Chapter 68: Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome

Chapter 68: Nursing Management: Respiratory Failure and Acute Respiratory
Distress Syndrome

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE
1. To evaluate the effectiveness of prescribed therapies for a patient with ventilatory failure,
which diagnostic test will be most useful to the nurse?
a. Chest x-rays
b. Pulse oximetry
c. Arterial blood gas (ABG) analysis
d. Pulmonary artery pressure monitoring
ANS: C
ABG analysis is most useful in this setting because ventilatory failure causes problems
with CO2 retention, and ABGs provide information about the PaCO2 and pH. The other
tests also may be done to help in assessing oxygenation or determining the cause of the
patient’s ventilatory failure.
DIF: Cognitive Level: Application REF: 1752-1754
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. While caring for a patient who has been admitted with a pulmonary embolism, the nurse
notes a change in the patient’s oxygen saturation (SpO2) from 94% to 88%. The nurse
will
a. increase the oxygen flow rate.
b. suction the patient’s oropharynx.
c. assist the patient to cough and deep breathe.
d. help the patient to sit in a more upright position.
ANS: A
Increasing oxygen flow rate usually will improve oxygen saturation in patients with
ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the
problem is with perfusion, actions that improve ventilation, such as deep-breathing and
coughing, sitting upright, and suctioning, are not likely to improve oxygenation.
DIF: Cognitive Level: Application REF: 1747-1749 | 1754
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The
patient is increasingly lethargic. The nurse will anticipate assisting with
a. administration of 100% oxygen by non-rebreather mask.
b. endotracheal intubation and positive pressure ventilation.
c. insertion of a mini-tracheostomy with frequent suctioning.
d. initiation of bilevel positive pressure ventilation (BiPAP).
Test Bank 68-2
ANS: B
The patient’s lethargy, low respiratory rate, and SpO2 indicate the need for mechanical
ventilation with ventilator-controlled respiratory rate. Administration of high flow
oxygen will not be helpful because the patient’s respiratory rate is so low. Insertion of a
mini-tracheostomy will facilitate removal of secretions, but it will not improve the
patient’s respiratory rate or oxygenation. BiPAP requires that the patient initiate an
adequate respiratory rate to allow adequate gas exchange.
DIF: Cognitive Level: Application REF: 1754-1756 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
4. The pulse oximetry for a patient with right lower lobe pneumonia indicates an oxygen
saturation of 90%. The patient has rhonchi, a weak cough effort, and complains of
fatigue. Which action is best for the nurse to take?
a. Position the patient on the right side.
b. Place a humidifier in the patient’s room.
c. Assist the patient with staged coughing.
d. Schedule a 2-hour rest period for the patient.
ANS: C
The patient’s assessment indicates that assisted coughing is needed to help remove
secretions, which will improve oxygenation. A 2-hour rest period at this time may allow
the oxygen saturation to drop further. Humidification will not be helpful unless the
secretions can be mobilized. Positioning on the right side may cause a further decrease in
oxygen saturation because perfusion will be directed more toward the more poorly
ventilated lung.
DIF: Cognitive Level: Application REF: 1754-1755
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
5. When the nurse is caring for an obese patient with left lower lobe pneumonia, gas
exchange will be best when the patient is positioned
a. on the left side.
b. on the right side.
c. in the tripod position.
d. in the high-Fowler’s position.
ANS: B
The patient should be positioned with the “good” lung in the dependent position to
improve the match between ventilation and perfusion. The obese patient’s abdomen will
limit respiratory excursion when sitting in the high-Fowler’s or tripod positions.
DIF: Cognitive Level: Application REF: 1754-1755
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity