Critical care practice questions Test 1

Kussmaul's respiration, the rapid deep breathing seen in DKA, is the body's effort to compensate for metabolic acidosis caused by: A. bicarbonate B. carbonic acid. C. ketone bodies. D. lactic acid.

C. ketone bodies.

A postoperative client is being weaned from mechanical ventilation. What is the most important factor for the nurse to consider when organizing activities? A. Remain with the client to assess responses. B. Allow family members to participate in the process. C. Permit the client more extended times alone for independence. D. Observe monitoring devices at the control panel of the ventilator.

A. Remain with the client to assess responses.

A nurse is caring for a client who was brought into the ED complaining of chest pain and difficulty breathing. Which of the following vital sign measurements most likely indicate that the client is struggling with dyspnea? A. Respiratory rate greater than 25/min B. Dry, hot skin C. Concave abdomen D. Oxygen saturation of 95%

A. Respiratory rate greater than 25/min Dyspnea refers to difficulties with breathing. The condition can occur for various reasons and can lead to respiratory insufficiency and respiratory failure if the client's condition progresses. The nurse who is caring for a client with dyspnea should look for signs and symptoms which include increased respiratory rate, cough, nasal flaring, use of accessory muscles to breathe, and cyanosis.

A nurse is caring for a client 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 greater than 16 breaths per minute

B. A PaO2 level below 60 mmHg Respiratory failure occurs when the body cannot remove enough carbon dioxide, and/or cannot take in enough oxygen to be sustainable. Clinical indicators of respiratory failure include pulse oximetry of less than 90% on room air, PaO2 level less than 60 mmHg, and a pCO2 level of over 50 mmHg. D.A pCO2 level over 50 mmHg Respiratory failure occurs when the body cannot remove enough carbon dioxide, and/or cannot take in enough oxygen to be sustainable. A pCO2 level of over 50 mmHg indicates respiratory failure.

A healthcare team is caring for a 68-year-old client with diabetes insipidus. Which task is most suitable to be delegated to licensed practical nurse (LPN) to provide effective client care? Select all that apply. A. Emptying the urinary drainage bag B. Monitoring urine output C. Feeding the client with food D. Administration of intravenous fluids E. Administering oral rehydration medication

B. Monitoring urine output E. Administering oral rehydration medication The LPN scope of practice includes monitoring urine output. Administration of any type of oral medication can also be performed by the LPN. Activities related to a client's hygiene such as emptying the drainage is usually performed by unlicensed assistive personnel (UAP). Feeding the client is usually performed by a UAP. Administration of intravenous fluids is the responsibility of the registered nurse.

A client with a suspected pulmonary embolism is scheduled for a spiral computed tomography scan. Which intervention should the nurse perform when preparing the client for the test? A. Check the client's blood glucose levels. B. Obtain informed consent from the client. C. Assess if the client is allergic to shellfish. D. Instruct the client to remove his or her dentures.

C. Assess if the client is allergic to shellfish.

A nurse is caring for a client with a history of hyperthyroidism who is now experiencing thyroid crisis (thyroid storm). What does the nurse consider to be the most likely precipitating factor in the client's current health problem? A. Increased iodine in the blood B. Removal of the parathyroid glands C. High levels of the hormone triiodothyronine D. Rebound increase in metabolism following anesthesia

C. High levels of the hormone triiodothyronine

A nurse is caring for a client with an endotracheal tube. Which is the most effective way for the nurse to loosen respiratory secretions? A. Increase oral fluid intake B. Provide chest physiotherapy C. Humidify the prescribed oxygen D. Instill a saturated solution of potassium iodide

C. Humidify the prescribed oxygen

Which nursing care should be provided to a client who has undergone unilateral adrenalectomy? A. Offer a high-sodium diet. B. Encourage the client to use saliva-inducing agents C. Instruct the client to wear a medical alert bracelet. D. Administer temporary glucocorticoid replacement therapy.

D. Administer temporary glucocorticoid replacement therapy. Temporary glucocorticoid replacement therapy is needed for a client who has undergone a unilateral adrenalectomy. Spironolactone therapy is used when surgery cannot be performed. A client on spironolactone therapy is advised to increase sodium intake to reduce the risk of hyponatremia. Spironolactone therapy can cause a side effect of dry mouth that can be managed by saliva-inducing agents. A client who has undergone bilateral adrenal gland removal will require lifelong replacement of glucocorticoids and should wear a medical alert bracelet as an indication.

A nurse is assessing a client for fluid volume overload. The nurse knows that which of the following orders should be implemented to determine if the client is in fluid overload? A. Draw blood cultures B. Count client respirations C. Place the client on 5L O2 nasal cannula D. Take the client to radiology for chest x-ray

D. Take the client to radiology for chest x-ray A chest x-ray would help to determine whether the client is in fluid overload. The x-ray will show if the fluid is backing up into the lungs.

