ARDS (Acute respiratory distress syndrome) Exam
100%Complete Solution
The nurse has placed the intubated client with acute respiratory distress syndrome (ARDS) in prone position for 30 mins. Which factors
would require the nurse to discontinue prone positioning and return the client to the supine position? SATA
1. The family is coming to visit
2. The client has increased secretions requiring frequent suctioning
3. The SpO2 and Po2 have decreased
4. The client is tachycardic with drop in BP
5. The face has increased skin breakdown and edema - ANS - 3,4,5
(The prone position is used to improve oxygenation, ventilation, and perfusion. The importance of placing clients with ARDS in prone
positioning should be explained to the family. The positioning allows for mobilization of secretions, and the nurse can provide suctioning.
Clinical judgment must be used to determine the length of time in the prone position. If the clients hemodynamic status, oxygenation, or
skin is compromised, the client should be returned to the supine position for evaluation. Facial edema is expected in the prone position, but
the skin breakdown is a concern)
To improve the oxygenation of a client with ARDS who is receiving mechanical ventilation, the nurse should place the client in which
position?
1. supine
2. semi-Fowlers
3. lateral side
4. prone - ANS - 4
(Prone position is used to improve oxygenation in clients with ARDS who are receiving mechanical ventilation. The positioning allows for
recruitment of collapsed alveolar units, improvement in ventilation, reduction in shunting, mobilization of secretions, and improvement in
functional reserve capacity (FRC). When the client is supine, side to side repositioning should be done every 2 hrs with the HOB elevated
at least 30 degrees)
A client with ARDS has fine crackles at lung bases, and the respirations are shallow at a rate of 28 breaths/min. The client is restless and
anxious. In addition to monitoring the arterial blood gas results, what should the nurse do? SATA
1. Monitor serum creatinine and BUN levels
2. Administer a sedative
3. Keep the HOB flat
4. Administer humidified O2
5. Auscultate the lungs - ANS - 1,4,5
(ARDS may cause renal failure and superinfection, so the nurse should monitor urine output and urine chemistries, Treatment of
hypoxemia can be complicated because changes in lung tissue leave less pulmonary tissue available for gas exchange, thereby causing
inadequate perfusion. Humidified oxygen may be one means of promoting oxygenation. The client has crackles in the lung bases so the
nurse should continue to assess breath sounds. SEdatives should be used with caution in clients with ARDS. The nurse should try other
measures to relieve the clients restlessness and anxiety. The HOB should be elevated to 30 degrees to promote chest expansion and
prevent atelectasis)
Which nursing interventions would be most likely to prevent the development of ARDS?
1. teaching cigarette smoking cessation
2. maintaining adequate serum K levels
3. monitoring clients for signs of hypercapnia
4. replacing fluids adequately during hypovolemic status - ANS - 4
(One of the major risk factors for development of ARDS is hypovolemic shock. Adequate fluid replacement is essential to minimize the risk
of ARDS in these clients. Teaching smoking cessation does not prevent ARDS. An abnormal serum K level and hypercapnia are not risk
factors for ARDS)
The nurse interprets which finding as an early sign of acute respiratory distress syndrome?
1 elevated carbon dioxide level
2. hypoxia not responsive to O2 therapy
3. metabolic acidosis
4. severe unexplained electrolyte imbalance - ANS - 2
(A hallmark of early ARDS is refractory hypoxemia. The clients Pao2 level continues to fall, despite higher concentrations of administered
oxygen. Elevated carbon dioxide and metabolic acidosis occur later in the disorder. Severe electrolyte imbalances are not indicators of
ARDS)
A client with ARDS is showing signs of increased dyspnea. The nurse reviews a report of blood gas values that recently arrived;
PH 7.35
PaCO2 25
HCO3 22
PaO2 95
Which finding is abnormal?
