Chapter 29 Critical Care of Patients with Respiratory Emergencies Practice Questions

Which assessment finding in a client with an endotracheal tube most strongly indicates to the nurse that the tube remains correctly in the trachea and is not in the esophagus? A. Stomach contents cannot be aspirated. B. Oxygen saturation is greater than 50%. C. End-tidal carbon dioxide level is 38 mm Hg. D. No air is heard in the stomach when auscultated with a stethoscope.

Answer: C. End-tidal carbon dioxide level is 38 mm Hg.

Which client will the nurse consider to be at greatest risk for acute respiratory distress syndrome (ARDS)? A. 22-year-old who received 10 units of blood after a motor vehicle accident B. 24-year-old with asthma who has not taken prescribed asthma medications for 2 weeks C. 62-year-old with chronic obstructive pulmonary disease who has pneumonia D. 78-year-old with chronic heart failure and pulmonary edema

Answer: A. 22-year-old who received 10 units of blood after a motor vehicle accident

Which precaution is a priority for the nurse to teach a client as part of discharge instructions after a pulmonary embolism (PE) to prevent harm? A.Report excessive bleeding immediately. B. Take your pulse and temperature twice daily. C. Drink at least 3 L of water or other fluids daily. D. Avoid crowds, small children, and people who are ill.

Answer: A.Report excessive bleeding immediately.

A client who 3 days ago underwent extensive abdominal surgery for cancer reports having a difficult time "catching her breath" and feeling very scared. After assessing the client, what is the nurse's best action or response to prevent harm? A. Ask the client about possible drug allergies B. Apply oxygen and initiate the Rapid Response Team C. Determine when she last received an opioid dose D. Check the oxygen saturation and encourage her to cough

Answer: B. Apply oxygen and initiate the Rapid Response Team

Which action is most important for the nurse to perform first for a client suspected of having acute respiratory failure? A.Initiating an IV B. Applying oxygen C. Calling the Rapid Response Team D. Asking the client about a history of respiratory disorders

Answer: B. Applying oxygen

Which assessment is most important for the nurse to perform for a client with chest trauma who is at high risk for pulmonary contusion? A.Observing for chest movements B. Auscultating for breath sounds C. Listening for hyperresonance D. Observing for deviation

Answer: B. Auscultating for breath sounds

Which client will the nurse assess most frequently for a venous thromboembolism (VTE) to prevent harm from a pulmonary embolism (PE)? A. 75-year old with left heart failure B. 65-year-old with breast cancer C. 55-year-old after a total knee replacement D. 44-year-old with type 2 diabetes mellitus

Answer: C. 55-year-old after a total knee replacement

Which assessment finding for a client who is receiving mechanical ventilation in synchronized intermittent mandatory ventilation (SIMV) mode indicates to the nurse probable readiness to be weaned? A.Fever from a respiratory infection has resolved. B. Client is alert and oriented to place and person. C. Client receives 1-2 mechanical ventilator breaths/min. D. Arterial blood gas values are maintained within normal limits.

Answer: C. Client receives 1-2 mechanical ventilator breaths/min.

Which phase of acute respiratory syndrome (ARDS) case management does the nurse identify for a client who has been intubated for 6 days and has progressive hypoxemia that responds poorly to high levels of oxygen? A. Resolution phase B. Recovery phase C. Exudative phase D. Fibrosing alveolitis phase

Answer: D. Fibrosing alveolitis phase

Which action will the nurse take first to prevent harm for a client being mechanically ventilated who is biting and chewing at the endotracheal tube (ET)? A. Request an order for soft wrist restraints. B. Immediately suction the client's mouth. C. Administer a paralyzing agent. D. Insert an oral airway.

Answer: D. Insert an oral airway.

Which assessment will the nurse perform first when a client at risk for acute respiratory distress syndrome (ARDS) becomes cyanotic and diaphoretic? A. Compare current ECG tracing with baseline measurement. B. Measure the blood pressure in both arms. C. Auscultate breath sounds bilaterally. D. Measure pulse oximetry.

Answer: D. Measure pulse oximetry.

