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64 Cards in this Set

  • Front
  • Back
Hypercapnic respiratory failure can be caused by:
A. ARDS
B. Asthma
C. pneumonia
D. pulmonary emboli
B. asthma
An early sign of acute respiratory failure is:
A. coma
B. cyanosis
C. restlessness
D. paradoxic breathing
C. Restlessness
The oxygen delivery system chosen for the patient in acute respiratory failure should:
A. always be a low-flow device, such as a nasal cannula
B. correct the PaO2 to a normal level as quickly as possible
C. administer positive pressure ventilation to prevent CO2 narcosis.
D. Maintain the PaO2 at 60 mmHg or greater at the lowest O2 concentration possible.
D. Maintain the PaO2 at 60 mmHg or greater at the lowest O2 concentration possible.
The most common eraly clinical manifestations of ARDS that the nurse may observe are:
A. Dyspnea and tachypnea
B. Cyanosis and apprehension
C. Hypotension and tachycardia
D. Respiratory distress and frothy sputum.
A. Dyspnea and tachypnea
Maintenanceof fluid balance in the patient with ARDS involves:
A. Hydration using colloids
B. Administration of surfactant
C. Mild fluid restriction and diuretics as necessary
D. Keeping the hemoglobin at levels of 15 to 16 g/dl (150 to 160 g/L).
C. Mild fluid restriction and diuretics as necessary
Which of the following interventions is designed to prevent or limit barotrauma in the patient with ARDS who is mechanically ventilated?
A. Increasing PEEP
B. Increasing tidal volume
C. Use of permissive hypercapnia
D. use of pressure support ventilation
C. Use of permissive hypercapnia
Respiratory failure can be defined as:
A. the absence of ventilation
B. Any episode in which part of the airway is obstructed
C. Inadequate gas exchange to meet the metabolic needs of the body.
D. An episode of acute hypoxemia caused by a pulmonary dysfunction
C. Inadequate gas exchange to meet the metabolic needs of the body.
Rationale: Respiratory failure results when the transfer of O2 or carbon dioxide functions of the respiratory system are impaired, and although the definition is determined by PaO2 and PaCO2 levels, the major factor in respiratory failure is inadequate gas exchange to meet tissue O2 needs. Absence of ventilation is respiratory arrest, and partial airway obstruction may not necessarily cause respiratory failure. Acute hypoxemia may be caused by factors other than pulmonary dysfunction.
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
**Primary problem is inadequate oxygen transfer.
hypoxemic respiratory failure
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
**Most often caused by V/Q mismatch and shunt.
hypoxemic respiratory failure
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
** Referred to as ventilatory failure.
hypercapnic respiratory failure
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
**Exsists when PaO2 is 60 mmHg or less, even when oxygen is administered at 60%.
hypoxemic respiratory failure
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
**Risk of inadequate oxygen saturation of hemoglobin exists.
hypoxemic respiratory failure
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
**The body is unable to compensate for acidemia of increased PaCO2.
hypercapnic respiratory failure
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
**The primary problem is insufficient carbon dioxide removal.
hypercapnic respiratory failure
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
**Referred to as oxygenation failure.
hypoxemic respiratory failure
Is this hypoxemic respiratory failure or hypercapnic respiratory failure?
**Results from an imbalance between ventilatory supply and ventilatory demand.
Hypercapnic respiratory failure.
T/F?
A V/Q ratio of 1:1 (V/Q=1) reflects an alveolar ventilation of 4-5l that is matched by 4-5 L of blood flow to the lungs each minute.
True
T/F?
The V/Q ratio is 1 or greater when there is less ventilation to an area of the lung than perfusion.
False.
The V/Q ratio is 1 or less when there is less ventilation to an area of the lung than perfusion.
T/F?
An extreme V/Q imbalance resulting from blood leaving the heart without being exposed to ventilated areas of the lung is known as a shunt.
True.
T/F?
An intrapulmonary shunt occurs when an obstruction impairs the flow of blood to ventilated areas of the lung.
False.
An intrapulmonary shunt occurs when an obstruction impairs the flow of air in the lungs from passing into the blood.
T/F?
In differentiating between a V/Q mismatch and an intrapulominary shunt, an increase in PaO2 on oxygen administration occurs in the patient with an intrapulmonary shunt.
False.
In differentiating between a V/Q mismatch and an intrapulmonary shunt, an increase in PaO2 on oxygen administration occurs in the patient with a V/Q mismatch.
T/F?
Gas transport is slowed in shunt, resulting in exertional hypoxemia that is not present at rest.
False.
Gas transport is slowed in diffusion limitation, resulting in exertional hypoxemia that is not present at rest.
What is the cause of a V/Q mismatch 1 or greater?
Pulmonary embolism
What is the cause of a V/Q mismatch of 1 or less?
Atelectasis
Ehat is the cause of a anatomic shunt?
Ventricular septal defect
What is the cause of Intrapulmonary shunt?
Pulmonary edema
What is the cause of diffusion limitation?
Pulmonary fibrosis