1. PH
2. PaCO2
,3 HCO3
4. PaO2 - ANS - 2
(The normal range for PaCO2 is 35-45. Thus the clients PACO2 level is low. The client is experiencing respiratory alkalosis (carbonic acid
deficit) due to hyperventilation. The nurse should report this finding to the HCP. because it requires intervention. the increase in ventilation
decreases the PaCO2 level, which leads to decreased carbonic acid and alkalosis. The bicarb level is normal in uncompensated
respiratory alkalosis along with the normal PaO2 level. Normal serum PH is 7.35-7.45; in uncompensated respiratory alkalosis the serum
PH is > 7.45)
The client with ARDS is on a ventilator. The clients peak inspiratory pressures and spontaneous respiratory rate are increasing, and the
PO2 is not improving. Using the SBAR technique for communication, the nurse calls the HCP with the recommendation for :
1. initiating IV sedation
2. starting a high protein diet
3. providing pain medication
4. increasing the ventilator rate - ANS - 1
(The client may be fighting the ventilator breaths. SEdation is indicated to improve compliance with the ventilator in an attempt to lower
peak inspiratory pressures. The workload of breathing does indicate the need for increased protein calories; however, this will not correct
the respiratory problem with high pressures and respiratory rate. There is no indication the client is experiencing pain. Increasing the rate
on the ventilator is not indicated with the clients increased spontaneous rate)
A client Dx with acute pancreatitis 5 days ago, is experiencing respiratory distress. Which finding should the nurse report to the hCP?
1. arterial oxygen level of 46
2. respirations of 12
3. lack of adventitious lung sounds
4. oxygen sat 96% on RA - ANS - 1
(manifestations of Adult respiratory distress syndrome ARDS, secondary to acute pancreatitis include respiratory distress, tachypnea,
dyspnea, fever, dry cough, fine crackles heard throughout lung fields, possible confusion and agitation, and hypoxemia with arterial oxygen
below 50. The nurse should report the low arterial of 46 to the HCP. A rr of 12 is normal and not considered a sign of respiratory distress.
Adventitious lung sounds such as crackles are typically found in clients with ARDS. Oxygen sat of 96% is satisfactory and does not
represent hypoxemia or low arterial oxygen saturation)
A client with the following arterial blood gas values: PH 7.52
PaO2 50
PaCO2 28
HCO3 24
Based on the clients PaO2, which conclusion would be accurate?
1. The client is severely hypoxic
2. The O2 level is low but poses no risk for the client
3. The clients PaO2 level is wnl
4. The client requires oxygen therapy with very low O2 concentrations - ANS - 1
(Normal PaO2 level ranges from 80-100. When PaO2 falls to 50 the nurse should be alert for signs of hypoxia and impending respiratory
failure. An O2 level this low poses a severe risk for respiratory failure. The client will require oxygenation at a concentration that maintains
the PaO2 at 55-60 or more.)
Which action should the nurse anticipate in a client who has been diagnosed with ARDS?
1. tracheostomy
2.. use of a nasal cannula
3. mechanical ventilation
4. insertion of a chest tube - ANS - 3
(endotracheal intubation and mechanical ventilation are required in ARDS to maintain adequate respiratory support. Endotracheal
intubation, not a tracheostomy, is usually the initial method of maintaining an airway. The client requires mechanical ventilation. nasal
oxygen will not provide adequate oxygenation. Chest tubes are used to remove air or fluid from intrapleural spaces.)
Which condition can place a client at risk for ARDS?
1. septic shock
2. COPD
3. asthma
4. HF - ANS - 1
(The two risk factors most commonly associated with the development of ARDS are gram negative septic shock and gastric content
aspiration. Nurses should be particularly vigilant in assessing a client for onset of ARDS if the client has experienced direct lung trauma or
a systemic inflammatory response syndrome; which can be caused by any physiologic insult that leads to widespread inflammation;
COPD, asthma, and HF are not direct causes of ARDS)
Which assessment is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated client?
1. assessing the clients skin color
2. monitoring the rr
3. verifying the amount of cuff inflation
4. auscultating breath sounds bilaterally - ANS - 4
(Auscultation for bilateral breath sounds is the most appropriate method for determining cuff placement The nurse should also look for
symmetrical rise and fall of the chest and should note the location of the exit mark on the tube. Assessments of skin color, rr, and the amt
of cuff inflation cannot validate the placement of the endotracheal tube)
, To promote effective airway clearance in a client with ARDS what should the nurse do?
1. Admin O2 every 2 hrs
2. Turn the client q4h
3. Admin sedatives to promote rest
4. Suction if cough is ineffective - ANS - 4
(The nurse should suction the client if the client is not able to cough up secretions and clear the airway. Administering oxygen will not
promote airway clearance. The client should be turned q2h to help move secretions. every 4h is not enough. Administering sedatives to
promote rest is contraindicated in ARDS because sedatives can depress respirations)
Which complication is associated with mechanical ventilation?
