45 degrees. This is part of the ventilator-associated pneumonia (VAP) bundle used in hospitals to prevent pneumonia in ventilated clients.

A student nurse is discussing ARDS with the preceptor and correctly describes the progression of ARDS as which of the following? 1. lung trauma releases cytokines which damage lung tissue 2. increased capillary permeability in the lung tissue leads to an inflammatory response 3. decreased lung compliance leads to scarring in the lung tissue 4. increased oxygen demands lead to lung expansion difficulty

1. lung trauma releases cytokines which damage lung tissue ARDS occurs when lung trauma leads to the release of cytokines into the lung tissue. This damages the lung tissue. The inflammatory response also leads to increased capillary permeability which allows fluid to enter the alveoli. Lung tissue becomes scarred, and a hyaline membrane forms, decreasing lung compliance which severely impairs gas exchange. This is a respiratory emergency, and can lead to irreversible lung damage and/or respiratory failure.

A 25-year-old client in the ICU is being treated for acute respiratory distress syndrome (ARDS). The client is on a ventilator and requires 80 percent FiO2. Which information would the nurse most likely need to report about the client to the respiratory therapist assigned to this case? 1. the client needs an arterial blood gas drawn 2. the client needs endotracheal suctioning 3. the client needs more oxygen because of O2 saturations 4. the client needs a hemoglobin level drawn

1. the client needs an arterial blood gas drawn Respiratory therapists have multiple duties in the healthcare facility and they frequently monitor and work out many technical details of the client's care when a ventilator is being used. A respiratory therapist would most likely change the ventilator settings but the nurse is able to increase the oxygen level on the ventilator and the nurse can suction the client. It is common for the respiratory therapist to draw arterial blood gas levels.

A nurse is caring for a client with ARDS. Which of the following clinical indicators would signify that this client is in respiratory failure? Select all that apply. 1. Pulse oximetry of 94% on room air 2. A PaO2 level below 60 mmHg 3. An ABG pH level of 7.35 4. A pCO2 level over 50 mmHg 5. A respiratory rate greater than 16 breaths per minute

2. A PaO2 level below 60 mmHg 4. A pCO2 level over 50 mmHg Respiratory failure occurs when the body cannot remove enough carbon dioxide, and/or cannot take in enough oxygen to be sustainable. Clinical indicators of respiratory failure include pulse oximetry of less than 90% on room air, PaO2 level less than 60 mmHg, and a pCO2 level of over 50 mmHg.

The nurse assesses a client and notices that the lungs have coarse crackles and the client is struggling to breath, and the client's legs are edematous. Which of the following actions should the nurse take first? 1. Call the healthcare provider 2. Check the vital signs 3. Give PRN hydralazine 25 mg IV 4. Palpate the client's pulses in the legs

2. Check the vital signs The nurse should check the client's vital signs first to determine if the client needs oxygen or any other treatment. The vital signs will also be needed to report to the healthcare provider.

A nurse must position the client prone after a diagnosis of acute respiratory distress syndrome (ARDS). Which of the following is a benefit of using this position? Select all that apply. 1. Decreased atelectasis 2. Reduced need for endotracheal intubation 3. Mobilization of secretions 4. Decreased pleural pressure 5. Increased response to corticosteroid therapy

3. mobilization of secretions 4. decreased pleural pressure the prone position reduces pressure on the lungs. when there is less pressure exerted on the lungs, atelectasis decreases. studies have shown that many clients in the prone position have increased lung secretions, which improves oxygenation. Prone positioning, or placing the client face down with the head turned to the side, helps with pulmonary function in the client diagnosed with ARDS. When the client is placed in prone position, the heart and diaphragm are not pressing against the lungs, which means that pleural pressure is reduced.

You're teaching a class on critical care concepts to a group of new nurses. You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding about this condition. Which statement by a new nurse demonstrates he understands the condition? 1. "This condition develops because the exocrine glands start to work incorrectly leading to thick, copious mucous to collect in the alveoli sacs." 2. "ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the lungs." 3. "Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has accumulated in the pleural space." 4. "This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."

4. "This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs." ARDS is a type of respiratory failure that occurs when the capillary membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac. 1 describes cystic fibrosis, 2 describes COPD, and 3 describes a pneumothorax.

The nurse is caring for a client after surgery. The client's lung sounds are clear on the left and soft, distant crackles on the right side. The nurse reviews the image above on the morning chest x-ray. Which intervention would be most appropriate for this client? 1. Prepare for intubation 2. Turn every 2 hours 3. Give an inhaled corticosteroid 4. Encourage incentive spirometer

4. Encourage incentive spirometer This image shows atelectasis in the right lung. Atelectasis is the collapse or closure of a the alveoli in the lungs resulting in reduced or absent gas exchange. It may affect part or all of a lung. On an x-ray, good air movement is black. Collapse, atelectasis, and fluid show up white. Atelectasis is common after surgery due to shallow breathing. The best intervention to promote lung expansion and prevent/improve atelectasis is incentive spirometry.