ACUTE RESP DISTRESS SYNDROME (ARDS) Answered with Complete Rationales 100% all correct!

ACUTE RESP DISTRESS SYNDROME (ARDS) 1. The unlicensed assistive personnel (UAP) is bathing the client diagnosed with acute respiratory distress syndrome (ARDS). The bed is in a high position with the opposite side rail in the low position. Which action should the nurse implement? 1. Demonstrate the correct technique for giving a bed bath. 2. Encourage the UAP to put the bed in the lowest position. 3. Instruct the UAP to get another person to help with the bath. 4. Provide praise for performing the bath safely for the client and the UAP. 2. The client diagnosed with ARDS is transferred to the intensive care department and placed on a ventilator. Which intervention should the nurse implement first? 1. Confirm that the ventilator settings are correct. 2. Verify that the ventilator alarms are functioning properly. 3. Assess the respiratory status and pulse oximeter reading. 4. Monitor the client’s arterial blood gas results. 3. The nurse suspects the client may be developing ARDS. Which assessment data confirm the diagnosis of ARDS? 1. Low arterial oxygen when administering high concentration of oxygen. 2. The client has dyspnea and tachycardia and is feeling anxious. 3. Bilateral breath sounds clear and pulse oximeter reading is 95%. 4. The client has jugular vein distention and frothy sputum. 4. The client who smokes two (2) packs of cigarettes a day develops ARDS after a near-drowning. The client asks the nurse, “What is happening to me? Why did I get this?” Which statement by the nurse is most appropriate? 1. “Most people who almost drown end up developing ARDS.” 2. “Platelets and fluid enter the alveoli due to permeability instability.” 3. “Your lungs are filling up with fluid, causing breathing problems.” 4. “Smoking has caused your lungs to become weakened, so you got ARDS.” 5. Which assessment data indicate to the nurse the client diagnosed with ARDS has experienced a complication secondary to the ventilator? 1. The client’s urine output is 100 mL in four (4) hours. 2. The pulse oximeter reading is greater than 95%. 3. The client has asymmetrical chest expansion. 4. The telemetry reading shows sinus tachycardia. 6. The health-care provider ordered STAT arterial blood gases (ABGs) for the client diagnosed with ARDS. The ABG results are pH 7.38, PaO2 92, PaCO2 38, HCO3 24. Which action should the nurse implement? 1. Continue to monitor the client without taking any action.2. Encourage the client to take deep breaths and cough. 3. Administer one (1) ampule of sodium bicarbonate IVP. 4. Notify the respiratory therapist of the ABG results. 7. The client with ARDS is on a mechanical ventilator. Which intervention should be included in the nursing care plan addressing the endotracheal tube care? 1. Do not move or touch the ET tube. 2. Obtain a chest x-ray daily. 3. Determine if the ET cuff is deflated. 4. Ensure that the ET tube is secure. 8. Which medication should the nurse anticipate the health-care provider ordering for the client diagnosed with ARDS? 1. An aminoglycoside antibiotic. 2. A synthetic surfactant. 3. A potassium cation. 4. A nonsteroidal anti-inflammatory drug. 9. The client diagnosed with ARDS is in respiratory distress and the ventilator is malfunctioning. Which intervention should the nurse implement first? 1. Notify the respiratory therapist immediately. 2. Ventilate with a manual resuscitation bag. 3. Request STAT arterial blood gases. 4. Auscultate the client’s lung sounds. 10. The nurse is caring for the client diagnosed with ARDS. Which interventions should the nurse implement? Select all that apply. 1. Assess the client’s level of consciousness. 2. Monitor urine output every shift. 3. Turn the client every two (2) hours. 4. Maintain intravenous fluids as ordered. 5. Place the client in the Fowler’s position. 11. Which instruction is priority for the nurse to discuss with the client diagnosed with ARDS who is being discharged from the hospital? 1. Avoid smoking and exposure to smoke.* 2. Do not receive flu or pneumonia vaccines. 3. Avoid any type of alcohol intake. 4. It will take about one (1) month to recuperate. 12. The client diagnosed with ARDS is on a ventilator and the high alarm indicates an increase in the peak airway pressure. Which intervention should the nurse implement first?1. Check the tubing for any kinks.* 2. Suction the airway for secretions. 