A client has an endotracheal tube and is receiving mechanical ventilation. The nurse identifies that periodic suctioning may be necessary. The nurse follows a specific protocol when performing this procedure. Place the steps in the order that they should be performed. 1 Obtain the vital signs. 2 Rotate the catheter during its withdrawal. 3 Hyperoxygenate for 30 seconds. 4 Suction for approximately 10 seconds. 5 Auscultate lung sounds.

1 Obtain VS 5 Auscultate LS 3 Hyperoxygenate 4 Suction 2 Rotate the catheter

A nurse is caring for a variety of clients. In which client is it most essential for the nurse to implement measures to prevent pulmonary embolism? A. A 59-year-old who had a knee replacement B. A 60-year-old who has bacterial pneumonia C. A 68-year-old who had emergency dental surgery D. A 76-year-old who has a history of thrombocytopenia

A. A 59-year-old who had a knee replacement Clients who have had a joint replacement have decreased mobility; they are at risk for developing thrombophlebitis, which may lead to pulmonary embolism if the clot becomes dislodged into the circulation. Bacterial pneumonia and emergency dental surgery are not associated with an increased risk for pulmonary embolism. A history of thrombocytopenia leads to a decreased ability to clot, so it increases the risk of bleeding but decreases the risk of a thrombus or embolus.

The nurse just received reports on the following four clients. Which client should the nurse see first? 1) A client who was admitted for sepsis with vasopressors infusing 2) A client who was admitted for respiratory distress with normal saline infusing and a respiratory rate of 20 3) A client who was admitted for a non-ST elevated MI (NSTEMI) with heparin infusing 4) A client who was admitted for a urinary tract infection with antibiotics infusing A. A client who was admitted for sepsis with vasopressors infusing B. A client who was admitted for respiratory distress with normal saline infusing and a respiratory rate of 20 C. A client who was admitted for a non-ST elevated MI (NSTEMI) with heparin infusing D. A client who was admitted for a urinary tract infection with antibiotics infusing

A. A client who was admitted for sepsis with vasopressors infusing When prioritizing client care, the nurse prioritizes airway, breathing and circulation first. The client with sepsis and a vasopressor infusing has a circulation issue, and is most unstable of the group due to the instability of blood pressure. This client should be seen first. See them in this order: 1, (2 or 3 didnt say) and last 4

Which potential causes of hypoglycemia should the nurse investigate in a diabetic patient? A. Addisonian crisis B. Excessive alcohol consumption C. Glucocorticoid treatment D. Liver disease E. Renal disease

A. Addisonian crisis B. Excessive alcohol consumption D. Liver disease E. Renal disease

A patient with end-stage lung cancer with bone involvement has had nutritional support withdrawn and is actively dying. The nurse assesses the patient and observes a respiratory rate of 26 breaths per minute with use of accessory muscles. The patient's heart rate has increased from 86 beats per minute to 110 beats per minute. The patient grimaces when moved and is moaning, but is responsive to name. The patient is on a morphine drip with a titration protocol. What is the most appropriate nursing intervention for this patient? A. Administer an additional dose of intravenous morphine equal to the current infusion rate, and increase the infusion by 50%. B. Contact the provider to request an order to give the patient an injection of 5 mg morphine IM, and reassess the patient in 10 minutes. C. Increase the infusion by 50% and reassess the patient in 1 hour. D. Maintain the infusion at the current rate.

A. Administer an additional dose of intravenous morphine equal to the current infusion rate, and increase the infusion by 50%.

A nurse is caring for several clients in the intensive care unit. Which is the greatest risk factor for a client to develop acute respiratory distress syndrome (ARDS)? A. Aspirating gastric contents B. Getting an opioid overdose C. Experiencing an anaphylactic reaction D. Receiving multiple blood transfusions

A. Aspirating gastric contents Aspirating gastric contents is a common cause of ARDS. Gastric enzymes injure alveolar-capillary membranes, which release inflammatory mediators; the process progresses to pulmonary edema, vascular narrowing and obstruction, pulmonary hypertension, and impaired gas exchange. Getting an opioid overdose is not as common a cause of ARDS as is aspiration pneumonia; this more likely will cause depressed respirations. Although anaphylaxis may cause ARDS, it is not a common cause. Although multiple blood transfusions have been known to precipitate ARDS, they are not a common cause.

The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? Select all that apply. A. Confusion B. Hyperactivity C. Excessive thirst D. Fruity-scented breath E. Decreased urinary output

A. Confusion C. Excessive thirst D. Fruity-scented breath

What clinical indicators should a nurse expect to identify in a client with acute respiratory distress syndrome (ARDS)? Select all that apply. A. Crackles B. Atelectasis C. Hypoxemia D. Severe dyspnea E.Increased pulmonary wedge pressure

A. Crackles B. Atelectasis C. Hypoxemia D. Severe dyspnea

A client with tongue occlusion has loss of gag reflex and alterations in level of consciousness. The blood gas test shows oxygen saturation as 40mm Hg and carbon dioxide saturation as 75 mm Hg. Which type of support provides immediate relief to the client? A. Tracheotomy B. Laryngeal repair C. Abdominal thrust maneuver D. Autotitrating positive airway pressure

A. Tracheotomy Upper airway obstruction may occur with tongue occlusion, which is associated with loss of gag reflex and alterations in the level of consciousness. The client suffering from severe hypoxia (O2 saturation of 40mm Hg) and who is hypercapnic (CO2 saturation of 75 mm Hg) requires an emergency tracheotomy for relief within 2 minutes. Laryngeal repair is performed to prevent laryngealstenosis and to cover exposed cartilage. The abdominal thrust maneuver clears upper airway obstruction caused by a foreign body. Autotitrating positive airway pressure resets the pressure throughout the breathing cycle in a client with severe sleep apnea.

