424 Sherpath Week 7

Which statement demonstrates that the patient understands how to prevent infection associated with O2 use at home? Select all that apply. One, some, or all responses may be correct.

"I will wash my hands before and after using my oxygen." "I will replace my nasal cannula after a cold."

Which statement by the licensed nurse indicates understanding of pressure support ventilation (PSV)?

"It delivers a preset pressure to be delivered during spontaneous breathing."

Which statement cues the nurse that the patient understood the teaching after education about pursed-lip breathing (PLB)? Select all that apply. One, some, or all responses may be correct.

"Pursed-lip breathing will help slow my breathing down." "I can use pursed-lip breathing to control my breathing when I feel really short of breath." "I should breathe slowly out through my pursed lips like I'm whistling." "Breathing out should be 3 times as long as breathing in."

Which statement would the nurse provide when approached by a patient who is scheduled for a wedge resection to remove benign modules in his left lung with concerns that he will be on oxygen for the rest of his life?

"The surgeon is removing a small portion of your lung, but you will still have enough lung tissue to oxygenate."

Which statement would the nurse include when educating fellow staff on BiPAP? Select all that apply. One, some, or all responses may be correct.

-Inspiratory positive airway pressure (IPAP) is a higher level of pressure that helps remove CO2 -Expiratory positive pressure (EPAP) is a lower level of pressure the keeps alveoli open at end of expiration. -BiPAP can help prevent re-intubation after extubation from mechanical ventilation.

Which patient would the nurse determine has a contraindication to oropharyngeal airway (OPA) insertion?

A 44-year-old female who has difficulty opening her eyes due to intoxication

Which characteristic applies to acute respiratory distress syndrome (ARDS)?

A sudden and progressive form of acute respiratory failure

Which statement describes acute respiratory failure (ARF)?

ARF is not a disease but is a symptom that reflects insufficient lung function.

Which complication of positive end expiratory pressure (PEEP) might occur in a patient with acute respiratory distress syndrome (ARDS)? Select all that apply. One, some, or all responses may be correct.

Added intrathoracic and intrapulmonic pressures remain in the lungs Compromised venous return Decreased amount of blood returning to both the right and left sides of the heart Reductions in preload, CO, and BP Barotrauma and volutrauma

Which complication is associated with hematological changes in acute respiratory distress syndrome (ARDS)? Select all that apply. One, some, or all responses may be correct.

Anemia Disseminated intravascular coagulation Thrombocytopenia Venous thromboembolism (VTE)

Which intervention would the nurse expect to perform when preparing a cystic fibrosis patient for postural drainage? Select all that apply. One, some, or all responses may be correct.

Anticipate administering aerosolized bronchodilators. Schedule the procedure at least 1 hour before meals or 3 hours after meals. Insert an IV for hydration therapy. Prepare the patient for a chest x-ray.

Which action by a new nurse performing open suction technique would require the precepting nurse to intervene?

Applies clean gloves to suction the tracheostomy.

Which item is essential to have at the bedside of the mechanically ventilated patient in case of power failure?

Bag-valve-mask (BVM)

Which complication is associated with a tracheostomy procedure?

Bleeding

Which step would the nurse take after assessing a patient an hour after chest tube insertion who has 250 mL of sanguineous drainage in the chest drainage unit?

Call the HCP to report the drainage of 350 mL.

Which factor is associated with the care of patients with lower than normal tidal volumes in acute respiratory distress syndrome (ARDS)? Select all that apply. One, some, or all responses may be correct.

Can cause permissive hypercapnia Tolerated if gradual, allowing the brain and systemic circulation to compensate Frequent arterial blood gas (ABG) samples needed Will require continuous IV analgesia and sedation

Which statement describes the outcome of hypoxemia that leads to anaerobic metabolism?

Cell function continues but uses more fuel and produces less energy.

Which action would the nurse take when the ventilator alarm indicates high pressure limit?

Check the ventilator tubing for kinks.

Which intervention is the most important following a tracheostomy procedure?

Checking the patient's oxygen saturation

Which respiratory illness is a likely cause of acute respiratory failure (ARF)? Select all that apply. One, some, or all responses may be correct.

Chronic bronchitis Emphysema Pulmonary edema Asthma

Which action would the nurse expect to perform during tracheostomy care for the patient with a non-disposable inner cannula?

Cleanse the non-disposable inner cannula.

Which complication is associated with immobility in the mechanically ventilated patient?

