TEST 4 (gas exchange)

The nurse working with a student nurse is providing care for a patient requiring mechanical ventilation. The student nurse asks the meaning of assist control. Which response by the nurse is the most appropriate? A. "Assist control is a means of delivering ventilation that delivers a preset volume and/or pressure each time the patient begins an inspiration." B. "Assist control allows the patient to breathe independently, but supplies a breath if the patient does not begin an inhalation in a specified period of time." C. "Assist control is used when weaning a patient from the ventilator because the patient must exercise the muscles of respiration in order to get a full breath." D. "Assist control is often used when a patient is receiving a paralytic agent."

A. "Assist control is a means of delivering ventilation that delivers a preset volume and/or pressure each time the patient begins an inspiration."

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to form of damage? A. Alveolar-capillary membrane B. Left ventricle C. Mainstem bronchus D. Trachea

A. Alveolar-capillary membrane

The nurse is assisting with endotracheal intubation of the patient and recognizes that the procedure will be done in what order? (Put a comma and space between each answer choice.) A. Assess balloon on endotracheal tube for symmetry and leaks. B. Assess lung fields for bilateral expansion. C. Inflate balloon of endotracheal tube. D. Insert endotracheal tube with laryngoscope and blade. E. Suction oropharynx

A. Assess balloon on endotracheal tube for symmetry and leaks. E. Suction oropharynx D. Insert endotracheal tube with laryngoscope and blade. C. Inflate balloon of endotracheal tube. B. Assess lung fields for bilateral expansion.

What are the diagnostic criteria for acute respiratory distress syndrome (ARDS)? (Select all that apply.) A. Bilateral infiltrates on chest x-ray study B. Decreased cardiac output C. PaO2/FiO2 ratio of less than 200 D. Pulmonary artery occlusion pressure (PAOP) of more than 18 mm Hg E. Acute onset within 7 days of clinical insult

A. Bilateral infiltrates on chest x-ray study C. PaO2/FiO2 ratio of less than 200

The nurse is concerned that a patient admitted for a total hip replacement is at risk for thrombus formation and pulmonary embolism. Which assessment finding supports the nurse's concern? A. Body mass index (BMI) 35.8 B. Former cigarette smoker C. Blood pressure 132/88 mm Hg D. Age 45 years

A. Body mass index (BMI) 35.8

The nurse is caring for a patient who is mechanically ventilated. The nurse understands that what statement should be considered when determining appropriate nursing interventions? A. Communication with intubated patients is often difficult. B. Controlled ventilation is the preferred mode for most patients. C. Patients with chronic obstructive pulmonary disease wean easily from mechanical ventilation. D. Wrist restraints are applied to all patients to avoid self-extubation.

A. Communication with intubated patients is often difficult.

The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following? (Select all that apply.) A. Coughing or attempting to talk B. Disconnection from the ventilator C. Kinks in the ventilator tubing D. Need for suctioning E. Spontaneous breathing

A. Coughing or attempting to talk C. Kinks in the ventilator tubing D. Need for suctioning

A patient's ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from.60 to.70, and the positive end-expiratory pressure is increased from 10 to 15 cm H2O. Shortly after these adjustments, the nurse notes that the patient's blood pressure drops from 120/76 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in blood pressure? A. Decrease in cardiac output B. Hypovolemia C. Increase in venous return D. Oxygen toxicity

A. Decrease in cardiac output

The patient diagnosed with acute respiratory distress syndrome (ARDS) would exhibit which symptom? A. Decreasing PaO2 levels despite increased FiO2 administration B. Elevated alveolar surfactant levels C. Increased lung compliance with increased FiO2 administration D. Respiratory acidosis associated with hyperventilation

A. Decreasing PaO2 levels despite increased FiO2 administration

The nurse caring for a mechanically ventilated patient prepares to include which strategies to prevent ventilator-associated pneumonia should be into the patient's plan of care? (Select all that apply.) A. Drain condensate from the ventilator tubing away from the patient. B. Elevate the head of the bed 30 to 45 degrees. C. Instill normal saline as part of the suctioning procedure. D. Perform regular oral care with chlorhexidine. E. Administer antibiotic therapy as prescribed

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

Which assessment data would cause the nurse to document the patient is experiencing early respiratory distress? Select all that apply. A. Dyspnea B. Restlessness C. Tachycardia D. Confusion E. Cyanosis

A. Dyspnea B. Restlessness C. Tachycardia

Which of the following devices is best suited to deliver 65% oxygen to a patient who is spontaneously breathing? A. Face mask with non-rebreathing reservoir B. Low-flow nasal cannula C. Simple face mask D. Venturi mask

A. Face mask with non-rebreathing reservoir

What strategies are appropriate for preventing deep vein thrombosis (DVT) and pulmonary embolus (PE) in an at-risk patient? (Select all that apply.) A. Graduated compression stockings B. Heparin or low-molecular weight heparin C. Sequential compression devices D. Strict bed rest E. Providing education regarding compression ultrasound

