CRITICAL CARE EXAM 1: RESPIRATORY PRACTICE
QUESTIONS
1) A nurse is caring for a patient with ARDS. The nurse views the ABG. What value
should the nurse report to the physician?
pH: 7.35
PaCO2: 26mmhg
PaO2:95
HCO3: 22
a) PaCO2
b)pH
c)HCO3
d)PaO2 - answer- a
The normal range for PaCO2 is 35-45. This patient is experiencing a superimposed
respiratory alkalosis likely due to hyperventilation. The nurse should report the PaCO2
to the physician.
2) A nurse must position the patient prone after his diagnosis of acute respiratory
distress syndrome (ARDS). Which of the following is a benefit of using this position?
Select all that apply.
A)Decreased atelectasis
B)Reduced need for endotracheal intubation
c)Mobilization of secretions
d)Decreased pleural pressure
e)Increased response to corticosteroid therapy - answer- a, c, d
Decreased atelectasis", "Mobilization of secretions" and "Decreased pleural pressure"
are correct. Prone positioning, or placing the patient face down with the head turned to
the side, helps with pulmonary function in the patient diagnosed with ARDS. When the
patient is placed in a prone position, the heart and diaphragm are not pressing against
the lungs, which means that pleural pressure is reduced. When there is less pressure
exerted on the lungs, atelectasis decreases. Studies have shown that many patients in
the prone position have increased lung secretions, which improves oxygenation.
-"Reduced need for endotracheal intubation" is incorrect. The prone position has not
been shown to decrease the likelihood of intubation.
-"Increased response to corticosteroid therapy" is incorrect because positioning does
not change the body's response to steroid therapy.
3) A 25-year-old patient in the ICU is being treated for acute respiratory distress
syndrome (ARDS). The patient is on a ventilator and requires 80 percent FiO2. Which
,information would the nurse most likely need to report about the patient to the
respiratory therapist working with her?
a)The patient needs endotracheal suctioning
b)The patient needs more oxygen because of his saturation
c)The patient needs an arterial blood gas drawn
d)The patient needs a hemoglobin level drawn - answer- c
Which patient below is at MOST risk for developing ARDS and has the worst
prognosis?
A. A 52-year-old male patient with a pneumothorax.
B. A 48-year-old male being treated for diabetic ketoacidosis.
C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection.
D. A 30-year-old female with cystic fibrosis. - answer- c
7. As the nurse, you know that acute respiratory distress syndrome (ARDS) can be
caused by direct or indirect lung injury. Select below all the INDIRECT causes of ARDS
A. Drowning
B. Aspiration
C. Sepsis
D. Blood transfusion
E. Pneumonia
F. Pancreatitis - answer- C, D, F
Indirect causes are processes that can cause inflammation OUTSIDE of the lungs....so
the issue arises somewhere outside the lungs
A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure).
Which finding below indicates the patient is developing a complication related to their
therapy and requires immediate treatment?
A. HCO3 26 mmHg
B. Blood pressure 70/45
C. PaO2 80 mmHg
D. PaCO2 38 mmHg - answer- B.
Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and
decrease the cardiac output
You are caring for a patient with acute respiratory distress syndrome. As the nurse, you
know that prone positioning can be beneficial for some patients with this condition.
Which findings below indicate this type of positioning was beneficial for your patient with
ARDS?
, A. Improvement in lung sounds
B. Development of a V/Q mismatch
C. PaO2 increased from 59 mmHg to 82 mmHg
D. PEEP needs to be titrated to 15 mmHg of water - answer- A and C.
Prone positioning helps improve PaO2 without actually giving the patient high
concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting
the V/Q mismatch).
You're precepting a nursing student who is assisting you to care for a patient on
mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the
PEEP setting is at 10 mmHg. Your response is:
A. "This pressure setting assists the patient with breathing in and out and helps improve
airflow."
B. "This pressure setting will help prevent a decrease in cardiac output and
hyperinflation of the lungs."
C. "This pressure setting helps prevent fluid from filling the alveoli sacs."
D. "This pressure setting helps open the alveoli sacs that are collapsed during
exhalation." - answer- d
The Emergency Department nurse is assessing a client who has sustained a blunt
injury to the chest wall. Which finding indicates the presence of pneumothorax?
a. low respiratory rate
b. diminished breath sounds
c. presence of a barrel chest
e. a sucking sound at the site of injury - answer- b.
The nurse instructs a client to use the pursed lip method of breathing and evaluates the
teaching by asking the client about the purpose of this type of breathing. The nurse
determines that the client understands if the client states that the primary purpose of
pursed-lip breathing is to promote?
a. promote oxygen intake
b. strengthen the diaphragm
c. strengthen the intercostal muscles
d. promote carbon dioxide elimination - answer- d
The nurse is caring for a client after a bronchoscopy and biopsy. Which of the following
findings should be reported immediately?
a. dry cough
b. hematuria
c. bronchospasm
e. blood-streaked sputum - answer- c
QUESTIONS
1) A nurse is caring for a patient with ARDS. The nurse views the ABG. What value
should the nurse report to the physician?
pH: 7.35
PaCO2: 26mmhg
PaO2:95
HCO3: 22
a) PaCO2
b)pH
c)HCO3
d)PaO2 - answer- a
The normal range for PaCO2 is 35-45. This patient is experiencing a superimposed
respiratory alkalosis likely due to hyperventilation. The nurse should report the PaCO2
to the physician.