A patient with hypoxemic respiratory failure who has pneumonia: What is the responisible factor with:
Thickening of alveolar-capillary membrane from secretions and fluid accumulation.
Diffusion limitation
A patient with hypoxemic respiratory failure who has pneumonia: What is the responisible factor with:Consolidation of lung lobules with exudate and alveolar collapse.
Shunt
A patient with hypoxemic respiratory failure who has pneumonia: What is the responisible factor with: Decreased alveolar ventilation from obstruction of bronchioles and terminal respiratory units.
V/Q mismatch
A patient with hypoxemic respiratory failure who has pneumonia: What is the responisible factor with: Pleuritic pain and inflammation.
Alveolar hypoventilation
Hypercapnic respiratory failure is most likely to occur in the patient who has:
A. rapid, deep respirations in response to pneumonia
B. slow, shallow respirations as a result of sedative overdose
C. Large airway resistance as a result if severe bronchospasm
D. Poorly ventilated areas of the lung due to pulomonary edema
B. slow, shallow respirations as a result of sedative overdose
Rationale: hypercapnic respiratory failure is associated with alveolar hypoventilation with increases in alveolar and arterial CO2 and often is caused by problems outside the lungs. A patient with slow, shallow respirations is not exchanging enough gas volume to eliminate CO2. Deep rapid respirations reflect hyperventilation and often accompany lung problems that cause hypoxemic respiratory failure. Pulmonary edema and large airway resistance cause obstruction of oxygenation and result in a V/Q mismatch or shunt typical of hypoxemic respiratory failure.
Acute respiratory failure in a patient with chronic lung disease would most likely be indicated by arterial blood gas (ABG) results of :
A. PaO2 52mmHg, PaCO2 56 mmHg, pH 7.4.
B. PaO2 46 mmHg, PaCO2 52 mmHg, pH 7.36.
C. PaO2 48 mmHg, PaCO2 54 mmHg, pH 7.38.
D. PaO2 50 mmHg, PaCO2 54 mmHg, pH 7.28.
D. PaO2 50 mmHg, PaCO2 54 mmHg, pH 7.28.
Rationale: In a patient with normal lung function, respiratory failure is commonly defined as PaO2<60mmHg or a PaCO2>45 mmHg or both, but because the patient with chronic pulomonary disease normally maintains low PaO2 and high PaCO2, acute respiratory failure in these patients can be defined as an acute decrease in PaO2 or increase in PaCO2 from the patients baseline parameters, accompanied by an acid pH. The pH of 7.28 reflects an acidemia and a loss of compensation in the patient with chronic lung disease.
Is this manifestation a primary characteristic of hypoxemic or hypercapnic respiratory failure?
** Cyanosis
Hypoxemic respiratory failure
Is this manifestation a primary characteristic of hypoxemic or hypercapnic respiratory failure?
**Morning headache
Hypercapnic respiratory failure
Is this manifestation a primary characteristic of hypoxemic or hypercapnic respiratory failure?
**Rapid, shallow respirations
Hypercapnic respiratory failure
Is this manifestation a primary characteristic of hypoxemic or hypercapnic respiratory failure?
**Metabolic acidosis
Hypoxemic respiratory failure
Is this manifestation a primary characteristic of hypoxemic or hypercapnic respiratory failure?
**"Three-word" dyspnea
Hypoxemic respiratory failure
Is this manifestation a primary characteristic of hypoxemic or hypercapnic respiratory failure?
**Use of tripod position
Hypercapnic respiratory failure
Is this manifestation a primary characteristic of hypoxemic or hypercapnic respiratory failure?
**Respiratory acidosis
Hypercapnic respiratory failure
The nurse detects the early onset of hypoxemia in the patient who experiences:
A. restlessness
B. Hypotension
C. Central cyanosis
D. Cardiac arrhythmias
A. restlessness
Because the brain is very sensitive to a decrease in oxygen delivery, restlessness, agitation, disorientation, and confusion are early signs of hypoxemia, for which the nurse should be alert. Mild hypertension is also an early sign, accompanied by tachycardia. Central cyanosis is an unreliable, late sign of hypoxemia, and cardiac arrhythmias also occur later.
The nurse assesses that a patient in respiratory distress is developing respiratory fatique and the risk of respiratory arrest when the patient:
A. has an increased I/E ratio.
B. Cannot breathe unless he is sitting upright.
C. Uses the abdominal muscles during expiration.
D. Has a change in respiratory rate from rapid to slow.
D. Has a change in respiratory rate from rapid to slow.
Rationale: The increase in respiratory rate required to blow off accumulated CO2 predisposes to respiratory muscle fatique, and the slowing of a rapid rate in a patient in acute distress indicates tiring and the possibility of respiratory arrest unless ventilatory assistance is provided. A decrease I/E ratio, orthopnea, and accessaory muscle use are common findings in respiratory distress but do not necessarily signal respiratory fatique or arrest.
A patient has a PaO2 of 50 mmHg and a PaCO2 of 42 mmHg because if an intrapulmonary shunt. The patient is most likely to respond best to:
A. Positive pressure ventilation
B. Oxygenation administration at a FIO2 of 100%
C. Administration of oxygen per nasal cannula at 1 to 3L/min
D. Clearance of airway secretions with coughing and suctioning
A. Positive pressure ventilation