1. gastrointestinal hemorrhage
2. immunosuppression
3. increased cardiac output
4. pulmonary emboli - ANS - 1
(gastrointestinal hemorrhage occurs in about 25% of clients receiving prolonged mechanical ventilation because of the development of
stress ulcers. Clients who are receiving steroid therapy and those with a previous hx of ulcers are most likely to be at risk. Other possible
complications include incorrect ventilation, oxygen toxicity, fluid imbalance, decreased cardiac output, pneumothorax, infection, and
atelectasis)
A client has developed a hospital acquired pneumonia. When preparing to administer cephalexin 500 mg, the nurse notices that the
pharmacy sent cefazolin. What should the nurse do?
SATA
1. administer the cefazolin
2. verify the medication prescription as written
3. contact the pharmacy and speak to the pharmacist
4. request the cephalexin be sent promptly
5. return the cefazolin to the pharmacy - ANS - 2,3,4,5
(One of the 5 rights of med admin is "right medication", Cefazolin was not the med prescribed. The pharmacist is a professional resource
and serves as a check to ensure the clients receive the right medication. Returning unwanted meds to the pharmacy will decrease the
opportunity for a medication error by the nurse who follows the current nurse)
A nurse receives the taped change of shift report for assigned clients and prioritizes the client rounds. In what order from first to last should
the nurse assess the clients?
1. A client who has an endotracheal tube and who will be transferred to a long term respiratory therapy care unit that day
2. A client with Type 2 diabetes who had a CVA 4 days ago
3. A client with cellulitis of the LLE with a fever of 100.8
4. A client receiving D5W IV at 125 mL/hr with 75 mL remaining - ANS - 1 3 4 2
(Because two major complications of endotracheal tube intubation, inadvertent extubation and aspiration, can be catastrophic events,
assessment of this client is a first priority. Cellulitis is a serious infection as there is inflammation of SC tissues; third spacing of fluid may
promote the formation of a FVD, which can be exacerbated by the fever due to insensible water loss. The nurse should assess this client
to determine the current VS and fluid status. The nurse should assess the client with the IV fluids next because the new bag of fluids will
need to be hung within 30-40 mins. IV therapy necessitates that the client be assessed for s/s of adequate hydration; moist mucous
membranes, skin turgor, VS wnl, adequate urine output, and LOC wnl; and the IV access site needs to be assessed. From the info
provided there is no indication that the client who had the CVA is unstable. Thus this client is last prior
The nurse is caring for a client on droplet precautions. Which protective gear is required to take care of this client? SATA
1 gloves
2. gown
3. surgical mask
4. glasses
5. respirator - ANS - 1,2,3,4
(gloves, gown, surgical mask, and eye protection are worn to protect healthcare workers and to help prevent spread of infection when
clients are placed in droplet isolation. Because droplets are too heavy to be airborne, a respirator is not required when caring for a client in
droplet precautions)
The nurse is caring for a client with pneumonia who is confused about time and place and has IV fluid infusing. Despite the nurses attempt
to reorient the client and then provide distraction, the client has begun to pull at the IV tubing. AFter increasing the frequency of
observation, in which order should the nurse implement interventions to ensure the clients safety?
1. review the clients medications for interactions that may cause or increase confusion
2. assess the clients respiratory status including o2 sat.
3. Ensure the client does not need toileting or pain meds
4. contact the HCP and request a prescription for soft wrist restraints - ANS - 2 3 1 4
(The nurse should first assess the clients respiratory status to determine if there is a physiological reason for the clients confusion. Other
physiological factors to assess include pain and elimination. Safety needs including medication interactions should then be evaluated.
Requesting restraints in order to maintain client safety should be used as a last resort)
The nurse assignment consists of 4 clients. After receiving report, in which order from first to last should then nurse assess these clients?
