Lewis Chapter 67: Acute Respiratory Failure and ARDS NCLEX
Test Questions and Answers Graded A+
The nurse is caring for a 27-yr-old man with Hydration is indicated for thick secretions, and
multiple fractured ribs from a motor vehicle chest physical therapy is indicated for patients
crash. Which clinical manifestation, if with 30 mL or more of sputum production per
experienced by the patient, is an early indication day.)
that the patient is developing respiratory failure?
A Tachycardia and pursed lip breathing A 72-yr-old woman with aspiration pneumonia
B Kussmaul respirations and hypotension develops severe respiratory distress. Her PaO2
C Frequent position changes and agitation is 42 mmHg and FIO2 is 80%. Which intervention
D Cyanosis and increased capillary refill time - should the nurse complete first?
ANSWER -C Frequent position changes
and agitation A Stat portable chest radiography
B Administer lorazepam (Ativan) 1 mg IV push
(A change in mental status is an early indication C Place the patient in a prone position on a
of respiratory failure. The brain is sensitive to rotational bed
variations in oxygenation, arterial carbon dioxide D Position the patient with arms supported away
levels, and acid-base balance. Restlessness, from the chest - ANSWER -D Position the
confusion, agitation, and combative behavior patient with arms supported away from the chest
suggest inadequate oxygen delivery to the
brain.) (The nurse will first position the patient to
facilitate ventilation. Additional oxygen support
may be necessary. Refractory hypoxemia
Arterial blood gas results are reported to the indicates the patient is not demonstrating acute
nurse for a 68-yr-old patient admitted with lung injury but has now developed acute
pneumonia: pH 7.31, PaCO2 49 mm Hg, HCO3 respiratory distress syndrome (ARDS). If the
26 mEq/L, and PaO2 52 mm Hg. What order PaO2 is 42 mm Hg on 80% FIO2 (fraction of
should the nurse complete first? inspired oxygen; room air is 21% FIO2), then the
PaO2/FIO2 ratio is 52.5, indicating ARDS
A Administer albuterol inhaler prn. (PaO2/FIO2 ratio < 200). Stat portable chest
B Increase fluid intake to 2500 mL per 24 hours. radiography may show worsening infiltrates or
C Initiate oxygen at 2 liters/minute by nasal "white lung." A rotational bed placing the patient
cannula. in prone position would be a strategy to use for
D Perform chest physical therapy four times per select patients with ARDS. This patient's age,
day. - ANSWER -C Initiate oxygen at 2 diagnosis, and comorbidities may indicate
liters/minute by nasal cannula. appropriateness for this treatment. Administration
of lorazepam (Ativan) 1 mg may be harmful to
(The arterial blood gas results indicate the this patient's oxygenation status. Further
patient is in uncompensated respiratory acidosis assessment would be needed to determine
with moderate hypoxemia. Oxygen therapy is safety.)
indicated to correct hypoxemia secondary to V/Q
mismatch. Supplemental oxygen should be
initiated at 1 to 3 L/min by nasal cannula, or 24% The nurse is caring for a 37-yr-old female patient
to 32% by simple face mask or Venturi mask to with multiple musculoskeletal injuries who has
improve the PaO2. Albuterol would be developed acute respiratory distress syndrome
administered next if needed for bronchodilation. (ARDS). Which intervention should the nurse
, Lewis Chapter 67: Acute Respiratory Failure and ARDS NCLEX
Test Questions and Answers Graded A+
initiate to prevent stress ulcers?
(Patients on PPV and PEEP frequently
A Observe stools for frank bleeding and occult experience decreased cardiac output (CO) and
blood. cardiac index (CI). High levels of PEEP increase
B Maintain head of the bed elevation at 30 to 45 intrathoracic pressure and cause decreased
degrees. venous return which results in decreased CO.
C Begin enteral feedings as soon as bowel Interventions to improve CO include lowering the
sounds are present. PEEP, administering crystalloid fluids or colloid
D Administer prescribed lorazepam (Ativan) to solutions, and use of inotropic drugs (e.g.,
reduce anxiety. - ANSWER -C Begin dobutamine, dopamine). Packed red blood cells
enteral feedings as soon as bowel sounds are may also be administered to improve CO and
present. oxygenation if the hemoglobin is less than 9 or 10
mg/dL.)