Rationale: Patients with a shunt are usually more hypoxemic than are patients with a V/Q mismatch, because the alveoli are filled with fluid, which prevents gas exchange. Hypoxemia secondary to an intrapulmonary shunt is usually not responsive to high O2 concentrations, and the patient will usually require positive pressure ventilation. Hypoxemia associated with a V/Q mismatch ususally responds favorably to oxygen administration at 1 to 3 L/min by nasal canula. Removal of secretions with coughing and suctioning is not generally effective in reversing an acute hypoxemia seconday to a shunt.
A patient with a massive hemothorax and pneumothorax has absent breath sounds in the right lung. To promote improved V/Q matching, the nurse positions the patient:
A. on the left side
B. on the right side
C. in a reclining chair bed
D. Supine with the head of the bed elevated
A. on the left side

Rationale: When there is impaired function of the lung, the patient should be positioned with the unaffected lung in the dependent position to promote perfusion to the functioning tissue. If the diseased lung is positioned dependently, more V/Q mismatch would occur. The head of the bed may be elevated, or a reclining chair may be used, with the patient positioned on the unaffected side, to maximize thoracic expansion if the patient has increased work of breathing.
A patient in hypercapnic respiratory failure has a nursing diagnosis of ineffective airway clearance related to increasing exhaustion. An appropriate nursing intervention for the patient includes:
A. inserting an oral airway
B. performing augmented coughing
C. Teaching the patient "huff" coughing
D. Teaching the patient slow pursed-lip breathing
B. performing augmented coughing

Rationale: Augmented coughing by applying pressure on the thorax or abdominal muscles at the beginning of expiration helps produce muscle movement, increases pleural pressure and expiratory flows, and assists the cough to remove secretions in the patient who is exhausted. An oral airway is used to only if there is a possibility that the tongue will obstruct the airway. Huff coughing is indicated for patients with problems with endotracheal tubes in place, which prevent glottal closure, and slow, pursed-lip breathing is used to prevent air trapping and give the patient a sense of control over breathing.
Hemodynamic monitoring is instituted in severe respiratory failure primarily to:
A. detect V/Q mismatches
B. Evaluate oxygenation and ventilation status
C. Evaluate cardiac status and blood flow to tissues
D. Continuously measure the arterial blood pressure.
C. Evaluate cardiac status and blood flow to tissues

Rationale: Hemodynamic monitoring with pulmonary artery catheter is instituted in severe respiratory failure to determine the amount of blood flow to tissues and the response of the lung and heart to hypoxemia. Continuous blood pressure monitoring may be performed, but blood pressure is a reflection of cardiac activity, which can be determined by the pulmonary artery catheter findings. Arterial blood gas values are important to evaluate oxygenation and ventilation status and V/Q mismatches.
Drug therapy that is indicated for the patient in acute respiratory failure includes:
A. Sedatives to reduce the work of breathing
B. Prophylactic antibiotics to prevent respiratory infection
C. Inhaled corticosteriods to relieve bronchospasm and inflammation
D. Agents that relieve symptoms and reverse the underlying disease process.
D. Agents that relieve symptoms and reverse the underlying disease process.