The nurse is caring for four clients. Which client does the nurse identify at greatest risk of developing acute respiratory distress syndrome (ARDS)? A.24-year-old male admitted with blunt chest trauma and aspiration B.39-year-old male with a history of alcohol abuse and chronic pancreatitis C.70-year-old male post heart valve surgery receiving 1 unit of packed red blood cells D.84-year-old female on antibiotics for pneumonia

Answer: A. 24-year-old male admitted with blunt chest trauma and aspiration All client scenarios create a risk for ARDS. However, the trauma client with direct chest injury and known aspiration is at greatest risk. ARDS risk factors include direct lung injury (most commonly aspiration of gastric contents), systemic illnesses, and injuries. The most common risk factor for ARDS is sepsis. Other risk factors include bacteremia, trauma with or without pulmonary contusion, multiple fractures, burns, massive transfusion, near drowning, post-perfusion injury after cardiopulmonary bypass surgery, pancreatitis, and fat embolism.

In addition to arterial blood gas level, for which diagnostic test will the nurse prepare a client who is suspected to have a pulmonary embolism (PE)? A. Computed tomography pulmonary angiography B. Carbon monoxide diffusion capacity C. Pneumoencephalogram D. 12-lead ECG

Answer: A. Computed tomography pulmonary angiography

Which symptom or change in assessment of a client with four broken ribs on the right side indicates to the nurse the possibility of a tension pneumothorax? A. Distended neck veins B. Mediastinal shift toward the left side C. Right-sided pain on deep inhalation D. Right side of the chest more prominent than the left

Answer: A. Distended neck veins

Which action does the nurse take first when a client who is intubated and being mechanically ventilated has an oxygen saturation of 89%, a heart rate of 120 beats/ min, is increasingly agitated and restless, and has lung sounds that are diminished on one side? A. Notify the provider and prepare for reintubation or repositioning the tube. B. Document the findings and request a prescription for a sedative. C. Call respiratory therapy to obtain a set of arterial blood gases. D. Reposition the tube and call radiology for a stat chest x-ray.

Answer: A. Notify the provider and prepare for reintubation or repositioning the tube.

For which client does the nurse expect interventions to include an open thoracotomy? A.28-year-old with a hemothorax and a 1500 mL blood loss from the chest tube B. 45-year-old with a tension pneumothorax and tracheal deviation toward the unaffected side C. 60-year-old with a simple pneumothorax and hyperresonance on the affected side D. 70-year-old with a simple fracture of four ribs on the left side and mild heart failure

Answer: A.28-year-old with a hemothorax and a 1500 mL blood loss from the chest tube

Which change in a client's laboratory values does the nurse interpret as being consistent with the presence of a pulmonary embolism (PE)? A.pH 7.36 B. Elevated D-dimer C. Low levels of factor V Leiden D. Decreased leukocyte count

Answer: B. Elevated D-dimer

Which assessment finding does the nurse expect for a client who was extubated 2 hours ago? A.Restlessness B. Hoarseness C. Dyspnea D. Stridor

Answer: B. Hoarseness

Which assessment findings indicate to the nurse that a client with a flail chest may require mechanical ventilation? A.Constant pain and anxiety B. Hypoxemia and hypercarbia C. Paradoxical chest movements D. Tachycardia and hypertension

Answer: B. Hypoxemia and hypercarbia

Which action will the nurse instruct an assistive personnel (AP) to avoid performing on a client after abdominal surgery to prevent harm from a pulmonary embolism? A.Encouraging fluid intake B. Massaging the client's calves C. Ambulating the client in the hall D. Changing the client's position every 2 hours

Answer: B. Massaging the client's calves

A client is being discharged to home on warfarin therapy after an acute pulmonary embolism (PE). Which client response indicates a need for further teaching by the nurse? A."I should limit my alcohol consumption." B."I should drink more green tea and cranberry juice." C."I should take the medication at the same time every day." D."I should make an appointment for weekly blood draws."

Answer: B."I should drink more green tea and cranberry juice." Clients who experience a venothromboembolism/pulmonary embolism are frequently discharged on anticoagulant therapy (e.g., warfarin [Coumadin]). The client should be educated to understand the risks and monitoring of this drug to include weekly monitoring for therapeutic levels, consistency in dosing regimens, and foods to avoid (e.g., leafy green vegetables, green tea, alcohol, cranberry juice).

