NCLEX ARDS AND ARF AND CH 65 CRITICAL CARE QUIZLET
QUESTIONS & ANSWERS
ARDS and ARF Ch 67
1.Which is a proper nursing action for a patient in acute respiratory failure?
A. Administer 100% oxygen to an intubated patient until the pathology has resolved.
B. Provide chest physical therapy for patients who produce more than 30 mL of sputum
per day.
C. Use continuous positive airway pressure (CPAP) if the patient has weak or absent
respirations.
D. Administer packed red blood cells to maintain the hemoglobin level at 7 g/dL or
higher.
B. Provide chest physical therapy for patients who produce more than 30 mL of sputum
per day.
Chest physical therapy is indicated for patients who produce more than 30 mL of
sputum per day or have evidence of atelectasis or pulmonary infiltrates. The selected
oxygen delivery system must also maintain PaO2 equal to or more than 55 to 60 mm
HG and SaO2 equal or greater than 90% at the lowest O2 concentration possible. High
oxygen concentrations replace the nitrogen gas normally present in the alveoli, causing
instability and atelectasis. In intubated patients, exposure to 60% or more oxygen for
longer than 48 hours poses a significant risk for oxygen toxicity. Noninvasive positive-
pressure ventilation such as CPAP is not appropriate for patients who have weak or no
respirations (are not inhaling). The hemoglobin level should be equal to or greater than
9 g/dL to ensure adequate oxygen saturation.
2.What distinguishes hypercapnic respiratory failure from hypoxemic respiratory failure?
A. Low oxygen saturation despite administration of supplemental oxygen
B. Acidemia for which the body cannot compensate
C. Respiration rate greater than 30 breaths/minute
D. Heart rate increases above 100 beats/minute
B. Acidemia for which the body cannot compensate
Hypercapnic respiratory failure is PaCO2 greater than 48 mm Hg in combination with
acidemia. The body cannot compensate for the acidemia. Hypoxemic respiratory failure
is a PaO2 less than 60 mm Hg despite receiving an inspired oxygen concentration
greater than or equal to 60%. The respiratory rate and heart rate are not part of the
definitions of these two conditions.
3.Which patient is most likely going into respiratory failure?
A. A patient who report that he feels short of breath while eating
B. A patient with the following arterial blood gas values over the past 3 hours: pH 7.50,
7.45, and 7.40
,C. A patient with an oxygen saturation value of 93%
D. A patient with chronic obstructive pulmonary disease (COPD) who has distant breath
sounds
B. A patient with the following arterial blood gas values over the past 3 hours: pH 7.50,
7.45, and 7.40
Manifestations of respiratory failure are related to the extent of change in PaO2 or
PaCO2, the rapidity of change, and ability to compensate. It is important to monitor
trends. Shortness of breath is a subjective report, and it can have many causes. A
single borderline oxygen saturation reading is not as indicative of failure as a negative
trend. Because of air trapping with COPD, the breath sounds are typically distant.
4.A patient with a severe acute asthma exacerbation presents to the emergency
department. Over the next hour, the patient remains in respiratory distress, but the
respirations have slowed. What is the best explanation?
A. The patient is developing respiratory muscle fatigue.
B. The respirations are exchanging oxygen and carbon dioxide more efficiently.
C. The patient's anxiety level is lessening.
D. The body has compensated by retaining sodium bicarbonate.
A. The patient is developing respiratory muscle fatigue.
A rapid respiratory rate requires a substantial amount of work. Change from a rapid rate
to a slower rate in a patient in acute respiratory distress suggests extreme progression
of respiratory muscle fatigue and increased probability of respiratory arrest. Ventilatory
exchange, without other indications of improvement, is decreased. As long as the
patient is in distress, there is no evidence that anxiety would lessen, and hypoxia would
increase anxiety. Compensation through the renal system takes days.
5.Which patient is having the most difficulty breathing?
A. The patient who reports one-pillow orthopnea
B. The patient with an inspiratory to expiratory ratio of 1:2
C. The patient who speaks a sentence before breathing
D. The patient with paradoxic breathing
D. The patient with paradoxic breathing
Paradoxic breathing indicates severe distress. The thorax and abdomen normally move
outward on inspiration and inward on exhalation. During paradoxic breathing, the
abdomen and chest move in the opposite manner, and the pattern results from maximal
use of the accessory muscles of respiration. Orthopnea, measured by the number of
pillows needed to breathe comfortably, is associated with the use of one to four pillows.
One pillow indicates a minor condition. Normal inspiratory to expiratory ratio is 1:2.
Speaking in sentences before having to take a breath indicates mild or no distress.
6.Which signs and symptoms differentiate hypoxemic respiratory failure from
hypercapnic respiratory failure (select all that apply)?
