CriticalfCarefexamf1:frespiratoryfPracticefquestions
1)fAfnursefisfcaringfforfafpatientfwithfARDS.fThefnursefviewsfthefABG.fWh
atfvaluefshouldfthefnursefreportftofthefphysician?
pH:f7.35
PaCO2:f26mmhg
PaO2:95
HCO3:f22
a)fPaCO2
b)pH
c)HCO3
d)PaO2f-fCORRECTfANSWER✔a
ThefnormalfrangefforfPaCO2fisf35-
45.fThisfpatientfisfexperiencingfafsuperimposedfrespiratoryfalkalosisflikelyf
dueftofhyperventilation.fThefnursefshouldfreportfthefPaCO2ftofthefphysicia
n.
2)fAfnursefmustfpositionfthefpatientfpronefafterfhisfdiagnosisfoffacutefrespir
atoryfdistressfsyndromef(ARDS).fWhichfofftheffollowingfisfafbenefitfoffusi
ngfthisfposition?fSelectfallfthatfapply.
A)Decreasedfatelectasis
,B)Reducedfneedfforfendotrachealfintubation
c)Mobilizationfoffsecretions
d)Decreasedfpleuralfpressure
e)Increasedfresponseftofcorticosteroidftherapyf-
fCORRECTfANSWER✔a,fc,fd
Decreasedfatelectasis",f"Mobilizationfoffsecretions"fandf"Decreasedfpleur
alfpressure"farefcorrect.fPronefpositioning,forfplacingfthefpatientffacefdownf
withfthefheadfturnedftofthefside,fhelpsfwithfpulmonaryffunctionfinfthefpatien
tfdiagnosedfwithfARDS.fWhenfthefpatientfisfplacedfinfafpronefposition,fthef
heartfandfdiaphragmfarefnotfpressingfagainstftheflungs,fwhichfmeansfthatfpl
euralfpressurefisfreduced.fWhenftherefisflessfpressurefexertedfonftheflungs,fa
telectasisfdecreases.fStudiesfhavefshownfthatfmanyfpatientsfinfthefpronefpo
sitionfhavefincreasedflungfsecretions,fwhichfimprovesfoxygenation.
-"Reducedfneedfforfendotrachealfintubation"fisfincorrect.fThefpronefpositio
nfhasfnotfbeenfshownftofdecreaseftheflikelihoodfoffintubation.
-"Increasedfresponseftofcorticosteroidftherapy"fisfincorrectfbecausefpositio
ningfdoesfnotfchangefthefbody'sfresponseftofsteroidftherapy.
3)fAf25-year-
oldfpatientfinfthefICUfisfbeingftreatedfforfacutefrespiratoryfdistressfsyndrom
ef(ARDS).fThefpatientfisfonfafventilatorfandfrequiresf80fpercentfFiO2.fWhic
hfinformationfwouldfthefnursefmostflikelyfneedftofreportfaboutfthefpatientfto
fthefrespiratory ftherapistfworkingfwithfher?
a)Thefpatientfneedsfendotrachealfsuctioning
b)Thefpatientfneedsfmorefoxygenfbecausefoffhisfsaturation
,c)Thefpatientfneedsfanfarterialfbloodfgasfdrawn
d)Thefpatientfneedsfafhemoglobinflevelfdrawnf-fCORRECTfANSWER✔c
4)fAfpatientfwhofhasfrecoveredffromfARDSfinfthefICUfisfnowfmalnourishe
dfandfhasflostfafsignificantfamountfoffweight.fThefphysicianfordersfTPNftofa
ddfnutritionfforfthefpatient,fwhofthenfdevelopsfre-
feedingfsyndrome.fWhichfofftheffollowingfsignsforfsymptomsfwouldfthefnu
rsefexpectftofseefwithfre-feedingfsyndrome?fSelectfallfthatfapply.
a.fImpairedfmentalfstatus
b.fInsulinfresistance
c.fSeizures
d.fPersistentfweightfloss
e.fConstipationf-fCORRECTfANSWER✔a,b,c
impairedfmentalfstatus",f"Insulinfresistance"fandf"Seizures"farefcorrect.fRe
-
feedingfsyndromefcanfoccurfasfafresponseftofnutrientfreintroductionfafterfaf
periodfoffstarvation.fWhenfanfextremelyfmalnourishedfpatientfreceivesfTP
N,fthefbodyfhasftofadjustftofreceivingfnutrientsfagain,fwhichfcanfcausefshifts
finfelectrolytes finfthefbody.fThesefshiftsfinfelectrolytesfcanfresultfinfsuddenf
andfoftenffatalfcomplications.fSignsfandfsymptomsfoffre-
feedingfsyndromefincludefconfusionfandfimpairedfmentalfstatus,finsulinfre
sistance,fseizures,fcomafandfdeath.