Which action will the nurse perform first when performing a check of the ventilator equipment after determining the client's gas exchange status? A.Turning off the alarms during the system check B. Checking the cuff pressure on the endotracheal tube C. Comparing the actual settings with the prescribed settings D. Draining the condensation from the ventilator trap tubing

Answer: C. Comparing the actual settings with the prescribed settings

The client, a woman who is 5 feet 11 inches tall and 176 lb (80 kg), has been mechanically ventilated at a tidal volume of 400 mL and a respiratory rate of 12 breaths/min for the past 24 hours. The most recent arterial blood gas (ABG) results for this client are pH = 7.32; Pao2 = 84 mm Hg; Paco2 = 56 mm Hg. What is the nurse's interpretation of these results? A. Ventilation adequate to maintain oxygenation. B. Ventilation excessive; respiratory alkalosis present. C. Ventilation inadequate; respiratory acidosis present. D. Ventilation status cannot be determined from information presented.

Answer: C. Ventilation inadequate; respiratory acidosis present.

1. An attempt by a primary health care provider to intubate a client for mechanical ventilation is unsuccessful after 45 seconds. What is the nurse's priority action? A. Placing a nasotracheal tube B. Assessing for bilateral breath sounds C. Assessing oxygen saturation by pulse oximetry D. Applying oxygen with a bag-valve-mask device

Answer: D. Applying oxygen with a bag-valve-mask device

The nurse anticipates a prescription for which drug when the client with a pulmonary embolism being managed with IV crystalloids remains hypotensive with a low cardiac output? A.Alteplase B. Warfarin C. Morphine D. Dobutamine

Answer: D. Dobutamine

What is the nurse's best action on finding that the cuff pressure of the client's endotracheal tube is 25 cm water? A. Move the endotracheal tube to the other side of the mouth. B. Remove 10 cm water pressure of air from the cuff. C. Add 10 cm water pressure of air to the cuff D. Document the finding as the only action.

Answer: D. Document the finding as the only action.

Which action does the nurse take to prevent harm through loss of tracheal tissue integrity in a client with an endotracheal tube (ET) who is being mechanically ventilated? A.Inserting an oral airway B. Providing meticulous oral care every 8 hours C. Deflating the cuff for 15 minutes every 2 hours D. Maintaining cuff inflation pressure less than 30 cm H2O

Answer: D. Maintaining cuff inflation pressure less than 30 cm H2O

A client in acute respiratory failure is classified as having ventilatory failure. The nurse understands that which finding is a potential extrapulmonary cause of ventilatory failure? A.Amyloidosis B.Pneumothorax C.Pulmonary edema D.Opioid analgesic overdose

Answer: D. Opioid analgesic overdose Opioid analgesic overdose is an extrapulmonary cause of ventilatory failure. All other causes are intrapulmonary.

Which intervention will the nurse expect to be prescribed for a client who has a simple fracture of three ribs on the right side after a fall? A.Cricothyroidotomy B. Mechanical ventilation C. Tight bandage around chest D. pain control for adequate breathing

Answer: D. pain control for adequate breathing

In addition to the pulmonary health care provider, with which members of the interprofessional team does the nurse expect to collaborate to achieve the desired outcomes of care for a client hospitalized with a large pulmonary embolism? Select all that apply. A.Occupational therapist B. Pastoral care workers C. Physical therapist D. Registered dietitian nutritionist E. Respiratory therapist F. Social worker

Answers: A, B, C, D, E, F A.Occupational therapist B. Pastoral care workers C. Physical therapist D. Registered dietitian nutritionist E. Respiratory therapist F. Social worker

For which problems will the nurse specifically assess when the high-pressure alarm of a client's mechanical ventilator sounds? Select all that apply. A.Mucus plug B. Bronchospasm C. Client coughing D. Air leak in tube cuff E. Client fighting the ventilator F. Ventilator tubing disconnected

Answers: A, B, C, E A.Mucus plug B. Bronchospasm C. Client coughing E. Client fighting the ventilator

Which clients will the nurse expect to most likely need to be intubated and mechanically ventilated? Select all that apply. A.25-year-old with burns who has severe swelling of oral mucosa B. 38-vear-old with copious secretions and ineffective cough C. 45-year-old with SpO, of 93% on a high-flow oxygen face mask D. 56-year-old with pneumonia, increasing fatigue, and shallow respirations E. 62-year-old with COPD who is able to cough and has an SpO, of 90% F. 72-year-old with moderate heart failure and orthopnea