Contractures

Match the O2 device with its description.

Delivers low O2 of 24%-44%; allows patient to eat or talk while wearing it - Nasal cannula Delivers 60%-90% O2 with high flow rates of 10-15L/min - Non-rebreather Covers nose and mouth delivering O2 concentrations of 35%-50% at 6-12 L/min - Simple face mask Delivers O2 concentration up to 100% at a flow rate of up to 60 L/min - High flow N/C

Which characteristic applies to indirect lung injury leading to acute respiratory distress syndrome (ARDS)?

Develops due to a problem somewhere else in the body

Which pharmacological intervention might the nurse anticipate for a patient to relieve pulmonary congestion and infection?

Diuretics

Which sign exhibited by the patient following decannulation would the nurse report immediately to the health care provider?

Dyspnea

Which action would help decrease the risk for acute respiratory failure (ARF)?

Encouraging hydration and nutrition

Which procedure would the nurse prepare for when caring for a patient who has been stabbed in the chest?

Exploratory thoracotomy

Which monitoring parameter is required for patients requiring mechanical ventilation for acute respiratory distress syndrome (ARDS)? Select all that apply. One, some, or all responses may be correct.

Heart rate BP SpO2 EtCO2

Which respiratory physiological change is present in the gerontological patient? Select all that apply. One, some, or all responses may be correct.

Higher PaCO2 Alveolar dilation Larger air spaces

Which statement describes the risk of administering high levels of oxygen to a COPD patient who is noted to have a high tolerance for high CO2 levels?

Hypoxemia becomes the patient's drive to breathe, and oxygen can reduce this drive.

Which classic sign indicates diffusion impairment?

Hypoxemia that worsens with exercise but not at rest

Which intervention would the nurse expect the HCP to order when managing decreased cardiac output in patients with acute respiratory distress syndrome (ARDS)?

IV fluids

Which statement summarizes nutritional therapy in patients with acute respiratory distress (ARF)?

Increased calories are needed to maintain a stable body weight and muscle mass.

Which variable is the primary cause of pulmonary edema in a patient with acute respiratory distress syndrome (ARDS)?

Increasing pulmonary capillary permeability

Which term describes a phase of acute respiratory distress syndrome (ARDS)? Select all that apply. One, some, or all responses may be correct.

Injury Reparative Fibrotic

Which action would be included in the patient teaching for "huff" coughing? Select all that apply. One, some, or all responses may be correct.

Instruct the patient that huff coughing prevents the glottis from closing. Instruct the patient to hold their breath for 2 or 3 seconds. Explain that the patient should cough several times saying the word "huff." Instruct the patient to forcefully exhale.

Which finding would the nurse expect when assessing the water seal chamber of a chest tube that was placed 5 hours ago in a patient to evacuate a pneumothorax?

Intermittent bubbling during exhalation, coughing, or sneezing

Which treatment option would the nurse expect the provider to order for a patient who just had a pneumonectomy and is concerned about pain? Select all that apply. One, some, or all responses may be correct.

Intravenous opioids Patient-controlled analgesia Oral narcotics

Which characteristic of continuous renal replacement therapy (CRRT) makes it desirable in patients with hemodynamic instability with acute respiratory distress syndrome?

It is a slow and gentle shift in fluid volume.

Which benefit is associated with pressure-control ventilation for patients with acute respiratory distress syndrome (ARDS)?

Keeps the inspiratory and plateau pressures from becoming too high.

Which change in PaO2 and PaCO2 can occur in acute respiratory failure (ARF)? Select all that apply. One, some, or all responses may be correct

Low PaO2 levels may exist despite supplemental oxygen. Hypercapnic respiratory failure usually demonstrates PaCO2 greater than 50 mm Hg. Changes in PaO2 and PaCO2 will result in the need for immediate intervention.

Which goal would the nurse include for a patient with acute respiratory failure (ARF)? Select all that apply. One, some, or all responses may be correct.

Maintain a patent airway Absence of dyspnea or recovery to baseline breathing patterns Maintain normal arterial blood gases (ABGs) Return to baseline breath sounds

Which clinical manifestation is an early indication of acute respiratory failure?

Mental status change

Which level of acute respiratory distress syndrome (ARDS) requires ICU care?

Moderate

Which statement reflects the expectation of recovery from acute respiratory distress syndrome (ARDS)?

Most patients will recover from ARDS within a year.