,A. Cyanosis
B. Tachypnea
C. Morning headache
D. Paradoxic breathing
E. Pursed-lip breathing
A. Cyanosis
B. Tachypnea
D. Paradoxic breathing
Clinical manifestations that occur with hypoxemic respiratory failure include cyanosis,
tachypnea, and paradoxic chest or abdominal wall movement with the respiratory cycle.
Clinical manifestations of hypercapnic respiratory failure include morning headache,
pursed-lip breathing, and decreased or increase respiratory rate with shallow breathing.
7.The oxygen delivery system chosen for the patient in acute respiratory failure should
A. always be a low-flow device, such as a nasal cannula.
B. correct the PaO2 to a normal level as quickly as possible.
C. administer positive-pressure ventilation to prevent CO2 narcosis.
D. maintain the PaO2 at ≥60 mm Hg at the lowest O2 concentration possible.
D. maintain the PaO2 at ≥60 mm Hg at the lowest O2 concentration possible.
The selected oxygen delivery system must maintain PaO2 at 55 to 60 mm Hg and
SaO2 at 90% or greater at the lowest oxygen concentration possible.
8.You are admitting a 45-year-old asthmatic patient in acute respiratory distress. You
auscultate the patient's lungs and notice cessation of inspiratory wheezing. The patient
has not yet received any medication. What does this finding suggest?
A. Spontaneous resolution of the acute asthma attack
B. An acute development of bilateral pleural effusions
C. Airway constriction requiring intensive interventions
D. Overworked intercostal muscles resulting in poor air exchange
C. Airway constriction requiring intensive interventions
When the patient in respiratory distress has inspiratory wheezing that ceases, it is an
indication of airway obstruction, and it requires emergency action to restore the airway.
9.You are caring for a patient who is admitted with a barbiturate overdose. The patient
is unresponsive, with a blood pressure of 90/60 mm Hg, apical pulse of 110
beats/minute, and respiratory rate of 8 breaths/minute. Based on the initial assessment
findings, you recognize that the patient is at risk for which type of respiratory failure?
A. Hypoxemic respiratory failure related to shunting of blood
B. Hypoxemic respiratory failure related to diffusion limitation
C. Hypercapnic respiratory failure related to alveolar hypoventilation
D. Hypercapnic respiratory failure related to increased airway resistance
C. Hypercapnic respiratory failure related to alveolar hypoventilation
The patient's respiratory rate is decreased because of barbiturate overdose, which
causes respiratory depression. The patient is at risk for hypercapnic respiratory failure
resulting from the decreased respiratory rate and decreased CO2 exchange.
, 10.You are providing care for an elderly patient who has a low PaO2 as a result of
worsening left-sided pneumonia. Which nursing intervention will help the patient
mobilize his secretions?
A. Augmented coughing or huff coughing
B. Positioning the patient to lie on his left side
C. Frequent and aggressive nasopharyngeal suctioning
D. Application of noninvasive positive-pressure ventilation (NIPPV)
A. Augmented coughing or huff coughing
Augmented coughing and huff coughing techniques may aid the patient in the
mobilization of secretions. If placed in a side-lying position, the patient should be
positioned on his right side (good lung down). Suctioning may be indicated, but it should
always be performed cautiously because of the risk of hypoxia. NIPPV is inappropriate
in the treatment of patients with excessive secretions.
11.For which patient would NIPPV be an appropriate intervention to promote
oxygenation?
A. A patient's whose cardiac output and blood pressure are unstable
B. A patient whose respiratory failure is caused by a head injury with loss of
consciousness
C. A patient with a diagnosis of cystic fibrosis and who is producing copious secretions
D. A patient who is experiencing respiratory failure as a result of the progression of
myasthenia gravis
D. A patient who is experiencing respiratory failure as a result of the progression of
myasthenia gravis
NIPPV is most effective in treating patients with respiratory failure due to chest wall and
neuromuscular disease. It is not recommended for patients who are experiencing
cardiac instability, decreased level of consciousness, or excessive secretions.
12.You are aware of the value of using a mini-tracheostomy to facilitate suctioning when
patients are unable to independently mobilize their secretions. For which patient is the
use of a mini-tracheostomy indicated?
A. A patient whose recent ischemic stroke has resulted in the loss of his gag reflex
B. A patient who requires long-term mechanical ventilation as the result of a spinal cord
injury
C. A patient whose increased secretions are the result of community-acquired
pneumonia
D. A patient with a head injury who has developed aspiration pneumonia
C. A patient whose increased secretions are the result of community-acquired
pneumonia
It is probably appropriate to suction a patient with pneumonia using a mini-tracheostomy
if blind suctioning is ineffective or difficult. An absent or compromised gag reflex, long-
term ventilation, and a history of aspiration contraindicates the use of a mini-
tracheostomy.
