Exam 2: ARDS/RF (NCLEX)

The client diagnosed with ARDS is on a ventilator and the high alarm indicates an increase in the peak airway pressure. Which intervention should the nurse implement first? 1. Check the tubing for any kinks 2. Suction the airway for secretion 3. Assess the lip line of the ET tube 4. Sedate the client with a muscle relaxant

1

The health-care provider ordered STAT arterial blood gases for the client diagnosed with ARDS. The ABG results are: pH 7.38, PaO2 92, PaCO2 38, HCO3 24. Which action should the nurse implement? 1. Continue to monitor the client without taking any action 2. Encourage the client to take deep breaths and cough 3. Administer one ampule of sodium bicarbonate IVP 4. Notify the respiratory therapist of the results

1

The nurse suspects the client may be developing ARDS. Which assessment data confirm the diagnosis of ARDS? 1. Low arterial oxygen when administering high concentration of oxygen 2. The client has dyspnea and tachycardia and feels anxious 3. Bilateral breath sounds clear and pulse oximeter reading is 95% 4. The client has JVD and frothy sputum

1

The nurse is caring for a client diagnosed with ARDS. Which interventions should the nurse implement? Select All that Apply 1. Assess the client's level of consciousness 2. Monitor urine output every shift 3. Turn the client every 2 hours 4. Maintain intravenous fluids as ordered 5. Place the client in the Fowler's position

1345

The client diagnosed with ARDS is in respiratory distress and the ventilator is malfunctioning. Which intervention should the nurse implement first? 1. Notify the respiratory therapist immediately 2. Ventilate with a manual resuscitation bag 3. Request STAT ABGs 4. Auscultate the client's lung sounds

2

Which medication should the nurse anticipate the health-care provider ordering for the client diagnosed with ARDS? 1. An aminoglycoside antibiotic 2. A synthetic surfactant 3. A potassium cation 4. A nonsteroidal anti-inflammatory drug

2 Surfactant therapy may be prescribed to reduce the surface tension in the aveoli. The surfactant helps maintain open alveoli, decreases the work of breathing, improves compliance, and helps prevent atelectasis.

A nurse who is participating in a client care conference with other members of the health care team is discussing the condition of a client with acute respiratory distress syndrome (ARDS). The health care provider states that as a result of fluid in the alveoli, surfactant production is falling. The nurse understands that which is the natural consequence of insufficient surfactant? 1.Atelectasis and viral infection 2.Bronchoconstriction and stridor 3.Collapse of alveoli and decreased compliance 4.Decreased ciliary action and retained secretions

3

Which assessment data indicate to the nurse the client diagnosed with ARDS has experienced a complication secondary to the ventilator? 1. The client's urine output is 100 mL in four hours 2. The pulse oximeter reading is greater than 95% 3. The client has asymetrical chest expansion 4. THe telemetry reading shows sinus tachycardia

3

The client with ARDS is on a mechanical ventilator. Which intervention should be included in the nursing care plan addressing the endotracheal tube care? 1. Do not move or touch the ET tube 2. Obtain a chest x-ray daily 3. Determine if the ET cuff is deflated 4. Ensure that the ET tube is secured

4

The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress syndrome? 1.Bilateral wheezing 2.Inspiratory crackles 3.Intercostal retractions 4.Increased respiratory rate

4

A patient has ARDS resulting from sepsis. Which measure is most likely to be implemented to maintain cardiac output? A. Administer crystalloid fluids or colloid solutions. B. Position the patient in the Trendelenburg position. C. Perform chest physiotherapy and assist with staged coughing. D. Place the patient on fluid restriction, and administer diuretics.

A

What are the most common early clinical manifestations of ARDS? A. Dyspnea and tachypnea B. Cyanosis and apprehension C. Hypotension and tachycardia D. Respiratory distress and frothy sputum

A

What pathophysiologic condition can result in ARDS? A. Damage to the alveolar-capillary membrane B. Copious exudates production C. Airway spasms and vasoconstriction D. Change in the inspiratory-to-expiratory ratio

A

A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a pneumothorax. Which action will the nurse anticipate taking? a. Lower the positive end-expiratory pressure (PEEP). b. Increase the fraction of inspired oxygen (FIO2). c. Suction more frequently. d. Increase the tidal volume.

