NUR 425 COMPREHENSIVE EXAMS QUESTIONS
AND ANSWERS SURE A+
✔✔List 3 things we need for good perfusion. - ✔✔1. Strong heart ---> HF
2. Patent blood vessels ---> Embolism
3. Blood flow ---> Shock
✔✔List 5 things we need for good ventilation. - ✔✔1. Good brain function ---> Brain
injury
2. Airway ---> Asthma, angioedema, secretions, choking
3. Strength ---> Fatigue
4. Nerve innervation ---> Spinal cord injury, paralysis
5. Chest expansion ---> Chest trauma, ascites, COPD (barrel chest), obesity
✔✔A PaO2 of <60 mmHg is called being _____. - ✔✔Hypoxemic
✔✔A PaCO2 of >45 mmHg is called being _____. - ✔✔Hypercapnic
✔✔True or false:
Respiratory failure is a disease in itself. - ✔✔False! It occurs due to a disease state, not
a disease in itself.
✔✔What is the #1 early sign of respiratory failure? - ✔✔Altered LOC
✔✔List some early manifestations of respiratory failure. - ✔✔1. ALTERED LOC
2. Fatigue
3. Restlessness
4. Anxiety
5. Tachycardia
6. Tachypnea
7. Mild HTN
,8. Morning headache
✔✔List some later manifestations of respiratory failure. - ✔✔1. Rapid, shallow breathing
pattern
2. Tripod position, pursed-lip breathing
3. Dyspnea, restrations, paradoxical breathing
4. Diaphoresis, prolonged hypoxemia
5. Anaerobic metabolism, leading to lactic acidosis
6. Abnormal breathing sounds
✔✔The belly goes in when you inhale - ✔✔Paradoxical breathing
✔✔List some nursing support for a pt. with respiratory failure. - ✔✔-Always assess first!
-Sit them up
-Administer oxygen, maintain PaO2 >55 and SaO2 >90 at lowest concentration possible
-Ventilatory support if needed
-Suctioning, hydration, effective coughing (airway clearance)
✔✔List some collaborative interventions for a pt. with respiratory failure. - ✔✔-Get labs:
CXR, ABG, CBC (primarily for H/H, WBC), ECG, sputum and blood culture
-Oxygen administration and ventilatory support
-Bronchodilators, corticosteroids, diuretics, nitrates, IV antibiotics, benzodiazepines,
opioids, narcan, flumazenil. These meds all depend on what is causing the respiratory
failure!
✔✔Sudden, progressive form of acute respiratory failure. Begins with an injury to the
moat between the alveoli and capillary. Capillary permeability occurs, allowing fluid to
go from the blood vessel into the alveoli, causing a ventilation problem, pulmonary
edema, stiff lungs, and low compliance. Refractory hypoxemia occurs. 50% mortality
rate. - ✔✔Acute Respiratory Distress Syndrome (ARDS)
✔✔No matter what you do, the SaO2 will not improve. - ✔✔Refractory hypoxemia
✔✔In ARDS, the PaO2/FiO2 ratio is less than ___ mmHg. - ✔✔200 (400 is ideal)
✔✔Which condition manifests as bilateral, extensive diffuse infiltrates on a CXR? -
✔✔ARDS
✔✔List the manifestations of ARDS. - ✔✔-Severe refractory hypoxemia
-"White-out" CXR --> Fluid in the lungs
-Ventilator will say high PIP (Peak Inspiratory Pressure)
-Ventilator will have high PEEP (Positive End Expiratory Pressure)
-Difficulty breathing, tachypnea, cough, restlessness, normal or fine lung sounds or
scattered crackles <-- at first, diffuse crackles and/or coarse crackles later
-Mild hypoxemia and respiratory alkalosis at first
, -CXR will show normal or scattered infiltrates as first, bilateral, extensive diffuse
infiltrates later
-Cyanosis later
✔✔This breath sound may indicate pulmonary edema and COPD. - ✔✔Crackles
✔✔This breath sound may indicate atelectasis or pleural effusion. - ✔✔Absent or
diminished
✔✔This breath sound may indicate lung consolidation that is seen with pneumonia. -
✔✔Bronchial breath sounds over lung periphery
✔✔This breath sound may indicate the present of pneumonia that has involved the
pleura. - ✔✔Pleural friction rub
✔✔List some appropriate nursing and collaborative management strategies for the
patient with ARDS. - ✔✔1. Endotracheal tube to maintain airway
2. Increase PEEP
3. High Frequency Oscillatory Ventilation (HFOV-makes pt. breathe 300-420 BPM)
4. Rot-a-prone bed (Optimizes O2 delivery)
5. Reduce metabolic demand (Stress, fever, pain) to reduce O2 demand
6. Take sputum cultures, administer antibiotics, treat the cause, such as sepsis
7. Prevent complications of Rot-A-Prone bed such as decubitus ulcers
8. Prevent ventilator assisted pneumonia
9. Put in prone position if P/F ratio is <100
Rot-A-Prone Bed:
-Shifts perfusion the anterior portion of the lungs
-Be careful of pressure points
-Protect corneas by lubricating and taping eyes closed
-Have bin or towel for all secretions from nose and mouth and provide moisture barrier
✔✔You're providing care to a patient who is being treated for aspiration pneumonia.
The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK
sign and symptom that the patient is developing acute respiratory distress syndrome
(ARDS)?
