NR 340 Critical Care Nursing Exam 1(Ch 1, 2,5,7, 9, 14) With 100% Correct Answers Grade A Certified 2025/26

Nurses are encouraged to implement care that is evidence based and to challenge practices that have "always been done" but are not supported by clinical evidence. Research studies are graded by the quality of evidence, with many different schemes used. Meta-analysis and systematic reviews are considered the highest level of evidence. This book uses AACN's grading scheme. During report using SBAR, the nurse states, "Since we have just initiated a potassium replacement protocol, the patient will need a potassium level drawn at 1300." This depicts: A. Situation B. Background C. Assessment D. Recommendation - correct answersD. Recommendation. Which of the following is a component of a healthy work environment? A. Collaboration B. Use of many agency nurses C. Crew-resource training D. Evidence-based practice - correct answersA. Collaboration. Process of gas exchange - correct answersVentilation - movement of gases in and out of the alveoli Diffusion at pulmonary capillaries (oxygen and carbon dioxide @ the alveolar-capillary membrane) Perfusion Diffusion to the cells Regulation of Breathing - correct answersRespiration stimulated by elevated CO2 Not true for COPD: stimulus is hypoxia rationale for low oxygen in patients with COPD Work of Breathing - correct answersAmount of effort required to maintain ventilation Respiratory pattern changes automatically WOB increases, more energy needed WOB high, respiratory failure Compliance - correct answersDistensibility or stretch Determined by elasticity, "recoil" Elastic recoil and compliance are inversely related Types: static - measured under condition of no airflow (inspiratory hold). static compliance in normal lungs ranges 50 - 170 mL/cm H2O (for every 1 cm H2O change of pressure in the lungs, the volume of gas increases by 50 - 170 mL) dynamic - measured while gases flowing. dynamic compliance - normal lung 50 - 80 mL/cm H2O poor compliance requires higher ventilatory pressures to achieve adequate lung volume Resistance - correct answersOpposition to gas flow in the airways airway length airway diameter: small tube, spasms, mucus flow rate of gasses: increased breathing effort airway resistance increases when the airway is lengthened or narrowed resistance increases when gas flow is increased increased airway resistance may result in decreased lung volume and inadequate ventilation Lung Volumes and Capacities - correct answersnursing responsibilities: Assess baseline function, Monitor responses spirometer Tidal Volume (VT) - correct answersnormal breath; 500 mL or 5 to 7 mL/kg Functional Residual Capacity (FRC) - correct answersvolume of gas remaining in the lungs at normal resting expiration average: 2300 mL Vital Capacity (VC) - correct answersmaximum volume of gas forcefully expired after maximum inspiration average: 4600 mL Respiratory Assessment - correct answersHealth History: oral and inhalant respiratory medications, OTC drugs, allergies (medication and environmental), last chest x-ray and tuberculosis screen, tobacco pack per year history, occupational history, sputum production, shortness of breath, dyspnea, cough, anorexia, weight loss, and chest pain Physical Examination: Inspection - head, neck, fingers, and chest. accessory muscles, sternal retractions, nasal flaring, asymmetrical chest movements, open-mouth breathing, and gasping breaths Respiratory Rate - tachypnea: rate 20, bradypnea: rate 10, assess rate and depth and altered patterns Abnormal Breathing Patterns: Cheyne-Stokes: cyclical with apneic periods Biot's: cluster breathing Kussmaul's: deep, regular, and rapid Apneustic: gasping inspirationsd Palpation: evaluate chest wall excursion, tracheal deviation, chest wall tenderness, subcutaneous crepitus, tactile fremitus Percussion: Resonance - normal lung sound Dullness - denser than normal tissue Flatness - air is absent Hyperresonance - increased amount of air Tympany - air-filled area Auscultation: assess breath sounds, presence of adventitious lung sounds, voice sounds. quiet environment. systematic approach. Breath Sounds: Normal - bronchial, bronchovesicular, vesicular Adventitious sounds - crackles, rhonchi, wheezes, pleural friction rub, stridor Arterial Blood Gases (ABGs) - correct answersadequacy of oxygenation and ventilation acid-base status interpret in conjunction with: clinical history, physical assessment ABG normal range: pH: 7.35 - 7.45 PaO2: 80 - 100 PaCO2: 35 - 45 HCO3: 22 - 26 SaO2: 93%-100% Oxygenation PaO2 SaO2 - correct answersPaO2 - partial pressure of oxygen dissolved in arterial blood normal value 80 - 100 mm Hg decreased in elderly value 60 mm Hg treated SaO2 - amount of oxygen bound to hemoglobin normal value 92%-99% frequently measured via pulse oximetry (SpO2) pH - correct answersconcentration of hydrogen ions (H+) normal range 7.35 - 7.45 pH 7.35 = acidosis ph 7.45 = alkalosis