A Because barotrauma is associated with high airway pressures, the level of PEEP should be decreased. The other actions will not decrease the risk for pneumothorax.

A 26-year-old patient is admitted to the hospital in severe respiratory distress. His oxygen saturations are 80% despite supplemental oxygen provided by facemask. The physician decides to intubate the patient to help with his breathing oxygenation. Which medication would the nurse most likely administer when assisting with intubation? a. Midazolam (Versed) b. Zolpidem (Ambien) c. Phentermine (Adipex-P) d. Modafinil (Provigil)

A Intubation is most often performed by inserting a tube into the mouth and passing it into the trachea in order to provide help and support for a patients breathing. Most registered nurses do not perform endotracheal intubation, but they may assist the physician with placing the tube. The nurse may give medications to sedate the patient during the procedure, since it can be traumatic for the patient. Some medications given for sedation include midazolam, fentanyl, and etomidate

A client is diagnosed with acute respiratory distress syndrome​ (ARDS). The​ client's spouse asks the nurse what caused ARDS. Which etiology of indirect injury to the lungs should the nurse include in the​ response? (Select all that​ apply.) A. Multiple blood transfusions B. Systemic sepsis C. Fat embolism D. Pancreatitis E. Smoke inhalation

ABD

The nurse is assessing an older adult client with acute respiratory distress syndrome​ (ARDS). Which assessment finding indicates an early sign of hypoxemia for this​ client?(Select all that​ apply.) A. Agitation B. Confusion C. Tachypnea D. Dyspnea E. Anxiety

ABE

The nurse is caring for a client with suspected acute respiratory distress syndrome​ (ARDS). Which symptom of ARDS should the nurse anticipate will appear within 24 to 48 hours after the initial​ insult?(Select all that​ apply.) A. Shortness of breath B. Rapid breathing C. Arterial blood gases varying from normal limits D. Fluid imbalance E. Chest​ x-ray clear of infiltrates

ABE

A nurse must position the patient prone after his diagnosis of acute respiratory distress syndrome (ARDS). Which of the following is a benefit of using this position? Select all that apply. A. Decreased atelectasis B. Reduced need for endotracheal intubation C. Mobilization of secretions D. Decreased fluid accumulation E. Increased response to corticosteroid therapy

ACD Prone positioning, or placing the patient face down with the head turned to the side, helps with pulmonary function in the patient diagnosed with ARDS. Studies have shown that patients who are positioned prone and who have respiratory conditions often have improved outcomes of decreased lung atelectasis, mobilization of secretions to enhance suctioning, and decreased fluid accumulation in the lung tissue.

Which of the following are the 5 characteristics of ARDS? A. Dyspnea B. Myasthenia Gravis C. Refractory hypoxemia D. Cyanosis E. Dense pulmonary infiltrates on CXR F. Decreased pulmonary compliance G. Non-cardiac pulmonary edema H. Chest pain

ACEFG

A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure). Which finding below indicates the patient is developing a complication related to their therapy and requires immediate treatment? A. HCO3 26 mmHg B. Blood pressure 70/45 C. PaO2 80 mmHg D. PaCO2 38 mmHg

B

Acute Respiratory Distress Syndrome (ARDS) can be defined as _____________________________. A. Sudden life-threatening deterioration of gas exchange in the lungs B. Non-cardiac pulmonary edema with increasing hypoxemia despite treatment with O2 C. Sudden life-threatening pulmonary edema that causes a deterioration of gas exchange despite treatment with O2

B

During assessment of a client with acute respiratory distress syndrome​ (ARDS), the nurse notes an oxygen saturation of​ 78% and a respiratory rate of 28​ breaths/min. The nurse notifies the healthcare provider and should prepare for intubation using which type of​ airway? A. Oropharyngeal airway B. Endotracheal tube C. Tracheostomy D. Nasopharyngeal airway

B

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

B

Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) can the RN delegate to an experienced LPN/LVN working in the intensive care unit? a. Assess breath sounds b. Insert a retention catheter c. Place patient in the prone position d. Monitor pulmonary artery pressures

B

A patient with acute respiratory distress syndrome (ARDS) and acute renal failure has the following medications prescribed. Which medication should the nurse discuss with the health care provider before administration? a. ranitidine (Zantac) 50 mg IV b. gentamicin (Garamycin) 60 mg IV c. sucralfate (Carafate) 1 g per nasogastric tubed. d. methylprednisolone (Solu-Medrol) 40 mg IV

B Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other medications are appropriate for the patient with ARDS.

