CRITICAL CARE ACUTE RESPIRATORY, ARDS AND SHOCK
PRACTICE QUESTIONS WITH DETAILED VERIFIED AND
100% ACCURATE ANSWERS BRAND NEW EXAM ALREADY
GRADED A+
A patient with acute respiratory distress syndrome (ARDS) is on
positive pressure ventilation (PPV). The patient's cardiac index is 1.4
L/min and pulmonary artery wedge pressure is 8 mm Hg. What order by
the provider would the nurse to question?
A.Increase PEEP from 10 to 15 cm H2O.
B.Start a dobutamine infusion at 3 mcg/kg/min.Incorrect Answer
C.Give 1 unit of packed RBCs over the next 2 hours.
D.Change the maintenance IV rate from 75 to 125 mL/hr. Correct
Answers A.Increase PEEP from 10 to 15 cm H2O.
Patients on PPV and PEEP often have decreased cardiac output (CO)
and cardiac index (CI). High levels of PEEP increase intrathoracic
pressure and cause decreased venous return which results in decreased
CO. Interventions to improve CO include lowering the PEEP, giving
crystalloid fluids or colloid solutions, and use of inotropic drugs (e.g.,
dobutamine, dopamine). Packed red blood cells may also be
administered to improve CO and oxygenation if the hemoglobin is less
than 9 or 10 mg/dL.
The nurse is caring for a patient who has developed acute respiratory
failure. Which medication is used to decrease patient pulmonary
congestion and agitation?
A. Morphine
B. AlbuterolIncorrect Answer
,C. Azithromycin
D. Methylprednisolone Correct Answers A. Morphine
For a patient with acute respiratory failure related to the heart, morphine
is used to decrease pulmonary congestion as well as anxiety, agitation,
and pain. Albuterol is used to reduce bronchospasm. Azithromycin is
used for pulmonary infections. Methylprednisolone is used to reduce
airway inflammation and edema.
When caring for older adult patients with respiratory failure, the nurse
will add which intervention to individualize care?
A. Assess frequently for manifestations of delirium
B. Position the patient in the supine position primarily.
C. Provide early endotracheal intubation to reduce complications.
D. Delay activity and ambulation to provide additional healing time.
Correct Answers A. Assess frequently for manifestations of delirium
Older adult patients are more predisposed to delirium and health care-
associated infections. Individualizing the older patient's care plan to
address these factors will improve care. Older adult patients are not
required to remain in a supine position only and should increase activity
as soon as stability is determined. Endotracheal intubation is not
provided early, and noninvasive positive pressure ventilation may be
considered as an alternative. The nurse should consider that the aging
process leads to decreased lung elastic recoil, weakened lung muscles
and reduced gas exchange, which may make the patient difficult to wean
from the ventilator.
,A patient is in acute respiratory distress syndrome (ARDS) from sepsis.
Which measure would be implemented to maintain cardiac output?
A. Administer IV crystalloid fluids.Correct Answer
B. Place the patient on a strict fluid restriction.
C. Position the patient in Trendelenburg position.
D. Perform chest physiotherapy and assist with staged coughing.
Correct Answers A. Administer IV crystalloid fluids.Correct Answer
Low cardiac output may necessitate crystalloid fluids in addition to
lowering positive end-expiratory pressure (PEEP) or giving inotropes.
The Trendelenburg position is not recommended to treat hypotension.
Chest physiotherapy is unlikely to relieve decreased cardiac output.
Fluid restriction would be an inappropriate intervention.
Arterial blood gas results are reported to the nurse for a patient admitted
with pneumonia: pH 7.31, PaCO2 49 mm Hg, HCO3 26 mEq/L, and
PaO2 52 mm Hg. What order should the nurse complete first?
A. Administer albuterol inhaler PRN.
B. Start oxygen at 2 L/min by nasal cannula.
C. Increase fluid intake to 2500 mL per 24 hours.Incorrect Answer
D. Perform chest physical therapy 4 times per day. Correct Answers B.
Start oxygen at 2 L/min by nasal cannula.
The arterial blood gas results show the patient is in uncompensated
respiratory acidosis with moderate hypoxemia. Oxygen therapy is
, 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% to 32% by simple face mask or Venturi mask to
improve the PaO2. Albuterol would be given next if needed for
bronchodilation. Hydration is indicated for thick secretions, and chest
physical therapy is indicated for patients with 30 mL or more of sputum
production per day.
When caring for a patient with acute respiratory distress syndrome
(ARDS), which finding indicates therapy is appropriate?
A. Arterial pH is 7.32.
B. PaO2 is greater than or equal to 60 mm Hg.
C. PEEP increased to 20 cm H2O caused BP to fall to 80/40.
D. No change in PaO2 when patient is turned from supine to prone
position. Correct Answers B. PaO2 is greater than or equal to 60 mm
Hg.
The overall goal in caring for the patient with ARDS is for the PaO2 to
be greater than or equal to 60 mm Hg with adequate lung ventilation to
maintain a normal pH of 7.35 to 7.45. PEEP is usually increased for
ARDS patients, but a dramatic reduction in BP indicates a complication
of decreased cardiac output. A positive occurrence is a marked
improvement in PaO2 from perfusion better matching ventilation when
the anterior air-filled, nonatelectatic alveoli become dependent in the
prone position.
