15- Acute Resp. Failure

A patient at high risk for pulmonary embolism is receiving enoxaparin. The nurse should provide the patient with what explanation?

✓ "This injection is being given to prevent blood clots from forming."

What is the most common cause of a pulmonary embolus?

✓ A deep vein thrombosis from lower extremities.

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to form of damage?

✓ Alveolar-capillary membrane

Intrapulmonary shunting refers to what outcome?

✓ Blood that is shunted from the right side of the heart to the left without oxygenation. (Shunting refers to blood that is not oxygenated in the lungs.)

The patient diagnosed with acute respiratory distress syndrome (ARDS) would exhibit which symptom?

✓ Decreasing PaO2 levels despite increased FiO2 administration

When fluid is present in the alveoli what is the result?

✓ Diffusion of oxygen and carbon dioxide is impaired.

The nurse caring for a mechanically ventilated patient prepares to include which strategies to prevent ventilator-associated pneumonia should be in the patient's plan of care? (Select all that apply.) "3"

✓ Drain condensate from the ventilator tubing away from the patient. ✓ Elevate the head of the bed 30 to 45 degrees. ✓ Perform regular oral care with chlorhexidine.

What strategies are appropriate for preventing deep vein thrombosis (DVT) and pulmonary embolus (PE) in an at-risk patient? (Select all that apply.) "3"

✓ Graduated compression stockings ✓ Heparin or low-molecular weight heparin ✓ Sequential compression devices

What diagnostic procedure is required to make a definitive diagnosis of pulmonary embolism?

✓ High resolution multi-detector CT angiogram *(MDCTA) also called spiral CT

The nurse assesses a patient who is admitted for an overdose of sedatives. The nurse expects to find which acid-base alteration?

✓ Hypoventilation and respiratory acidosis

Which statement is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP)? SATA "3"

✓ Implementing a comprehensive oral care program is an intervention for preventing VAP. ✓ Oral care protocols should include oral suctioning and brushing teeth. ✓ Protocols that include chlorhexidine gluconate have been effective in preventing VAP.

Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of acute respiratory distress syndrome (ARDS)? (Select all that apply.) "4"

✓ Increase functional residual capacity ✓ Prevent collapse of unstable alveoli ✓ Improve arterial oxygenation ✓ Open collapsed alveoli

What is a strategy for preventing thromboembolism in patients at risk who cannot take anticoagulants?

✓ Insertion of a vena cava filter.

Which of the following are components of the Institute for Healthcare Improvement's (IHI's) ventilator bundle? (Select all that apply.) "4"

✓ Interrupt sedation each day to assess readiness to extubate. ✓ Maintain head of bed at least 30 degrees elevation. ✓ Provide deep vein thrombosis prophylaxis. ✓ Provide prophylaxis for peptic ulcer disease.

During rounds, the primary care provider (PCP) alerts the team that proning is being considered for a patient with acute respiratory distress syndrome. The nurse should have what understanding about the benefit of proning?

✓ It is an optional treatment if the PaO2/FiO2 ratio is less than 100.

The nurse is caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome. The nurse understands that the priority nursing concern for this patient is which of the following?

✓ Management and protection of the airway

The nurse is concerned that a patient is at increased risk of developing a pulmonary embolus and develops a plan of care for prevention to include which intervention?

✓ Mobility

The nurse is caring for a patient with acute respiratory distress syndrome who is hypoxemic despite mechanical ventilation. The primary care provider (PCP) orders 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 PCP of this assessment and anticipates what order?

✓ Neuromuscular blockade

A patient presents to the emergency department in acute respiratory failure secondary to community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease. The nurse anticipates which treatment to facilitate ventilation?

✓ Noninvasive positive-pressure ventilation (NPPV)

The nurse is caring for a patient in acute respiratory failure and understands that the patient should be positioned (Select all that apply.) "3"

✓ high Fowler's. ✓ side lying with head of bed elevated. ✓ sitting in a chair.