A. Graduated compression stockings B. Heparin or low-molecular weight heparin C. Sequential compression devices

Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of acute respiratory distress syndrome (ARDS)? (Select all that apply.) A. Increase functional residual capacity B. Prevent collapse of unstable alveoli C. Improve arterial oxygenation D. Open collapsed alveoli E. Improve venous oxygenation

A. Increase functional residual capacity B. Prevent collapse of unstable alveoli C. Improve arterial oxygenation D. Open collapsed alveoli

Which of the following are components of the Institute for Healthcare Improvement's (IHI's) ventilator bundle? (Select all that apply.) A. Interrupt sedation each day to assess readiness to extubate. B. Maintain head of bed at least 30 degrees elevation. C. Provide deep vein thrombosis prophylaxis. D. Provide prophylaxis for peptic ulcer disease. E. Swab the mouth with foam swabs every 2 hours.

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

During rounds, the primary care provider (PCP) alerts the team that proning is being considered for a patient with acute respiratory distress syndrome. The nurse should have what understanding about the benefit of proning? A. It is an optional treatment if the PaO2/FiO2 ratio is less 100. B. It presents less of a risk for skin breakdown because the patient is face down. C. It is possible with minimal help from co-workers. D. It is used to provide continuous lateral rotational turning.

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

The nurse is caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome. The nurse understands that the priority nursing concern for this patient is which of the following? A. Management and protection of the airway B. Prevention of gastric aspiration C. Prevention of skin breakdown and nerve damage D. Psychological support to patient and family

A. Management and protection of the airway

A patient admitted with smoke inhalation injuries develops signs and symptoms of acute respiratory distress syndrome (ARDS). Which health-care provider prescription does the nurse anticipate for this patient? A. Mechanical ventilation B. Oxygen via a nasal cannula C. Face mask oxygen administration D. Continuous positive airway pressure

A. Mechanical ventilation

What sign is indicative of respiratory distress in infants? A. Nasal flaring B. Respiratory rate of 55 breaths/min C. Irregular respiratory pattern D. Abdominal breathing

A. Nasal flaring

Which statement is true regarding venous thromboembolism (VTE) and pulmonary embolus (PE)? A. PE should be suspected in any patient who has unexplained cardiorespiratory complaints and risk factors for VTE. B. Bradycardia and hyperventilation are classic symptoms of PE. C. Dyspnea, chest pain, and hemoptysis occur in nearly all patients with PE. D. Most critically ill patients are at low risk for VTE and PE and do not require prophylaxis.

A. PE should be suspected in any patient who has unexplained cardiorespiratory complaints and risk factors for VTE.

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment? A. Paradoxical chest movement B. Complaint of chest wall pain C. Heart rate of 110 beats/minute D. Large bruised area on the chest

A. Paradoxical chest movement

A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse's first action in this situation? A. Prepare intubation equipment and call the physician. B. Examine the child's oropharynx and call the physician. C. Obtain a throat culture for respiratory syncytial virus (RSV). D. Obtain vital signs and listen to breath sounds.

A. Prepare intubation equipment and call the physician.

A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous respirations are 12 breaths/min. The patient receives a dose of morphine sulfate, and now respirations decrease to 4 breaths/min. What adjustments may need to be made to the patient's ventilator settings? A. Add positive end-expiratory pressure (PEEP). B. Add pressure support. C. Change to assist/control ventilation at a rate of 4 breaths/min. D. Increase the synchronized intermittent mandatory ventilation respiratory rate.

D. Increase the synchronized intermittent mandatory ventilation respiratory rate.

The nurse is caring for a patient whose ventilator settings include 15 cm H2O of positive end-expiratory pressure (PEEP). The nurse understands that although beneficial, PEEP may result in what possible problem? A. Fluid overload secondary to decreased venous return. B. High cardiac index secondary to more efficient ventricular function. C. Hypoxemia secondary to prolonged positive pressure at expiration. D. Low cardiac output secondary to increased intrathoracic pressure

D. Low cardiac output secondary to increased intrathoracic pressure

The nurse caring for a mechanically ventilated patient notes the high pressure alarm sounding but cannot quickly identify the cause of the alarm. The nurse notes the patient's oxygen saturation is decreasing and heart rate and respiratory rate are increasing. What is the nurse's priority action? A. Ask the respiratory therapist to get a new ventilator B. Call the rapid response team to assess the patient C. Continue to find the cause of the alarm and fix it D. Manually ventilate the patient while calling for a respiratory therapist

D. Manually ventilate the patient while calling for a respiratory therapist

The nurse is concerned that a patient is at increased risk of developing a pulmonary embolus and develops a plan of care for prevention to include which intervention? A. Antiseptic oral care B. Bed rest with head of bed elevated C. Coughing and deep breathing D. Mobility

D. Mobility

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? A. They have a widened, shorter airway. B. There is a defect in their sucking ability. C. The gag reflex increases mucus production. D. Mucus and edema obstruct small airways.