What distinguishes hypercapnic respiratory failure from hypoxemic respiratory failure? A. Low oxygen saturation despite administration of supplemental oxygen B. Acidemia for which the body cannot compensate C. Respiration rate greater than 30 breaths/minute D. Heart rate increases above 100 beats/minute

B Hypercapnic respiratory failure is PaCO2 greater than 48 mm Hg in combination with acidemia. The body cannot compensate for the acidemia. Hypoxemic respiratory failure is a PaO2 less than 60 mm Hg despite receiving an inspired oxygen concentration greater than or equal to 60%. The respiratory rate and heart rate are not part of the definitions of these two conditions.

The nurse knows that which of the following conditions would most likely contribute to the development of ARDS? A) Simple Pneumothorax B) Right Lobular Pulmonary Contusion C) Cardiac Tamponade D) Subcutaneous Emphysema

B Pulmonary contusion causes fluid build-up to occur in the lungs which can in-turn impair gas exchange and and prevent oxygen and CO2 exchange. This fluid build-up can contribute to the development of ARDS (Acute Respiratory Distress Syndrome). This is the MOST likely to contribute this disorder.

A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. The nurse will anticipate assisting with a. administration of 100% oxygen by non-rebreather mask. b. endotracheal intubation and positive pressure ventilation. c. insertion of a mini-tracheostomy with frequent suctioning. d. initiation of bilevel positive pressure ventilation (BiPAP).

B The patient's lethargy, low respiratory rate, and SpO2 indicate the need for mechanical ventilation with ventilator-controlled respiratory rate. Administration of high flow oxygen will not be helpful because the patient's respiratory rate is so low. Insertion of a mini-tracheostomy will facilitate removal of secretions, but it will not improve the patient's respiratory rate or oxygenation. BiPAP requires that the patient initiate an adequate respiratory rate to allow adequate gas exchange.

The nurse is planning care for a client with acute respiratory distress syndrome​ (ARDS). Which independent nursing intervention should the nurse include in the care of this​ client?(Select all that​ apply.) A. Prescribe surfactant therapy. B. Suction the airway as needed. C. Obtain a sputum culture. D. Maintain the head of the bed at less than 30 degrees. E. Position the client in a prone position for 60 minutes five times a day.

BC

Maintenance of fluid balance in the patient with ARDS involves A. hydration using colloids. B. administration of surfactant. C. mild fluid restriction and diuretics as necessary. D. keeping the hemoglobin level greater than 12 g/dL (120 g/L).

C

The nurse is caring for a client who had an episode of​ near-drowning 5 days ago. This​ morning, the nurse noted rhonchi in the lower lung lobes on auscultation. Which action by the nurse is best​? A. Monitoring vital signs and oxygen saturation every 2 hours B. Documenting the findings as normal C. Notifying the healthcare provider D. Preparing for intubation

C

Which is part of the nursing management for ARDS? A. Aggressive use of intravenous (IV) fluids B. Administration of a β-blocker C. Use of positive end-expiratory pressure (PEEP) D. Use of the lateral recumbent position

C

A client is brought into the emergency department after aspirating on pureed foods at the​ long-term care facility. The nurse knows that which physiologic change can trigger acute respiratory distress​ syndrome? A. Intracellular edema B. Increased surfactant production C. Destruction of extracellular platelets D. Release of chemical mediators

D

A patient is experiencing respiratory failure due to pulmonary edema. The physician suspects ARDS but wants to rule out a cardiac cause. A pulmonary artery wedge pressure is obtained. As the nurse you know that what measurement reading obtained indicates that this type of respiratory failure is NOT cardiac related? A. >25 mmHg B. <10 mmHg C. >50 mmHg D. <18 mmHg

D

The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress sysndrome? a. Bilateral wheezing b. Inspiratory crackles c. Intercostal retractions d. Increased respiratory rate

D

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is correct? a. "PEEP will prevent fibrosis of the lung from occurring." b. "PEEP will push more air into the lungs during inhalation." c. "PEEP allows the ventilator to deliver 100% oxygen to the lungs." d. "PEEP prevents the lung air sacs from collapsing during exhalation."

