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A subset within healthcare, nursing focuses on caring for individuals, families, and communities. Nursing provides practical experience in human anatomy and physiology, as well as clinical practice

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Acute Respiratory Failure Clinical Judgement Activity

 

1. Which of the following statements best describes oxygenation failure?

 

A. Impaired gas exchange occurs at the alveolar level causing insufficient oxygenation of pulmonary blood.

B. Altered air movement causes inadequate oxygen intake.

C. Occurs when chest pressure does not change enough to allow adequate air movement.

D. Results from a physical problem of the lungs or chest wall or respiratory center of the brain.

 

2. Which of the following statements best describes ventilation failure?

 

A. Pulmonary perfusion is normal, but ventilation is inadequate, leading to impaired gas exchange.

B. Chest pressure changes are normal and air movement is adequate, but pulmonary blood not oxygenated sufficiently.

C. Caused by a right-to-left shunting of blood in the pulmonary vessels

D. Results from hyperventilation.

 

3. The nurse knows which of the following clients are at risk for developing combined

ventilatory and oxygenation respiratory failure?

 

A. A client with a history of consuming three alcoholic beverages per week .

B. A client with a history of smoking and has a diagnosis of asthma.

C. A client with a history of sleep apnea and obesity.

D. A client with a history of anemia and recently diagnosed with pneumonia.

 

4. The nurse is caring for a client with ventilatory failure. Which of the following statements is correct regarding the differences between intrapulmonary and extrapulmonary causes of ventilatory failure?

 

A. Intrapulmonary causes of ventilatory failure may be caused by neuromuscular disorders.

B. Airway diseases, such as chronic obstructive pulmonary disease (COPD), can cause extrapulmonary ventilation failure.

C. Intrapulmonary causes of ventilation failure may result in a perfusion/ventilation mismatch.

D. A client suffering from a catastrophic stroke is at risk for developing intrapulmonary ventilation failure.

 

5. Acute respiratory failure (ARF) is defined by which of the following blood gas values:

 

A. PaO2 80mm Hg, PaCO2-45mm Hg, pH-7.40, SaO2-92%

B. PaO2 90mm Hg, PaCO2-35mm Hg, pH-7.45, SaO2-89%

C. PaO2 65mm Hg, PaCO2-40mm Hg, pH-7.35, SaO2-90%

D. PaO2 55mm Hg, PaCO2-50mm Hg, pH-7.30, SaO2-85%

 

6. Clients that present with acute respiratory failure always have which abnormal vital sign reading?

 

A. Hypertension

B. Bradycardia

C. SaO2 less than 90%

D. PaO2 greater than 90 mmHg

 

7. The nurse is caring for a client admitted with pneumonia and recent weight loss. The client’s current vital signs are HR-100, BP-125/78, RR-30, SpO2-89%, Temperature-100.0 oral. What is the nurse’s priority action?

 

A. Consult home health

B. Administer oxygen therapy

C. Ensure adequate nutrition

D. Administer antibiotic therapy

 

 

P.R., a 61-year-old woman who has a history of chronic obstructive pulmonary disease (COPD), is being admitted to your unit with a diagnosis of pneumonia and acute respiratory failure.  She was endotracheally intubated orally in the emergency room and placed on mechanical ventilation.  Her vital signs are BP 112/68, HR 134, Temp 101.0 degrees with aSpO2 of 53%.  Her ventilator settings are synchronized intermittent mandatory ventilation of 12 breaths/min, tidal volume 700ml, FiO2 50% and positive end expiratory pressure (PEEP) 5 cmH2O.

 

Chart View

pH

7.28

PaCO2

62 mmHg

HCO3

26 mmol/L

PaO2

48 mmHg

SpO2

53%

 

8. The  arterial blood gas (ABG) results drawn in the emergency room before intubation are sent to you.  Interpret P.R.’s ABG results. Fill in the blank_____________________________

 

9. After intubation, the nurse knows that which of the following most accurately determines appropriate endotracheal tube placement? Select all that apply.

 

A. Endotracheal cuff pressure

B. Abdominal sounds

C. End-tidal carbon dioxide level

D. Arterial blood gasses

E. Chest x-ray

 

10. Endotracheal tube placement has been verified at 2cm above the carina. P.R.’s SpO2 is currently 60%. The nurse anticipates which of the following interventions?

 

A. Physician decreases the FiO2 from 80% to 50%.

B. Manual Ambu-bag ventilation with 100% oxygen.

C. Physician decreases PEEP to 3 cmH2O.

D. Document the level of the endotracheal tube at the lips.

 

11. The nurse caring for P.R. is reviewing orders related to mechanical ventilation. Which of the following nursing interventions incorporate best practice for the care of the mechanically ventilated client?  Select all that apply

 

A. Perform mouthcare every four hours.

B. Perform respiratory assessment at least every four hours.

C. Apply restraints first to prevent accidental dislodgement of the endotracheal tube.

D. Avoid the use of sedative medications to prevent decreased level of consciousness.

E. Avoid turning the client to prevent dislodgment of endotracheal tube.

F. Assess the client’s mouth around the endotracheal tube for pressure injuries.

 

12. P.R.’s son arrives at the bedside. As the nurse is updating the son, the high-pressure alarm on the ventilator sounds. The son appears frightened by the sound. Which of the following statements made by the nurse can provide reassurance and education to the son?

