CRITICAL CARE EXAM 1: RESPIRATORY PRACTICE QUESTIONS AND CORRECT ANSWERS

CRITICAL CARE EXAM 1: RESPIRATORY
PRACTICE QUESTIONS AND CORRECT
ANSWERS

1)A2AA2nurseA2isA2caringA2forA2aA2patientA2withA2ARDS.A2TheA2nurseA2viewsA2theA2ABG.A2
WhatA2valueA2shouldA2theA2nurseA2reportA2toA2theA2physician?

pH:A27.35
PaCO2:A226mmhg
PaO2:95
HCO3:A222

a)A2PaCO2
b)pH
c)HCO3
d)PaO2A2-A2Ans--a

TheA2normalA2rangeA2forA2PaCO2A2isA235-
45.A2ThisA2patientA2isA2experiencingA2aA2superimposedA2respiratoryA2alkalosisA2likelyA2du
eA2toA2hyperventilation.A2TheA2nurseA2shouldA2reportA2theA2PaCO2A2toA2theA2physician.

2)A2AA2nurseA2mustA2positionA2theA2patientA2proneA2afterA2hisA2diagnosisA2ofA2acuteA2respi
ratoryA2distressA2syndromeA2(ARDS).A2WhichA2ofA2theA2followingA2isA2aA2benefitA2ofA2usin
gA2thisA2position?A2SelectA2allA2thatA2apply.

A)DecreasedA2atelectasis
B)ReducedA2needA2forA2endotrachealA2intubation
c)MobilizationA2ofA2secretions
d)DecreasedA2pleuralA2pressure
e)IncreasedA2responseA2toA2corticosteroidA2therapyA2-A2Ans--a,A2c,A2d

DecreasedA2atelectasis",A2"MobilizationA2ofA2secretions"A2andA2"DecreasedA2pleuralA2pre
ssure"A2areA2correct.A2ProneA2positioning,A2orA2placingA2theA2patientA2faceA2downA2withA2t
heA2headA2turnedA2toA2theA2side,A2helpsA2withA2pulmonaryA2functionA2inA2theA2patientA2dia
gnosedA2withA2ARDS.A2WhenA2theA2patientA2isA2placedA2inA2aA2proneA2position,A2theA2hea
rtA2andA2diaphragmA2areA2notA2pressingA2againstA2theA2lungs,A2whichA2meansA2thatA2pleur
alA2pressureA2isA2reduced.A2WhenA2thereA2isA2lessA2pressureA2exertedA2onA2theA2lungs,A2a
telectasisA2decreases.A2StudiesA2haveA2shownA2thatA2manyA2patientsA2inA2theA2proneA2po
sitionA2haveA2increasedA2lungA2secretions,A2whichA2improvesA2oxygenation.
-"ReducedA2needA2forA2endotrachealA2intubation"A2isA2incorrect.A2TheA2proneA2positionA2h
asA2notA2beenA2shownA2toA2decreaseA2theA2likelihoodA2ofA2intubation.
-"IncreasedA2responseA2toA2corticosteroidA2therapy"A2isA2incorrectA2becauseA2positioningA
2doesA2notA2changeA2theA2body'sA2responseA2toA2steroidA2therapy.

,3)A2AA225-year-
oldA2patientA2inA2theA2ICUA2isA2beingA2treatedA2forA2acuteA2respiratoryA2distressA2syndrom
eA2(ARDS).A2TheA2patientA2isA2onA2aA2ventilatorA2andA2requiresA280A2percentA2FiO2.A2Whi
chA2informationA2wouldA2theA2nurseA2mostA2likelyA2needA2toA2reportA2aboutA2theA2patientA2
toA2theA2respiratoryA2therapistA2workingA2withA2her?

a)TheA2patientA2needsA2endotrachealA2suctioning
b)TheA2patientA2needsA2moreA2oxygenA2becauseA2ofA2hisA2saturation
c)TheA2patientA2needsA2anA2arterialA2bloodA2gasA2drawn
d)TheA2patientA2needsA2aA2hemoglobinA2levelA2drawnA2-A2Ans--c

4)A2AA2patientA2whoA2hasA2recoveredA2fromA2ARDSA2inA2theA2ICUA2isA2nowA2malnourished
A2andA2hasA2lostA2aA2significantA2amountA2ofA2weight.A2TheA2physicianA2ordersA2TPNA2toA2
addA2nutritionA2forA2theA2patient,A2whoA2thenA2developsA2re-
feedingA2syndrome.A2WhichA2ofA2theA2followingA2signsA2orA2symptomsA2wouldA2theA2nurse
A2expectA2toA2seeA2withA2re-feedingA2syndrome?A2SelectA2allA2thatA2apply.