The ventilator of a client has leakage of air from its tubing. Alveolar hypoventilation is suspected. What blood gas value does the nurse expect to see? A. pH of 7.32 B. Po2 of 95 mm Hg C. Pco2 of 30 mm Hg D. HCO3- of 20 mEq/L (20 mmol/L)

A. pH of 7.32 Respiratory acidosis is expected. A pH of 7.32 is below the expected range of 7.35 to 7.45; hypoxia causes hypercapnia, resulting in a decreased pH. A Po2 of 95 mm Hg is within the expected range of 80 to 100 mm Hg. An HCO3- level of 20 mEq/L (20 mmol/L) is lower than the expected range of 21 to 28 mEq/L (21 to 28 mmol/L). In respiratory acidosis, the bicarbonate level is expected to be normal or higher if compensation is present. A Pco2 of 30 mm Hg is below the expected range of 35 to 45 mm Hg. In respiratory acidosis, the Pco2 is expected to increase.

Immediately after a bilateral adrenalectomy a client is receiving corticosteroids that are to be continued after discharge from the hospital. Which statement by the client indicates to the nurse that additional education is needed? A. "I need to have periodic tests of my blood for glucose." B. "I am glad that I only have to take the medication once a day." C. "I must take the medicine with meals while I have food in my stomach." D. "I should tell the doctor if I am overly restless or have trouble sleeping."

B. "I am glad that I only have to take the medication once a day." Usually a larger dose is given at 8 am and the second dose is given before 4 pm to mimic expected hormonal secretion and prevent insomnia. Having periodic blood tests for glucose is necessary because long-term administration of steroids leads to elevated blood glucose levels and possible steroid-induced diabetes. Oral corticosteroids should be taken with food or antacids to prevent gastric irritation and gastric hemorrhage. Neurological and emotional side effects, such as euphoria, mood swings, and sleeplessness, are expected.

A client with acute respiratory distress syndrome is intubated and placed on a ventilator. What should the nurse do when caring for this client and the mechanical ventilator? A. Deflate the cuff on the endotracheal tube for a few minutes every one to two hours B. Assess the need for suctioning when the high-pressure alarm of the ventilator is activated. C. Adjust the temperature of fluid in the humidification chamber depending on the volume of gas delivered. D. Regulate the positive end-expiratory pressure (PEEP) according to the rate and depth of the client's respirations.

B. Assess the need for suctioning when the high-pressure alarm of the ventilator is activated.

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. Blood pressure 70/45 The answer is B. Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and decrease the cardiac output (watch out for a low blood pressure) along with hyperinflation of the lungs (possible pneumothorax or subq emphysema which is air that escapes into the skin because the lungs are leaking air).

Which client is at high risk for an adrenal gland disorder? A. Client A B. Client B C. Client C D. Client D

B. Client B The normal value of sodium is 136 to 145 mEq/L, bicarbonate is 23 to 30 mEq/L, potassium is 3.5 to 5.0 mEq/L and total calcium is 9 to 10.5 mg/dL. The laboratory value of client B shows low levels of sodium, bicarbonate, potassium, and total calcium, which indicates hypofunction of the adrenal gland. The laboratory values of client A, client C, and client D show normal values. Thus, client A, client C, and client D are not at risk of an adrenal gland disorder.Test-

A nurse is using a non-rebreather mask to administer oxygen to an adult client who is in respiratory distress. Which nursing intervention should the nurse employ when using this type of oxygen delivery device? A. Slowly increase the amount of oxygen administered over the first hour B.Ensure that the mask fits well over the mouth and nose C. Assess the client's skin and hair every 4 hours D. Avoid administering solid food and only give liquids with this type of mask

B. Ensure that the mask fits well over the mouth and nose A non-rebreather mask is a form of mask for oxygen delivery that fits snugly over the client's mouth and nose. This type of mask is typically used when the client's respiratory status is deteriorating, and the nurse should be aware that the client may eventually need to be intubated in this situation. The mask has side flaps that allow carbon dioxide to escape when the client breathes out as well as a reservoir bag at the base of the appliance. The nurse should ensure that the mask fits well over the mouth and nose and that its components are intact with use. The client cannot eat or drink with the mask in place.

A client with a diagnosis of Graves disease refuses to have radioactive iodine (RAI) therapy, and a subtotal thyroidectomy is performed. What should the nurse do postoperatively to reduce the risk of thyroid storm? A. Provide a high-calorie diet. B. Prevent infection at the surgical site. C. Encourage postoperative breathing exercises. D. Demonstrate how to support the neck after surgery.