QUESTIONS & ANSWERS
ARDS and ARF Ch 67
1.Which is a proper nursing action for a patient in acute respiratory failure?
A. Administer 100% oxygen to an intubated patient until the pathology has resolved.
B. Provide chest physical therapy for patients who produce more than 30 mL of sputum
per day.
C. Use continuous positive airway pressure (CPAP) if the patient has weak or absent
respirations.
D. Administer packed red blood cells to maintain the hemoglobin level at 7 g/dL or
higher.
B. Provide chest physical therapy for patients who produce more than 30 mL of sputum
per day.
Chest physical therapy is indicated for patients who produce more than 30 mL of
sputum per day or have evidence of atelectasis or pulmonary infiltrates. The selected
oxygen delivery system must also maintain PaO2 equal to or more than 55 to 60 mm
HG and SaO2 equal or greater than 90% at the lowest O2 concentration possible. High
oxygen concentrations replace the nitrogen gas normally present in the alveoli, causing
instability and atelectasis. In intubated patients, exposure to 60% or more oxygen for
longer than 48 hours poses a significant risk for oxygen toxicity. Noninvasive positive-
pressure ventilation such as CPAP is not appropriate for patients who have weak or no
respirations (are not inhaling). The hemoglobin level should be equal to or greater than
9 g/dL to ensure adequate oxygen saturation.
2.What distinguishes hypercapnic respiratory failure from hypoxemic respiratory failure?
A. Low oxygen saturation despite administration of supplemental oxygen
B. Acidemia for which the body cannot compensate
C. Respiration rate greater than 30 breaths/minute
D. Heart rate increases above 100 beats/minute
B. Acidemia for which the body cannot compensate
Hypercapnic respiratory failure is PaCO2 greater than 48 mm Hg in combination with
acidemia. The body cannot compensate for the acidemia. Hypoxemic respiratory failure
is a PaO2 less than 60 mm Hg despite receiving an inspired oxygen concentration
greater than or equal to 60%. The respiratory rate and heart rate are not part of the
definitions of these two conditions.
3.Which patient is most likely going into respiratory failure?
A. A patient who report that he feels short of breath while eating
B. A patient with the following arterial blood gas values over the past 3 hours: pH 7.50,
7.45, and 7.40
,C. A patient with an oxygen saturation value of 93%
D. A patient with chronic obstructive pulmonary disease (COPD) who has distant breath
sounds
B. A patient with the following arterial blood gas values over the past 3 hours: pH 7.50,
7.45, and 7.40
Manifestations of respiratory failure are related to the extent of change in PaO2 or
PaCO2, the rapidity of change, and ability to compensate. It is important to monitor
trends. Shortness of breath is a subjective report, and it can have many causes. A
single borderline oxygen saturation reading is not as indicative of failure as a negative
trend. Because of air trapping with COPD, the breath sounds are typically distant.
4.A patient with a severe acute asthma exacerbation presents to the emergency
department. Over the next hour, the patient remains in respiratory distress, but the
respirations have slowed. What is the best explanation?
A. The patient is developing respiratory muscle fatigue.
B. The respirations are exchanging oxygen and carbon dioxide more efficiently.
C. The patient's anxiety level is lessening.
D. The body has compensated by retaining sodium bicarbonate.
A. The patient is developing respiratory muscle fatigue.
A rapid respiratory rate requires a substantial amount of work. Change from a rapid rate
to a slower rate in a patient in acute respiratory distress suggests extreme progression
of respiratory muscle fatigue and increased probability of respiratory arrest. Ventilatory
exchange, without other indications of improvement, is decreased. As long as the
patient is in distress, there is no evidence that anxiety would lessen, and hypoxia would
increase anxiety. Compensation through the renal system takes days.
5.Which patient is having the most difficulty breathing?
A. The patient who reports one-pillow orthopnea
B. The patient with an inspiratory to expiratory ratio of 1:2
C. The patient who speaks a sentence before breathing
D. The patient with paradoxic breathing
D. The patient with paradoxic breathing
Paradoxic breathing indicates severe distress. The thorax and abdomen normally move
outward on inspiration and inward on exhalation. During paradoxic breathing, the
abdomen and chest move in the opposite manner, and the pattern results from maximal
use of the accessory muscles of respiration. Orthopnea, measured by the number of
pillows needed to breathe comfortably, is associated with the use of one to four pillows.
One pillow indicates a minor condition. Normal inspiratory to expiratory ratio is 1:2.
Speaking in sentences before having to take a breath indicates mild or no distress.
6.Which signs and symptoms differentiate hypoxemic respiratory failure from
hypercapnic respiratory failure (select all that apply)?