D. Mucus and edema obstruct small airways.

The nurse caring for a patient diagnosed with acute respiratory failure identifies "Risk for Ineffective Airway Clearance" as a nursing diagnosis. What nursing intervention is relevant to this diagnosis? A. Elevate head of bed to 30 degrees. B. Obtain order for venous thromboembolism prophylaxis. C. Provide adequate sedation. D. Reposition patient every 2 hours.

D. Reposition patient every 2 hours

The primary care provider orders the following mechanical ventilation settings for a patient who weighs 75 kg and whose spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO2: 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H2O A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

D. Respiratory alkalosis

In assessing a patient, the nurse understands that what symptomology is an early sign of hypoxemia? A. Clubbing of nail beds B. Cyanosis C. Hypotension D. Restlessness

D. Restlessness

What risk is the rationale for the recommendation of endotracheal rather than nasotracheal intubation? A. Basilar skull fracture B. Cervical hyperextension C. Impaired ability to "mouth" words D. Sinusitis and infection

D. Sinusitis and infection

The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient? A. High-Fowler's position with the left arm extended B. Supine with the head of the bed elevated 30 degrees C. On the right side with the left arm extended above the head D. Sitting upright with the arms supported on an over bed table

D. Sitting upright with the arms supported on an over bed table

A nurse caring for a patient with a pulmonary embolism expects to find which diagnostic result? A. Patchy infiltrates on chest x-ray B. Metabolic alkalosis on arterial blood gas C. Elevated CO2 level found on end-tidal carbon dioxide monitor D. Tachycardia and nonspecific T-wave changes on EKG

D. Tachycardia and nonspecific T-wave changes on EKG

The nurse is caring for a mechanically ventilated patient. The primary care providers are considering performing a tracheostomy because the patient is having difficulty weaning from mechanical ventilation. Related to tracheostomy, the nurse understands which of the following? A. Patient outcomes are better if the tracheostomy is done within a week of intubation. B. Percutaneous tracheostomy can be done safely at the bedside by the respiratory therapist. C. Procedures performed in the operating room are associated with fewer complications. D. The greatest risk after a percutaneous tracheostomy is accidental decannulation.

D. The greatest risk after a percutaneous tracheostomy is accidental decannulation.

Positive end-expiratory pressure (PEEP) is a mode of ventilatory assistance that produces which of the following conditions A. Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume. B. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient's ability to generate negative pressure. C. The patient must have a respiratory drive, or no breaths will be delivered. D. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O.

D. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O.

Which treatment can be used to dissolve a thrombus that is lodged in the pulmonary artery? A. Aspirin B. Embolectomy C. Heparin D. Thrombolytics

D. Thrombolytics

After coronary artery bypass graft surgery a patient is transported to the surgical intensive care unit at noon and placed on mechanical ventilation. How should the nurse interpret the patient's initial arterial blood gas levels? pH 7.31 PaCO2 48 mm Hg Bicarbonate 22 mEq/L PaO2 115 mm Hg O2 saturation 99% A. Normal arterial blood gas levels with a high oxygen level B. Partly compensated respiratory acidosis, normal oxygen C. Uncompensated metabolic acidosis with high oxygen levels D. Uncompensated respiratory acidosis; hyperoxygenated

D. Uncompensated respiratory acidosis; hyperoxygenated

A patient presents to the emergency department demonstrating agitation and reporting numbness and tingling in the fingers. Arterial blood gas levels reveal the following: pH 7.51, PaCO2 25, HCO3 25. How should the nurse interprets these blood gas values? A. Compensated metabolic alkalosis B. Normal values C. Uncompensated respiratory acidosis D. Uncompensated respiratory alkalosis

D. Uncompensated respiratory alkalosis

The amount of effort needed to maintain a given level of ventilation is referred to using what term? A. Compliance B. Resistance C. Tidal volume D. Work of breathing

D. Work of breathing

The laboratory has just called with the arterial blood gas (ABG) results on four patients. Which result is most important for the nurse to report immediately to the health care provider? A. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97% B. pH 7.35, PaO2 85 mm Hg, PaCO2 50 mm Hg, and O2 sat 95% C. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98% D. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

D. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

The nurse has instructed a patient recovering from a pulmonary embolism on long-term anticoagulant therapy. Which patient statement indicates that instruction has been effective? A. "I will expect bloody sputum when I brush my teeth." B. "I need to use a soft toothbrush and an electric razor, and avoid injuries." C. "I need to eat a well-balanced diet with green salads." D. "I can expect to be bruised, since this is normal."