3. Assess the lip line of the ET tube. 4. Sedate the client with a muscle relaxant 13. When explaining respiratory failure to the patient’s family, what should the nurse use as an accurate description? a. The absence of ventilation b. Any episode in which part of the airway is obstructed c. Inadequate gas exchange to meet the metabolic needs of the body d. An episode of acute hypoxemia caused by a pulmonary dysfunction 14. When teaching the patient about what was happening when experiencing an intrapulmonary shunt, which explanation is accurate? a. This occurs when an obstruction impairs the flow of blood to the ventilated areas of the lung. b. This occurs when blood passes through an anatomic channel in the heart and bypasses the lungs. c. This occurs when blood flows through the capillaries in the lungs without participating in gas exchange. d. Gas exchange across the alveolar capillary interface is compromised by thickened or damaged alveolar membranes. 15. When the V/Q lung scan result returns with a mismatch ratio that is greater than 1, which condition should be suspected? a. Pain b. Atelectasis c. Pulmonary embolus d. Ventricular septal defect 16. Which physiologic mechanism of hypoxemia occurs with pulmonary fibrosis? a. Anatomic shunt c. Intrapulmonary shunt b. Diffusion limitation d. V/Q mismatch ratio of less than 1 17. Which assessment finding should cause the nurse to suspect the early onset ofhypoxemia? a. Restlessness c. Central cyanosis b. Hypotension d. Cardiac dysrhythmias 18. The nurse assesses that a patient in respiratory distress is developing respiratory fatigue and the risk of respiratory arrest when the patient displays which behavior? a. Cannot breathe unless he is sitting upright b. Uses the abdominal muscles during expiration c. Has an increased inspiratory-expiratory (I/E) ratio d. Has a change in respiratory rate from rapid to slow 19. A patient has a PaO2 of 50 mm Hg and a PaCO2 of 42 mm Hg because of an intrapulmonary shunt. Which therapy is the patient most likely to respond best to? a. Positive pressure ventilation b. Oxygen administration at a FIO2 of 100% c. Administration of O2 per nasal cannula at 1 to 3 L/min d. Clearance of airway secretions with coughing and suctioning 20. A patient with a massive hemothorax and pneumothorax has absent breath sounds in the right lung. To promote improved V/Q matching, how should the nurse position the patient? a. On the left side b. On the right side c. In a reclining chair bed d. Supine with the head of the bed elevated 21. Priority Decision: After endotracheal intubation and mechanical ventilation have been started, a patient in respiratory failure becomes very agitated and is breathing asynchronously with the ventilator. What is it most important for the nurse to do first? a. Evaluate the patient’s pain level, ABGs, and electrolyte values b. Sedate the patient to unconsciousness to eliminate patient awareness c. Administer the PRN vecuronium (Norcuron) to promote synchronous ventilationsd. Slow the rate of ventilations provided by the ventilator to allow for spontaneous breathing by the patient 22. What is the primary reason that hemodynamic monitoring is instituted in severe respiratory failure? a. To detect V/Q mismatches b. To continuously measure the arterial BP c. To evaluate oxygenation and ventilation status d. To evaluate cardiac status and blood flow to tissues d. Hemodynamic monitoring with a pulmonary artery catheter is instituted in severe respiratory failure to 23. In caring for a patient in acute respiratory failure, the nurse recognizes that noninvasive positive pressure ventilation (NIPPV) may be indicated for which patient? a. Is comatose and has high oxygen requirements b. Has copious secretions that require frequent suctioning c. Responds to hourly bronchodilator nebulization treatments d. Is alert and cooperative but has increasing respiratory exhaustion d. Noninvasive positive pressure ventilation (NIPPV) involves the application of a face mask and delivery of 24. The patient progressed from acute lung injury to acute respiratory distress syndrome (ARDS). He is on the ventilator and receiving propofol (Diprivan) for sedation and fentanyl (Sublimaze) to decrease anxiety, agitation, and pain in order to decrease his work of breathing, O2 consumption, carbon dioxide production, and risk of injury. What intervention is recommended in caring for this patient? a. A sedation holiday b. Monitoring for hypermetabolism c. Keeping his legs still to avoid dislodging the airway d. Repositioning him every 4 hours to decrease agitation 25. Although ARDS may result from direct lung injury or indirect lung injury as a result of systemic inflammatory response syndrome (SIRS), the nurse is aware that ARDS is most likely to occur in the patient with a host insult resulting from a. Sepsis.b. oxygen toxicity. c. prolonged hypotension. d. cardiopulmonary bypass. 