Chapter 27: Pulmonary Embolism & Acute Respiratory Distress Syndrome (Davis Edge Questions)

The nurse is caring for a patient with acute respiratory distress syndrome with a severity ration of 101 on positive end-expiratory pressure (PEEP). What category of severity is this patient? a. mild b. Moderate c. Progressive d. Severe

b. Moderate

The nurse is caring for a patient with an increased risk for developing acute respiratory distress syndrome (ARDS). Calculate the ARDS ratio if the patient's PaO2 is 70 on an FiO2 of 60%. Round to the nearest whole number. Enter numeral only.

117 70 (PaO2) / 0.6 (FiO2 %) = 117

The nurse is identifying the risk factors for a patient developing a pulmonary embolism. Which factor places the patient at the highest risk? Dehydration Immobility A deep vein thrombosis (DVT) A coagulation disorder

A deep vein thrombosis (DVT)

The nurse is caring for a hospitalized patient being treated with heparin for a pulmonary embolism. The most recent activated partial thromboplastin time (aPTT) is 3.0 times the normal value. What is the nurse's best action?

Decrease the rate of infusion

Which vital sign change should the nurse anticipate while caring for a client diagnosed with acute respiratory distress syndrome on mechanical ventilation? Decreased respiratory rate Decreased temperature Decreased heart rate Decreased blood pressure

Decreased blood pressure

Which of the following is the primary risk factor for pulmonary embolism?

Deep vein thrombosis

A patient presents to the emergency department with symptoms of a pulmonary embolism. What is the nurse's first action?

Apply oxygen.

The nurse is caring for a client diagnosed with acute respiratory distress syndrome on mechanical ventilation. As the nurse enters the client's room, the low-pressure alarm is heard. What is the nurse's best action?Assess for condensation in the ventilator tubing. Suction any secretions using closed technique. Check ventilator tubing for a leak in the system.Observe for any kinks in the ventilator tubing

Check ventilator tubing for a leak in the system.

Select the priority nursing action or finding when providing care to a client who is diagnosed with acute respiratory distress syndrome (ARDS): Infection Prevention and Control Administer Analgesics OR Catheter Care

Clients diagnosed with ARDS are at an increased risk for infection; therefore, it is important to implement interventions aimed at decreasing this risk. Foley catheter care should include inspection and cleaning of the urinary meatus due to the increased risk for iatrogenic infections such as urinary tract infection. Prescribed analgesics are administered to treat pain and not for infection prevention and control.

Diagnostic Testing for PE

Electrocardiogram (ECG) Pulmonary angiography Ventilation/perfusion scan (V/Q scan) Plasma D-dimer level INCORRECT. Diagnostic testing for PE includes imaging and laboratory studies. Diagnostic studies include an ECG, a chest CT with contrast (not without), a V/Q scan, and pulmonary angiography. Laboratory studies include arterial blood gas analysis (not venous) and a plasma D-dimer level.

A patient treated for a pulmonary embolism is being discharged from the hospital. Which patient teaching should the nurse include in the teaching plan? Select all that apply.

Exercise regimen recommended by provider Smoking cessation therapies or support group Take prescribed medication at appropriate time

The nurse is teaching a family about the reasons why someone has a pulmonary embolism. What should the nurse include with the teaching? Select all that apply. Fat Thrombus Tumor Amniotic fluid Air

FatThrombusTumorAmniotic fluidAir

The nurse suspects a patient to have a pulmonary embolism. Which of the following common signs and symptoms would support the nurse's belief? Select all that apply.

Hemoptysis Dyspnea with accessory muscle use Unilateral lower extremity edema Cough

Drug Therapy to Treat PE

Heparin drip Altapase Warfarin CORRECT. Drug therapy prescribed to treat PE includes heparin (single dose followed by a continuous infusion). Anticoagulation will continue after discharge with warfarin. Thrombolytic therapy with altaplase may be prescribed for patients who are hemodynamically unstable as thrombolysis actively reduces the clot. Protamine sulfate should be on standby to treat active bleeding; however, this is not prescribed to treat the PE itself but a complication associated with heparin therapy. Vitamin K is used to treat active bleeding for a patient who has transitioned to warfarin. Vitamin K, like protamine sulfate, is not prescribed to treat the PE but to treat complications associated with warfarin therapy.