B. Prevent infection at the surgical site. Conditions such as trauma and infection can precipitate thyroid storm (thyroid crisis, thyrotoxic crisis). A high-calorie diet does not prevent crisis; it restores glycogen reserves depleted by an increased metabolic rate. Postoperative breathing exercises prevent respiratory complications, not thyroid storm. Learning how to support the neck after surgery limits tension on the suture line, thereby decreasing the risk of hemorrhage, not thyroid storm.

A nurse is caring for a client with myxedema who has undergone abdominal surgery. What should the nurse consider when administering opioids to this client? A. Tolerance to the drug develops readily. B. One-third to one-half the usual dose should be prescribed. C. Opioids may interfere with the secretion of thyroid hormones. D. Sedation will have a paradoxical effect, causing hyperactivity.

B. One-third to one-half the usual dose should be prescribed. Because of a decreased metabolism, the usual adult dose of an opioid may result in an overdose. A decreased basal metabolic rate prolongs the time for drug detoxification and elimination. Hypothyroidism does not alter tolerance. Opioids do not alter the thyroid hormone; opioids will cause excessive sedation, not hyperactivity.

Which finding would the nurse expect in the urinalysis report of a client with diabetes insipidus? A. pH of urine: 9 B. Specific gravity of urine: 0.4 C. Red blood cells in urine: 6 hpf D. White blood cells in urine: 8 hpf

B. Specific gravity of urine: 0.4 The normal specific gravity of urine lies between 1.003 and 1.030. The specific gravity of urine of clients with diabetes insipidus is low due to the impaired functioning of antidiuretic hormone. The pH of normal urine ranges from 6.5 to 7.0. A pH higher than 8 indicates a urinary tract infection (UTI). Normal urine contains between 0 and 4 hpf of red blood cells (RBCs). A count greater than 4 hpf indicates tuberculosis, cystitis, neoplasm, and glomerulonephritis. In a normal urine sample, white blood cells (WBCs) lie in the range of 0 to 5 hpf. Any increase in the number of WBCs indicates a urinary tract inflammation.

After stabilization of an acute adrenal insufficiency (addisonian crisis), intravenous medications are decreased gradually, and the client now is receiving hydrocortisone by mouth. What instruction should the nurse include when performing discharge teaching? A. Eat a diet high in sodium. B. Take the medication with food. C. Maintain the same dose indefinitely. D. Eliminate a dose if side effects occur.

B. Take the medication with food.

Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? A. Providing oxygen B. Encouraging carbohydrates C. Administering fluid replacement D. Teaching facts about dietary principles

C. Administering fluid replacement

The nurse is assessing a client's arterial blood gases and determines that the client is in compensated respiratory acidosis. The pH value is 7.34; which other result helped the nurse reach this conclusion? A. PO2 value is 80 mm Hg. B. PCO2 value is 60 mm Hg. C. HCO3 value is 50 mEq/L (50 mmol/L). D. Serum potassium value is 4 mEq/L (4 mmol/L).

C. HCO3 value is 50 mEq/L (50 mmol/L). The HCO3 value is elevated. The urinary system compensates by retaining H+ ions, which become part of the bicarbonate ions; the bicarbonate level becomes elevated and increases the pH level to near the expected range. The expected HCO3 value is 21 to 28 mEq/L (21 to 28 mmol/L), and the expected pH value is 7.35 to 7.45. The body's usual PO2 value is 80 to 100 mm Hg; 80 mm Hg is within the expected range. The body's PCO2 value is 35 to 45 mm Hg; although in compensated respiratory acidosis [1] [2] the PCO2 level may be increased, it is the increased HCO3 level that indicates compensation. A K+ level of 4 mEq/L (4 mmol/L) is within the expected range of 3.5 to 5 mEq/L (3.5 to 5 mmol/L); the serum potassium level is not significant in identifying compensated respiratory acidosis.

The arterial blood gases of a client with chronic obstructive pulmonary disease (COPD) deteriorate, and respiratory failure is impending. Which clinical indicator should the nurse assess first? A. Cyanosis B. Bradycardia C. Mental confusion D. Distended neck veins

C. Mental confusion Decreased oxygen to the vital centers in the brain results in restlessness and confusion. Cyanosis is a late sign of respiratory failure. Tachycardia, not bradycardia, will occur as a compensatory mechanism to help increase oxygen to body cells. Distended neck veins occur with fluid volume excess (e.g., pulmonary edema).

A nurse in the ICU is caring for a client that has been ventilated for 2 weeks due to Acute Respiratory Distress Syndrome (ARDS). The client's FiO2 has been at 60% for the last 48 hours. What is the nurse's immediate priority concern at this time? A. Risk for sepsis B. Fluid retention C. Oxygen toxicity D. Ventilator associated pneumonia

C. Oxygen toxicity Clients with ARDS require high levels of oxygen. Levels above 50% FiO2 for prolonged periods of time can cause oxygen toxicity. This is why the SpO2 goal for these clients tends to be approximately 92-94%. If a client has an SpO2 of 100%, the FiO2 needs to be decreased!