26. What are the primary pathophysiologic changes that occur in the injury or exudative phase of ARDS (select all that apply)? a. Atelectasis d. Hyaline membranes line the alveoli b. Shortness of breath e. Influx of neutrophils, monocytes, and lymphocytes c. Interstitial and alveolar edema 27. In patients with ARDS who survive the acute phase of lung injury, what manifestations are seen when they progress to the fibrotic phase? a. Chronic pulmonary edema and atelectasis b. Resolution of edema and healing of lung tissue c. Continued hypoxemia because of diffusion limitation d. Increased lung compliance caused by the breakdown of fibrotic tissue 28. In caring for the patient with ARDS, what is the most characteristic sign the nurse would expect the patient to exhibit? a. Refractory hypoxemia c. Progressive hypercapnia b. Bronchial breath sounds d. Increased pulmonary artery wedge pressure (PAWP) 29. The nurse suspects the early stage of ARDS in any seriously ill patient who manifests what? a. Develops respiratory acidosis c. Exhibits dyspnea and restlessness b. Has diffuse crackles and rhonchi d. Has a decreased PaO2 and an increased PaCO2 30. A patient with ARDS has a nursing diagnosis of risk for infection. To detect the presence of infections commonly associated with ARDS, what should the nurse monitor?a. Gastric aspirate for pH and blood b. Quality, quantity, and consistency of sputum c. Subcutaneous emphysema of the face, neck, and chest d. Mucous membranes of the oral cavity for open lesions b. Ventilator-associated pneumonia (VAP) is one of the most common complications of ARDS. Early detection 31. The best patient response to treatment of ARDS occurs when initial management includes what? a. Treatment of the underlying condition b. Administration of prophylactic antibiotics c. Treatment with diuretics and mild fluid restriction d. Endotracheal intubation and mechanical ventilation 32. When mechanical ventilation is used for the patient with ARDS, what is the rationale for applying positive end-expiratory pressure (PEEP)? a. Prevent alveolar collapse and open up collapsed alveoli b. Permit smaller tidal volumes with permissive hypercapnia c. Promote complete emptying of the lungs during exhalation d. Permit extracorporeal oxygenation and carbon dioxide removal outside the body 33. The nurse suspects that a patient with PEEP is experiencing negative effects of this ventilatory maneuver when which of the following is assessed? a. Increasing PaO2 b. Decreasing blood pressure c. Decreasing heart rate (HR) d. Increasing central venous pressure (CVP) b. PEEP increases intrathoracic and intrapulmonic pressures, compresses the pulmonary capillary bed, and reduces 34. Prone positioning is considered for a patient with ARDS who has not responded to other measures to increase PaO2The nurse knows that this strategy will a. increase the mobilization of pulmonary secretions. b. decrease the workload of the diaphragm and intercostal muscles. c. promote opening of atelectatic alveoli in the upper portion of the lung. d. promote perfusion of nonatelectatic alveoli in the anterior portion of the lung. 1. The client diagnosed with ARDS is transferred to the intensive care department and placed on a ventilator. Which intervention should the nurse implement first? A. Confirm that they ventilator settings are correct B. Verify that the ventilator alarms are functioning properly C. Assess the respiratory status and pulse oximeter reading D. Monitor the client's arterial blood gas results 2. The nurse suspects the client may be developing ARDS. Which assessment data confirm the diagnosis of ARDS? A. Low arterial oxygen when administering high concentration of oxygen B. The client has dyspnea and tachycardia and feels anxious C. Bilateral breath sounds clear and pulse oximeter reading is 95% D. The client has JVD and frothy sputum 3. The client who smokes two packs of cigarettes a day develops ARDS after a near-drowning. The client asks the nurse, "What is happening to me? Why did I get this?" Which statement by the nurse is most appropriate? A. Most people who almost drown end up developing ARDS B. Platelets and fluid enter the alveoli due to permeability instability C. Your lungs are filling up with fluid, causing breathing problems D. Smoking has caused your lungs to become weakened, so you got ARDS 4. Which assessment data indicate to the nurse the client diagnosed with ARDS has experienced a complication secondary to the ventilator? A. The client's urine output is 100 mL in four hours B. The pulse oximeter reading is greater than 95% C. The client has asymmetrical chest expansion D. THe telemetry reading shows sinus tachycardia 5. The health-care provider ordered STAT arterial blood gases for the client