-"Persistentfweightfloss"fisfincorrectfbecausefbyftheftimefafpatientfdevelopsf
re-
, feedingfsyndrome,fthefonsetfoffsymptomsfisfsofsuddenfthatfweightflossfcan
notfbefmeasuredfasfpartfoffthefsyndrome.
-"Constipation"fisfincorrect,fasfitfisfnotfafsymptomfoffrefeedingfsyndrome.
5)fAfnursefisfcaringfforfafpatientfwithfARDS.fWhichfofftheffollowingfclinica
lfindicatorsfwouldfsignifyfthatfthisfclientfisfinfrespiratoryffailure?
fSelectfallfthatfapply.
a.fPulsefoximetryfoff94%fonfroomfair
b.fAfPaO2flevelfbelowf60fmmHg
c.fAnfABGfpHflevelfoff7.35
d.fAfpCO2flevelfoverf50fmmHg
e.fAfrespiratoryfratefoffoverf16/minutef-fCORRECTfANSWER✔b,fdf
Respiratoryfdiseasesfcanfcausefsuchfcompromisefthatfthefpatientfwillfsuffer
fsymptoms;fhowever,ftherefarefcertainfclinicalfindicatorsfthatfcanfclarifyfwh
etherfthefpatientfisfactuallyfinfrespiratoryffailure.fClinicalfindicatorsfoffrespi
ratoryffailurefincludefpulsefoximetryfofflessfthanf91%fonfroomfair,fPaO2fle
velflessfthanf60fmmHg,fandfafpCO2flevelfoffoverf50fmmHg.
6)fAfnursefisfcaringfforfafpatientfwhofisfinfrespiratoryfdistressfbecausefoffA
RDS.fWhichfofftheffollowingfnursingfdiagnosesfwouldfmostflikelyfbefassoc
iatedfwithfthisfcondition?
a.fIneffectivefthermoregulation
b.fImpairedfurinaryfelimination
1)fAfnursefisfcaringfforfafpatientfwithfARDS.fThefnursefviewsfthefABG.fWh
atfvaluefshouldfthefnursefreportftofthefphysician?
pH:f7.35
PaCO2:f26mmhg
PaO2:95
HCO3:f22
a)fPaCO2
b)pH
c)HCO3
d)PaO2f-fCORRECTfANSWER✔a
ThefnormalfrangefforfPaCO2fisf35-
45.fThisfpatientfisfexperiencingfafsuperimposedfrespiratoryfalkalosisflikelyf
dueftofhyperventilation.fThefnursefshouldfreportfthefPaCO2ftofthefphysicia
n.
2)fAfnursefmustfpositionfthefpatientfpronefafterfhisfdiagnosisfoffacutefrespir
atoryfdistressfsyndromef(ARDS).fWhichfofftheffollowingfisfafbenefitfoffusi
ngfthisfposition?fSelectfallfthatfapply.
A)Decreasedfatelectasis
,B)Reducedfneedfforfendotrachealfintubation
c)Mobilizationfoffsecretions
d)Decreasedfpleuralfpressure
e)Increasedfresponseftofcorticosteroidftherapyf-
fCORRECTfANSWER✔a,fc,fd
Decreasedfatelectasis",f"Mobilizationfoffsecretions"fandf"Decreasedfpleur
alfpressure"farefcorrect.fPronefpositioning,forfplacingfthefpatientffacefdownf
withfthefheadfturnedftofthefside,fhelpsfwithfpulmonaryffunctionfinfthefpatien
tfdiagnosedfwithfARDS.fWhenfthefpatientfisfplacedfinfafpronefposition,fthef
heartfandfdiaphragmfarefnotfpressingfagainstftheflungs,fwhichfmeansfthatfpl
euralfpressurefisfreduced.fWhenftherefisflessfpressurefexertedfonftheflungs,fa
telectasisfdecreases.fStudiesfhavefshownfthatfmanyfpatientsfinfthefpronefpo
sitionfhavefincreasedflungfsecretions,fwhichfimprovesfoxygenation.
-"Reducedfneedfforfendotrachealfintubation"fisfincorrect.fThefpronefpositio
nfhasfnotfbeenfshownftofdecreaseftheflikelihoodfoffintubation.