D By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation. PEEP will not prevent the fibrotic changes that occur with ARDS, push more air into the lungs, or change the fraction of inspired oxygen (FIO2) delivered to the patient.

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)? A. The patient is experiencing bradypnea. B. The patient is tired and confused. C. The patient's PaO2 remains at 45 mmHg. D. The patient's blood pressure is 180/96.

C

Which instruction is priority for the nurse to discuss with the client diagnosed with ARDS who is being discharged from the hospital? 1. Avoid smoking and exposure to smoke 2. Do not receive flu or pneumonia vaccines 3. Avoid any type of alcohol intake 4. It will take about one month to recuperate

1

The nurse is developing a plan of care for a client at risk for acute respiratory distress syndrome (ARDS). As part of the plan, the nurse will check for which item to detect an early sign of this disorder? 1.Edema 2.Dyspnea 3.Frothy sputum 4.Diminished breath sounds

2

The client diagnosed with ARDS is transferred to the intensive care department and placed on a ventilator. Which intervention should the nurse implement first? 1. Confirm that they ventilator settings are correct 2. Verify that the ventilator alarms are functioning properly 3. Assess the respiratory status and pulse oximeter reading. 4. Monitor the client's arterial blood gas results

3

The client who smokes two packs of cigarettes a day develops ARDS after a near-drowning. The client asks the nurse, "What is happening to me? Why did I get this?" Which statement by the nurse is most appropriate? 1. Most people who almost drown end up developing ARDS 2. Platelets and fluid enter the alveoli due to permeability instability. 3. Your lungs are filling up with fluid, causing breathing problems 4. Smoking has caused your lungs to become weakened, so you got ARDS

3

A patient with a severe acute asthma exacerbation presents to the emergency department. Over the next hour, the patient remains in respiratory distress, but the respirations have slowed. What is the best explanation? A. The patient is developing respiratory muscle fatigue. B. The respirations are exchanging oxygen and carbon dioxide more efficiently. C. The patient's anxiety level is lessening. D. The body has compensated by retaining sodium bicarbonate.

A

A pediatric client is not responding to treatment for acute respiratory distress syndrome​ (ARDS) and requires intubation. The mother is anxious that the procedure will hurt. Which is the best response by the​ nurse? A. "We will administer medication to help him sleep through the intubation and as needed while he is on the​ ventilator." B. ​"He may feel a little​ nervous, but he will get used to the ventilator soon​ enough." C. "He will actually feel better and may even like the ventilator because he will be able to breathe more​ comfortably." D. "Don't worry; intubation and using a ventilator​ doesn't hurt at​ all."

A

Which is a classic finding for a patient with ARDS? A. Hypoxemia despite increased oxygen administration B. Bronchodilators ordered to relieve airway spasms C. Development of Kussmaul respirations D. Development of Cheyne-Stokes respirations

A

A male client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A. Kinking of the ventilator tubing B. disconnected ventilator tube C. An ET cuff leak D. A change in the oxygen concentration without resetting the oxygen level alarm

A Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm or pulmonary embolus, mucus plugging, water in the tube, coughing or biting on the ET tube, and the client's being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm.

When admitting a patient in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the nurse? a. The patient is somnolent. b. The patient's SpO2 is 90%. c. The patient complains of weakness. d. The patient's blood pressure is 162/94.

A Increasing somnolence will decrease the patient's respiratory rate and further increase the PaCO2 and respiratory failure. Rapid action is needed to prevent respiratory arrest. An SpO2 of 90%, weakness, and elevated blood pressure all require ongoing monitoring but are not indicators of possible impending respiratory arrest.

A patient develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with a. inserting a pulmonary artery catheter. b. obtaining a ventilation-perfusion scan. c. drawing blood for arterial blood gases. d. positioning the patient for a chest radiograph.

A Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will not help in differentiating cardiogenic from noncardiogenic pulmonary edema.

A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. Which of the following conditions has he most likely developed? A. Acute respiratory distress syndrome (ARDS). B. Atelectasis. C. Bronchitis. D. Pneumonia

A Severe hypoxia after smoke inhalation typically is related to ARDS. The other choices aren't typically associated with smoke inhalation.

When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective? a. The patient's PaO2 is 90 mm Hg, and the SaO2 is 92%. b. Endotracheal suctioning results in minimal mucous return. c. Sputum and blood cultures show no growth after 24 hours. d. The skin on the patient's back is intact and without redness.