1. an 85 year old with bacterial pneumonia, temp of 102.2 and shortness of breath
2. A 60 year old with chest tubes who is 2 days post op following a thoracotomy for lung cancer requesting something for pain
3. A 35 year old with suspected TB who has a cough
4. A 56 year old with emphysema who has a scheduled dose of a bronchodilator due to be administered with no report of acute respiratory
100%Complete Solution
The nurse has placed the intubated client with acute respiratory distress syndrome (ARDS) in prone position for 30 mins. Which factors
would require the nurse to discontinue prone positioning and return the client to the supine position? SATA
1. The family is coming to visit
2. The client has increased secretions requiring frequent suctioning
3. The SpO2 and Po2 have decreased
4. The client is tachycardic with drop in BP
5. The face has increased skin breakdown and edema - ANS - 3,4,5
(The prone position is used to improve oxygenation, ventilation, and perfusion. The importance of placing clients with ARDS in prone
positioning should be explained to the family. The positioning allows for mobilization of secretions, and the nurse can provide suctioning.
Clinical judgment must be used to determine the length of time in the prone position. If the clients hemodynamic status, oxygenation, or
skin is compromised, the client should be returned to the supine position for evaluation. Facial edema is expected in the prone position, but
the skin breakdown is a concern)
To improve the oxygenation of a client with ARDS who is receiving mechanical ventilation, the nurse should place the client in which
position?
1. supine
2. semi-Fowlers
3. lateral side
4. prone - ANS - 4
(Prone position is used to improve oxygenation in clients with ARDS who are receiving mechanical ventilation. The positioning allows for
recruitment of collapsed alveolar units, improvement in ventilation, reduction in shunting, mobilization of secretions, and improvement in
functional reserve capacity (FRC). When the client is supine, side to side repositioning should be done every 2 hrs with the HOB elevated
at least 30 degrees)
A client with ARDS has fine crackles at lung bases, and the respirations are shallow at a rate of 28 breaths/min. The client is restless and
anxious. In addition to monitoring the arterial blood gas results, what should the nurse do? SATA
1. Monitor serum creatinine and BUN levels
2. Administer a sedative
3. Keep the HOB flat
4. Administer humidified O2
5. Auscultate the lungs - ANS - 1,4,5
(ARDS may cause renal failure and superinfection, so the nurse should monitor urine output and urine chemistries, Treatment of
hypoxemia can be complicated because changes in lung tissue leave less pulmonary tissue available for gas exchange, thereby causing
inadequate perfusion. Humidified oxygen may be one means of promoting oxygenation. The client has crackles in the lung bases so the
nurse should continue to assess breath sounds. SEdatives should be used with caution in clients with ARDS. The nurse should try other
measures to relieve the clients restlessness and anxiety. The HOB should be elevated to 30 degrees to promote chest expansion and
prevent atelectasis)
Which nursing interventions would be most likely to prevent the development of ARDS?
1. teaching cigarette smoking cessation
2. maintaining adequate serum K levels
3. monitoring clients for signs of hypercapnia
4. replacing fluids adequately during hypovolemic status - ANS - 4
(One of the major risk factors for development of ARDS is hypovolemic shock. Adequate fluid replacement is essential to minimize the risk
of ARDS in these clients. Teaching smoking cessation does not prevent ARDS. An abnormal serum K level and hypercapnia are not risk
factors for ARDS)
The nurse interprets which finding as an early sign of acute respiratory distress syndrome?
1 elevated carbon dioxide level
2. hypoxia not responsive to O2 therapy
3. metabolic acidosis
4. severe unexplained electrolyte imbalance - ANS - 2
(A hallmark of early ARDS is refractory hypoxemia. The clients Pao2 level continues to fall, despite higher concentrations of administered
oxygen. Elevated carbon dioxide and metabolic acidosis occur later in the disorder. Severe electrolyte imbalances are not indicators of
ARDS)
A client with ARDS is showing signs of increased dyspnea. The nurse reviews a report of blood gas values that recently arrived;
PH 7.35
PaCO2 25
HCO3 22
PaO2 95
Which finding is abnormal?