-"Increasedfresponseftofcorticosteroidftherapy"fisfincorrectfbecausefpositio
ningfdoesfnotfchangefthefbody'sfresponseftofsteroidftherapy.
3)fAf25-year-
oldfpatientfinfthefICUfisfbeingftreatedfforfacutefrespiratoryfdistressfsyndrom
ef(ARDS).fThefpatientfisfonfafventilatorfandfrequiresf80fpercentfFiO2.fWhic
hfinformationfwouldfthefnursefmostflikelyfneedftofreportfaboutfthefpatientfto
fthefrespiratory ftherapistfworkingfwithfher?
a)Thefpatientfneedsfendotrachealfsuctioning
b)Thefpatientfneedsfmorefoxygenfbecausefoffhisfsaturation
,c)Thefpatientfneedsfanfarterialfbloodfgasfdrawn
d)Thefpatientfneedsfafhemoglobinflevelfdrawnf-fCORRECTfANSWER✔c
4)fAfpatientfwhofhasfrecoveredffromfARDSfinfthefICUfisfnowfmalnourishe
dfandfhasflostfafsignificantfamountfoffweight.fThefphysicianfordersfTPNftofa
ddfnutritionfforfthefpatient,fwhofthenfdevelopsfre-
feedingfsyndrome.fWhichfofftheffollowingfsignsforfsymptomsfwouldfthefnu
rsefexpectftofseefwithfre-feedingfsyndrome?fSelectfallfthatfapply.
a.fImpairedfmentalfstatus
b.fInsulinfresistance
c.fSeizures
d.fPersistentfweightfloss
e.fConstipationf-fCORRECTfANSWER✔a,b,c
impairedfmentalfstatus",f"Insulinfresistance"fandf"Seizures"farefcorrect.fRe
-
feedingfsyndromefcanfoccurfasfafresponseftofnutrientfreintroductionfafterfaf
periodfoffstarvation.fWhenfanfextremelyfmalnourishedfpatientfreceivesfTP
N,fthefbodyfhasftofadjustftofreceivingfnutrientsfagain,fwhichfcanfcausefshifts
finfelectrolytes finfthefbody.fThesefshiftsfinfelectrolytesfcanfresultfinfsuddenf
andfoftenffatalfcomplications.fSignsfandfsymptomsfoffre-
feedingfsyndromefincludefconfusionfandfimpairedfmentalfstatus,finsulinfre
sistance,fseizures,fcomafandfdeath.
-"Persistentfweightfloss"fisfincorrectfbecausefbyftheftimefafpatientfdevelopsf
re-
, feedingfsyndrome,fthefonsetfoffsymptomsfisfsofsuddenfthatfweightflossfcan
notfbefmeasuredfasfpartfoffthefsyndrome.
-"Constipation"fisfincorrect,fasfitfisfnotfafsymptomfoffrefeedingfsyndrome.
5)fAfnursefisfcaringfforfafpatientfwithfARDS.fWhichfofftheffollowingfclinica
lfindicatorsfwouldfsignifyfthatfthisfclientfisfinfrespiratoryffailure?
fSelectfallfthatfapply.
a.fPulsefoximetryfoff94%fonfroomfair
b.fAfPaO2flevelfbelowf60fmmHg
c.fAnfABGfpHflevelfoff7.35
d.fAfpCO2flevelfoverf50fmmHg
e.fAfrespiratoryfratefoffoverf16/minutef-fCORRECTfANSWER✔b,fdf
Respiratoryfdiseasesfcanfcausefsuchfcompromisefthatfthefpatientfwillfsuffer
fsymptoms;fhowever,ftherefarefcertainfclinicalfindicatorsfthatfcanfclarifyfwh
etherfthefpatientfisfactuallyfinfrespiratoryffailure.fClinicalfindicatorsfoffrespi
ratoryffailurefincludefpulsefoximetryfofflessfthanf91%fonfroomfair,fPaO2fle
velflessfthanf60fmmHg,fandfafpCO2flevelfoffoverf50fmmHg.
6)fAfnursefisfcaringfforfafpatientfwhofisfinfrespiratoryfdistressfbecausefoffA
RDS.fWhichfofftheffollowingfnursingfdiagnosesfwouldfmostflikelyfbefassoc
iatedfwithfthisfcondition?
a.fIneffectivefthermoregulation
b.fImpairedfurinaryfelimination