A The purpose of prone positioning is to improve the patient's oxygenation as indicated by the PaO2 and SaO2. The other information will be collected but does not indicate whether prone positioning has been effective.

Which assessment finding by the nurse when caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased? a. The patient has subcutaneous emphysema. b. The patient has a sinus bradycardia with a rate of 52. c. The patient's PaO2 is 50 mm Hg and the SaO2 is 88%. d. The patient has bronchial breath sounds in both the lung fields.

A The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not indications that PEEP should be reduced.

A patient who has recovered from ARDS in the ICU is now malnourished and has lost a significant amount of weight. The physician orders TPN to add nutrition for the patient, who subsequently develops re-feeding syndrome. Which of the following signs or symptoms would the nurse expect to see with re-feeding syndrome? Select all that apply. a. Impaired mental status b. Insulin resistance c. Seizures d. Persistent weight loss e.Constipation

ABC Re-feeding syndrome occurs as the body's response when a person is fed or given nutrients after a period of starvation. When a patient is extremely malnourished and then receives TPN with its significant nutrient formulation, the body has to adjust to receiving nutrients again, which causes shifts in electrolytes in the body. As a result, the patient may experience significant complications associated with electrolyte imbalance as the body responds to the increased nutrient intake. The patient may suffer from confusion and impaired mental status, insulin resistance, seizures, and paralysis.

Which signs and symptoms differentiate hypoxemic respiratory failure from hypercapnic respiratory failure (select all that apply)? A. Cyanosis B. Tachypnea C. Morning headache D. Paradoxic breathing E. Pursed-lip breathing

ABD Clinical manifestations that occur with hypoxemic respiratory failure include cyanosis, tachypnea, and paradoxic chest or abdominal wall movement with the respiratory cycle. Clinical manifestations of hypercapnic respiratory failure include morning headache, pursed-lip breathing, and decreased or increase respiratory rate with shallow breathing.

Which patient below is at MOST risk for developing ARDS and has the worst prognosis? A. A 52-year-old male patient with a pneumothorax. B. A 48-year-old male being treated for diabetic ketoacidosis. C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection. D. A 30-year-old female with cystic fibrosis.

C

The high-pressure alarm on a patient's ventilator goes off. When the nurse enters the room to assess the patient, who has acute respiratory distress syndrome (ARDS), the oxygen saturation monitor reads 87% and the patient is struggling to sit up. Which action should the nurse take first? A.) Reassure the patient that the ventilator will do the work of breathing for him. B.) Manually ventilate the patient while assessing possible reasons for the high-pressure alarm. C.) Increase the fraction of inspired oxygen (Fio2) on the ventilator to 100% in preparation for endotracheal suctioning. D.) Insert an oral airway to prevent the patient from biting on the endotracheal tube.

B

The high-pressure alarm on a patient's ventilator goes off. When the nurse enters the room to assess the patient, who has acute respiratory distress syndrome (ARDS), the oxygen saturation monitor reads 87% and the patient is struggling to sit up. Which action should the nurse take first? a. Reassure the patient that the ventilator will do the work of breathing for him. b. Manually ventilate the patient while assessing possible reasons for the high-pressure alarm. c. Increase the fraction of inspired oxygen (Fio2) on the ventilator to 100% in preparation for endotracheal suctioning. d. Insert an oral airway to prevent the patient from biting on the endotracheal tube.

B

Which is a proper nursing action for a patient in acute respiratory failure? A. Administer 100% oxygen to an intubated patient until the pathology has resolved. B. Provide chest physical therapy for patients who produce more than 30 mL of sputum per day. C. Use continuous positive airway pressure (CPAP) if the patient has weak or absent respirations. D. Administer packed red blood cells to maintain the hemoglobin level at 7 g/dL or higher.