1. PH
2. PaCO2
,3 HCO3
4. PaO2 - ANS - 2
(The normal range for PaCO2 is 35-45. Thus the clients PACO2 level is low. The client is experiencing respiratory alkalosis (carbonic acid
deficit) due to hyperventilation. The nurse should report this finding to the HCP. because it requires intervention. the increase in ventilation
decreases the PaCO2 level, which leads to decreased carbonic acid and alkalosis. The bicarb level is normal in uncompensated
respiratory alkalosis along with the normal PaO2 level. Normal serum PH is 7.35-7.45; in uncompensated respiratory alkalosis the serum
PH is > 7.45)
The client with ARDS is on a ventilator. The clients peak inspiratory pressures and spontaneous respiratory rate are increasing, and the
PO2 is not improving. Using the SBAR technique for communication, the nurse calls the HCP with the recommendation for :
1. initiating IV sedation
2. starting a high protein diet
3. providing pain medication
4. increasing the ventilator rate - ANS - 1
(The client may be fighting the ventilator breaths. SEdation is indicated to improve compliance with the ventilator in an attempt to lower
peak inspiratory pressures. The workload of breathing does indicate the need for increased protein calories; however, this will not correct
the respiratory problem with high pressures and respiratory rate. There is no indication the client is experiencing pain. Increasing the rate
on the ventilator is not indicated with the clients increased spontaneous rate)
A client Dx with acute pancreatitis 5 days ago, is experiencing respiratory distress. Which finding should the nurse report to the hCP?
1. arterial oxygen level of 46
2. respirations of 12
3. lack of adventitious lung sounds
4. oxygen sat 96% on RA - ANS - 1
(manifestations of Adult respiratory distress syndrome ARDS, secondary to acute pancreatitis include respiratory distress, tachypnea,
dyspnea, fever, dry cough, fine crackles heard throughout lung fields, possible confusion and agitation, and hypoxemia with arterial oxygen
below 50. The nurse should report the low arterial of 46 to the HCP. A rr of 12 is normal and not considered a sign of respiratory distress.
Adventitious lung sounds such as crackles are typically found in clients with ARDS. Oxygen sat of 96% is satisfactory and does not
represent hypoxemia or low arterial oxygen saturation)
A client with the following arterial blood gas values: PH 7.52
PaO2 50
PaCO2 28
HCO3 24
Based on the clients PaO2, which conclusion would be accurate?
1. The client is severely hypoxic
2. The O2 level is low but poses no risk for the client
3. The clients PaO2 level is wnl
4. The client requires oxygen therapy with very low O2 concentrations - ANS - 1
(Normal PaO2 level ranges from 80-100. When PaO2 falls to 50 the nurse should be alert for signs of hypoxia and impending respiratory
failure. An O2 level this low poses a severe risk for respiratory failure. The client will require oxygenation at a concentration that maintains
the PaO2 at 55-60 or more.)
Which action should the nurse anticipate in a client who has been diagnosed with ARDS?
1. tracheostomy
2.. use of a nasal cannula
3. mechanical ventilation
4. insertion of a chest tube - ANS - 3
(endotracheal intubation and mechanical ventilation are required in ARDS to maintain adequate respiratory support. Endotracheal
intubation, not a tracheostomy, is usually the initial method of maintaining an airway. The client requires mechanical ventilation. nasal
oxygen will not provide adequate oxygenation. Chest tubes are used to remove air or fluid from intrapleural spaces.)
Which condition can place a client at risk for ARDS?
1. septic shock
2. COPD
3. asthma
4. HF - ANS - 1
(The two risk factors most commonly associated with the development of ARDS are gram negative septic shock and gastric content
aspiration. Nurses should be particularly vigilant in assessing a client for onset of ARDS if the client has experienced direct lung trauma or
a systemic inflammatory response syndrome; which can be caused by any physiologic insult that leads to widespread inflammation;
COPD, asthma, and HF are not direct causes of ARDS)
Which assessment is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated client?
1. assessing the clients skin color
2. monitoring the rr
3. verifying the amount of cuff inflation
4. auscultating breath sounds bilaterally - ANS - 4
(Auscultation for bilateral breath sounds is the most appropriate method for determining cuff placement The nurse should also look for
symmetrical rise and fall of the chest and should note the location of the exit mark on the tube. Assessments of skin color, rr, and the amt
of cuff inflation cannot validate the placement of the endotracheal tube)
, To promote effective airway clearance in a client with ARDS what should the nurse do?
1. Admin O2 every 2 hrs
2. Turn the client q4h
3. Admin sedatives to promote rest
4. Suction if cough is ineffective - ANS - 4
(The nurse should suction the client if the client is not able to cough up secretions and clear the airway. Administering oxygen will not
promote airway clearance. The client should be turned q2h to help move secretions. every 4h is not enough. Administering sedatives to
promote rest is contraindicated in ARDS because sedatives can depress respirations)
Which complication is associated with mechanical ventilation?