a.A2ImpairedA2mentalA2status
b.A2InsulinA2resistance
c.A2Seizures
d.A2PersistentA2weightA2loss
e.A2ConstipationA2-A2Ans--a,b,c

impairedA2mentalA2status",A2"InsulinA2resistance"A2andA2"Seizures"A2areA2correct.A2Re-
feedingA2syndromeA2canA2occurA2asA2aA2responseA2toA2nutrientA2reintroductionA2afterA2aA2
periodA2ofA2starvation.A2WhenA2anA2extremelyA2malnourishedA2patientA2receivesA2TPN,A2t
heA2bodyA2hasA2toA2adjustA2toA2receivingA2nutrientsA2again,A2whichA2canA2causeA2shiftsA2i
nA2electrolytesA2inA2theA2body.A2TheseA2shiftsA2inA2electrolytesA2canA2resultA2inA2suddenA2
andA2oftenA2fatalA2complications.A2SignsA2andA2symptomsA2ofA2re-
feedingA2syndromeA2includeA2confusionA2andA2impairedA2mentalA2status,A2insulinA2resista
nce,A2seizures,A2comaA2andA2death.
-"PersistentA2weightA2loss"A2isA2incorrectA2becauseA2byA2theA2timeA2aA2patientA2developsA2
re-
feedingA2syndrome,A2theA2onsetA2ofA2symptomsA2isA2soA2suddenA2thatA2weightA2lossA2can
notA2beA2measuredA2asA2partA2ofA2theA2syndrome.
-"Constipation"A2isA2incorrect,A2asA2itA2isA2notA2aA2symptomA2ofA2refeedingA2syndrome.

5)A2AA2nurseA2isA2caringA2forA2aA2patientA2withA2ARDS.A2WhichA2ofA2theA2followingA2clinical
A2indicatorsA2wouldA2signifyA2thatA2thisA2clientA2isA2inA2respiratoryA2failure?
A2SelectA2allA2thatA2apply.


a.A2PulseA2oximetryA2ofA294%A2onA2roomA2air
b.A2AA2PaO2A2levelA2belowA260A2mmHg
c.A2AnA2ABGA2pHA2levelA2ofA27.35
d.A2AA2pCO2A2levelA2overA250A2mmHg

, e.A2AA2respiratoryA2rateA2ofA2overA216/minuteA2-A2Ans--b,A2dA2

RespiratoryA2diseasesA2canA2causeA2suchA2compromiseA2thatA2theA2patientA2willA2sufferA2
symptoms;A2however,A2thereA2areA2certainA2clinicalA2indicatorsA2thatA2canA2clarifyA2wheth
erA2theA2patientA2isA2actuallyA2inA2respiratoryA2failure.A2ClinicalA2indicatorsA2ofA2respiratory
A2failureA2includeA2pulseA2oximetryA2ofA2lessA2thanA291%A2onA2roomA2air,A2PaO2A2levelA2le
ssA2thanA260A2mmHg,A2andA2aA2pCO2A2levelA2ofA2overA250A2mmHg.

6)A2AA2nurseA2isA2caringA2forA2aA2patientA2whoA2isA2inA2respiratoryA2distressA2becauseA2ofA
2ARDS.A2WhichA2ofA2theA2followingA2nursingA2diagnosesA2wouldA2mostA2likelyA2beA2associ
atedA2withA2thisA2condition?

a.A2IneffectiveA2thermoregulation
b.A2ImpairedA2urinaryA2elimination
c.A2IneffectiveA2tissueA2perfusion
d.A2DisturbedA2personalA2identityA2-A2Ans--c

7)A2AA2nurseA2walksA2intoA2aA2clientA2whoA2isA2inA2respiratoryA2distress.A2TheA2clientA2hasA
2aA2trachealA2deviationA2toA2theA2rightA2side.A2TheA2nurseA2knowsA2toA2prepareA2forA2whic
hA2ofA2theA2followingA2emergentA2procedures?

a.A2ChestA2tubeA2insertionA2onA2theA2leftA2side.
b.A2ChestA2tubeA2insertionA2onA2theA2rightA2side.
c.A2Intubation
d.A2TracheostomyA2-A2Ans--a

TrachealA2deviationA2indicatesA2aA2pneumothorax,A2theA2directionA2ofA2theA2deviationA2ind
icatesA2theA2sideA2theA2pneumothoraxA2isA2on.A2IfA2theA2tracheaA2isA2deviatingA2toA2theA2ri
ght,A2thenA2theA2pneumoA2isA2onA2theA2left.A2TheA2treatmentA2forA2thisA2isA2aA2chestA2tubeA
2onA2theA2sideA2ofA2trheA2deflatedA2lung.


8)A2AA226-year-
oldA2patientA2isA2admittedA2toA2theA2hospitalA2inA2severeA2respiratoryA2distress.A2HisA2oxyg
enA2saturationsA2areA280%A2despiteA2supplementalA2oxygenA2providedA2byA2aA2facemask.
A2TheA2providerA2decidesA2toA2intubateA2theA2patientA2toA2helpA2withA2hisA2breathingA2oxyg
enation.A2WhichA2medicationA2wouldA2theA2nurseA2mostA2likelyA2administerA2whenA2assisti
ngA2withA2intubation?

a.A2ModafinilA2(Provigil)
b.A2PhentermineA2(Adipex-P)
c.A2EtomidateA2(Amidate)
d.A2ZolpidemA2(Ambien)A2-A2Ans--c

"EtomidateA2(Amidate)"A2isA2correct.A2IntubationA2isA2mostA2oftenA2performedA2byA2inserti
ngA2aA2tubeA2intoA2theA2mouthA2andA2passingA2itA2intoA2theA2tracheaA2inA2orderA2toA2provid
eA2supportA2forA2aA2patient'sA2breathing.A2MostA2registeredA2nursesA2doA2notA2performA2en