(Stress ulcers prevention includes early initiation
of enteral nutrition to protect the gastrointestinal
(GI) tract from mucosal damage. Antiulcer agents The nurse is admitting a 45-yr-old patient with
such as histamine (H2)-receptor antagonists, asthma in acute respiratory distress. The nurse
proton pump inhibitors, and mucosal protecting auscultates the patient's lungs and notes
agents are also indicated to prevent stress cessation of the inspiratory wheezing. The patient
ulcers. Monitoring for GI bleeding does not has not yet received any medication. What
prevent stress ulcers. Ventilator-associated should this finding suggest to the nurse?
pneumonia related to aspiration is prevented by
elevation of the head of bed to 30 to 45 degrees A Spontaneous resolution of the acute asthma
Stress ulcers are not caused by anxiety. Stress attack
ulcers are related to GI ischemia from B An acute development of bilateral pleural
hypotension, shock, and acidosis.) effusions
C Airway constriction requiring immediate
interventions
A 56-yr-old man with acute respiratory distress D Overworked intercostal muscles resulting in
syndrome (ARDS) is on positive pressure poor air exchange - ANSWER -C Airway
ventilation (PPV). The patient's cardiac index is constriction requiring immediate interventions
1.4 L/min and pulmonary artery wedge pressure
is 8 mm Hg. What order by the physician is (When a patient in respiratory distress has
important for the nurse to question? inspiratory wheezing and then it ceases, it is an
indication of airway obstruction. This finding
A Initiate a dobutamine infusion at 3 mcg/kg/min. requires emergency action to restore airway
B Administer 1 unit of packed red blood cells patency. Cessation of inspiratory wheezing does
over the next 2 hours. not indicate spontaneous resolution of the acute
C Change the maintenance intravenous (IV) rate asthma attack, bilateral pleural effusion
from 75 to 125 mL/hr. development, or overworked intercostal muscles
D Increase positive end-expiratory pressure in this asthmatic patient that is in acute
(PEEP) from 10 to 15 cm H2O. - respiratory distress.)
ANSWER -D Increase positive end-
expiratory pressure (PEEP) from 10 to 15 cm
H2O. The nurse is caring for a patient who is admitted
Test Questions and Answers Graded A+
The nurse is caring for a 27-yr-old man with Hydration is indicated for thick secretions, and
multiple fractured ribs from a motor vehicle chest physical therapy is indicated for patients
crash. Which clinical manifestation, if with 30 mL or more of sputum production per
experienced by the patient, is an early indication day.)
that the patient is developing respiratory failure?
A Tachycardia and pursed lip breathing A 72-yr-old woman with aspiration pneumonia
B Kussmaul respirations and hypotension develops severe respiratory distress. Her PaO2
C Frequent position changes and agitation is 42 mmHg and FIO2 is 80%. Which intervention
D Cyanosis and increased capillary refill time - should the nurse complete first?
ANSWER -C Frequent position changes
and agitation A Stat portable chest radiography
B Administer lorazepam (Ativan) 1 mg IV push
(A change in mental status is an early indication C Place the patient in a prone position on a
of respiratory failure. The brain is sensitive to rotational bed
variations in oxygenation, arterial carbon dioxide D Position the patient with arms supported away
levels, and acid-base balance. Restlessness, from the chest - ANSWER -D Position the
confusion, agitation, and combative behavior patient with arms supported away from the chest
suggest inadequate oxygen delivery to the
brain.) (The nurse will first position the patient to
facilitate ventilation. Additional oxygen support
may be necessary. Refractory hypoxemia
Arterial blood gas results are reported to the indicates the patient is not demonstrating acute
nurse for a 68-yr-old patient admitted with lung injury but has now developed acute
pneumonia: pH 7.31, PaCO2 49 mm Hg, HCO3 respiratory distress syndrome (ARDS). If the
26 mEq/L, and PaO2 52 mm Hg. What order PaO2 is 42 mm Hg on 80% FIO2 (fraction of
should the nurse complete first? inspired oxygen; room air is 21% FIO2), then the
PaO2/FIO2 ratio is 52.5, indicating ARDS
A Administer albuterol inhaler prn. (PaO2/FIO2 ratio < 200). Stat portable chest
B Increase fluid intake to 2500 mL per 24 hours. radiography may show worsening infiltrates or
C Initiate oxygen at 2 liters/minute by nasal "white lung." A rotational bed placing the patient
cannula. in prone position would be a strategy to use for
D Perform chest physical therapy four times per select patients with ARDS. This patient's age,
day. - ANSWER -C Initiate oxygen at 2 diagnosis, and comorbidities may indicate
liters/minute by nasal cannula. appropriateness for this treatment. Administration
of lorazepam (Ativan) 1 mg may be harmful to
(The arterial blood gas results indicate the this patient's oxygenation status. Further
patient is in uncompensated respiratory acidosis assessment would be needed to determine
with moderate hypoxemia. Oxygen therapy is safety.)