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

C. Sepsis D. Blood transfusion F. Pancretitis The answers are: C, D, F Indirect causes are processes that can cause inflammation OUTSIDE of the lungs....so the issue arises somewhere outside the lungs. Therefore, sepsis (infection...as long as it is outside the lungs), blood transfusion, and pancreatitis are INDIRECT causes. Drowning, aspiration, and pneumonia are issues that arise in the lungs (therefore, they are DIRECT causes of lung injury).

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. The patient's PaO2 remains at 45 mmHg. The answer is C. A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the patient is STILL hypoxic. Option C is the answer because it states the patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60 mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants to know the HALLMARK sign and symptom.

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. white-out infiltrates bilaterally The answer is C. This is a finding found in ARDS....pronounce white-out infiltrates bilaterally.

You're precepting a nursing student who is assisting you care for a patient on mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the PEEP setting is at 10 mmHg. Your response is: A. "This pressure setting assists the patient with breathing in and out and helps improve air flow." B. "This pressure setting will help prevent a decrease in cardiac output and hyperinflation of the lungs." C. "This pressure setting helps prevent fluid from filling the alveoli sacs." D. "This pressure setting helps open the alveoli sacs that are collapsed during exhalation."

D. "This pressure setting helps open the alveoli sacs that are collapsed during exhalation." The answer is D. This setting of PEEP (it can range between 10 to 20 mmHg of water) and it helps to open the alveoli sacs that are collapsed, especially during exhalation.

In addition to treatment of the underlying cause, which medical intervention should the nurse anticipate will be included in the management of a client with acute respiratory distress syndrome (ARDS)? A. Chest tube insertion B. Aggressive diuretic therapy C. Administration of beta-blockers D. Positive end-expiratory pressure (PEEP)

D. Positive end-expiratory pressure (PEEP) Mechanical ventilation with PEEP will help prevent alveolar collapse and improve oxygenation. Fluid is not in the pleural space, so chest tube insertion is not indicated. Aggressive diuretic therapy and administration of beta-blockers are contraindicated because of severe hypotension from the fluid shift into the interstitial spaces in the lungs.`

A nurse is caring for a client who is in respiratory distress because of ARDS. Which of the following conditions would most likely be present in this client? A. Lack of tissue perfusion B. Anuria C. Disturbed personality identity D. Problems with thermoregulation

A. Lack of tissue perfusion Acute respiratory distress syndrome (ARDS) is a life-threatening condition that affects the lungs and prevents the client from getting enough oxygen. This client will most likely be unable to effectively perfuse the tissues because decreased oxygen from lung disease prevents adequate oxygen from reaching the bloodstream and therefore peripheral tissues.

A nurse is caring for a group of clients on a medical-surgical unit. Which client has the highest risk for developing a pulmonary embolism? A. An obese client with leg trauma B. A pregnant client with acute asthma C. A client with diabetes who has cholecystitis D. A client with pneumonia who is immunocompromised

A. An obese client with leg trauma An obese client with leg trauma has two risk factors for the development of pulmonary embolism: obesity and leg trauma. A pregnant client with acute asthma has one risk factor for the development of pulmonary embolism: pregnancy. A client with diabetes who has cholecystitis has one risk factor for the development of pulmonary embolism: diabetes. A client with pneumonia who is immunocompromised has no risk factors for the development of pulmonary embolism.

A nurse must position the client prone after a 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 pleural pressure E. Increased response to corticosteroid therapy

A. Decreased atelectasis The prone position reduces pressure on the lungs. When there is less pressure exerted on the lungs, atelectasis decreases. C. Mobilization of secretions Studies have shown that many clients in the prone position have increased lung secretions, which improves oxygenation. D. Decreased pleural pressure Prone positioning, or placing the client face down with the head turned to the side, helps with pulmonary function in the client diagnosed with ARDS. When the client is placed in prone position, the heart and diaphragm are not pressing against the lungs, which means that pleural pressure is reduced.

The nurse is attending an in-service presentation related to hospice care. Which of the following statements are accurate about hospice? A. Hospice emphasizes comfort rather than cure from disease. B. Hospice is a place to treat dying patients. C. Hospice referrals are appropriate only for cancer patients. D. Referrals to hospice are made to improve quality of life.

A. Hospice emphasizes comfort rather than cure from disease. D. Referrals to hospice are made to improve quality of life.

A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin complains of tingling and numbness of the fingers and toes and shortness of breath. The cardiac monitor shows the appearance of a U wave. What complication does the nurse suspect? A. Hypokalemia B. Hypoglycemia C. Hypernatremia D. Hypercalcemia

A. Hypokalemia

9. You are caring for a patient with acute respiratory distress syndrome. As the nurse you know that prone positioning can be beneficial for some patients with this condition. Which findings below indicate this type of positioning was beneficial for your patient with ARDS? A. Improvement in lung sounds B. Development of a V/Q mismatch C. PaO2 increased from 59 mmHg to 82 mmHg D. PEEP needs to be titrated to 15 mmHg of water

A. Improvement in lung sounds C. PaO2 increased from 59 mmHg to 82 mmHg The answers are A and C. Prone positioning helps improve PaO2 (82 mmHg is a good finding) without actually giving the patient high concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting the V/Q mismatch). In this position, the heart is no longer laying against the posterior part of the lungs (improves air flow...hence improvement of lung sounds) and it helps move secretions from other areas that were fluid filled and couldn't move in the supine position, hence helping improve atelectasis.