B. "I need to use a soft toothbrush and an electric razor, and avoid injuries."

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions? A. "I will call my health care provider if I still feel tired after a week." B. "I will continue to do deep breathing and coughing exercises at home." C. "I will schedule two appointments for the pneumonia and influenza vaccines." D. "I will cancel my follow-up chest x-ray appointment if I feel better next week."

B. "I will continue to do deep breathing and coughing exercises at home."

The nurse is discharging a patient home following treatment for community-acquired pneumonia. As part of the discharge teaching, the nurse should provide instruction? A. "If you get the pneumococcal vaccine, you'll never get pneumonia again." B. "It is important for you to get an annual influenza shot to reduce your risk of pneumonia." C. "Stay away from cold, drafty places because that increases your risk of pneumonia when you get home." D. "Since you have been treated for pneumonia, you now have immunity from getting it in the future."

B. "It is important for you to get an annual influenza shot to reduce your risk of pneumonia."

Which type of croup is always considered a medical emergency? A. Laryngitis B. Epiglottitis C. Spasmodic croup D. Laryngotracheobronchitis (LTB)

B. Epiglottitis

The nurse is assisting with endotracheal intubation and understands correct placement of the endotracheal tube in the trachea would be identified by which of the following? (Select all that apply.) A. Auscultation of air over the epigastrium B. Equal bilateral breath sounds upon auscultation C. Position above the carina verified by chest x-ray D. Positive detection of carbon dioxide (CO2) through CO2 detector devices E. Fogging of the endotracheal tube

B. Equal bilateral breath sounds upon auscultation C. Position above the carina verified by chest x-ray D. Positive detection of carbon dioxide (CO2) through CO2 detector devices

A patient is having difficulty weaning from mechanical ventilation. The nurse assesses the patient and notes what potential cause of this difficult weaning? A. Cardiac output of 6 L/min B. Hemoglobin of 8 g/dL C. Negative sputum culture and sensitivity D. White blood cell count of 8000

B. Hemoglobin of 8 g/dL

The nurse assesses a patient who is admitted for an overdose of sedatives. The nurse expects to find which acid-base alteration? A. Hyperventilation and respiratory acidosis B. Hypoventilation and respiratory acidosis C. Hypoventilation and respiratory alkalosis D. Respiratory acidosis and normal oxygen levels

B. Hypoventilation and respiratory acidosis

A 65-year-old patient admitted to the progressive care unit with a diagnosis of community-acquired pneumonia, has a history of chronic obstructive pulmonary disease and diabetes. A set of arterial blood gases obtained on admission without supplemental oxygen shows pH 7.35; PaCO2 55 mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. These blood gases reflect what condition? A. Hypoxemia and compensated metabolic alkalosis. B. Hypoxemia and compensated respiratory acidosis. C. Normal oxygenation and partly compensated metabolic alkalosis. D. Normal oxygenation and uncompensated respiratory acidosis.

B. Hypoxemia and compensated respiratory acidosis.

The nurse in the intensive care unit (ICU) is caring for a patient diagnosed with acute respiratory distress syndrome (ARDS). Vital signs prior to endotracheal intubation: HR 108 bpm, RR 32 bpm, BP 88/58 mm Hg, and oxygen saturation 82%. The patient is intubated and placed on mechanical ventilation with positive pressure ventilation. Which assessment finding indicates a further decrease of cardiac output secondary to positive pressure ventilation? A. Blood pressure 90/60 mm Hg B. Urine output 25mL/hr C. Heart rate 110 bpm D. Oxygen saturation 90%

B. Urine output 25mL/hr

The nurse is providing discharge instructions to an older adult patient who is going home after having a total knee replacement. Which will the nurse include in the discharge teaching to decrease the patient's risk for developing a thrombosis or pulmonary embolism? A. Place pillows under the knees when in bed B. Use compression stockings C. Limit ambulation D. Limit fluids

B. Use compression stockings

After the nurse has received change-of-shift report, which patient should the nurse assess first? A. A patient with pneumonia who has crackles in the right lung base B. A patient with chronic bronchitis who has a low forced vital capacity C. A patient with possible lung cancer who has just returned after bronchoscopy D. A patient with hemoptysis and a 16-mm induration after tuberculin skin testing

C. A patient with possible lung cancer who has just returned after bronchoscopy

The nurse is providing care to a patient with an infected leg wound. The patient is exhibiting symptoms of a systemic infection and is receiving intravenous antibiotics. The patient states to the nurse, "I am having trouble breathing." Based on this data, which does the nurse suspect the patient is experiencing? A. Allergic response from antibiotic therapy B. Deep vein thrombosis C. Acute respiratory distress syndrome D. Anemia

C. Acute respiratory distress syndrome

A patient is brought into the emergency department (ED) after being in a motor vehicle accident. The patient has suffered traumatic injury that may involve multiple body systems. Which is the priority nursing assessment for this patient? A. Breathing and ventilation B. Circulation with hemorrhage control C. Airway maintenance with cervical spine protection D. Disability and neurological assessment