1. gastrointestinal hemorrhage
2. immunosuppression
3. increased cardiac output
4. pulmonary emboli - ANS - 1
(gastrointestinal hemorrhage occurs in about 25% of clients receiving prolonged mechanical ventilation because of the development of
stress ulcers. Clients who are receiving steroid therapy and those with a previous hx of ulcers are most likely to be at risk. Other possible
complications include incorrect ventilation, oxygen toxicity, fluid imbalance, decreased cardiac output, pneumothorax, infection, and
atelectasis)
A client has developed a hospital acquired pneumonia. When preparing to administer cephalexin 500 mg, the nurse notices that the
pharmacy sent cefazolin. What should the nurse do?
SATA
1. administer the cefazolin
2. verify the medication prescription as written
3. contact the pharmacy and speak to the pharmacist
4. request the cephalexin be sent promptly
5. return the cefazolin to the pharmacy - ANS - 2,3,4,5
(One of the 5 rights of med admin is "right medication", Cefazolin was not the med prescribed. The pharmacist is a professional resource
and serves as a check to ensure the clients receive the right medication. Returning unwanted meds to the pharmacy will decrease the
opportunity for a medication error by the nurse who follows the current nurse)
A nurse receives the taped change of shift report for assigned clients and prioritizes the client rounds. In what order from first to last should
the nurse assess the clients?
1. A client who has an endotracheal tube and who will be transferred to a long term respiratory therapy care unit that day
2. A client with Type 2 diabetes who had a CVA 4 days ago
3. A client with cellulitis of the LLE with a fever of 100.8
4. A client receiving D5W IV at 125 mL/hr with 75 mL remaining - ANS - 1 3 4 2
(Because two major complications of endotracheal tube intubation, inadvertent extubation and aspiration, can be catastrophic events,
assessment of this client is a first priority. Cellulitis is a serious infection as there is inflammation of SC tissues; third spacing of fluid may
promote the formation of a FVD, which can be exacerbated by the fever due to insensible water loss. The nurse should assess this client
to determine the current VS and fluid status. The nurse should assess the client with the IV fluids next because the new bag of fluids will
need to be hung within 30-40 mins. IV therapy necessitates that the client be assessed for s/s of adequate hydration; moist mucous
membranes, skin turgor, VS wnl, adequate urine output, and LOC wnl; and the IV access site needs to be assessed. From the info
provided there is no indication that the client who had the CVA is unstable. Thus this client is last prior
The nurse is caring for a client on droplet precautions. Which protective gear is required to take care of this client? SATA
1 gloves
2. gown
3. surgical mask
4. glasses
5. respirator - ANS - 1,2,3,4
(gloves, gown, surgical mask, and eye protection are worn to protect healthcare workers and to help prevent spread of infection when
clients are placed in droplet isolation. Because droplets are too heavy to be airborne, a respirator is not required when caring for a client in
droplet precautions)
The nurse is caring for a client with pneumonia who is confused about time and place and has IV fluid infusing. Despite the nurses attempt
to reorient the client and then provide distraction, the client has begun to pull at the IV tubing. AFter increasing the frequency of
observation, in which order should the nurse implement interventions to ensure the clients safety?
1. review the clients medications for interactions that may cause or increase confusion
2. assess the clients respiratory status including o2 sat.
3. Ensure the client does not need toileting or pain meds
4. contact the HCP and request a prescription for soft wrist restraints - ANS - 2 3 1 4
(The nurse should first assess the clients respiratory status to determine if there is a physiological reason for the clients confusion. Other
physiological factors to assess include pain and elimination. Safety needs including medication interactions should then be evaluated.
Requesting restraints in order to maintain client safety should be used as a last resort)
The nurse assignment consists of 4 clients. After receiving report, in which order from first to last should then nurse assess these clients?
1. an 85 year old with bacterial pneumonia, temp of 102.2 and shortness of breath
2. A 60 year old with chest tubes who is 2 days post op following a thoracotomy for lung cancer requesting something for pain
3. A 35 year old with suspected TB who has a cough
4. A 56 year old with emphysema who has a scheduled dose of a bronchodilator due to be administered with no report of acute respiratory