Rationale: Drug therapy indicated for acute respiratory failure depends on the symptoms that are present and the underlying cause of the respiratory failure. Bronchodilators and IV corticosteriods are used if bronchospasm and inflammation are present; antibiotics are used if infection is present; diuretics are used if pulmonary congestion is caused by heart failure; and sedatives may be used if anxiety and agitation increase the degree of hypoxemia.
In caring for a patient in acute respiratory failure, the nurse recognizes that noninvasive positive pressure ventilation (NIPPV)may be indicated for a patient who:
A. is comatose and has high oxygen requirements
B. has copious secretions that require frequent suctioning
C. responds to hourly bronchodilator nebulization treatments
D. is alert and cooperative but has increasing respiratory exhaustion
D. is alert and cooperative but has increasing respiratory exhaustion

Rationale: NIPPV involves the application of a face mask and delivery of a volume of air under inspiratory pressure. Because the device is worn externally, the patient must be able to cooperate in its use, and frequent access to the airway for suctioning or inhaled medications must not be necessary. It is not indicated when high levels of oxygen are needed or respirations are absent.
Although acute respiratory distress syndrome (ARDS) may result from direct lung injury or indirect lung injury as a result of systemic inflammatory response syndrome (SIRS), the nurse is aware that ARDS us most likely to occur in the patient with a host insult resulting from:
A: septic shock
B. Oxygen toxicity
C. Multiple trauma
D. Prolonged hypotension
A: septic shock

Rationale: Although ARDS may occur in the patient who has virtually any severe illness or trauma and may be both a cause and result of SIRS, the most common precipitating insults of ARDS are septic shock and gastric aspiration.
Identify the three primary changes that occur in the injury or exudative phase of ARDS.
1. Interstitial and alveolar edema from damage to vascular endothelium and increased capillary permeability
2. Atelectasis from destruction of type II cells, resulting in inactivation of surfactant
3. Hyaline membrane from exudation if high molecular weight substances in the edema fluid.
Patients with ARDS who survive the acute phase of lung injury and who progress to the fibrotic stage manifest:
A. chronic pulmonary edema and atelectasis
B. resolution of edema and healing of lung tissue.
C. continued hypoxemia because of diffusion limitation
D. increased lung compliance due to breakdown of fibrotic tissue
C. continued hypoxemia because of diffusion limitation

Rationale: In the fibrotic phase of ARDS, diffuse scarring and fibrosis of the lungs occur, resulting in decreased surface area for gas exchange and continued hypoxemia due to diffusion limitation. Although edema is resolved, lung compliance is decreased because of interstitial fibrosis, and long-term mechanical ventilation is required with a poor prognosis for survival.
In caring for the patient with ARDS, the most characteristic sign the nurse would expect the patient to exhibit is:
A. refractory hypoxemia
B. Bronchial breath sounds
C. progressive hypercapnia
D. Increased pulmonary artery wedge pressure.
A. refractory hypoxemia

Rationale: Hypoxemia that does not respond to oxygenation by any route is a hallmark of ARDS and is always present. PaCO2 levels may be normal until the patient is no longer able to compensate in response to the hypoemia. Bronchial breath sounds may be associated with the progression of ARDS. Pulomonary capillary wedge pressures that are normally elevated in cardiopulmonary edema are normal in the pulmonary edema of ARDS.
The nurse suspects the early stage of ARDS in any seriously ill patient who:
A. develops respiratory acidosis
B. has diffuse crackles and rhonchi
C. Exhibits dyspnea and restlessness
D. has a decreased PaO2 and an increased PaCO2
C. Exhibits dyspnea and restlessness

Rationale: Early signs of ARDS are insidious and difficult to detect, but the nurse should be alert for any early signs of hypoxemia, such as restlessness, dyspnea, and decreased mentation, in patients at risk for ARDS. Abnormal findings on physical examination or diagnostic studies, such as adventitious lung sounds, signs of respiratory distress, respiratory alkalosis, or decreasing PaO2, are usually indications that ARDS has progressed beyond initial stages.
A patient with ARDS has a nursing diagnosis of risk for infection. To detect the presence of infections commonly associated with ARDS, the nurse monitors:
A. gastric aspirate for pH and blood
B. the quality, quantity, and consistency of sputum
C. for subcutaneous emphysema of the face, neck, and chest
D. the mucus membranes of the oral cavity for open lesions
B. the quality, quantity, and consistency of sputum

Rationale: Nosocomial pneumonia is one of the most common complications of ARDS, and early detection required frequent monitoring of sputum smears and cultures and assessment of the quality, quantity, and consistency of sputum. Blood in gastric aspirate may indicate stress ulcer, and subcuaneous emphysema of the face, neck and chest occurs with barotrauma during mechanical ventilation. Oral infections may result from prophylactic antibiotics and impaired host defenses but are not common.
The best patient response to treatment of ARDS occurs when initial management includes:
A. treatment of the underlying cause
B. administration of prophylactic antibiotics
C. treatment with diuretics and mild fluid restriction
D. endotracheal intubation and mechanical ventilation.
A. treatment of the underlying cause