A client with respiratory distress due to an overdose of antidepressant drugs is hospitalized. Which intervention should be performed as a priority? A. Intubating the client B. Administering an antidote C. Administering activated charcoal D. Initiating electrocardiogram monitoring

A. Intubating the client

You're providing care to a patient who was just transferred to your unit for the treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which results are expected during this early phase of acute respiratory distress syndrome that correlates with this diagnosis? A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23 B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26 C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29 D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19

A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23 - first cant get any o2 in - then cant get any CO2 out The answer is A. This option demonstrates respiratory alkalosis. In the early stages of ARDS (exudative) the patient will start to enter in respiratory alkalosis. The patient starts to have tachypnea (the body's way of trying to increase the oxygen level but it can't). They will have a very low PaO2 level (normal PaO2 is 80 mmHg), the blood pH will become high (normal is 7.35-7.45) (alkalotic). In the late stage, the patient can enter into respiratory acidosis.

The client is suspected of having a pulmonary embolus. Which diagnostic test con- firms the diagnosis? A. Plasma D-dimer test. B. Arterial blood gases. C. Chest x-ray. D. Magnetic resonance imaging (MRI).

A. Plasma D-dimer test. The plasma D-dimer test is highly specific for the presence of a thrombus; an elevated D-dimer indicates a thrombus formation and lysis

What interventions should the nurse implement when caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. A. Providing frequent oral care B. Instituting fall risk precautions C. Restricting fluids to 2 L per day D. Placing the client in high-Fowler position E. Monitoring for and reporting neurologic changes

A. Providing frequent oral care B. Instituting fall risk precautions E. Monitoring for and reporting neurologic changes The excess production of antidiuretic hormone associated with SIADH leads to increased water reabsorption by the kidneys. Increased water reabsorption results in decreased urinary output, increased intravascular fluid volume, serum hypoosmolality, and dilutional hyponatremia. Because treatment includes restricting fluids, frequent oral care is provided to increase client comfort. Fall risk precautions are instituted to protect the client from injury that might occur as a result of neurologic changes associated with declining serum sodium. The nurse monitors for and reports changes in neurologic status resulting from cerebral edema and hyponatremia. Immediate treatment goals are to restore normal fluid balance and normal serum osmolality. Fluids are restricted to no more than 1000 mL and to no more than 500 mL for the client with severe hyponatremia. Treatment of SIADH includes placing the bed flat or elevating the head of the bed no more than 10 degrees. This position promotes venous return to the heart, which increases left ventricular filling pressure. Increasing left ventricular filling pressure stimulates osmoreceptors to send a message to the pituitary (via the hypothalamus) that antidiuretic hormone release should be decreased.

When caring for an intubated client receiving mechanical ventilation, the nurse hears the high-pressure alarm. Which action is most appropriate? A. Remove secretions by suctioning. B. Lower the setting of the tidal volume. C. Check that tubing connections are secure. D. Obtain a specimen for arterial blood gases (ABGs).

A. Remove secretions by suctioning.

The nurse is caring for a client with a possible pulmonary embolism (PE). Which diagnostic test should the nurse initially anticipate will be prescribed for this client because it is the evidence-based gold standard for a PE diagnosis? A. Spiral (helical) computed tomographic angiography (CTA) B.D-dimer and arterial blood gas (ABG) laboratory tests C. Ventilation-perfusion (V/Q) scan D. Pulmonary angiography

A. Spiral (helical) computed tomographic angiography (CTA) A spiral (helical) computed tomographic angiography (CTA) is considered the gold standard for a pulmonary embolism (PE) medical diagnosis. The spiral CTA also has the added advantage of diagnosing other pulmonary abnormalities. A pulmonary angiography is still used as a PE diagnostic test, usually if the client also has coronary disease and invasive treatment (i.e., angioplasty) may become necessary; however, it is no longer the gold standard because it is expensive and invasive, and the spiral CTA has excellent accuracy and better accessibility. Ventilation/perfusion (V/Q) scans are currently used only in certain circumstances such as when the client has contrast dye allergy. D-dimer and arterial blood gas (ABG) laboratory tests are typically prescribed for a client with a possible PE; however, these tests are not specific or sensitive enough to be used alone to make the PE diagnosis. An ABG is used to evaluate the client's oxygenation status during medical diagnosis and treatment to determine if additional emergency treatment is needed, such as intubation and mechanical ventilation. A D-dimer simply reveals the presence or absence of fibrin split products which occur when a blood clot degrades or breaks down; however, about half of clients with a PE still test negative (a normal result) and several other conditions can produce a positive D-dimer result.