diagnosed with ARDS. The ABG results are: pH 7.38, PaO2 92, PaCO2 38, HCO3 24. Which action should the nurse implement? A. Continue to monitor the client without taking any action B. Encourage the client to take deep breaths and cough C. Administer one ampule of sodium bicarbonate IVP D. Notify the respiratory therapist of the results 6. The client with ARDS is on a mechanical ventilator. Which intervention should be included in the nursing care plan addressing the endotracheal tube care?A. Do not move or touch the ET tube B. Obtain a chest x-ray daily C. Determine if the ET cuff is deflated D. Ensure that the ET tube is secured 7. Which medication should the nurse anticipate the health-care provider ordering for the client diagnosed with ARDS? A. An aminoglycoside antibiotic B. A synthetic surfactant C. A potassium cation D. A nonsteroidal anti-inflammatory drug 8. The client diagnosed with ARDS is in respiratory distress and the ventilator is malfunctioning. Which intervention should the nurse implement first? A. Notify the respiratory therapist immediately B. Ventilate with a manual resuscitation bag C. Request STAT ABGs D. Auscultate the client's lung sounds 9. The nurse is caring for a client diagnosed with ARDS. Which interventions should the nurse implement? Select All that Apply 1. Assess the client's level of consciousness 2. Monitor urine output every shift 3. Turn the client every 2 hours 4. Maintain intravenous fluids as ordered 5. Place the client in the Fowler's position 10. Which instruction is priority for the nurse to discuss with the client diagnosed with ARDS who is being discharged from the hospital? A. Avoid smoking and exposure to smoke B. Do not receive flu or pneumonia vaccines C. Avoid any type of alcohol intake D. It will take about one month to recuperate 11. The client diagnosed with ARDS is on a ventilator and the high alarm indicates an increase in the peak airway pressure. Which intervention should the nurse implement first? A. Check the tubing for any kinks B. Suction the airway for secretion C. Assess the lip line of the ET tube D. Sedate the client with a muscle relaxant 12. The nurse will monitor for clinical manifestations of hypercapnia when a patient in the emergency department has A. chest trauma and multiple rib fractures B. carbon monoxide poisoning after a house fire C. left-sided ventricular failure and acute pulmonary edema D. tachypnea and acute respiratory distress syndrome (ARDS) 13. When a patient is diagnosed with pulmonary fibrosis, the nurse will teach the patient about the risk for poor oxygenation because of A. too-rapid movement of blood flow through the pulmonary blood vessels B. incomplete filling of the alveoli with air because of reduced respiratory ability C. decreased transfer of oxygen into the blood because of thickening of the alveoli D. mismatch between lung ventilation and blood flow through the blood vessels of the lung 14. A patient is diagnosed with a large pulmonary embolism. When explaining to the patient what has happened to cause respiratory failure, which information will the nurse include? a. "Oxygen transfer into your blood is slow because of thick membranes between the small air sacs and the lung circulation." b. "Thick secretions in your small airways are blocking air from moving into the small air sacs in your lungs." c. "Large areas of your lungs are getting good blood flow but are not receiving enough air to fill the small air sacs." d. "Blood flow through some areas of your lungs is decreased even though you are taking adequate breaths." 15. A patient is brought to the emergency department unconscious following abarbiturate overdose. Which potential complication will the nurse include when developing the plan of care? A. Hypercapnic respiratory failure related to decreased ventilatory effort B. Hypoxemic respiratory failure related to diffusion limitations C. Hypoxemic respiratory failure related to shunting of blood D. Hypercapnic respiratory failure related to increased airway resistance 16. When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first? A. Monitor the patient every 10 to 15 minutes B. Notify the patient's health care provider immediately C. Attempt to calm and reassure the patient. D. Assess vital signs and pulse oximetry 17. To evaluate both oxygenation and ventilation in a patient with acute respiratory failure, the nurse uses the findings revealed with A. arterial blood gas (ABG) analysis B. hemodynamic monitoring C. chest x-rays D. pulse oximetry 18. A finding indicating to the nurse that a 22-year-old patient with respiratory distress is in acute respiratory failure includes a A. shallow breathing pattern. B. partial pressure