Answers: A, B, D A.25-year-old with burns who has severe swelling of oral mucosa B. 38-vear-old with copious secretions and ineffective cough D. 56-year-old with pneumonia, increasing fatigue, and shallow respirations

Which actions are most appropriate for the nurse to take immediately when a client has indications of a pulmonary embolism (PE)? Select all that apply. A. Apply oxygen. B. Reassure the client. C. Increase the IV flow rate. D. Elevate the head of the bed. E. Initiate the Rapid Response Team. F. Instruct the client to not cross his or her legs

Answers: A, B, D, E A. Apply oxygen. B. Reassure the client. D. Elevate the head of the bed. E. Initiate the Rapid Response Team.

Which conditions or changes are responsible for the problems associated with acute respiratory distress syndrome (ARDS)? Select all that apply. A.Increased lung fluid B. Systemic inflammatory response C. Dried out and flaky pulmonary epithelium D. Decreased lung volume E. Refractory hypoxemia F. Excessive surfactant production

Answers: A, B, D, E A.Increased lung fluid B. Systemic inflammatory response D. Decreased lung volume E. Refractory hypoxemia

Which actions are most important for the nurse to perform to prevent a mechanically ventilated client from developing ventilator-associated pneumonia (VAP)? Select all that apply. A.Preventing aspiration B. Performing oral care every at least 12 hours C. Suctioning every 1-2 hours around the clock D. Turning and repositioning client every 2 hours E. Preventing pressure ulcers around the mouth F. Keeping the HOB elevated at least 30 degrees

Answers: A, B, D, E, F A.Preventing aspiration B. Performing oral care every at least 12 hours D. Turning and repositioning client every 2 hours E. Preventing pressure ulcers around the mouth F. Keeping the HOB elevated at least 30 degrees

Which factors or conditions are major risk factors for venous thromboembolism (VTE) leading to pulmonary embolism (PE)? Select all that apply. A. Obesity B. Pregnancy C. Malnutrition D. Cigarette smoking E. Prolonged immobility F. Use of anticoagulants G. Central venous catheters H. Chronic obstructive pulmonary disease (COPD)

Answers: A, B, D, E, G A.Obesity B. Pregnancy D. Cigarette smoking E. Prolonged immobility G. Central venous catheters

Which condition, sign, or symptom does the nurse consider most relevant in assessing a client suspected to have ARDS? Select all that apply. A. Dyspnea B. Electrocardiogram shows ST elevation C. Intercostal retractions D. PaO2 84% on oxygen at 6 L/min E. Substernal pain or rubbing F. Wheezing on exhalation

Answers: A, C, D A. Dyspnea C. Intercostal retractions D. PaO2 84% on oxygen at 6 L/min

Which information is most relevant for the nurse to document after a client has been successfully intubated by the health care provider? select all that apply. A.Level of the tube B. TV fluid infusion rate C. Presence (or absence) of dysrhythmias D. Presence of bilateral and equal breath sounds E. Changes in vital signs during the procedure F. Placement verification by end-tidal carbon dioxide levels

Answers: A, C, D, E, F A. Level of the tube C. Presence (or absence) of dysrhythmias D. Presence of bilateral and equal breath sounds E. Changes in vital signs during the procedure F. Placement verification by end-tidal carbon dioxide levels

Which conditions indicate to the nurse that a client being mechanically ventilated needs to be suctioned? Select all that apply. A. Presence of ronchi when listening to breath sounds B. Presence of moisture in the ventilator tubing C. Audible secretions in the endotracheal tube D. Low-pressure alarm sounds E. Increased peak inspiratory pressure (PIP) F. Tubing becomes disconnected from the ventilator

Answers: A, C, E A. Presence of ronchi when listening to breath sounds C. Audible secretions in the endotracheal tube E. Increased peak inspiratory pressure (PIP)

3. A client being mechanically ventilated has all of the following changes. Which changes are most relevant in helping the nurse determine whether suctioning is needed at this time? Select all that apply. A. Decreased SpO2 B. Elevated temperature C. Crackles auscultated over the trachea D. Crackles auscultated in the lung periphery E. High-pressure ventilator alarm sounds F. Presence of fluid within the endotracheal tube G. Presence of fluid within the ventilator tubing

