Oxygenation Practice Questions
Arterial blood gas (ABG) results of an intubated, mechanically ventilated patient are: pH = 7.33 PaO2 = 50, PaCO2 = 49 Bicarbonate = 27. The nurse would anticipate the priority action would be to: Increase respiratory rate and FiO2. Increase IV fluids. Add positive end expiratory pressure. Decrease the respiratory rate and FiO2.
Increase respiratory rate and FiO2.
A patient with hypoxia has 3 L/min nasal cannula applied. If the hypoxia does not resolve with the 3 L/min nasal cannula, what is the nurse's next action? Increase the nasal cannula to 5 L/min. Start a non-rebreather mask at 15 L/min. Apply high flow nasal cannula. Intubate the patient.
Increase the nasal cannula to 5 L/min.
The nurse instructs a patient on the advantages of noninvasive mechanical ventilation. Which patient statement reflects a need for additional teaching? "Noninvasive ventilation is not uncomfortable and I won't have to be admitted to the ICU to use it." "I will not have to have a tube down my throat for it to work." "I will probably recover faster, so I can get out of the hospital faster." "I am more likely to have fewer complications such as pneumonia."
"Noninvasive ventilation is not uncomfortable and I won't have to be admitted to the ICU to use it."
A patient is scheduled to have a surgical procedure that will require endotracheal intubation and mechanical ventilation for several days postoperatively. What will the nurse tell the patient about postoperative communication? "You will be sedated and won't need to communicate." "I will call the anesthesiologist to discuss your concerns." "We will use a variety of strategies to make sure that your needs are met." "You will have to use gestures to communicate."
"We will use a variety of strategies to make sure that your needs are met."
What will the nurse expect to assess in a patient with respiratory failure and hypoxemia? Agitation, disorientation, lethargy, chest pain Exertional dyspnea, circumoral cyanosis, distal (toes, fingers) cyanosis. Subcutaneous emphysema, absent breath sounds, sharp chest pain. Rales, distended neck veins, orthostatic hypotension.
Agitation, disorientation, lethargy, chest pain
Your patient is an 18 year-old intubated female who is recovering from the flu. You are doing your initial assessment, and are now checking her ventilator settings. She is on an SIMV mode with a set rate of 16 breaths/min, and a set tidal volume of 400mL. You notice that the patient is actually breathing 18 breaths/min, with a tidal volume of 200 - 400mL. You understand that the patient is getting which of the following? 18 breaths/minute at a tidal volume of 400mL 16 mandatory breaths at a tidal volume of 400mL, and 2 of her self-triggered breaths at a volume of 200mL. 18 breaths at whatever tidal volume she can draw. 9 breaths at tidal volume 200mL, 9 breaths at tidal volume 400mL.
16 mandatory breaths at a tidal volume of 400mL, and 2 of her self-triggered breaths at a volume of 200mL.
Which patient would the nurse identify as benefiting from the use of noninvasive ventilation such as CPAP? A 57-year-old male with a history of sleep apnea. A 55-year-old female with an acute exacerbation of asthma. A 48-year-old female with an acute myocardial infarction. A 72-year-old male with sepsis.
A 57-year-old male with a history of sleep apnea.
A patient with ARDS has PEEP added to the mechanical ventilation therapy. Which assessment finding indicates that the use of PEEP has been effective? A PO2 of 92 mmHg. PCO2 of 52 mmHg. A respiratory rate of 33. A urine output of 50 mL/hr.
A PO2 of 92 mmHg.
A hi-frequency oscillating ventilator would benefit an ARDS patient because: It would reduce further lung injury caused by volutrauma It would reduce further lung injury caused by barotrauma It would reduce further lung injury caused by sonartrauma a and b
A and B (It would reduce further lung injury caused by volutrauma It would reduce further lung injury caused by barotrauma )
The nurse is reviewing the health history of a patient diagnosed with an acute lung injury for a cause of the disease process. Which statement correctly identifies the cause for this type of lung injury? Acute lung injury can be caused indirectly from sepsis, traumas, or pancreatitis. Acute lung injury is a single organ dysfunction syndrome that has a chronic onset. Acute lung injury is caused by few infiltrates on chest radiography. Acute lung injury is caused by right ventricular failure.
Acute lung injury can be caused indirectly from sepsis, traumas, or pancreatitis.