indicated to correct hypoxemia secondary to V/Q
mismatch. Supplemental oxygen should be
initiated at 1 to 3 L/min by nasal cannula, or 24% The nurse is caring for a 37-yr-old female patient
to 32% by simple face mask or Venturi mask to with multiple musculoskeletal injuries who has
improve the PaO2. Albuterol would be developed acute respiratory distress syndrome
administered next if needed for bronchodilation. (ARDS). Which intervention should the nurse
, Lewis Chapter 67: Acute Respiratory Failure and ARDS NCLEX
Test Questions and Answers Graded A+
initiate to prevent stress ulcers?
(Patients on PPV and PEEP frequently
A Observe stools for frank bleeding and occult experience decreased cardiac output (CO) and
blood. cardiac index (CI). High levels of PEEP increase
B Maintain head of the bed elevation at 30 to 45 intrathoracic pressure and cause decreased
degrees. venous return which results in decreased CO.
C Begin enteral feedings as soon as bowel Interventions to improve CO include lowering the
sounds are present. PEEP, administering crystalloid fluids or colloid
D Administer prescribed lorazepam (Ativan) to solutions, and use of inotropic drugs (e.g.,
reduce anxiety. - ANSWER -C Begin dobutamine, dopamine). Packed red blood cells
enteral feedings as soon as bowel sounds are may also be administered to improve CO and
present. oxygenation if the hemoglobin is less than 9 or 10
mg/dL.)
(Stress ulcers prevention includes early initiation
of enteral nutrition to protect the gastrointestinal
(GI) tract from mucosal damage. Antiulcer agents The nurse is admitting a 45-yr-old patient with
such as histamine (H2)-receptor antagonists, asthma in acute respiratory distress. The nurse
proton pump inhibitors, and mucosal protecting auscultates the patient's lungs and notes
agents are also indicated to prevent stress cessation of the inspiratory wheezing. The patient
ulcers. Monitoring for GI bleeding does not has not yet received any medication. What
prevent stress ulcers. Ventilator-associated should this finding suggest to the nurse?
pneumonia related to aspiration is prevented by
elevation of the head of bed to 30 to 45 degrees A Spontaneous resolution of the acute asthma
Stress ulcers are not caused by anxiety. Stress attack
ulcers are related to GI ischemia from B An acute development of bilateral pleural
hypotension, shock, and acidosis.) effusions
C Airway constriction requiring immediate
interventions
A 56-yr-old man with acute respiratory distress D Overworked intercostal muscles resulting in
syndrome (ARDS) is on positive pressure poor air exchange - ANSWER -C Airway
ventilation (PPV). The patient's cardiac index is constriction requiring immediate interventions
1.4 L/min and pulmonary artery wedge pressure
is 8 mm Hg. What order by the physician is (When a patient in respiratory distress has
important for the nurse to question? inspiratory wheezing and then it ceases, it is an
indication of airway obstruction. This finding
A Initiate a dobutamine infusion at 3 mcg/kg/min. requires emergency action to restore airway
B Administer 1 unit of packed red blood cells patency. Cessation of inspiratory wheezing does
over the next 2 hours. not indicate spontaneous resolution of the acute
C Change the maintenance intravenous (IV) rate asthma attack, bilateral pleural effusion
from 75 to 125 mL/hr. development, or overworked intercostal muscles
D Increase positive end-expiratory pressure in this asthmatic patient that is in acute
(PEEP) from 10 to 15 cm H2O. - respiratory distress.)
ANSWER -D Increase positive end-
expiratory pressure (PEEP) from 10 to 15 cm
H2O. The nurse is caring for a patient who is admitted