C. Airway maintenance with cervical spine protection

The nurse is preparing to discharge a patient recovering from a pulmonary embolism. Which topics are appropriate for the nurse to include in the teaching session? A. Resume the use of any over-the-counter medications B. Diet to include green leafy vegetables C. Anticoagulant administration schedule D. Resume normal activity level

C. Anticoagulant administration schedule

The nurse is providing care for a patient requiring mechanical ventilation. When the nurse enters the room at the beginning of the shift, the patient's monitor displays a heart rate of 64 and oxygen saturation of 88%. Which nursing action is the priority? A. Increasing the oxygen concentration and quickly assessing the patient B. Removing the patient from the ventilator and hyperoxygenating and hyperventilating the patient C. Assessing the patient for airway obstruction D. Checking ventilator settings

C. Assessing the patient for airway obstruction

Intrapulmonary shunting refers to what outcome? A. Alveoli that are not perfused. B. Blood that is shunted from the left side of the heart to the right and causes heart failure. C. Blood that is shunted from the right side of the heart to the left without oxygenation. D. Shunting of blood supply to only one lung.

C. Blood that is shunted from the right side of the heart to the left without oxygenation.

The nurse is assessing the exhaled tidal volume (EVT) in a mechanically ventilated patient. What is the rationale for this assessment? A. Assess for tension pneumothorax. B. Assess the level of positive end-expiratory pressure. C. Compare the tidal volume delivered with the tidal volume prescribed. D. Determine the patient's work of breathing.

C. Compare the tidal volume delivered with the tidal volume prescribed.

What is the basic underlying pathophysiology of acute respiratory distress syndrome? A. A decrease in the number of white blood cells available. B. Damage to the right mainstem bronchus. C. Damage to the type II pneumocytes, which produce surfactant. D. Decreased capillary permeability.

C. Damage to the type II pneumocytes, which produce surfactant.

The nurse caring for a patient recovering from an abdominal hysterectomy suspects the patient is experiencing a pulmonary embolism. Which clinical manifestation supports the nurse's suspicion? A. Nausea B. Decreased urine output C. Dyspnea and shortness of breath D. Activity intolerance

C. Dyspnea and shortness of breath

The nurse is caring for a mechanically ventilated patient and is charting outside the patient's room when the ventilator alarm sounds. What is the priority order for the nurse to complete these actions? (Put a comma and space between each answer choice.) A. Check quickly for possible causes of the alarm that can be fixed. B. After troubleshooting, connect back to mechanical ventilator and reassess patient. C. Go to patient's bedside. D. Manually ventilate the patient while getting respiratory therapist

C. Go to patient's bedside. A. Check quickly for possible causes of the alarm that can be fixed. D. Manually ventilate the patient while getting respiratory therapist B. After troubleshooting, connect back to mechanical ventilator and reassess patient.

The nurse is planning care for a newly admitted patient diagnosed with pulmonary embolism. The nurse anticipates the patient will need anticoagulant therapy. What is true regarding this therapy for the treatment of this condition? A. It is considered second-line treatment. B. Major hemorrhage is common. C. Heparin and warfarin (Coumadin) are usually initiated at the same time. D. Heparin alters the synthesis of vitamin K-dependent clotting factors, preventing further clots.

C. Heparin and warfarin (Coumadin) are usually initiated at the same time.

What diagnostic procedure is required to make a definitive diagnosis of pulmonary embolism? A. Arterial blood gas (ABG) analysis. B. Chest x-ray examination. C. High resolution multidetector CT angiogram. D. Ventilation-perfusion scanning.

C. High resolution multidetector CT angiogram.

A patient diagnosed with a pulmonary embolism has a reduction in arterial oxygen saturation level and dyspnea. Which is the priority nursing diagnosis for this patient? A. Ineffective Tissue Perfusion B. Anxiety C. Impaired Gas Exchange D. Impaired Physical Mobility

C. Impaired Gas Exchange

What is a strategy for preventing thromboembolism in patients at risk who cannot take anticoagulants? A. Administration of two aspirin tablets every 4 hours. B. Infusion of thrombolytics. C. Insertion of a vena cava filter. D. Subcutaneous heparin administration every 12 hours.

C. Insertion of a vena cava filter

A patient receiving treatment for acute respiratory distress syndrome (ARDS) is demonstrating anxiety and fear of having to stay on the ventilator indefinitely. Which interventions by the nurse are appropriate? Select all that apply. A. Explain about care areas specifically designed for long-term ventilatory support. B. Dim the lights and reduce distracting noise, such as the television. C. Instruct that intubation and ventilation are temporary measures. D. Encourage family visits and participation in care. E. Remain with the patient as much as possible.

C. Instruct that intubation and ventilation are temporary measures. D. Encourage family visits and participation in care. E. Remain with the patient as much as possible.