Which evidence based intervention would the nurse use to prevent pneumonia in the patient receiving mechanical ventilation? Administration of an H2 antagonist to prevent peptic ulcers Aseptic technique when performing oral hygiene Elevation of the head of the bed to 10 degrees to prevent aspiration Changing the ventilator circuit hourly
Administration of an H2 antagonist to prevent peptic ulcers
A patient who was in a motor vehicle accident 2 days ago is on your floor. Today the patient stated that he has been having a lot of difficulty breathing. His lung sounds are clear throughout, however his SaO2 is 86% on room air. He has a stat chest x-ray done, which shows the following. The very next thing that should be done is: Apply oxygen at 2 L/min Recheck the SaO2 reading because the probe may not have been on the patient's finger properly. Draw stat labs to find out if the patient is having a heart attack Instruct the patient to take short, shallow breaths for a while.
Apply oxygen at 2 L/min
Which is the nurse's priority action for a patient suspected of experiencing a pulmonary embolism? Apply oxygen by mask or nasal cannula at 5 L/min. Increase the IV flow rate. Assess the chest and axillary area for the presence of petechiae. Place the patient supine with her head and neck flat and legs elevated.
Apply oxygen by mask or nasal cannula at 5 L/min.
Your patient, Sed Entary, had major abdominal surgery 3 days ago. She has had a significant amount of pain, and has been unwilling to walk around, or even get up into a chair. Ms. Entary has smoked 2 ppd for the past 10 years (and had a stroke last year), but even bribing her with cigarettes has not helped get her up and moving. She has been willing to take her daily oral contraceptive pills, however. Her husband has been at her bedside, and has been rubbing Ms. Entary's legs to help soothe her pain. 15 minutes ago, the husband came running out of the room yelling " she can't breathe, she can't breathe! She breathing as fast as a train, but she can't breathe!" The next thing that must be done for Ms. Entary is: Make her walk around the room several times. Start a Heparin drip at 1000 units/hour Apply oxygen by nasal cannula or mask at 5 L/min Call the ICU and inform them that you will be transferring a patient to them right away.
Apply oxygen by nasal cannula or mask at 5 L/min
A high-pressure alarm on a patient's mechanical ventilator is alarming. Which of the following actions should the nurse take LAST? Assess CO2 levels from ABG results. Assess if the patient needs to be suctioned. Assess if the patient is biting the tube, or rolled onto the tube. Assess for a mucous plug.
Assess CO2 levels from ABG results.
Which of the following assessments is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated patients? Auscultating breath sounds bilaterally. Assessing the patient's skin color. Monitoring the respiratory rate. Verifying the amount of cuff inflation.
Auscultating breath sounds bilaterally.
Outcome criteria for evaluating the effectiveness of airway suctioning should include which of the following? Breath sounds clear on auscultation. Respirations unlabored. Hollow sound on chest percussion. Decreased mucus production.
Breath sounds clear on auscultation.
The patient being mechanically ventilated has become more restless over the course of the shift. Which is the nurse's best action? Darkens the room and ask visitors to leave. Documents the observation as the only action. Administers a dose of pain medicine or sedative. Checks the patient's oxygen saturation by pulse oximetry.
Checks the patient's oxygen saturation by pulse oximetry.
The pulmonary edema associated with ARDS is a result of left ventricular failure True False
False
In caring for a brain-injured patient with damage to the cortex, which changes in respiratory and ventilatory efforts would the nurse expect to observe? Decreased voluntary initiation of ventilatory effort. Increased rate of breathing per minute. Increased respiratory effort by the use of chest and diaphragm muscles. Decrease in CO2 in blood analysis.
Decreased voluntary initiation of ventilatory effort.
After suctioning a patient's tracheostomy tube, the nurse waits a few minutes before suctioning again. The nurse should use intermittent suction primarily to help prevent: Depriving the patient of sufficient oxygen supply. Stimulating the patient's cough reflex. Dislodging the tracheostomy tube. Obstructing the suctioning catheter with secretions.
Depriving the patient of sufficient oxygen supply.
A nurse is suctioning an intubated, mechanically ventilated patient. Immediate complications that should be observed for include: Dysrhythmias Hypothermia Hematuria Decreased urinary output
Dysrhythmias
The nurse is explaining the purpose of a tracheostomy tube for mechanical ventilation. Which patient statement indicated the need for additional teaching? "The tracheostomy tube is: Helpful in allowing the respiratory muscles to be strengthened by increasing resistance to airflow." Used for long-term management, usually more than 2 or 3 weeks." Easier to use when there are increased secretions that need to be removed by suctioning." Generally a method that allows oral nutrition to be resumed."
Helpful in allowing the respiratory muscles to be strengthened by increasing resistance to airflow."