The nurse is caring for a client who has undergone a total hip replacement. The nurse recognizes which clinical manifestations that indicate a pulmonary embolism? Select all that apply. A. Sudden chest pain B. Flushing of the face C. Elevation of temperature D. Abrupt onset of shortness of breath E.Pain rating increase from 2 to 8 in the hip

A. Sudden chest pain D. Abrupt onset of shortness of breath

What points should be considered when a client with a respiratory disorder undergoes a spiral-computed tomography (CT) scan to diagnose a pulmonary embolism? Select all that apply. A. The test involves the administration of a contrast medium. B. Clients should have their hydration levels assessed. C. Clients are instructed to lie still on a hard table. D. Clients are served shellfish before the test. E. A client's serum creatinine level is evaluated after the test.

A. The test involves the administration of a contrast medium. B. Clients should have their hydration levels assessed. C. Clients are instructed to lie still on a hard table.

A client with a primary brain tumor has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse will expect to see which clinical findings upon assessment? Select all that apply. A.Nausea and vomiting B. Hyperthermia C. Bradycardia D. Increased weight E. Decreased serum sodium F. Decreased level of consciousness

A.Nausea and vomiting D. Increased weight E. Decreased serum sodium F. Decreased level of consciousness

A client who is admitted with emphysema shows progressive respiratory failure and has a Paco2 of 60. To address the problems, the nurse expects to receive a prescription for: A. Mucolytics B. Bronchodilators C. Mechanical ventilation D. Intermittent positive-pressure breathing (IPPB)

C. Mechanical ventilation Mechanical ventilation indicates progressive respiratory failure; ventilatory support is needed when the Paco2 is more than 50. Mucolytics will liquefy secretions, but will not correct the respiratory failure. Bronchodilators may dilate bronchi, but will not improve respiratory exchange to decrease CO2. IPPB will not correct respiratory failure.

A client is admitted with a tentative diagnosis of pneumonia. On admission the client is not in respiratory distress, but later develops chest pain and a fever of 103° F (39.4° C). A productive cough produces rust-colored sputum. How should the nurse interpret these findings? A. Onset of pulmonary edema B. Expected course of pneumonia C. Presence of a pulmonary embolus D. Insidious onset of tuberculosis (TB)

B. Expected course of pneumonia Chest pain, fever, productive cough, and rust-colored sputum are cardinal signs of pneumonia Chest pain results from excessive coughing; fever, increased sputum, and rust-colored sputum result from the infectious process. Dependent edema, respiratory distress, and crackles on auscultation of the lungs are associated with pulmonary edema. Although chest pain is expected with a pulmonary embolus, rust-colored sputum and a high fever are not. Pulmonary TB is associated with a low-grade fever, nonproductive or mucopurulent blood-tinged sputum, night sweats, and fatigue.

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. atelectasis The answer is B. Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales (hence the sac won't collapse). If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue) when there is a decrease production in surfactant.

A client is suffering from fluid overload due to a history of severe liver disease. Which of the following interventions would be the highest priority for this client? A.Weigh the client daily B. Elevate the lower extremities to reduce edema C. Monitor for heart arrhythmias and the presence of crackles on auscultation D. Check skin regularly for signs of skin breakdown

C. Monitor for heart arrhythmias and the presence of crackles on auscultation Fluid overload can develop as a result of various types of disease processes. It can lead to edema, weight gain, and electrolyte imbalance. To avoid complications of fluid overload, the nurse should listen to the client's heart rate to determine if excess fluid has caused heart arrhythmias. The nurse should also listen to the client's breath sounds for signs of breathing difficulties because of increased fluid.

The nurse is assessing a client who reports frequent urination. Which inquiry made by the nurse will help determine diabetes insipidus? A. "Do you have history of cancer?" B. "Are you on fluoroquinolone therapy?" C. "Are you on lithium carbonate therapy?" D. "Do you have a history of lymphoma?"

C. "Are you on lithium carbonate therapy?" Lithium carbonate is known to interfere with normal kidney response to antidiuretic hormone. Therefore enquiring about lithium carbonate therapy can help assess for diabetes insipidus, which has a clinical manifestation of frequent urination. Inquiry about history of cancer helps in assessing syndrome of inappropriate antidiuretic hormone (SIADH) because some cancer therapy drugs result in SIADH. Treatment with fluoroquinolone antibiotics also can result in SIADH. Hodgkin's and Non-Hodgkin's lymphoma are causes of SIADH.

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. A 69-year-old female with sepsis caused by a gram-negative bacterial infection. The answer is C. Sepsis is the MOST common cause of ARDS because of systemic inflammation experienced. This is also true if the cause of the sepsis is a gram-negative bacterium (this also makes the infection harder to treat...hence poor prognosis). With sepsis, the immune cells that are present with the inflammation travel to the lungs and damage the alveolar capillary membrane leading to fluid to leak in the alveolar sacs.