of arterial oxygen (PaO2) of 45 mm Hg. C. partial pressure of carbon dioxide in arterial gas (PaCO2) of 34 mm Hg. D. respiratory rate of 32/min 19. While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's arterial oxyhemoglobin saturation (SpO2) from 94% to 88%. The nurse will A. assist the patient to cough and deep-breathe B. help the patient to sit in a more upright position C. suction the patient's oropharynx D. increase the oxygen flow rate 20. A patient with hypercapnic respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. Which collaborative intervention will the nurse anticipate? a. Administration of 100% oxygen by non-rebreather mask b. Endotracheal intubation and positive pressure ventilation c. Insertion of a mini-tracheostomy with frequent suctioning d. Initiation of bilevel positive pressure ventilation (BiPAP) 21. When the nurse is caring for an obese patient with left lower-lobe pneumonia, gas exchange will be best when the patient is positioned a. on the left side. b. on the right side. c. in the high-Fowler's position. d. in the tripod position 22. When admitting a patient in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the nurse? a. The patient is somnolent. b. The patient's SpO2 is 90%. c. The patient complains of weakness. d. The patient's blood pressure is 162/94. 23. The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider? a. The patient has a cough that is productive of blood-tinged sputum. b. The patient has scattered crackles throughout the posterior lung bases. c. The patient's temperature is 101.5° F after 2 days of IV antibiotic therapy. d. The patient's SpO2 has dropped to 90%, although the O2 flow rate has been increased 24. When caring for a patient who developed acute respiratory distress syndrome (ARDS) as a result of a urinary tract infection (UTI), the nurse is asked by the patient's family how a urinary tract infection could cause lung damage. Which response by the nurse is appropriate? a. "The infection spread through the circulation from the urinary tract to the lungs."b. "The urinary tract infection produced toxins that damaged the lungs." c. "The infection caused generalized inflammation that damaged the lungs." d. "The fever associated with the infection led to scar tissue formation in the lungs." 25. All the following medications are ordered for a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) and acute renal failure. Which medication should the nurse discuss with the health care provider before administration? a. IV ranitidine (Zantac) 50 mg IV b. sucralfate (Carafate) 1 g per nasogastric tube c. IV gentamicin (Garamycin) 60 mg d. IV methylprednisolone (Solu-Medrol) 40 mg 26. After prolonged cardiopulmonary bypass, a patient develops increasing shortness of breath and hypoxemia. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with a. positioning the patient for a chest radiograph. b. drawing blood for arterial blood gases. c. obtaining a ventilation-perfusion scan. d. inserting a pulmonary artery catheter. 27. Which information obtained by the nurse when assessing a patient with acute respiratory distress syndrome (ARDS) who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates a complication of ventilator therapy is occurring? a. The patient has subcutaneous emphysema b. The patient has a sinus bradycardia, rate 52 c. The patient's PaO2 is 50 mm Hg and the SaO2 is 88% d. The patient has bronchial breath sounds in both the lung fields. 28. Which statement by the nurse when explaining the purpose of positive endexpiratory pressure (PEEP) to the family members of a patient with ARDS is correct? a. "PEEP will prevent fibrosis of the lung from occurring” b. "PEEP will push more air into the lungs during inhalation” c. "PEEP allows the ventilator to deliver 100% oxygen to the lungs” d. "PEEP prevents the lung air sacs from collapsing during exhalation” 29. When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective? a. The skin on the patient's back is intact and without rednessb. Sputum and blood cultures show no growth after 24 hours c. The patient's PaO2 is 90 mm Hg, and the SaO2 is 92% d. Endotracheal suctioning results in minimal mucous return 30. A patient with acute respiratory distress syndrome (ARDS) has progressed to the fibrotic phase. The patient's family members are anxious about the patient's condition and are continuously present at the hospital. In addressing the family's concerns, it is important for the nurse to a. support the family and help them understand the realistic expectation that the patient's chance for survival is poor b. inform the family that home health nurses will be able to help them maintain the mechanical ventilation at