A. The patient is experiencing bradypnea.
B. The patient is tired and confused.
C. The patient's PaO2 remains at 45 mmHg.
D. The patient's blood pressure is 180/96. - ✔✔C (The answer is C. A hallmark sign and
symptom found in ARDS is refractory hypoxemia. This is where that although the
patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the
AND ANSWERS SURE A+
✔✔List 3 things we need for good perfusion. - ✔✔1. Strong heart ---> HF
2. Patent blood vessels ---> Embolism
3. Blood flow ---> Shock
✔✔List 5 things we need for good ventilation. - ✔✔1. Good brain function ---> Brain
injury
2. Airway ---> Asthma, angioedema, secretions, choking
3. Strength ---> Fatigue
4. Nerve innervation ---> Spinal cord injury, paralysis
5. Chest expansion ---> Chest trauma, ascites, COPD (barrel chest), obesity
✔✔A PaO2 of <60 mmHg is called being _____. - ✔✔Hypoxemic
✔✔A PaCO2 of >45 mmHg is called being _____. - ✔✔Hypercapnic
✔✔True or false:
Respiratory failure is a disease in itself. - ✔✔False! It occurs due to a disease state, not
a disease in itself.
✔✔What is the #1 early sign of respiratory failure? - ✔✔Altered LOC
✔✔List some early manifestations of respiratory failure. - ✔✔1. ALTERED LOC
2. Fatigue
3. Restlessness
4. Anxiety
5. Tachycardia
6. Tachypnea
7. Mild HTN
,8. Morning headache
✔✔List some later manifestations of respiratory failure. - ✔✔1. Rapid, shallow breathing
pattern
2. Tripod position, pursed-lip breathing
3. Dyspnea, restrations, paradoxical breathing
4. Diaphoresis, prolonged hypoxemia
5. Anaerobic metabolism, leading to lactic acidosis
6. Abnormal breathing sounds
✔✔The belly goes in when you inhale - ✔✔Paradoxical breathing
✔✔List some nursing support for a pt. with respiratory failure. - ✔✔-Always assess first!
-Sit them up
-Administer oxygen, maintain PaO2 >55 and SaO2 >90 at lowest concentration possible
-Ventilatory support if needed
-Suctioning, hydration, effective coughing (airway clearance)
✔✔List some collaborative interventions for a pt. with respiratory failure. - ✔✔-Get labs:
CXR, ABG, CBC (primarily for H/H, WBC), ECG, sputum and blood culture
-Oxygen administration and ventilatory support
-Bronchodilators, corticosteroids, diuretics, nitrates, IV antibiotics, benzodiazepines,
opioids, narcan, flumazenil. These meds all depend on what is causing the respiratory
failure!
✔✔Sudden, progressive form of acute respiratory failure. Begins with an injury to the
moat between the alveoli and capillary. Capillary permeability occurs, allowing fluid to
go from the blood vessel into the alveoli, causing a ventilation problem, pulmonary
edema, stiff lungs, and low compliance. Refractory hypoxemia occurs. 50% mortality
rate. - ✔✔Acute Respiratory Distress Syndrome (ARDS)
✔✔No matter what you do, the SaO2 will not improve. - ✔✔Refractory hypoxemia
✔✔In ARDS, the PaO2/FiO2 ratio is less than ___ mmHg. - ✔✔200 (400 is ideal)
✔✔Which condition manifests as bilateral, extensive diffuse infiltrates on a CXR? -
✔✔ARDS
✔✔List the manifestations of ARDS. - ✔✔-Severe refractory hypoxemia
-"White-out" CXR --> Fluid in the lungs
-Ventilator will say high PIP (Peak Inspiratory Pressure)
-Ventilator will have high PEEP (Positive End Expiratory Pressure)
-Difficulty breathing, tachypnea, cough, restlessness, normal or fine lung sounds or
scattered crackles <-- at first, diffuse crackles and/or coarse crackles later
-Mild hypoxemia and respiratory alkalosis at first
, -CXR will show normal or scattered infiltrates as first, bilateral, extensive diffuse
infiltrates later
-Cyanosis later
✔✔This breath sound may indicate pulmonary edema and COPD. - ✔✔Crackles
✔✔This breath sound may indicate atelectasis or pleural effusion. - ✔✔Absent or
diminished
✔✔This breath sound may indicate lung consolidation that is seen with pneumonia. -
✔✔Bronchial breath sounds over lung periphery
✔✔This breath sound may indicate the present of pneumonia that has involved the
pleura. - ✔✔Pleural friction rub
✔✔List some appropriate nursing and collaborative management strategies for the
patient with ARDS. - ✔✔1. Endotracheal tube to maintain airway
2. Increase PEEP
3. High Frequency Oscillatory Ventilation (HFOV-makes pt. breathe 300-420 BPM)
4. Rot-a-prone bed (Optimizes O2 delivery)
5. Reduce metabolic demand (Stress, fever, pain) to reduce O2 demand
6. Take sputum cultures, administer antibiotics, treat the cause, such as sepsis
7. Prevent complications of Rot-A-Prone bed such as decubitus ulcers
8. Prevent ventilator assisted pneumonia
9. Put in prone position if P/F ratio is <100
Rot-A-Prone Bed:
-Shifts perfusion the anterior portion of the lungs
-Be careful of pressure points
-Protect corneas by lubricating and taping eyes closed
-Have bin or towel for all secretions from nose and mouth and provide moisture barrier
✔✔You're providing care to a patient who is being treated for aspiration pneumonia.
The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK
sign and symptom that the patient is developing acute respiratory distress syndrome
(ARDS)?
A. The patient is experiencing bradypnea.
B. The patient is tired and confused.
C. The patient's PaO2 remains at 45 mmHg.
D. The patient's blood pressure is 180/96. - ✔✔C (The answer is C. A hallmark sign and
symptom found in ARDS is refractory hypoxemia. This is where that although the
patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the