You're teaching a class on critical care concepts to a group of new nurses. You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding about this condition. Which statement by a new nurse demonstrates he understands the condition? A. "This condition develops because the exocrine glands start to work incorrectly leading to thick, copious mucous to collect in the alveoli sacs." B. "ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the lungs." C. "Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has accumulated in the pleural space." D. "This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."

D. "This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs." The answer is D. ARDS is a type of respiratory failure that occurs when the capillary membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac. Option A describes cystic fibrosis, option B describes COPD, and option C describes a pneumothorax.

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. <18 mmHg The answer is D. A pulmonary artery wedge pressure measures the left atrial pressure. A pulmonary catheter is "wedged" with a balloon in the pulmonary arterial branch to measure the pressure. If the reading is less than 18 mmHg it indicates this is NOT a cardiac issue but most likely ARDS. Therefore, the pulmonary edema is due to damage to the alveolar capillary membrane leaking fluid into the alveolar sac....NOT a heart problem ex: heart failure.

A nurse is caring for a client with a tentative diagnosis of pheochromocytoma who is receiving chlorpromazine. A 24-hour urine specimen to assess the presence of vanillylmandelic acid (VMA) is prescribed to assist in confirmation of the diagnosis. What information should the nurse include in the client teaching regarding this test? Select all that apply. A. The client may take chlorpromazine during the test. B. Encourage the client to engage in usual activities during the test. C. Only salicylates (aspirin) can be taken for discomfort during the test. D. All urine excreted over the 24-hour period must be saved and refrigerated. E. Avoid coffee, chocolate, and citrus fruit for three days before and during the test.

D. All urine excreted over the 24-hour period must be saved and refrigerated. E. Avoid coffee, chocolate, and citrus fruit for three days before and during the test.

A nurse is caring for a client with diabetes insipidus. Which clinical manifestation should a nurse expect the client to exhibit? A. Increased blood glucose B. Decreased serum sodium C. Increased specific gravity D. Decreased urine osmolarity

D. Decreased urine osmolarity Insufficient antidiuretic hormone (ADH) decreases water uptake by the kidney tubules, resulting in very dilute urine with low osmolarity [1] [2]. Diabetes insipidus does not affect glucose levels; diabetes mellitus affects glucose levels. Serum sodium levels increase because of hemoconcentration. Specific gravity decreases with dilute urine.

A client with a history of emphysema is admitted with a diagnosis of acute respiratory failure with respiratory acidosis. Oxygen is being administered at 3 L/min nasal cannula. Four hours after admission, the client has increased restlessness and confusion followed by a decreased respiratory rate and lethargy. What should the nurse do? A. Question the client about the confusion. B. Change the method of oxygen delivery. C. Percuss and vibrate the client's chest wall. D. Discontinue or decrease the oxygen flow rate.

D. Discontinue or decrease the oxygen flow rate. With emphysema, it is believed that the respiratory center no longer responds to elevated carbon dioxide as the stimulus to breathe [1] [2] but rather to lowered oxygen levels; therefore, the oxygen being delivered must be lowered to supply enough for oxygenation without being so elevated that it negates the stimulus to breathe. However, the results of one recent study of clients with stable chronic obstructive pulmonary disease (COPD) indicate that the hypercarbic drive is preserved. More research is needed before this theory is applied clinically. A confused client cannot answer questions about the confusion. There are no indications that respiratory secretions have increased.

A nurse is caring for a client who has a tracheostomy tube and is on a ventilator. What must the nurse ensure about the tracheostomy tube? A. Has an inner cannula B. Is changed every week C. Is cleansed once a day D. Has a low-pressure cuff

D. Has a low-pressure cuff

A client requiring long-term ventilator management is discharged from the health care facility. Which health care setting should this client be referred to? A. Home care B. Rehabilitation C. Assisted living D. Intermediate care

D. Intermediate care Intermediate care or a skilled nursing facility offers skilled care from licensed nursing staff. The client should be admitted to this facility until he or she can move back into the community or home care. The primary objective of home care is health promotion and education. It involves the provision of medically related professional and paraprofessional services at the client's home. Clients require rehabilitation after a physical or mental illness, injury, or chemical addiction. It focuses on the prevention of complications due to illness and helps to maximize the client's level of independence. Assisted living offers long-term care setting with a home-like environment. The residents may require some assistance with activities of daily living but are quite independent.

A 25-year-old client in the ICU is being treated for acute respiratory distress syndrome (ARDS). The client is on a ventilator and requires 80 percent FiO2. Which information would the nurse most likely need to report about the client to the respiratory therapist assigned to this case? A. The client needs a hemoglobin level drawn B. The client needs endotracheal suctioning C. The client needs more oxygen because of O2 saturations D. The client needs an arterial blood gas drawn

D. The client needs to have an arterial blood gas drawn Respiratory therapists have multiple duties in the healthcare facility and they frequently monitor and work out many technical details of the client's care when a ventilator is being used. A respiratory therapist would most likely change the ventilator settings but the nurse is able to increase the oxygen level on the ventilator and the nurse can suction the patient. It is common for the respiratory therapist to draw arterial blood gas levels.