 

A.  “Your mom may need suctioning to remove secretions and the ventilator is letting us know so we can assess her.”

B. “Your mom’s ventilator tubing connections may have come undone and the ventilator is letting us know so we can assess her.”

C. “Your mom’s endotracheal tube cuff may be leaking, and the ventilator is letting us know so we can assess her.”

D. “ Your mom is not taking any spontaneous breaths at the moment and the ventilator is letting us know so we can assess her.”

 

13. During multidisciplinary rounds, the physician adjusts P.R.’s tidal volume and FiO2 settings. The nurse knows that tidal volume and FiO2 represent (Select all that apply):

 

A. The volume of air the client receives with each breath.

B. The oxygen delivered to the client.

C. The pressure at the end of expiration to gas exchange.

D. The speed at which each breath is delivered.

E. The pressure used by the ventilator to deliver a breath.

 

14. After P.R.’s FiO2 is increased to 100%, the SpO2 remains 75%. The nurse identifies this as ____________ ____________(a cardinal feature of acute respiratory distress syndrome [ARDS]). Fill in the blank.

 

15. The nurse understands that the most likely cause of P.R’s development of acute respiratory distress syndrome (ARDS) is:

 

A. Chronic obstructive pulmonary disease (COPD)

B. Pneumonia

C. Ventilator-associated lung injury (VALI)

D. Barotrauma

 

16. What signs and symptoms would the nurse expect to assess in the client with acute respiratory distress syndrome (ARDS)? Select all that apply

 

A. Dyspnea

B. Diffuse haziness appearance of the lungs on chest x-ray

C. Elevated PaO2

D. Normothermia

E. Cyanosis

 

17. Over the next eight hours, P.R. begins to display retractions, respiratory rate is 34 breaths per minute, and a chest x-ray revealed a “whited out” appearance.  The nurse anticipates moving P.R. into which position?

 

A. Supine

B. Prone

C. Trendelenburg

D. Reverse Trendelenburg

 

Two hours after moving P.R. into the desired position, P.R.’s ABGs are as follows:

Chart View

pH

7.30

PaCO2

52 mmHg

HCO3

22 mmol/L

PaO2

70 mmHg

SpO2

88%

 

18. Interpret the above ABGs. Fill in the blank___________________________________

 

19. P.R.’s respiratory status is improving. True or False

 

20. Because P.R. was diagnosed with pneumonia, the healthcare provider orders antibiotic therapy. The nurse knows which of the following must be obtained for appropriate antibiotic selection?

 

A. Urine culture and sensitivity

B. Sputum culture and sensitivity

C. Lateral chest x-ray

D. Pulmonary function test

 

 

21. The pharmacy sends ceftriaxone IV 1g in 100 mL 0.9% Normal Saline with instructions to infuse over 40 minutes. At how many mL/hr would the nurse regulate the IV infusion pump? (Round to the nearest whole number). Make sure to show your work for full credit.

 

 

 

Due to P.R.’s history of COPD, the prescriber orders albuterol inhaler 3 mL every 6 hours.

 

22. What is an adverse effect associated with the use of albuterol? (Select all that apply)

a. Tachycardia
b. Hypotension
c. Tremors
d. Chest pain
e. GI distress.
f. Weight gain

 

23. Select the following correct statements about preventing ventilator-associated pneumonia (VAP) when caring for P.R. or a similar patient receiving mechanical ventilation with an endotracheal tube (ETT). Select all that apply.

 

A. No interruption of sedation to avoid undue stress for patient.  

B. Perform hand hygiene only when hands are visibly soiled.

C. Perform oral care every 2 hours.

D. Maintain HOB at 15 degrees at all times.

E. Discuss need for antibiotic therapy as preventive measure with physician.

F. Administer scheduled pantoprazole 40mg IV push daily.

G. When providing suctioning, it’s only necessary to maintain clean technique.

 

 

 

 

 

 

24. The nurse knows that which of the following ventilator-associated events (VAEs) can occur due to positive pressure that decreases blood return to the heart?

 

A. Stress ulcers

B. Barotrauma

C. Volutrauma

D. Hypotension

 

 

After a period of time on the ventilator, P.R.’s condition improves, and the healthcare provider determines she can be weaned from mechanical ventilation. After a spontaneous breathing trial, the provider orders for the client to be extubated.

 

25. The nurse performs which of the following interventions in preparation for removal of the endotracheal tube?

 

A. Avoid suctioning prior extubation to prevent hypoxemia.

B. Advise the client to avoid coughing after removal of endotracheal tube.

C. Assess vital signs every five minutes immediately after extubation.

D. Allow the client to talk on the phone as much as desired.

 

26. The nurse is aware that which of the following is a late sign of a narrowed airway?

 

A. Mild dyspnea.

B. Coughing.

C. High-pitched sound during inspiration.

D. Inability to expectorate secretions.

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