Answers: A, C, E, F A. Decreased SpO2 C. Crackles auscultated over the trachea E. High-pressure ventilator alarm sounds F. Presence of fluid within the endotracheal tube

Which additional assessment findings support the nurse's suspicion that the client who reports a sudden onset of shortness of breath may have a pulmonary embolism (PE)? Select all that apply? A. SpO2 85% B. Hoarseness C. Diaphoresis D. Hypertension E. Crushing chest pain radiating to the jaw F. Crackles in a lower lung lobe

Answers: A, C, F A.SpO2 85% C. Diaphoresis F. Crackles in a lower lung lobe

What changes in care orders does the nurse anticipate in response to reporting to the primary health care provider that a client who has been receiving heparin IV for the past 3 days may have received twice the prescribed dose? Select all that apply. A.Activated partial thromboplastin time (aPTT) B. International normalized ratio (INR) C. Arterial blood gas (ABG) values D. Protamine sulfate E. Prothrombin time F. Vitamin K

Answers: A, D A. Activated partial thromboplastin time (aPTT) D. Protamine sulfate

Which client information indicates to the nurse that management of a pulmonary embolism (PE) is effective? Select all that apply. A.Pulse oximetry of 95% B. Arterial blood gas, pH of 7.28 C. Client's desire to go home D. Absence of pallor or cyanosis E. Mental status at client's baseline F. Palpable peripheral pulses

Answers: A, D, E, F A.Pulse oximetry of 95% D. Absence of pallor or cyanosis E. Mental status at client's baseline F. Palpable peripheral pulses

Which client processes does the nurse understand contribute to or cause pure ventilatory failure? Select all that apply. A. Hematologic disease B. Loss of lung elastic tissue C. Weak diaphragm contraction D. Stiffness of the chest wall E. Infectious diseases such as pneumonia F. Defect in the respiratory control center of the brain

Answers: B, C, D, F B. Loss of lung elastic tissue C. Weak diaphragm contraction D. Stiffness of the chest wall F. Defect in the respiratory control center of the brain

Which symptoms indicate to the nurse that the management of a client with a pulmonary embolism (PE) is not effective? Select all that apply. A.Partial thromboplastin time (PTT) is 2.0 times normal B. ECG shows increasing dysrhythmias C. Client has stopped sweating D. Neck veins are distended E. Sacral edema is present F. Pulse oximetry is 88%

Answers: B, D, E, F B. ECG shows increasing dysrhythmias D. Neck veins are distended E. Sacral edema is present F. Pulse oximetry is 88%

By which critical arterial blood gas (ABG) values will the nurse interpret as meeting the classification for acute respiratory failure? Select all that apply. A.Paco2 39 mm Hg B. Paco2 62 mm Hg C. PaO2 78 mm Hg D. PaO2 55 mm Hg E. pH value of < 7.3 F. SaO2 80%

Answers: B, D, E, F B. Paco2 62 mm Hg D. PaO2 55 mm Hg E. pH value of < 7.3 F. SaO2 80%

What are the characteristics of a mechanical ventilator that is pressure-cycled? Select all that apply. A. Its main function is to provide positive pressure only during expiration to keep lungs partially inflated. B. Air is forced into the lungs during inhalation until a preset pressure is reached. C. The client's own inspiratory efforts control the volume provided. D. It usually requires either a tracheostomy or endotracheal tube. E. A safety feature is that a client cannot be hyperventilated. F. Tidal volumes and inspiratory times are varied.

Answers: B, D, F B. Air is forced into the lungs during inhalation until a preset pressure is reached. D. It usually requires either a tracheostomy or endotracheal tube. F. Tidal volumes and inspiratory times are varied.

2. Which actions does the nurse ensure are performed for a client being mechanically ventilated to prevent ventilator-associated pneumonia (VAP)? Select all that apply. A. Assessing temperature every 4 hours B. Checking ventilator settings every 4 hours C. Getting the patient out of bed as soon as prescribed D. Keeping the head of the bed elevated to 30 degrees or above E. Maintaining the client in the prone position F. Providing adequate humidification G. Providing meticulous mouth care every 12 hours H. Suggesting that the pneumonia vaccine be prescribed

Answers: C, D, G C. Getting the patient out of bed as soon as prescribed D. Keeping the head of the bed elevated to 30 degrees or above G. Providing meticulous mouth care every 12 hours