NR341 Exam 1 – Respiratory Failure, Ventilation, ARDS &
Nursing Priorities (High-Yield Review)|Rationales
Verified and Graded A+ Latest Updated 2026
Normal age-related respiratory changes in older adults
-Kyphosis
-barrel chest
-decreased chest expansion
-decreased alveolar surface area
-decreased vital capacity
Risk factors for pneumonia and aspiration in older adults
-Decreased chest expansion
-weaker cough reflex
-reduced alveolar surface area.
Levels of respiratory/ventilatory support equipment
-Simple adjuncts (OPA/NPA)
-Non-invasive ventilation (CPAP/BiPAP)
-Artificial airways (LMA/ETT/trach)
-Mechanical ventilation.
Contraindication for oropharyngeal airway (OPA)
If the patient has an intact gag reflex (risk of vomiting/aspiration).
CPAP
Continuous Positive Airway Pressure: one continuous pressure keeps alveoli open, improves
oxygenation.
BiPAP
Bilevel Positive Airway Pressure: two pressures (higher for inspiration, lower for expiration);
helps oxygenation and ventilation.
Contraindications for NPPV (CPAP/BiPAP)
-Claustrophobia
-apnea
-facial trauma
,-uncontrolled vomiting
-inability to protect airway
-neuromuscular disease.
Endotracheal tube (ETT) vs tracheostomy
ETT is for short-term airway management; tracheostomy is for long-term airway management.
Main risk of mechanical ventilation
Ventilator-associated pneumonia (VAP).
FiOI
Fraction of inspired oxygen: the percentage of oxygen the patient receives (21% = room air).
PEEP
Positive End-Expiratory Pressure: keeps alveoli open at end of exhalation, improves oxygenation
in ARDS, prevents collapse.
Risk of high PEEP
Barotrauma (pneumothorax) and decreased cardiac output.
High-pressure ventilator alarm
Indicates obstruction: secretions, kinked tubing, patient biting tube, decreased lung compliance,
coughing/fighting vent.
Low-pressure ventilator alarm
Indicates disconnection or leak: tubing disconnect, ET/trach cuff leak, ventilator malfunction, or
apnea.
First action when vent alarm sounds
Check the patient first, then the ventilator. If unresolved, bag the patient.
Ventilator-associated pneumonia (VAP) occurrence
48 hours or more after intubation.
Best nursing interventions to prevent VAP
HOB 30-45°, oral care q2h with chlorhexidine, suctioning, daily sedation vacations, hand
hygiene.
Hallmark sign of ARDS
, Refractory hypoxemia: oxygen doesn't improve even with high FiOI.
Common causes of ARDS
Sepsis (most common), aspiration, pneumonia, trauma, shock.
Signs of a tension pneumothorax
Tracheal deviation, SOB, cyanosis, rapid breathing, restlessness, tachycardia.
Emergency treatment for tension pneumothorax
Needle decompression followed by chest tube insertion.
Tidaling in a chest tube drainage system
Water rising/falling with breathing in the water-seal chamber. Normal unless lung re-expands or
tubing blocked.
Continuous bubbling in the water-seal chamber
Indicates an air leak.
When to notify provider about chest tube drainage
If drainage is >100 mL/hr or suddenly increases.
Supplies at bedside for a chest tube patient
Sterile water, occlusive dressing, ambu bag, suction equipment.
The nurse obtains a unit of blood at from the blood bank at 0830. The nurse calculates that
the transfusion must be started by what time?
12:30
The nurse finds a client without a pulse or respirations. What is the nurses immediate
response after assessing the client for unresponsiveness?
Start CPR
A client with symptomatic bradycardia needs a temporary transcutaneous pacemaker (TCP).
What is the most appropriate nursing intervention before the procedure?
Provide adequate sedation and analgesia as ordered
An intubated, mechanically ventilated client is becoming mildly restless and tachycardic. The
clients O2 saturation is 90 % and there are course rhonchi heard in the lungs upon
auscultation. What is the priority action of the nurse?