A patient's status deteriorates and mechanical ventilation is now required. The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously in between the mechanical breaths at his own tidal volume. This mode of ventilation is referred to by what term? A. Assist/control ventilation B. Controlled ventilation C. Intermittent mandatory ventilation D. Positive end-expiratory pressure

C. Intermittent mandatory ventilation

The nurse caring for a patient with an endotracheal tube understands that endotracheal suctioning is needed to facilitate removal of secretions. What additional information is the nurse aware of concerning this intervention? A. It decreases intracranial pressure. B. It depresses the cough reflex. C. It is done as indicated by patient assessment. D. It is more effective if preceded by saline instillation to loosen secretions.

C. It is done as indicated by patient assessment.

The nurse is planning care for a patient with a pulmonary embolism. Which intervention would assist with the patient's decrease in cardiac output? A. Provide oxygen B. Keep protamine sulfate at the bedside C. Monitor pulmonary arterial pressures D. Assess for bleeding

C. Monitor pulmonary arterial pressures

The nurse is caring for a patient with acute respiratory distress syndrome who is hypoxemic despite mechanical ventilation. The primary care provider (PCP) orders a nontraditional ventilator mode as part of treatment. Despite sedation and analgesia, the patient remains restless and appears to be in discomfort. The nurse informs the PCP of this assessment and anticipates what order? A. Continuous lateral rotation therapy B. Guided imagery C. Neuromuscular blockade D. Prone positioning

C. Neuromuscular blockade

A patient presents to the emergency department in acute respiratory failure secondary to community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease. The nurse anticipates which treatment to facilitate ventilation? A. Emergency tracheostomy and mechanical ventilation B. Mechanical ventilation via an endotracheal tube C. Noninvasive positive-pressure ventilation (NPPV) D. Oxygen at 100% via bag-valve-mask device

C. Noninvasive positive-pressure ventilation (NPPV)

A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery with the following arterial blood gas (ABG) levels. What is the nurse's interpretation of these values? pH 7.4 PaCO2 40 mm Hg Bicarbonate 24 mEq/L PaO2 95 mm Hg O2 saturation 97% Respirations 20 breaths per minute A. Compensated metabolic acidosis B. Metabolic alkalosis C. Normal ABG values D. Respiratory acidosis

C. Normal ABG values

While neuromuscular blocking agents are used in the management of some ventilated patients what is their primary mode of action? A. Analgesia B. Anticonvulsant C. Paralysis D. Sedation

C. Paralysis

A mode of pressure-targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through what action by the endotracheal tube? A. Continuous positive airway pressure B. Positive end-expiratory pressure C. Pressure support ventilation D. T-piece adapter

C. Pressure support ventilation

The nurse notes that the patient's arterial blood gas levels indicate hypoxemia. The patient is not intubated and has a respiratory rate of 22 breaths/min. what is the nurse's first intervention to relieve hypoxemia? A. Call the physician for an emergency intubation procedure. B. Obtain an order for bilevel positive airway pressure (BiPAP). C. Provide for oxygen administration. D. Suction secretions from the oropharynx.

C. Provide for oxygen administration

A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous respirations are 12 breaths/min. After receiving a dose of morphine sulfate, respirations decrease to 4 breaths/min. Which acid-base disturbance will likely occur? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis

Which acid-base disturbances commonly occurs with the hyperventilation and impaired gas exchange seen in severe exacerbation of asthma? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis

When assessing the patient for hypoxemia, the nurse recognizes what as an early sign of the effect of hypoxemia on the cardiovascular system? A. Heart block B. Restlessness C. Tachycardia D. Tachypnea

C. Tachycardia

The nurse caring for a patient admitted with septic shock is aware of the need to assess for the development of acute respiratory distress syndrome (ARDS). Which early clinical manifestation would indicate the development of ARDS? A. Intercostal retractions B. Cyanosis C. Tachypnea D. Tachycardia

C. Tachypnea

The nurse discharging a patient diagnosed with asthma instructs the patient to prevent exacerbation by taking what action? A. Obtaining an appointment for follow-up pulmonary function studies 1 week after discharge. B. Limiting activity until patient is able to climb two flights of stairs. C. Taking all asthma medications as prescribed. D. Taking medications on a "prn" basis according to symptoms.

C. Taking all asthma medications as prescribed.

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The nurse is caring for a postoperative patient with chronic obstructive pulmonary disease (COPD). Which assessment would be a cue to the patient developing postoperative pneumonia? A. Bradycardia B. Change in sputum characteristics C. Hypoventilation and respiratory acidosis D. Pursed-lip breathing

B. Change in sputum characteristics

A patient who has a right-sided chest tube after a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is appropriate? A. Adjust the dial on the wall regulator. B. Continue to monitor the collection device. C. Document the presence of a large air leak. D. Notify the surgeon of a possible pneumothorax

B. Continue to monitor the collection device.

When fluid is present in the alveoli what is the result? A. Alveoli collapse and atelectasis occurs. B. Diffusion of oxygen and carbon dioxide is impaired. C. Hypoventilation occurs. D. The patient is in heart failure.