Which assessment findings would the nurse most likely expect in a patient diagnosed with a pulmonary embolism? Select all that apply.

High ventilation/low perfusion Pulmonary hypertension Reduced left ventricular preload

The nurse is concerned that a client diagnosed with acute respiratory distress syndrome might develop multi-organ dysfunction. Which lab results should the nurse assess? Select all that apply. Liver function tests White blood cell count Complete blood cell count Potassium level Renal function test

Liver function tests Renal function test

The nurse is caring for a patient who is receiving intravenous therapy for a pulmonary embolism. The activated partial thromboplastin time (aPTT) returns at 100 seconds. What action should the nurse anticipate? Leave the heparin infusion at the current rate and reevaluate the aPPT in 4 hours. Stop the heparin infusion and discontinue the medication. Lower the dose of heparin and reevaluate the aPTT in 4 to 6 hours. Increase the dose of heparin and reevaluate the aPTT in 6 hours

Lower the dose of heparin and reevaluate the aPTT in 4 to 6 hours. Rationale: If the aPTT is above therapeutic (40-90 seconds), the rate of the infusion will be reduced.

Select the priority nursing action or finding when providing care to a client who is diagnosed with acute respiratory distress syndrome (ARDS): For a patient diagnosed with ARDS, which is the priority? Auscultate heart sounds OR Monitor Pulse oximetry

Monitor Pulse oximetry Hypoxemia refractory to the administration of oxygen therapy is common in clients who are diagnosed with ARDS; therefore, the priority nursing action is to monitor pulse oximetry readings. A decrease in pulse oximetry readings from the baseline occurs due to intrapulmonary shunting. While auscultating heart sounds may be required, it is more appropriate to auscultate lung sounds as crackles may be present due to fluid buildup or lung sounds may be diminished due to atelectasis and fibrotic changes in the lungs.

A patient has a positive D-dimer and has just returned from a positive spiral CT scan. What vital sign changes should the nurse anticipate? Select all that apply. Tachycardia Hypotension Hyperthermia Hypoventilation Hypoxia

Tachycardia, hyperthermia, hypotension, hypoxia Tachycardia Rationale: Pulse increases because of hypoxemia. Hyperthermia Rationale: Fever may develop because of inflammatory response. Hypotension Rationale: Blood pressure may decrease from baseline in cases of massive pulmonary embolism (PE) because of decreased left heart preload. Hypoxia Rationale: Hypoxia will occur from the ventilation/perfusion (V/Q) mismatch.

Select the priority nursing action or finding when providing care to a client who is diagnosed with acute respiratory distress syndrome (ARDS): For the patient diagnosed with ARDS, which is the priority nursing assessment? Monitor for bradycardia OR Monitor for tachypnea

Monitor for tachypnea When providing care to a client who is diagnosed with ARDS, the nurse should monitor vital signs closely. Symptoms of ARDS include an increased respiratory rate, or tachypnea, so the client's breathing must be monitored. The hypoxemia associated with ARDS causes tachycardia, not bradycardia. Additionally, the nurse should monitor the client's blood pressure, as hypotension is anticipated due to the increased intrathoracic pressure and decreased venous return associated with positive end-expiratory pressure (PEEP).

Risk Factors for PE

Obesity Deep vein thrombosis (DVT) Cigarette smoking CORRECT. Risk factors for PE include DVT, obesity, and cigarette smoking. A hip or leg, not wrist, fracture is a risk factor for PE. Chronic heart disease is also a risk factor for PE, but transient heart disease is not.

A patient diagnosed with a pulmonary embolism is receiving a heparin infusion. Which lab should the nurse monitor in order to adjust the rate of infusion?

Partial thromboplastin time

The nurse should review which lab study to indicate the presence of a thrombus in the body?

Plasma d-dimer

The nurse is caring for a patient with many risks for the development of a blood clot. Which laboratory test helps to validate that one is present? Negative D-dimer Positive D-dimer Elevated hematocrit Elevated hemoglobin

Positive D-dimerRationale: A positive D-dimer indicates the presence of a clot but requires further testing. This test may be one of the first blood studies done for a patient with acute symptoms of a pulmonary embolism (PE).