Rationale: Because ARDS is precipitated by a physiologic insult, a critical factor in its prevention and early management is treatment of the underlying condition. Prophylactic antibiotics, treatment with diuretics and fluid restriction and mechanical ventilation are also used as ARDS progresses.
When mechanical ventilation is used for the patient with ARDS, positive end-expiratory pressure (PEEP) is often applied to:
A. prevent alveolar collapse and open up collapsed alveoli
B. permit smaller tidal volumes with permissive hypercapnia
C. promote cpmplete emptying of the lungs during exhalation
D. permit extracorporeal oxygenation and carbon dioxide removal outside the body.
A. prevent alveolar collapse and open up collapsed alveoli

Rationale: PEEP used with mechanical ventilation applies positive pressure to the airway and lungs at the end of exhalation, keeping the lung partially expanded and preventing collapse of the alveoli and helping open up collapsed alveoli. Permissive hypercapnia is allowed when the patient with ARDS is ventilated with smaller tidal volumes to prevent barotrauma. Extracorporeal membrane oxygenation and extracorporeal CO2 removal involve passing blood across a gas-exchanging membrane outside the body and then returning oxygenated blood back to the body.
The nurse suspects that a patient with PEEP is experiencing negative effects of this ventilatory maneuver upon finding an:
A. increasing PaO2
B. decreasing heart rate
C. Decreasing blood pressure
D. increasing central venous pressure (CVP)
C. Decreasing blood pressure

Rationale: PEEP increases intrathoracic and intrapulmonic pressures, compresses the pulmonary capillary bed, and reduces blood return to both the right and left side of the heart. Preload (CVP) and cardiac output are decreased, often with a dramatic decrease in blood pressure.
Prone positioning is considered for a patient with ARDS who has not responded to other measures to increase PaO2. The nurse knows that this is strategy.
A. increases the mobilization of pulmonary secretions
B. decreases the workload of the diaphragm and intercostals muscles
C. promotes opening of atelectic alveoli int eh upper portion of the lung
D. promotes perfusion of nonatelectic alveoli in the anterior portion of the lung.
D. promotes perfusion of nonatelectic alveoli in the anterior portion of the lung.

Rationale: When a patient with ARDS us supine, alveoli in the posterior areas of the lung are dependent and fluid filled, and the heart and mediastinal contents place more pressure on the lungs, predisposing to atelectasis. If the patient is turned prone, air filled, non atelectic alveoli in the anterior portion of the lung recieve more blood, and perfusion may be better matched to ventilation, causing less V/Q mismatch. Lateral rotation therapy is used to stimulate postural drainage and help mobilize pulomonary secretions.
Hypercapnic respiratory failure can be caused by
A. ARDS.
B. asthma.
C. pneumonia.
D. pulmonary emboli.
B. asthma.
An early sign of acute respiratory failure is
A. coma.
B. cyanosis.
C. restlessness.
D. paradoxic breathing.
C. restlessness.
The oxygen delivery system chosen for the patient in acute respiratory failure should
A. always be a low-flow device, such as a nasal cannula.
B. correct the PaO<sub>2</sub> to a normal level as quickly as possible.
C. administer positive pressure ventilation to prevent CO<sub>2</sub> narcosis.
D. maintain the PaO<sub>2</sub> at 60 mm Hg or greater at the lowest O<sub>2</sub> concentration possible.
D. maintain the PaO<sub>2</sub> at 60 mm Hg or greater at the lowest O<sub>2</sub> concentration possible.
The most common early clinical manifestations of ARDS that the nurse may observe are
A. dyspnea and tachypnea.
B. cyanosis and apprehension.
C. hypotension and tachycardia.
D. respiratory distress and frothy sputum.
A. dyspnea and tachypnea.
Maintenance of fluid balance in the patient with ARDS involves
A. hydration using colloids.
B. administration of surfactant.
C. mild fluid restriction and diuretics as necessary.
D. keeping the hemoglobin at levels of 15 to 16 g/dl (150 to 160 g/L).
C. mild fluid restriction and diuretics as necessary.
Which of the following interventions is designed to prevent or limit barotrauma in the patient with ARDS who is mechanically ventilated?
A. increasing PEEP
B. increasing the tidal volume
C. use of permissive hypercapnia
D. use of pressure support ventilation
C. use of permissive hypercapnia