home after patient discharge c. refer the family to social support services and case management to plan for transfer of the patient to a long-term care facility d. d. provide hope and encouragement to the family because the patient's disease process has started to resolve 31. The nurse obtains the vital signs for a patient admitted 2 days ago with gramnegative sepsis: temperature 101.2° F, blood pressure 90/56 mm Hg, pulse 92, respirations 34. Which action should the nurse take next? a. Notify the health care provider of the patient's vital signs. b. Obtain oxygen saturation using pulse oximetry. c. Document the vital signs and continue to monitor. d. Administer PRN acetaminophen (Tylenol) 650 mg. 32. Which intervention is key to preventing ventilator-associated pneumonia as a complication in a patient with acute respiratory distress syndrome (ARDS)? A. Scheduled prophylactic nasopharyngeal suctioning B. Instilling normal saline down the endotracheal tube to loosen secretions C. Providing frequent mouth care and oral hygieneD. Using high tidal volumes on the ventilator 33. What are the most common early clinical manifestations of ARDS? A. Dyspnea and tachypnea B. Cyanosis and apprehension C. Hypotension and tachycardia D. Respiratory distress and frothy sputum 34. Which intervention is most likely to prevent or limit barotrauma in the patient with ARDS who is mechanically ventilated? A. Decreasing PEEP B. Use of permissive hypercapnia C. Increasing the tidal volume D. Use of positive pressure ventilation 35. A nurse walks in to a client who is in respiratory distress. The client has tracheal deviation to the right side. The nurse knows to prepare for which of the following emergent procedures? a. Chest tube insertion on the right side b. Chest tube insertion on the left side c. Intubation d. Tracheostomy 36. A 26-year-old patient is admitted to the hospital in severe respiratory distress. His oxygen saturations are 80% despite supplemental oxygen provided by facemask. The physician decides to intubate the patient to help with his breathing oxygenation. Which medication would the nurse most likely administer when assisting with intubation? a. Midazolam (Versed) b. Zolpidem (Ambien) c. Phentermine (Adipex-P) d. Modafinil (Provigil) 37. A nurse must position the patient prone after his diagnosis of acute respiratory distress syndrome. Which of the following is a benefit of using this position? Select all that apply. 1. Decreased atelectasis 2. Reduced need for endotracheal intubation 3. Mobilization of secretions 4. Decreased fluid accumulation 5. Increased response to corticosteroid therapy 38. A nurse is planning care for a patient with ARDS who will receive anoropharyngeal airway after his airway became obstructed. The nurse knows that which of the following is true about this procedure? Select all the apply. a. It is better tolerated than a nasopharyngeal airway b. The client must have a gag reflex c. Oral care must be given every 8 hours d. For the client who has general anesthesia e. For the client who has a head injury 39. In ARDS, initially the patient experiences respiratory alkalosis due to the increased CO2 being expelled out from the increased respiratory rate. The nurse knows that which of the following factors contributes to the later signs of respiratory acidosis? a. Alveoli is inactivated, which causes pulmonary edema b. Hyaline membranes form which does not allow CO2 escape, increasing the CO2 concentration in the blood c. Refractory hypoxemia, which impairs gas exchange with CO2 d. The normal hydrostatic pressure that pushes fluid out of the capillaries interact with CO2 thus rising its levels 40. The oxygen delivery system chosen for the patient in acute respiratory failure should A. always be a low-flow device, such as a nasal cannula. B. correct the PaO2 to a normal level as quickly as possible. C. administer positive-pressure ventilation to prevent CO2 narcosis. D. maintain the PaO2 at ≥60 mm Hg at the lowest O2 concentration possible 41. For which patient would NIPPV be an appropriate intervention to promote oxygenation?A. A patient's whose cardiac output and blood pressure are unstable B. A patient whose respiratory failure is caused by a head injury with loss of consciousness C. A patient with a diagnosis of cystic fibrosis and who is producing copious secretions D. A patient who is experiencing respiratory failure as a result of the progression of myasthenia gravis 42. Maintenance of fluid balance in the patient with ARDS involves A. hydration using colloids. B. administration of surfactant. C. mild fluid restriction and diuretics as necessary. D. keeping the hemoglobin level greater than 12 g/dL (120 g/L) 43. Which is a proper nursing action for a patient in acute respiratory failure? A. Administer 100% oxygen to an intubated patient until the pathology has resolved. B. Provide chest physical therapy for patients who produce more than 30 mL of sputum per day. C. Use continuous positive airway pressure (CPAP) if the patient has weak or absent respirations. D. Administer packed red blood cells to maintain the hemoglobin level at 7 g/dL or higher. 