B. Diffusion of oxygen and carbon dioxide is impaired.

The nurse educator prepares to speak to a group of nursing students about direct and indirect insults to the lungs that may lead to the development of acute respiratory distress syndrome (ARDS). Which conditions will the nurse include in the teaching session? Select all that apply. A. Septic shock B. Viral pneumonia C. Aspirin overdose D. Head injury E. Angioplasty

A. Septic shock B. Viral pneumonia C. Aspirin overdose D. Head injury

When it is noted that a patient's endotracheal tube is not secured tightened, he respiratory care practitioner assists the nurse in taping the tube. After the tube is retaped, the nurse auscultates the patient's lungs and notes that the breath sounds over the left lung fields are absent. The nurse suspects is the cause of this finding? A. The endotracheal tube is in the right mainstem bronchus. B. The patient has a left pneumothorax. C. The patient has aspirated secretions during the procedure. D. The stethoscope earpiece is clogged with wax.

A. The endotracheal tube is in the right mainstem bronchus.

The nurse is caring for a patient in acute respiratory failure and understands that the patient should be positioned (Select all that apply.) A. high Fowler's. B. side lying with head of bed elevated. C. sitting in a chair. D. supine with the bed flat. E. prone with face turned to the left

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

A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital signs and normal arterial blood gases (ABGs) and is placed on a T-piece for ventilatory weaning. During the nurse's 7 PM (1900) assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretions. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. In communicating with the physician, which statement indicates the nurse understands what is likely occurring with the patient? A. "May we have an order for cardiac enzymes? This patient is exhibiting signs of a myocardial infarction." B. "My assessment indicates potential fluid overload." C. "The patient is having frequent PVCs that are compromising the cardiac output." D. "The patient is having a hypertensive crisis; what medications would you like to order?"

B. "My assessment indicates potential fluid overload."

A patient at high risk for pulmonary embolism is receiving enoxaparin. The nurse should provide the patient with what explanation? A. "I'm going to contact the pharmacist to see if you can take this medication by mouth." B. "This injection is being given to prevent blood clots from forming." C. "This medication will dissolve any blood clots you might get." D. "I will contact your primary care provide to discuss why you are getting this medication." t

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

The nurse calculates the PaO2/FiO2 ratio for the following values: PaO2 is 78 mm Hg; FiO2 is 0.6 (60%). What is the outcome and the relationship to the ARDS diagnosing criteria? A. 46.8; meets criteria for ARDS B. 130; meets criteria for ARDS C. 468; normal lung function D. Not enough data to compute the ratio

B. 130; meets criteria for ARDS

The nurse monitors a patient in the emergency department after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed? A. A large air leak in the water-seal chamber B. 400 mL of blood in the collection chamber C. Complaint of pain with each deep inspiration D. Subcutaneous emphysema at the insertion site

B. 400 mL of blood in the collection chamber

What is the most common cause of a pulmonary embolus? A. An amniotic fluid embolus. B. A deep vein thrombosis from lower extremities. C. A fat embolus from a long bone fracture. D. Vegetation that dislodges from an infected central venous catheter.

B. A deep vein thrombosis from lower extremities.

An hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action should the nurse take? A. Clamp the chest tube in two places. B. Administer the prescribed morphine. C. Milk the chest tube to remove any clots. D. Assist the patient with incentive spirometry

B. Administer the prescribed morphine.

The nurse is providing care for the patient requiring mechanical ventilation. Which action by the nurse would be inappropriate when providing care to this patient? A. Confirming airway placement by auscultating the lungs and checking the length marking of the tube at the lip B. Assuring that tube cuff inflation is no greater than 15 cm H2O, and that there is no audible air leak C. Assuring ventilator tubing is secured and does not pull on the patient's airway D. Verifying correct ventilator settings

B. Assuring that tube cuff inflation is no greater than 15 cm H2O, and that there is no audible air leak

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? A. Ask the patient to lie down to complete a full physical assessment. B. Briefly ask specific questions about this episode of respiratory distress. C. Complete the admission database to check for allergies before treatment. D. Delay the physical assessment to first complete pulmonary function tests

B. Briefly ask specific questions about this episode of respiratory distress.

What factors may predispose a patient to respiratory acidosis? select all that apply A. Anxiety and fear B. Central nervous system depression C. Diabetic ketoacidosis D. Nasogastric suctioning E. Overdose of sedatives

B. Central nervous system depression E. Overdose of sedatives

A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital signs and normal arterial blood gases (ABGs), and is placed on a T-piece for ventilatory weaning. During the nurse's 7 PM (1900) assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretions. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. How does the nurse interpret the following blood gas levels? pH 7.28 PaCO2 46 mm Hg Bicarbonate 22 mEq/L PaO2 58 mm Hg O2 saturation 88% A. Hypoxemia and compensated respiratory alkalosis B. Hypoxemia and uncompensated respiratory acidosis C. Normal arterial blood gas levels D. Normal oxygen level and partially compensated metabolic acidosis