Which weaning parameter would tell the nurse if the patient has enough muscle strength to breathe without assistance?

Negative inspiratory force

Which inotropic medication might be utilized for a patient with acute respiratory distress syndrome (ARDS)? Select all that apply. One, some, or all responses may be correct.

Norepinephrine Vasopressin Dopamine Dobutamine

Which mechanism helps BiPAP improve ventilation?

Opening collapsed airways

Match each degree of acute respiratory distress syndrome (ARDS) to the expected P/F ratio.

P/F ratio < 300 with PEEP or CPAP > 5 cm H2O - Mild P/F ratio < 200 with PEEP or CPAP > 5 cm H2O - Moderate P/F ratio < 100 with PEEP or CPAP > 5 cm H2O - Severe

Which arterial blood gas (ABG) finding is expected in early acute respiratory distress syndrome (ARDS)? Select all that apply. One, some, or all responses may be correct.

PaO2 of 68 mm Hg pH of 7.48 HCO3 of 20 mEq/L

Which statement describes the impact of pain in ventilation and perfusion? Select all that apply. One, some, or all responses may be correct.

Pain interferes with chest and abdominal wall movement. Pain decreases O2 demand. Pain increases muscle tension. Pain activates the stress response.

Which task would the licensed nurse to delegate to the unlicensed assistive personnel (UAP) caring for the mechanically ventilated patient?

Performing oral care

Which clinical data is most indicative of ventilator-associated pneumonia (VAP)?

Positive bacterial sputum culture

Which physiologic change can occur from barotrauma accompanying mechanical ventilation in patients with acute respiratory distress syndrome? Select all that apply. One, some, or all responses may be correct.

Pulmonary interstitial emphysema Pneumothorax Subcutaneous emphysema Pneumopericardium

Match each medication or medication class to its action.

Reduce pain, anxiety, restlessness - Morphine Relieve bronchospasm - Albuterol Reduce pulmonary congestion - Corticosteroids Reduce airway inflammation - Antibiotics

Which intervention would the nurse perform for the patient experiencing signs of respiratory distress resulting from a capped tracheostomy with cuff deflation? Select all that apply. One, some, or all responses may be correct.

Remove the cap from the tube. Reinflate the cuff of the tracheostomy tube.

Which sign or symptom is associated with a decrease in lung compliance? Select all that apply. One, some, or all responses may be correct

Respiratory distress Profound dyspnea Hypoxemia Increased work of breathing

Which diagnostic test is used to identify acute respiratory failure (ARF)? Select all that apply. One, some, or all responses may be correct.

Serum blood cultures Arterial blood gases (ABGs) ECG Complete blood count

Which parameter is assessed when preparing to extubate a patient? Select all that apply. One, some, or all responses may be correct.

Spontaneous tidal volume Ability to cough Minimal secretions

What action would the nurse take first when the tracheostomy tube becomes dislodged?

Spread the opening of the stoma.

Which position would likely reduce the risk of aspiration in the ventilated patient with an endotracheal tube (ET)?

Supine with head of bed at 30 degrees

Which complication would the nurse suspect in a patient with a Heimlich valve that is complaining of chest pain, difficulty breathing, and heart palpitations?

Tension pneumothorax

Which statement reflects the body's reaction to elevated PaCO2?

The body can tolerate increased PaCO2 levels better than low PaO2 levels.

Which problem would the nurse suspect when observing increased bubbling in the water seal chamber of a patient with a chest drainage system?

There is a leak in the drainage system or from the patient.

Which equipment would the nurse need to prepare for a chest tube insertion? Select all that apply. One, some, or all responses may be correct.

Thoracotomy tray Bottle of sterile water Suction tubing and canister Occlusive dressing Disposable chest drainage unit (CDU)

Which statement describes the purpose for using a high flow oxygen delivery method?

To allow maximization of O2 delivery

Which statement reflects the primary purpose of the physical assessment and health history in patients with acute respiratory failure (ARF)?

To identify the severity of the condition

Which condition is a contraindication to chest physiotherapy? Select all that apply. One, some, or all responses may be correct.

Traumatic brain injury (TBI) Unstable spinal fractures Recent hemoptysis

Which manifestation is associated with increased work of breathing (WOB)? Select all that apply. One, some, or all responses may be correct.

Tripod position Inability to speak Pursed lip breathing Absent or decreased breath sounds

Which oxygen device would the nurse choose to administer 35% O2 to a patient with COPD?

Venturi mask