CCRN questions exam 2

2. A patient presents with a productive cough, hypoxemia, a fever, hypotension, tachycardia, and tachypnea. Hypoxemia was corrected with the administration of oxygen. Which of the following should be done next? A. Administer antibiotics. B. Start a vasopressor. C. Collect a sputum culture. D. Initiate 0.9 normal saline. - ANS(D) Correcting the hypotension (with isotonic fluid resuscitation in order to maintain organ perfusion) is the priority at this time. Antibiotics (choice (A)) will need to be started after blood cultures are obtained. A vasopressor (choice (B)) may not be needed if the MAP is restored with fluids. Although a sputum culture (choice (C)) may be indicated, blood cultures need to be drawn first so that antibiotics can be given (within the first hour, if possible). 10. A patient has a history of chronic respiratory failure secondary to COPD and now has acute respiratory failure secondary to pneumonia. Upon arrival at the critical care unit, his ABGs were a pH of 7.29, a PaCO 2 of 77, a PaO 2 of 51, and an HCO 3 of 31. He is receiving noninvasive ventilation with settings that read as follows: FiO 2 0.40, IPAP 12 cm, and EPAP 5 cm. After 1 hour of therapy, the patient's ABG results are a pH of 7.20, a PaCO 2 of 89, a PaO 2 of 48, and an HCO 3 of 32. What is the correct evaluation of this data? A) Alveolar hyperventilation is getting worse; the BiPAP settings need adjustment. B) Metabolic acidosis is worse; the FiO 2 needs to be increased. C) Alveolar hypoventilation is getting worse; the patient needs to be intubated. D) The pH is acceptable for a patient with COPD; continue the current therapy. - ANSC. The patient did not respond to noninvasive ventilation since the PaCO 2 increased, respiratory acidosis is worse, and severe hypoxemia was not corrected. BiPAP should not be continued. The issue is not metabolic acidosis. The pH is not acceptable. 20. A patient is alert and is receiving mechanical ventilation with the following settings: assist-control mode at 10 breaths/minute, FiO 2 0.40, and PEEP 5 cm H 2 O pressure. Vital signs include a 18 breaths/minute, with norepinephrine at 7 mcg/min for the past 4 hours. The patient has tolerated repositioning in bed and a head of bed elevation up to 90°. Which of the following would be an appropriate next step in terms of mobility for this patient? A) Allow the patient to sit on the edge of the bed, with assistance. B) Reduce the head of bed elevation to 45°. C) Maintain the patient's current level of mobility. D) Help the patient stand and pivot to a chair. - ANSA. This patient tolerated the current activity with head of bed elevation in high Fowler's position and is now ready to progress to sitting without back support with his legs dangling. This patient does not have contraindications to mobility progression; therefore, reducing the patient's mobility (choice (B)) or maintaining the patient's current level of mobility (choice (C)) would not provide progress. Although