A patient with ARDS is on a mechanical ventilator and is becoming increasingly restless with a heart rate of 128, and total respiratory rate of 30. The SaO2 is 88% and the ventilator settings are: FiO2 50%; PEEP 8cm; AC 10; and a tidal volume of 700mL. There are coarse rhonchi audible in all lung fields, the patient is coughing, and the peak-pressure ventilator alarms are sounding. The appropriate nursing action would be to: Hyperoxygenate with 100% oxygen and suction the patient. Administer the ordered neuromuscular blockade medications Increase the FiO2 to 60% and tidal volume to 1000 mL for 2 minutes only. Increase the PEEP to 10 cm and sedate the patient.
Hyperoxygenate with 100% oxygen and suction the patient.
On admission, the patient's arterial blood gas (ABG) values were: pH, 7.20; PaO2, 64 mm Hg; PaCO2, 60 mm Hg; and HCO3-, 22 mEq/L. A chest tube is inserted, and oxygen at 4 L/minute is started. Thirty minutes later, his repeat blood gas values are: pH, 7.30; PaO2, 76 mm Hg; PaCO2, 50 mm Hg; and HCO3-, 22 mEq/L. This change would indicate: Improving respiratory status. Impending respiratory failure. Developing respiratory acidosis. Obstruction in the chest tube.
Improving respiratory status.
During multidisciplinary rounds, a discussion is held regarding the use of medications in acute respiratory distress syndrome (ARDS). Which statement is most accurate based upon published research findings? Inhaled nitrous oxide promotes blood flow to ventilated areas of the lungs. Corticosteroids are used for their anti-inflammatory property to manage secretion excess in response to ARDS. Exogenous surfactant therapy is more beneficial to adult patients with ARDS than when it is given to neonates. Cytokine inhibitors were shown to decrease mortality rates.
Inhaled nitrous oxide promotes blood flow to ventilated areas of the lungs
A patient with acute respiratory distress syndrome (ARDS) is on a ventilator. The patient's peak inspiratory pressures and spontaneous respiratory rate are increasing, and the PO2 is not improving. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the health care provider with the recommendation for: Initiating IV sedation. Starting a high-protein diet. Providing pain medication. Increasing the ventilator rate.
Initiating IV sedation.
What will the nurse assess in a patient experiencing the fibrotic phase of acute lung injury? Long-term ventilator dependence. Pulmonary wedge pressures (PCWP) are less than 2 mmHg. Bilateral fluid can be seen on radiographic exams at the costophrenic angle. Severe bleeding is noted from all body orifices.
Long-term ventilator dependence.
A patient at risk for ARDS has become cyanotic and diaphoretic. Which is the nurse's priority assessment? Measuring pulse oximetry Auscultating breath sounds bilaterally Measuring the blood pressure in both arms Comparing the current electrocardiographic tracing with the baseline measurement.
Measuring pulse oximetry
A patient is admitted to the emergency department with the following arterial blood gas (ABG): pH 7.43 PaCO2 35 mmHg PaO2 55 mmHg HCO3- 24 mEq SaO2 85% What is your interpretation? Normal acid-base status with hypoxemia Uncompensated respiratory acidosis with hypoxemia Uncompensated metabolic acidosis with hypoxemia Fully compensated metabolic acidosis with hypoxemia
Normal acid-base status with hypoxemia
A patient with ARDS has been in the ICU for several days. Which of the following interventions is the most important? Antibiotic therapy Bronchodilators Oxygen therapy Diuretic therapy
Oxygen therapy
Which is the most important intervention for the patient with ARDS? Oxygen therapy Antibiotic therapy Bronchodilators Diuretic therapy
Oxygen therapy
A patient with acute respiratory distress syndrome (ARDS) is showing signs of increased dyspnea. The nurse reviews a report of blood gas values that recently arrived (see below). Which finding should the nurse report to the health care provider? pH: 7.35 PaCO2: 25mmHg HCO3-: 22 mEq/L PaO2: 95mmHg PaCO2 HCO3- pH PaO2
PaCO2
What is particularly important for the nurse to assess in a patient who is beginning noninvasive ventilatory support such as CPAP/BiPAP? SELECT ALL THAT APPLY Patient orientation and level of alertness Respiratory pattern, depth Status of skin of the nose Bowel sounds and presence of insufflation (air in the stomach). Peripheral pulses
Patient orientation and level of alertness Respiratory pattern, depth Status of skin of the nose Bowel sounds and presence of insufflation (air in the stomach).
Which nursing action would best optimize overall oxygenation and ventilation in the patient with acute respiratory distress syndrome (ARDS)? Provide adequate rest and recovery time between procedures. Hyperventilate the patient before and after suctioning. Administer sedation frequently. Suction the patient at least every hour.
Provide adequate rest and recovery time between procedures.