B

Which patient is most likely going into respiratory failure? A. A patient who report that he feels short of breath while eating B. A patient with the following arterial blood gas values over the past 3 hours: pH 7.50, 7.45, and 7.40 C. A patient with an oxygen saturation value of 93% D. A patient with chronic obstructive pulmonary disease (COPD) who has distant breath sounds

B

You are caring for a patient who is admitted with a barbiturate overdose. The patient is unresponsive, with a blood pressure of 90/60 mm Hg, apical pulse of 110 beats/minute, and respiratory rate of 8 breaths/minute. Based on the initial assessment findings, you recognize that the patient is at risk for which type of respiratory failure? A. Hypoxemic respiratory failure related to shunting of blood B. Hypoxemic respiratory failure related to diffusion limitation C. Hypercapnic respiratory failure related to alveolar hypoventilation D. Hypercapnic respiratory failure related to increased airway resistance

C

A nurse is caring for a patient with ARDS. Which of the following clinical indicators would signify that this client is in respiratory failure? Select all that apply. a. Pulse oximetry of 94% on room air b. A PaO2 level below 60 mmHg c. An ABG pH level of 7.35 d. A pCO2 level over 50 mmHg e. A respiratory rate of over 16/minute

BD Respiratory diseases can cause such compromise that the patient will suffer symptoms; however, there are certain clinical indicators that can clarify whether the patient is actually in respiratory failure. Clinical indicators of respiratory failure include pulse oximetry of less than 91% on room air, PaO2 level less than 60 mmHg, and a pCO2 level of over 50 mmHg.

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

C

A pregnant woman has been diagnosed with acute respiratory distress syndrome​ (ARDS) and prescribed corticosteroids. The woman asks the nurse if it is safe to take this medication. Which is the best reply by the​ nurse? A. "That is an​ error; you​ shouldn't take corticosteroids during​ pregnancy." B. "Let's call the doctor and pharmacist to double check the safety profile of these​ drugs." C. "Corticosteroids are safe to take during pregnancy in some​ cases, and you need the​ medicine." D. ​"If the doctor prescribed the​ medication, I'm sure that​ it's fine to take​ it."

C

The nurse is caring for a patient with emphysema and respiratory failure who is receiving mechanical ventilation through an endotracheal tube. To prevent ventilator-associated pneumonia (VAP), which action is most important to include in the plan of care? A.) Administer ordered antibiotics as scheduled. B.) Hyperoxygenate the patient before suctioning. C.) Maintain the head of bed at a 30- to 45-degree angle. D.) Suction the airway when coarse crackles are audible.

C

The nursing instructor is teaching her students about the differences between ARF (Acute Respiratory Failure) and ARDS (Acute Respiratory Distress Syndrome). Which statement best describes this difference if made by the student? A) "ARF occurs in patients with chronic conditions while ARDS occurs in patients with trauma injuries" B) "They are almost the same thing except that ARDS is worse than ARF" C) "ARDS tends to occur up to a day or two after the initiating event, and unlike ARF requires mechanical ventilation to maintain oxygen status" D) "ARF is a disorder that mostly affects the breathing pattern while ARDS mostly affects the gas exchange by blocking the alveoli with fluid"

C

To evaluate the effectiveness of prescribed therapies for a patient with ventilatory failure, which diagnostic test will be most useful to the nurse? a. Chest x-rays b. Pulse oximetry c. Arterial blood gas (ABG) analysis d. Pulmonary artery pressure monitoring

C

When caring for a patient who developed acute respiratory distress syndrome (ARDS) as a result of a urinary tract infection (UTI), the nurse is asked by the patient's family how a urinary tract infection could cause lung damage. Which response by the nurse is appropriate? a. "The infection spread through the circulation from the urinary tract to the lungs." b. "The urinary tract infection produced toxins that damaged the lungs." c. "The infection caused generalized inflammation that damaged the lungs." d. "The fever associated with the infection led to scar tissue formation in the lungs."

C

Which intervention is key to preventing ventilator-associated pneumonia as a complication in a patient with acute respiratory distress syndrome (ARDS)? A. Scheduled prophylactic nasopharyngeal suctioning B. Instilling normal saline down the endotracheal tube to loosen secretions C. Providing frequent mouth care and oral hygiene D. Using high tidal volumes on the ventilator

C

A nurse is taking pulmonary artery catheter measurements of a male client with acute respiratory distress syndrome. The pulmonary capillary wedge pressure reading is 12mm Hg. The nurse interprets that this readings is: A. High and expected B. Low and unexpected C. Normal and expected D. Uncertain and unexpected

C The normal pulmonary capillary wedge pressure (PCWP) is 8 to 13 mm Hg, and the client is considered to have high readings if they exceed 18 to 20 mm Hg. The client with acute respiratory distress syndrome has a normal PCWP, which is an expected finding because the edema is in the interstitium of the lung and is noncardiac.