2) A nurse must position the patient prone after his diagnosis of acute respiratory
distress syndrome (ARDS). Which of the following is a benefit of using this position?
Select all that apply.
A)Decreased atelectasis
B)Reduced need for endotracheal intubation
c)Mobilization of secretions
d)Decreased pleural pressure
e)Increased response to corticosteroid therapy - answer- a, c, d
Decreased atelectasis", "Mobilization of secretions" and "Decreased pleural pressure"
are correct. Prone positioning, or placing the patient face down with the head turned to
the side, helps with pulmonary function in the patient diagnosed with ARDS. When the
patient is placed in a prone position, the heart and diaphragm are not pressing against
the lungs, which means that pleural pressure is reduced. When there is less pressure
exerted on the lungs, atelectasis decreases. Studies have shown that many patients in
the prone position have increased lung secretions, which improves oxygenation.
-"Reduced need for endotracheal intubation" is incorrect. The prone position has not
been shown to decrease the likelihood of intubation.
-"Increased response to corticosteroid therapy" is incorrect because positioning does
not change the body's response to steroid therapy.
3) A 25-year-old patient in the ICU is being treated for acute respiratory distress
syndrome (ARDS). The patient is on a ventilator and requires 80 percent FiO2. Which
,information would the nurse most likely need to report about the patient to the
respiratory therapist working with her?
a)The patient needs endotracheal suctioning
b)The patient needs more oxygen because of his saturation
c)The patient needs an arterial blood gas drawn
d)The patient needs a hemoglobin level drawn - answer- c
Which patient below is at MOST risk for developing ARDS and has the worst
prognosis?
A. A 52-year-old male patient with a pneumothorax.
B. A 48-year-old male being treated for diabetic ketoacidosis.
C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection.
D. A 30-year-old female with cystic fibrosis. - answer- c
7. As the nurse, you know that acute respiratory distress syndrome (ARDS) can be
caused by direct or indirect lung injury. Select below all the INDIRECT causes of ARDS
A. Drowning
B. Aspiration
C. Sepsis
D. Blood transfusion
E. Pneumonia
F. Pancreatitis - answer- C, D, F
Indirect causes are processes that can cause inflammation OUTSIDE of the lungs....so
the issue arises somewhere outside the lungs
A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure).
Which finding below indicates the patient is developing a complication related to their
therapy and requires immediate treatment?
A. HCO3 26 mmHg
B. Blood pressure 70/45
C. PaO2 80 mmHg
D. PaCO2 38 mmHg - answer- B.
Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and
decrease the cardiac output
You are caring for a patient with acute respiratory distress syndrome. As the nurse, you
know that prone positioning can be beneficial for some patients with this condition.
Which findings below indicate this type of positioning was beneficial for your patient with
ARDS?
, A. Improvement in lung sounds
B. Development of a V/Q mismatch
C. PaO2 increased from 59 mmHg to 82 mmHg
D. PEEP needs to be titrated to 15 mmHg of water - answer- A and C.
Prone positioning helps improve PaO2 without actually giving the patient high
concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting
the V/Q mismatch).
You're precepting a nursing student who is assisting you to care for a patient on
mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the
PEEP setting is at 10 mmHg. Your response is:
A. "This pressure setting assists the patient with breathing in and out and helps improve
airflow."
B. "This pressure setting will help prevent a decrease in cardiac output and
hyperinflation of the lungs."
C. "This pressure setting helps prevent fluid from filling the alveoli sacs."
D. "This pressure setting helps open the alveoli sacs that are collapsed during
exhalation." - answer- d
The Emergency Department nurse is assessing a client who has sustained a blunt
injury to the chest wall. Which finding indicates the presence of pneumothorax?
a. low respiratory rate
b. diminished breath sounds
c. presence of a barrel chest
e. a sucking sound at the site of injury - answer- b.
The nurse instructs a client to use the pursed lip method of breathing and evaluates the
teaching by asking the client about the purpose of this type of breathing. The nurse
determines that the client understands if the client states that the primary purpose of
pursed-lip breathing is to promote?
a. promote oxygen intake
b. strengthen the diaphragm
c. strengthen the intercostal muscles
d. promote carbon dioxide elimination - answer- d
The nurse is caring for a client after a bronchoscopy and biopsy. Which of the following
findings should be reported immediately?
a. dry cough
b. hematuria
c. bronchospasm
e. blood-streaked sputum - answer- c