A 27 year-old chemistry student is on your floor because a beaker of concentrated hydrochloric acid exploded this morning in the lab and immediately became a noxious gas. You become concerned with which of the following findings? Expiratory wheezes throughout all lung fields. SaO2 88% despite 3 L/min oxygen per nasal cannula A dry, hacky, non-productive cough The patient seems to breathe easier with guided imagery exercises.
SaO2 88% despite 3 L/min oxygen per nasal cannula
Which assessment findings would indicate to the nurse that a patient was experiencing respiratory distress? SELECT ALL THAT APPLY Tachycardia Use of abdominal muscles Intercostal muscle retractions. Bradypnea Jugular vein distention
Tachycardia Use of abdominal muscles Intercostal muscle retractions.
Your patient, Sed Entary, had major abdominal surgery 3 days ago. She has had a significant amount of pain, and has been unwilling to walk around, or even get up into a chair. Ms. Entary has smoked 2 ppd for the past 10 years (and had a stroke last year), but even bribing her with cigarettes has not helped get her up and moving. She has been willing to take her daily oral contraceptive pills, however. Her husband has been at her bedside, and has been rubbing Ms. Entary's legs to help soothe her pain. The surgeon finally comes in to see Ms. Entary and orders Alteplase to treat her pulmonary embolism. You politely remind the surgeon that: This should have been started 6 hours ago. That the patient has had major abdominal surgery and a history of a stroke, so the Alteplace is contraindicated for her. That the Alteplace should infuse at a faster rate than was ordered. That the protocol suggests using Heparin concurrently.
That the patient has had major abdominal surgery and a history of a stroke, so the Alteplace is contraindicated for her.
Your patient, Sed Entary, had major abdominal surgery 3 days ago. She has had a significant amount of pain, and has been unwilling to walk around, or even get up into a chair. Ms. Entary has smoked 2 ppd for the past 10 years (and had a stroke last year), but even bribing her with cigarettes has not helped get her up and moving. She has been willing to take her daily oral contraceptive pills, however. Her husband has been at her bedside, and has been rubbing Ms. Entary's legs to help soothe her pain. 15 minutes ago, the husband came running out of the room yelling " she can't breathe, she can't breathe! She breathing as fast as a train, but she can't breathe!" You immediately go in to assess Ms. Entary, and expect which of the following results? The patient is sitting up in the room, looking as if nothing was wrong. The patient is breathing 8 times per minute. The SaO2 is 82% The patient is complaining of abdominal pain at the incision site.
The SaO2 is 82%
Which statement accurately describes the purpose of sedation vacation for a patient to prevent ventilator-associated pneumonia? The patient's own tidal volume and respiratory rate can be evaluated during sedation vacation The vacation from sedation relieves stress, which decreases the chance of infection During sedation vacation the patient has a chance to take deep breaths and improve ventilation while more awake. New data show that sedation vacation is no longer recommended because there is concern about the safety of interrupting sedation.
The patient's own tidal volume and respiratory rate can be evaluated during sedation vacation
Which assessment finding requires the nurse's immediate action? The tape securing the endotracheal tube is wet with perspiration and saliva, and is no longer sticky. The patient has been intubated for four days. The endotracheal tube is secured at the right margin of the lip. The hydrocolloid membrane (Duoderm) on the skin of the cheeks is beginning to peel at the edges.
The tape securing the endotracheal tube is wet with perspiration and saliva, and is no longer sticky.
Which setting on a ventilator would require a nursing intervention to improve the outcome for a 60 kg patient with acute lung injury? Tidal volume (Vt) = 1500 mL. FiO2 = 0.30 or 30%. Respiratory rate = 16 per minute, when the CO2 levels are normal. Inspiratory: Expiratory ratio (I:E) = 1:2
Tidal volume (Vt) = 1500 mL.
In providing care to a patient on a mechanical ventilator, the nurse correlates the administration of warm humidified oxygen with which rationale? To decrease viscosity of secretions. To increase oxygen saturation To increase airway diameter. To decrease the risk of hypoxia.
To decrease viscosity of secretions.
Which finding indicates that suctioning is required for the patient who is being mechanically ventilated? The patient is talking around the endotracheal tube. Condensation is present in the ventilator tubing. Breath sounds are heard only in one lung. Wheezes and rhonchi are auscultated.
Wheezes and rhonchi are auscultated.
A nurse is caring for a patient who was intubated because of respiratory failure. The patient is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The patient has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as: synchronized intermittent mandatory ventilation (SIMV) pressure support ventilation (PSV) assist-control (AC) ventilation continuous positive airway pressure (CPAP)
synchronized intermittent mandatory ventilation (SIMV)
