Chapter 67: Acute Respiratory Failure and Acute Respiratory Distress Syndrome

Chapter 67: Acute Respiratory Failure and Acute Respiratory Distress Syndrome

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. Which diagnostic test will provide the nurse with the most specific information to evaluate the effectiveness of interventions for a patient with ventilatory failure?

a.	Chest x-ray
b.	O2 saturation
c.	Arterial blood gas analysis
d.	Central venous pressure monitoring

 

 

ANS:  C

Arterial blood gas (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 may also be done to help in assessing oxygenation or determining the cause of the patient’s ventilatory failure.

 

DIF:    Cognitive Level: Apply (application)           REF:               1614

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%. Which action should the nurse take?

a.	Suction the patient’s oropharynx.
b.	Increase the prescribed O2 flow rate.
c.	Instruct the patient to cough and deep breathe.
d.	Help the patient to sit in a more upright position.

 

 

ANS:  B

Increasing O₂ flow rate will usually improve O₂ 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: Apply (application)           REF:               1609

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Physiological Integrity

 

3. A patient with respiratory failure has a respiratory rate of 6 breaths/min and an oxygen saturation (SpO₂) of 88%. The patient is increasingly lethargic. Which intervention will the nurse anticipate?

a.	Administration of 100% O2 by non-rebreather mask
b.	Endotracheal intubation and positive pressure ventilation
c.	Insertion of a mini-tracheostomy with frequent suctioning
d.	Initiation of continuous positive pressure ventilation (CPAP)

 

 

ANS:  B

The patient’s lethargy, low respiratory rate, and SpO₂ indicate the need for mechanical ventilation with ventilator-controlled respiratory rate. Giving high-flow O₂ 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. CPAP requires that the patient initiate an adequate respiratory rate to allow adequate gas exchange.

 

DIF:    Cognitive Level: Apply (application)           REF:               1616

TOP:   Nursing Process: Planning               MSC:  NCLEX: Physiological Integrity

 

4. The oxygen saturation (SpO₂) for a patient with left lower lobe pneumonia is 90%. The patient has wheezes, a weak cough effort, and complains of fatigue. Which action should the nurse take next?

a.	Position the patient on the left side.
b.	Assist the patient with staged coughing.
c.	Place a humidifier in the patient’s room.
d.	Schedule a 4-hour rest period for the patient.

 

 

ANS:  B

The patient’s assessment indicates that assisted coughing is needed to help remove secretions, which will improve oxygenation. A 4-hour rest period at this time may allow the O₂ saturation to drop further. Humidification will not be helpful unless the secretions can be mobilized. Positioning on the left side may cause a further decrease in oxygen saturation because perfusion will be directed more toward the more poorly ventilated lung.

 

DIF:    Cognitive Level: Apply (application)           REF:               1616

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Physiological Integrity