The nurse should closely monitor for signs and symptoms of a pulmonary embolism in a patient with which risk factors? Select all that apply.

Post-knee surgery Smoker Chronic heart disease Truck driver

For the patient diagnosed with ARDS on ventilation, which is the best position? semi fowler's OR prone

Prone The nurse should place a client in a prone position while on mechanical ventilation. This may improve oxygenation through increased recruitment of collapsed posterior alveolar units and reduction in the V/Q mismatch. With gravity, the blood flow is directed to the better-aerated anterior portion of the lungs.

The nurse should ensure that which reversal agent is readily available in case of active bleeding while a patient is receiving a heparin infusion?

Protamine sulfate

The nurse is caring for a client with acute respiratory distress syndrome. What interventions can the nurse take to prevent complications? Reposition the client frequently. Assess for a leak in the system if there is a high-pressure alarm. Limit suctioning. Restrict visitation of family members to evening hours only.

Reposition the client frequently.

The nurse anticipates which signs during the exudative phase of acute respiratory distress syndrome? Select all that apply. Respiratory acidosis Respiratory alkalosis Decreased cardiac output Bradycardia Rales on auscultation

Respiratory alkalosis Rales on auscultation

Patient Education to Prevent Recurrence of PE

Smoking cessation Exercise regimen to include aerobic exercise Take prescribed medication, such as warfarin Adequate daily fluid intake Client teaching to prevent the recurrence of PE includes implementation of an exercise regimen to include aerobic exercise. The exercise will strengthen the client's heart and cardiovascular system, improve venous return to the heart, and assist with weight loss. Smoking cessation is encouraged during hospitalization and at every subsequent visit to the client's primary care provider. Teaching to prevent recurrence of PE should also include the importance of taking all prescribed medication, such as warfarin, at the appropriate time. Although a cardiac-prudent diet and at least 64 ounces of water a day is important and should be encouraged, it is important to minimize saturated, not unsaturated, fat.

The patient with a deep vein thrombosis develops sudden shortness of breath and difficulty breathing. After performing an assessment and applying oxygen, the nurse contacts the provider for further tests. What diagnostic test should the nurse request to determine if this is a pulmonary thrombosis? Chest x-ray Electrocardiogram Spiral computed tomography scan Venous ultrasound

Spiral computed tomography scan Rationale: A spiral computed tomography (CT) scan with contrast is the most commonly ordered test to diagnose a PE.

Select the priority nursing action or finding when providing care to a client who is diagnosed with acute respiratory distress syndrome (ARDS): Mechanical Ventilation—Increased Airway Pressure Suction ET Tube OR Assess For Leak

Suction ET Tube Frequent monitoring of airway pressure on the ventilator is a vital assessment when providing care to a client who is diagnosed with ARDS. Increases in airway pressure may indicate the presence of secretions or worsening disease; therefore, suctioning the client's ET tube will clear any secretions. The nurse should assess for a leak in the system when decreased, not increased, airway pressure is noted.

Select the priority nursing action or finding when providing care to a client who is diagnosed with acute respiratory distress syndrome (ARDS): Client and Family Education Disease Treatment OR Visitor Limitations

The client and his or her support system should understand the pathophysiology of ARDS, the severity of the disease, and the treatment required. Understanding the medications, invasive lines, and mechanical ventilation may help decrease anxiety and provide some sense of control. Providing time for visiting if possible, may help the family stay engaged and involved in their family member's care. Visiting also provides tremendous support for the client.

Client Education for Anticoagulant Therapy

Use of soft toothbrush Need for coagulation studies Action of the medication No flossing The nurse should explain the mechanism of action of anticoagulants and thrombolytics and that the client will be required to have follow-up laboratory samples drawn if on warfarin to determine effective dosing of anticoagulants. Bleeding precautions should be initiated that include encouraging the use of electric razors (not blades), use of soft toothbrushes, and no flossing. The diet should limit foods high in vitamin K, as these foods interfere with the efficacy of warfarin.

