Sole - Chapter 15: Acute Respiratory Failure

During rounds, the provider alerts the team that proning is being considered for a patient with acute respiratory distress syndrome. The nurse understands that proning is A. An optional treatment to improve ventilation. B. Less of a risk for skin breakdown because the patient is face down. C. Possible with minimal help from coworkers. D. Used to provide continuous lateral rotational turning.

A

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to damage to the A. Alveolar-capillary membrane. B. Left ventricle. C. Mainstem bronchus. D. Trachea.

A

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

The patient with acute respiratory distress syndrome (ARDS) would exhibit which of the following symptoms? 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

Identify diagnostic criteria for ARDS. (Select all that apply.) A. Bilateral infiltrates on chest x-ray study B. Decreased cardiac output C. PaO2/ FiO2 ratio of less than 200 D. Pulmonary artery occlusion pressure (PAOP) of more than 18 mm Hg E. PAOP less than 18 mm Hg

A, C

The nurse is caring for a patient in acute respiratory failure and understands that the patient should be positioned (Select all that apply.) A. High Fowler's. B. Side lying with head of bed elevated. C. Sitting in a chair. D. Supine with the bed flat. E. Trendelenburg.

A, B, C

Which of the following are components of the Institute for Healthcare Improvement's (IHI's) 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 of 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, B, C, D

Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of ARDS? (Select all that apply.) A. Increases functional residual capacity B. Prevents collapse of unstable alveoli C. Improves arterial oxygenation D. Opens collapsed alveoli E. Improves carbon dioxide retention

A, B, C, D

The nurse is caring for a mechanically ventilated patient. The nurse understands that strategies to prevent ventilator-associated pneumonia include which of the following? (Select all that apply.) A. Drain condensate from the ventilator tubing away from the patient. B. Elevate the head of the bed 30 to 45 degrees. C. Instill normal saline as part of the suctioning procedure. D. Perform regular oral care with chlorhexidine. E. Awaken the patient daily to determine the need for continued ventilation.

A, B, D

When fluid is present in the alveoli, 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

The nurse calculates the PaO2/FiO2 ratio for the following values: PaO2 is 78 mm Hg; FiO2 is 0.6 (60%). A. 46.8; meets criteria for ARDS B. 130; meets criteria for ARDS C. 468; normal lung function D. Not enough data to compute the ratio

B

The nurse is assessing a patient with acute respiratory distress syndrome. An expected assessment is A. Cardiac output of 10 L/min and low systemic vascular resistance. B. PAOP of 10 mm Hg and PaO2 of 55. C. PAOP of 20 mm Hg and cardiac output of 3 L/min. D. PAOP of 5 mm Hg and high systemic vascular resistance.

B

The nurse is assessing a patient. Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS)? 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

Which of the following statements is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP)? (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. Using oral swabs or toothettes are just as effective as brushing the teeth.

B, C, D

Intrapulmonary shunting refers to A. Alveoli that are not perfused. B. Blood that is shunted from the left side of the heart to the right and causes heart failure. C. Blood that is shunted from the right side of the heart to the left without oxygenation. D. Shunting of blood supply to only one lung.

C

The basic underlying pathophysiology of acute respiratory distress syndrome results in A. A decrease in the number of white blood cells available. B. Damage to the right mainstem bronchus. C. Damage to the type II pneumocytes, which produce surfactant. D. Decreased capillary permeability.

C

The nurse is caring for a patient with acute respiratory distress syndrome who is hypoxemic despite mechanical ventilation. The provider prescribes a nontraditional ventilator mode as part of treatment. Despite sedation and analgesia, the patient remains restless and appears to be in discomfort. The nurse informs the provider of this assessment and anticipates an order for A. Continuous lateral rotation therapy. B. Guided imagery. C. Neuromuscular blockade. D. Prone positioning.

C

In assessing a patient, the nurse understands that an early sign of hypoxemia is A. Clubbing of nail beds. B. Cyanosis. C. Hypotension. D. Restlessness.

D

The nurse is caring for a patient with acute respiratory failure and identifies "Risk for Ineffective Airway Clearance" as a nursing diagnosis. A nursing intervention relevant to this diagnosis is to A. Elevate the head of the bed to 30 degrees. B. Obtain an order for venous thromboembolism prophylaxis. C. Provide adequate sedation. D. Reposition the patient every 2 hours.

D