The nurse is providing care to a client with acute respiratory distress syndrome​ (ARDS). Which independent intervention should the nurse prepare to perform for this​ client? (Select all that​ apply.) A. Order a Foley catheter to monitor urine output. B. Prescribe analgesia for pain. C. Maintain the head of the bed at 30 degrees. D. Recommend a prone position to facilitate oxygenation. E. Auscultate heart and lung sounds.

CDE

As the nurse you know that acute respiratory distress syndrome (ARDS) can be caused by direct or indirect lung injury. Select below all the INDIRECT causes of ARDS: A. Drowning B. Aspiration C. Sepsis D. Blood transfusion E. Pneumonia F. Pancreatitis

CDF

The nurse is caring for a client with respiratory acidosis secondary to​ end-stage acute respiratory distress syndrome​ (ARDS). Which result should the nurse anticipate on the arterial blood​ gas? A. High PaO2 and high PaCO2 B. Low PaO2 and low PaCO2 C. High PaO2 and low PaCO2 D. Low PaO2 and high PaCO2

D

The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider? a. Cough that is productive of blood-tinged sputum b. Scattered crackles throughout the posterior lung bases c. Temperature of 101.5° F (38.6° C) after 2 days of IV antibiotic therapy d. Oxygen saturation (SpO2) has dropped to 90% with administration of 100% O2 by non-rebreather mask.

D

The nurse is caring for an adult who is diagnosed with acute respiratory distress syndrome​ (ARDS) after a​ near-drowning episode last week. Which type of medication should the nurse anticipate the provider ordering to help open​ alveoli? A. Corticosteroids B. Nonsteroidal​ anti-inflammatory drugs​ (NSAIDs) C. Inhaled nitric oxide D. Surfactant therapy

D

The oxygen delivery system chosen for the patient in acute respiratory failure should A. always be a low-flow device, such as a nasal cannula. B. correct the PaO2 to a normal level as quickly as possible. C. administer positive-pressure ventilation to prevent CO2 narcosis. D. maintain the PaO2 at ≥60 mm Hg at the lowest O2 concentration possible.

D

What is the classic chest x-ray finding in a patient with late-stage ARDS? A. Hyperinflation B. Infiltrates in the bases C. Deflated lung on one side D. White lung

D

Which of the following ABG values would the nurse expect to see on the patient with Acute Respiratory Failure? A) pH 7.35 B) O2 72 C) HCO3 26 D) PCO2 55

D

Which patient is having the most difficulty breathing? A. The patient who reports one-pillow orthopnea B. The patient with an inspiratory to expiratory ratio of 1:2 C. The patient who speaks a sentence before breathing D. The patient with paradoxic breathing

D

A nurse is assessing a female client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute respiratory distress syndrome? A. Bilateral wheezing B. Inspiratory Crackles C. Intercostal retractions D. Increased respiratory rate

D The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.

When assessing a 22-year-old patient who required emergency surgery and multiple transfusions 3 days ago, the nurse finds that the patient looks anxious and has labored respirations at a rate of 38 breaths/min. The oxygen saturation is 90% with the oxygen delivery at 6 L/min via nasal cannula. Which action is most appropriate? A.) Increase the flow rate on the oxygen to 10 L/min and reassess the patient after about 10 minutes. B.) Assist the patient in using the incentive spirometer and splint his chest with a pillow while he coughs. C.) Administer the ordered morphine sulfate to the patient to decrease his anxiety and reduce the hyperventilation. D.)Switch the patient to a nonrebreather mask at 95% to 100% fraction of inspired oxygen (FIO2) and call the health care provider to discuss the patient's status.

D The patient's history and symptoms suggest the development of acute respiratory distress syndrome (ARDS), which will require intubation and mechanical ventilation to maintain oxygenation and gas exchange. The HCP must be notified so that appropriate interventions can be taken. Application of a nonrebreather mask can improve oxygenation up to 95 to 100%. The maximum oxygen delivery with a nasal cannula is an Fio2 of 44%. This is achieved with the oxygen flow at 6 L/min, so increasing the flow to 10 L/min will not be helpful. Helping the patient to cough and deep breathe will not improve the lung stiffness that is causing his respiratory distress. Morphine sulfate will only decrease the respiratory drive and further contribute to his hypoxemia.