Nursing Priorities (High-Yield Review)|Rationales
Verified and Graded A+ Latest Updated 2026
Normal age-related respiratory changes in older adults
-Kyphosis
-barrel chest
-decreased chest expansion
-decreased alveolar surface area
-decreased vital capacity
Risk factors for pneumonia and aspiration in older adults
-Decreased chest expansion
-weaker cough reflex
-reduced alveolar surface area.
Levels of respiratory/ventilatory support equipment
-Simple adjuncts (OPA/NPA)
-Non-invasive ventilation (CPAP/BiPAP)
-Artificial airways (LMA/ETT/trach)
-Mechanical ventilation.
Contraindication for oropharyngeal airway (OPA)
If the patient has an intact gag reflex (risk of vomiting/aspiration).
CPAP
Continuous Positive Airway Pressure: one continuous pressure keeps alveoli open, improves
oxygenation.
BiPAP
Bilevel Positive Airway Pressure: two pressures (higher for inspiration, lower for expiration);
helps oxygenation and ventilation.
Contraindications for NPPV (CPAP/BiPAP)
-Claustrophobia
-apnea
-facial trauma
,-uncontrolled vomiting
-inability to protect airway
-neuromuscular disease.
Endotracheal tube (ETT) vs tracheostomy
ETT is for short-term airway management; tracheostomy is for long-term airway management.
Main risk of mechanical ventilation
Ventilator-associated pneumonia (VAP).
FiOI
Fraction of inspired oxygen: the percentage of oxygen the patient receives (21% = room air).
PEEP
Positive End-Expiratory Pressure: keeps alveoli open at end of exhalation, improves oxygenation
in ARDS, prevents collapse.
Risk of high PEEP
Barotrauma (pneumothorax) and decreased cardiac output.
High-pressure ventilator alarm
Indicates obstruction: secretions, kinked tubing, patient biting tube, decreased lung compliance,
coughing/fighting vent.
Low-pressure ventilator alarm
Indicates disconnection or leak: tubing disconnect, ET/trach cuff leak, ventilator malfunction, or
apnea.
First action when vent alarm sounds
Check the patient first, then the ventilator. If unresolved, bag the patient.
Ventilator-associated pneumonia (VAP) occurrence
48 hours or more after intubation.
Best nursing interventions to prevent VAP
HOB 30-45°, oral care q2h with chlorhexidine, suctioning, daily sedation vacations, hand
hygiene.
Hallmark sign of ARDS
, Refractory hypoxemia: oxygen doesn't improve even with high FiOI.
Common causes of ARDS
Sepsis (most common), aspiration, pneumonia, trauma, shock.
Signs of a tension pneumothorax
Tracheal deviation, SOB, cyanosis, rapid breathing, restlessness, tachycardia.
Emergency treatment for tension pneumothorax
Needle decompression followed by chest tube insertion.
Tidaling in a chest tube drainage system
Water rising/falling with breathing in the water-seal chamber. Normal unless lung re-expands or
tubing blocked.
Continuous bubbling in the water-seal chamber
Indicates an air leak.
When to notify provider about chest tube drainage
If drainage is >100 mL/hr or suddenly increases.
Supplies at bedside for a chest tube patient
Sterile water, occlusive dressing, ambu bag, suction equipment.
The nurse obtains a unit of blood at from the blood bank at 0830. The nurse calculates that
the transfusion must be started by what time?
12:30
The nurse finds a client without a pulse or respirations. What is the nurses immediate
response after assessing the client for unresponsiveness?
Start CPR
A client with symptomatic bradycardia needs a temporary transcutaneous pacemaker (TCP).
What is the most appropriate nursing intervention before the procedure?
Provide adequate sedation and analgesia as ordered
An intubated, mechanically ventilated client is becoming mildly restless and tachycardic. The
clients O2 saturation is 90 % and there are course rhonchi heard in the lungs upon
auscultation. What is the priority action of the nurse?