B. Hypoxemia and uncompensated respiratory acidosis

A patient with a respiratory rate of eight breaths per minute has an oxygen saturation of 82%. Which nursing diagnosis is a priority for this patient? A. Risk for Infection B. Impaired Spontaneous Ventilation C. Risk for Acute Confusion D. Decreased Cardiac Output

B. Impaired Spontaneous Ventilation

Which statement is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP)? (Select all that apply.) A. Tooth brushing is performed every 2 hours for the greatest effect. B. Implementing a comprehensive oral care program is an intervention for preventing VAP. C. Oral care protocols should include oral suctioning and brushing teeth. D. Protocols that include chlorhexidine gluconate have been effective in preventing VAP. E. Avoid brushing teeth for two hours after chlorhexidine use.

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

Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS) in a patient admitted with respiratory distress? A. Increased oxygen saturation via pulse oximetry B. Increased peak inspiratory pressure on the ventilator C. Normal chest radiograph with enlarged cardiac structures D. PaO2/FiO2 ratio > 300

B. Increased peak inspiratory pressure on the ventilator

What is the treatment for an acute exacerbation of asthma? A. Corticosteroids and theophylline by mouth B. Inhaled bronchodilators and intravenous corticosteroids C. Prone positioning or continuous lateral rotation D. Sedation and inhaled bronchodilators

B. Inhaled bronchodilators and intravenous corticosteroids

The nurse caring for a newborn on a ventilator for acute respiratory distress syndrome (ARDS) informs the parents that the newborn is improving. Which data supports the nurse's assessment of the newborn's condition? A. Increased PCO2 B. Oxygen saturation of 92% C. Pulmonary vascular resistance increases D. Less than 1 mL/kg/hour urine output

B. Oxygen saturation of 92%

What does oxygen saturation (SaO2) represent? A. Alveolar oxygen tension. B. Oxygen that is chemically combined with hemoglobin. C. Oxygen that is physically dissolved in plasma. D. Total oxygen consumption.

B. Oxygen that is chemically combined with hemoglobin.

The nurse assessing a patient diagnosed with acute respiratory distress syndrome expects what assessment finding? A. Cardiac output of 10 L/min and low systemic vascular resistance. B. PAOP of 10 mm Hg and PaO2 of 55. C. PAOP of 20 mm Hg and cardiac output of 3 L/min. D. PAOP of 5 mm Hg and high systemic vascular resistance.

B. PAOP of 10 mm Hg and PaO2 of 55.

A patient with acute respiratory distress syndrome (ARDS) is being weaned from mechanical ventilation. Which nursing action is appropriate for this patient? A. Increase percentage of oxygen being provided through the ventilator B. Place in the Fowler position C. Provide morning care during the weaning procedures D. Medicate with morphine for pain as needed

B. Place in the Fowler position

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? A. Start a peripheral IV line to administer sedatives. B. Position the patient sitting up on the side of the bed. C. Obtain a collection device to hold 3 liters of pleural fluid. D. Remind the patient not to eat or drink anything for 6 hours

B. Position the patient sitting up on the side of the bed.

What is an early signs of the effect of hypoxemia on the nervous system? A. Cyanosis B. Restlessness C. Tachycardia D. Tachypnea

B. Restlessness

The nurse is providing care to several patients on a medical-surgical unit. Which patient is at highest risk for a nonthrombotic pulmonary embolism? A. The patient who is receiving intravenous pain medication B. The patient who is postoperative from a femur fracture repair C. The patient with a primary lung tumor D. The patient who uses intravenous illicit drugs

B. The patient who is postoperative from a femur fracture repair

The nurse working in the intensive care unit is assigned a patient requiring mechanical ventilation. When responding to the ventilator alarm, the nurse sees a high-pressure alarm. Which nursing action is the priority? A. Silencing the alarm B. Removing the patient from the ventilator and using a bag-valve device to oxygenate the patient until the respiratory therapist can be summoned C. Emptying the collected water from the ventilator tubing D. Assessing the patient

D. Assessing the patient

A patient scheduled for surgery is being instructed in leg exercises and the pneumatic compression device. The nurse includes these instructions to decrease which postoperative complication? A. Infection B. Delayed wound healing C. Contractures D. Deep vein thrombosis

D. Deep vein thrombosis

The nurse is providing care to a patient who is diagnosed with acute respiratory distress syndrome (ARDS). Which clinical manifestation does the nurse anticipate for this patient who is experiencing hypoxia as a result of the ARDS diagnosis? A. Fluid imbalance B. Hypertension C. Bradycardia D. Dyspnea

D. Dyspnea