PRACTICE QUESTIONS WITH DETAILED VERIFIED AND
100% ACCURATE ANSWERS BRAND NEW EXAM ALREADY
GRADED A+
A patient with acute respiratory distress syndrome (ARDS) is on
positive pressure ventilation (PPV). The patient's cardiac index is 1.4
L/min and pulmonary artery wedge pressure is 8 mm Hg. What order by
the provider would the nurse to question?
A.Increase PEEP from 10 to 15 cm H2O.
B.Start a dobutamine infusion at 3 mcg/kg/min.Incorrect Answer
C.Give 1 unit of packed RBCs over the next 2 hours.
D.Change the maintenance IV rate from 75 to 125 mL/hr. Correct
Answers A.Increase PEEP from 10 to 15 cm H2O.
Patients on PPV and PEEP often have decreased cardiac output (CO)
and cardiac index (CI). High levels of PEEP increase intrathoracic
pressure and cause decreased venous return which results in decreased
CO. Interventions to improve CO include lowering the PEEP, giving
crystalloid fluids or colloid solutions, and use of inotropic drugs (e.g.,
dobutamine, dopamine). Packed red blood cells may also be
administered to improve CO and oxygenation if the hemoglobin is less
than 9 or 10 mg/dL.
The nurse is caring for a patient who has developed acute respiratory
failure. Which medication is used to decrease patient pulmonary
congestion and agitation?
A. Morphine
B. AlbuterolIncorrect Answer
,C. Azithromycin
D. Methylprednisolone Correct Answers A. Morphine
For a patient with acute respiratory failure related to the heart, morphine
is used to decrease pulmonary congestion as well as anxiety, agitation,
and pain. Albuterol is used to reduce bronchospasm. Azithromycin is
used for pulmonary infections. Methylprednisolone is used to reduce
airway inflammation and edema.
When caring for older adult patients with respiratory failure, the nurse
will add which intervention to individualize care?
A. Assess frequently for manifestations of delirium
B. Position the patient in the supine position primarily.
C. Provide early endotracheal intubation to reduce complications.
D. Delay activity and ambulation to provide additional healing time.
Correct Answers A. Assess frequently for manifestations of delirium
Older adult patients are more predisposed to delirium and health care-
associated infections. Individualizing the older patient's care plan to
address these factors will improve care. Older adult patients are not
required to remain in a supine position only and should increase activity
as soon as stability is determined. Endotracheal intubation is not
provided early, and noninvasive positive pressure ventilation may be
considered as an alternative. The nurse should consider that the aging
process leads to decreased lung elastic recoil, weakened lung muscles
and reduced gas exchange, which may make the patient difficult to wean
from the ventilator.
,A patient is in acute respiratory distress syndrome (ARDS) from sepsis.
Which measure would be implemented to maintain cardiac output?
A. Administer IV crystalloid fluids.Correct Answer
B. Place the patient on a strict fluid restriction.
C. Position the patient in Trendelenburg position.
D. Perform chest physiotherapy and assist with staged coughing.
Correct Answers A. Administer IV crystalloid fluids.Correct Answer
Low cardiac output may necessitate crystalloid fluids in addition to
lowering positive end-expiratory pressure (PEEP) or giving inotropes.
The Trendelenburg position is not recommended to treat hypotension.
Chest physiotherapy is unlikely to relieve decreased cardiac output.
Fluid restriction would be an inappropriate intervention.
Arterial blood gas results are reported to the nurse for a patient admitted
with pneumonia: pH 7.31, PaCO2 49 mm Hg, HCO3 26 mEq/L, and
PaO2 52 mm Hg. What order should the nurse complete first?
A. Administer albuterol inhaler PRN.
B. Start oxygen at 2 L/min by nasal cannula.
C. Increase fluid intake to 2500 mL per 24 hours.Incorrect Answer
D. Perform chest physical therapy 4 times per day. Correct Answers B.
Start oxygen at 2 L/min by nasal cannula.
The arterial blood gas results show the patient is in uncompensated
respiratory acidosis with moderate hypoxemia. Oxygen therapy is
, 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% to 32% by simple face mask or Venturi mask to
improve the PaO2. Albuterol would be given next if needed for
bronchodilation. Hydration is indicated for thick secretions, and chest
physical therapy is indicated for patients with 30 mL or more of sputum
production per day.
When caring for a patient with acute respiratory distress syndrome
(ARDS), which finding indicates therapy is appropriate?
A. Arterial pH is 7.32.
B. PaO2 is greater than or equal to 60 mm Hg.
C. PEEP increased to 20 cm H2O caused BP to fall to 80/40.
D. No change in PaO2 when patient is turned from supine to prone
position. Correct Answers B. PaO2 is greater than or equal to 60 mm
Hg.
The overall goal in caring for the patient with ARDS is for the PaO2 to
be greater than or equal to 60 mm Hg with adequate lung ventilation to
maintain a normal pH of 7.35 to 7.45. PEEP is usually increased for
ARDS patients, but a dramatic reduction in BP indicates a complication
of decreased cardiac output. A positive occurrence is a marked
improvement in PaO2 from perfusion better matching ventilation when
the anterior air-filled, nonatelectatic alveoli become dependent in the
prone position.