44. The high-pressure alarm on a patient’s ventilator goes off. When you enter the room to assess the patient, who has ARDS, the oxygen saturation monitor reads 87% and the patient is struggling to sit up. Which action should you take next? a. Insert an oral airway to prevent the patient from biting on the endotracheal tube b. Reassure the patient that the ventilator will do the work of breathing for him c. Manually ventilate the patient while assessing possible reasons for the highpressure alarm d. Increase the fraction of inspired oxygen on the ventilator to 100% in preparation for endotracheal suctioning 45. The nursing assistant tells you that a patient who is receiving oxygen at a flow rate of 6 L/min by nasal cannula is complaining of nasal passage discomfort. What intervention should you suggest to improve the patient’s comfort for this problem? a. Suggest that the patient sit up in a chair at the bedside b. Suggest that the patient’s oxygen be humidified c. Suggest that a simple face mask be used instead of a nasal cannula d. Suggest that the patient be provided with an extra pillow 46. A patient with acute respiratory distress syndrome (ARDS) is receiving oxygen bya nonrebreather mask, but arterial blood gas measurements still show poor oxygenation. As the nurse responsible for this patient’s care, you would anticipate a physician order for what action? a. Perform endotracheal intubation and initiate mechanical ventilation b. Immediately begin continuous positive airway pressure (CPAP) via the patient’s nose and mouth c. Administer furosemide (Lasix) 100 mg IV push stat d. Call a code for respiratory arrest 47. 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 48. You are 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.” 49. A client has just been intubated for placement on a mechanical ventilator. What is the first assessment of the tube placement? A. Chest X-RayB. Auscultation of breath sounds C. Pulse oximetry reading of 95% D. End tidal CO2 monitoring 50. What are strategies to prevent Ventilator-associated Pneumonia? select all that apply. 1. Oral care every 4 hours 2. HOB elevated 30-45 degrees unless contraindicated by the patient's condition 3. HOB elevated 10-15 degrees, unless contraindicated by the patient's condition 4. Allow family to suction patient as needed to remove secretions 5. Keeping the bedside clean 51. A Client has been intubated and placed on a volume-cycled mechanical ventilator. The nurse carefully assess the client for findings associated with a risk associated with this type of ventilator. What is the risk? A. Hypoventilation B. Hypercapnia C. Respiratory acidosis D. Barotrauma 52. The client is on CPAP for weaning from a mechanical ventilator. Assessment reveals a respiratory rate of 32/min, oxygen saturation of 88 percent, and use of accessory muscles. What should the nurse anticipate will occur? A. The FiO2 will be increased. B. Weaning will continue. C. The client will be placed back on full ventilatory support. D. The client will be extubated 53. A patient is placed on volume-cycled ventilation. The nurse plans care for this client based on which characteristic of this method of ventilation? A. Delivers a set volume, which will help overcome the client's airway resistance changes. B. The mechanism by which the phase of the breath switches from inspiration to expiration. C. Provides a consistent tidal volume. D. Delivers a preset volume of gas to the lungs to generate high pressures54. You, the nurse, have been monitoring the client with subcutaneous emphysema around the shoulder and lower neck. You notice that the area has expanded and is traveling up the neck. Based on your knowledge, what should the nurse anticipate doing in the near future? A. Preparing the client for surgery B. Encouraging the client to use the IS C. Palpating the area D. Assisting with tracheostomy insertion 55. The student nurse diligently assesses her patient with a chest tube. She notices that the suction control chamber of the chest tube is not bubbling. What is the first thing this student should do? A. Document this normal finding B. Encourage the patient to cough and deep breathe C. Check the level of the suction on the wall D. Clamp the chest tube and call for help