,A. Cyanosis
B. Tachypnea
C. Morning headache
D. Paradoxic breathing
E. Pursed-lip breathing
A. Cyanosis
B. Tachypnea
D. Paradoxic breathing
Clinical manifestations that occur with hypoxemic respiratory failure include cyanosis,
tachypnea, and paradoxic chest or abdominal wall movement with the respiratory cycle.
Clinical manifestations of hypercapnic respiratory failure include morning headache,
pursed-lip breathing, and decreased or increase respiratory rate with shallow breathing.
7.The oxygen delivery system chosen for the patient in acute respiratory failure should
A. always be a low-flow device, such as a nasal cannula.
B. correct the PaO2 to a normal level as quickly as possible.
C. administer positive-pressure ventilation to prevent CO2 narcosis.
D. maintain the PaO2 at ≥60 mm Hg at the lowest O2 concentration possible.
D. maintain the PaO2 at ≥60 mm Hg at the lowest O2 concentration possible.
The selected oxygen delivery system must maintain PaO2 at 55 to 60 mm Hg and
SaO2 at 90% or greater at the lowest oxygen concentration possible.
8.You are admitting a 45-year-old asthmatic patient in acute respiratory distress. You
auscultate the patient's lungs and notice cessation of inspiratory wheezing. The patient
has not yet received any medication. What does this finding suggest?
A. Spontaneous resolution of the acute asthma attack
B. An acute development of bilateral pleural effusions
C. Airway constriction requiring intensive interventions
D. Overworked intercostal muscles resulting in poor air exchange
C. Airway constriction requiring intensive interventions
When the patient in respiratory distress has inspiratory wheezing that ceases, it is an
indication of airway obstruction, and it requires emergency action to restore the airway.
9.You are caring for a patient who is admitted with a barbiturate overdose. The patient
is unresponsive, with a blood pressure of 90/60 mm Hg, apical pulse of 110
beats/minute, and respiratory rate of 8 breaths/minute. Based on the initial assessment
findings, you recognize that the patient is at risk for which type of respiratory failure?
A. Hypoxemic respiratory failure related to shunting of blood
B. Hypoxemic respiratory failure related to diffusion limitation
C. Hypercapnic respiratory failure related to alveolar hypoventilation
D. Hypercapnic respiratory failure related to increased airway resistance
C. Hypercapnic respiratory failure related to alveolar hypoventilation
The patient's respiratory rate is decreased because of barbiturate overdose, which
causes respiratory depression. The patient is at risk for hypercapnic respiratory failure
resulting from the decreased respiratory rate and decreased CO2 exchange.
, 10.You are providing care for an elderly patient who has a low PaO2 as a result of
worsening left-sided pneumonia. Which nursing intervention will help the patient
mobilize his secretions?
A. Augmented coughing or huff coughing
B. Positioning the patient to lie on his left side
C. Frequent and aggressive nasopharyngeal suctioning
D. Application of noninvasive positive-pressure ventilation (NIPPV)
A. Augmented coughing or huff coughing
Augmented coughing and huff coughing techniques may aid the patient in the
mobilization of secretions. If placed in a side-lying position, the patient should be
positioned on his right side (good lung down). Suctioning may be indicated, but it should
always be performed cautiously because of the risk of hypoxia. NIPPV is inappropriate
in the treatment of patients with excessive secretions.
11.For which patient would NIPPV be an appropriate intervention to promote
oxygenation?
A. A patient's whose cardiac output and blood pressure are unstable
B. A patient whose respiratory failure is caused by a head injury with loss of
consciousness
C. A patient with a diagnosis of cystic fibrosis and who is producing copious secretions
D. A patient who is experiencing respiratory failure as a result of the progression of
myasthenia gravis
D. A patient who is experiencing respiratory failure as a result of the progression of
myasthenia gravis
NIPPV is most effective in treating patients with respiratory failure due to chest wall and
neuromuscular disease. It is not recommended for patients who are experiencing
cardiac instability, decreased level of consciousness, or excessive secretions.
12.You are aware of the value of using a mini-tracheostomy to facilitate suctioning when
patients are unable to independently mobilize their secretions. For which patient is the
use of a mini-tracheostomy indicated?
A. A patient whose recent ischemic stroke has resulted in the loss of his gag reflex
B. A patient who requires long-term mechanical ventilation as the result of a spinal cord
injury
C. A patient whose increased secretions are the result of community-acquired
pneumonia
D. A patient with a head injury who has developed aspiration pneumonia
C. A patient whose increased secretions are the result of community-acquired
pneumonia
It is probably appropriate to suction a patient with pneumonia using a mini-tracheostomy
if blind suctioning is ineffective or difficult. An absent or compromised gag reflex, long-
term ventilation, and a history of aspiration contraindicates the use of a mini-
tracheostomy.