The charge nurse is revising the ventilated patients in the intensive care unit for their risk of developing acute respiratory distress syndrome (ARDS). Which patients should be most closely monitored for symptoms? SATA a. 88 year old with aspiration pneumonia after a stroke b. 19 year old involved in a multi-car accident c. 45 year old who had a five-vessel coronary bypass graft surgery d. 54 year old with colostomy from diverticulitis e. 62 year old with a lower lobe removal from lung cancer

a. 88 year old with aspiration pneumonia after a stroke b. 19 year old involved in a multi-car accident c. 45 year old who had a five-vessel coronary bypass graft surgery e. 62 year old with a lower lobe removal from lung cancer

The patient with a severe pneumonia is showing confusion, lethargy, and a pink complexion. What stage of respiratory failure are they exhibiting? a. Early b. Intermediate c. Advanced d. Late

b. Intermediate

The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) whose condition is deteriorating. What ventilatory options may be considered to improve the refractory hypoxemia? SATA a. Reduce the tidal volume b. Increase the PEEP c. Decrease the FiO2 d. High-frequency oscillating ventilation e. Partial liquid ventilation

a. Reduce the tidal volume b. Increase the PEEP d. High-frequency oscillating ventilation e. Partial liquid ventilation

The nurse is reviewing the chest x-ray report of a ventilated patient requiring an FiO2 of 70%. Which finding is most concerning? a. Atelectasis b. Bilateral infiltrates c. 5% pneumothorax d. Endotracheal tube 4 cm above the carina

b. Bilateral infiltrates During the early phases of ARDS, several chest X-Rays can be used to identify the bilateral infilrates that are the hallmark sign of this disease process. Atelectasis can be corrected by increasing the tidal volume or positive end-expiratory pressure (PEEP), the 5% pneumothorax is very small and does not typically cause compromise, and the Endotracheal tube is in the correct location.

During the early stages of acute respiratory distress syndrome (ARDS), the nurse should monitor for which arterial blood gas exchange? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

b. Respiratory alkalosis

The nurse is caring for a ventilated patient with acute respiratory distress syndrome whose temperature is 37.8 C. What action should the nurse take? a. Deliver the scheduled intravenous antibiotic b. Administer the ordered antipyretic c. Assess for purulent secretions d. Send a sputum for culture

c. Assess for purulent secretions

The nurse is caring for a patient in acute respiratory failure whose oxygenation continues to decrease. The patient is currently on a nonrebreather mask with 100% FiO2. The nurse requests an order for the device in this image. How will this benefit the patient? a. It provides a higher level of O2 b. It breathes for the patient so they don't have to c. It provides pressure with each of the patient's own breaths d. It pushed air into the lungs

c. It provides pressure with each of the patient's own breaths

The nurse is caring for a ventilated patient with respiratory failure who is restless and anxious. The nurse notes that the pulse oximetry saturation is decreasing as the patient becomes more agitated. What action should the nurse take? a. Increase the FiO2 on the ventilator b. Suction the lungs c. Provide sedation d. Reposition the patient onto the side

c. Provide sedation

Initially, the nurse should monitor the patient with ARDS ABGs for: hypoxemia and respiratory alkalosis OR hypercapnia and acidosis

hypoxemia and respiratory alkalosis Initially the nurse should monitor the client's ABG for hypoxemia and respiratory alkalosis, secondary to poor gas exchange and hyperventilation. As the disease progresses, the client will experience respiratory acidosis due to hypercapnia.

The nurse is caring for a patient that is 80 years old, obese, and confused with a fractured hip from a fall. The patient's hemoglobin is 7.9 g/dL. The patient's history includes smoking 1 pack per day, drinking 3 beers a day, and breast cancer 3 years ago. Which are risk factors for the development of a deep vein thrombosis (DVT)? Anemia, Smoking Confusion, Cancer HX Obesity, Fracture Drinking, Age

obesity, fracture

Which condition occurs when a circulating clot moves through the heart to the lungs, blocking an artery supplying blood to the lungs? Aortic aneurysm Virchow's triad Deep venous thrombosis (DVT) Pulmonary embolism

pulmonary embolism