Lewis Ch-70: Respiratory Failure and Acute Respiratory Distress Syndrome Flashcards
(23 cards)
To evaluate the effectiveness of prescribed therapies for a client with ventilatory failure, which of the following diagnostic tests 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
c. Arterial blood gas (ABG) analysis
ABG = Arterial Blood Gas
It’s a blood test pulled from an artery (not a vein!)—usually the radial artery in the wrist.
It tells you what’s going on with a patient’s:
• Oxygenation
• Ventilation
• Acid-base balance
Basically, it’s like opening the lungs’ report card, and seeing if they’re doing their job or about to get held back a grade.
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Why is it useful for ventilatory failure?
Because ventilatory failure = the lungs can’t move air in and out effectively.
And the ABG tells you:
• PaO₂ (oxygen level in the blood)
• PaCO₂ (carbon dioxide level → super important for ventilation)
• pH (is the blood acidic or alkaline?)
• HCO₃ (bicarbonate → kidneys’ role in acid-base balance)
If the PaCO₂ is high, the patient isn’t blowing off enough CO₂ = hypoventilation
If the PaO₂ is low, they aren’t getting enough O₂ = hypoxemia
So if you’re trying to evaluate whether ventilation therapy is working (like BiPAP, intubation, etc.), ABG is your golden ticket.
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Why not the other answers?
• a. Chest x-ray = Good for spotting pneumonia or a pneumothorax, but tells you nothing about gas exchange or ventilation.
• b. Pulse oximetry = Only shows oxygen saturation, not CO₂ or pH. It’s like looking at half the story.
• d. Pulmonary artery pressure monitoring = That’s advanced ICU-level heart and lung pressure monitoring. Overkill for just checking if your vent therapy is working
The nurse is caring for a client who has been admitted with a pulmonary embolism and notes a change in the client’s oxygen saturation from 94% to 88%. Which of the following actions should the nurse implement?
a. Increase the oxygen flow rate
b. Suction the clients oropharynx
c. Assist the client to cough and deep breathe.
d. Help the client to sit in a more upright position.
a. Increase the oxygen flow rate
Why not the other options?
• b. Suction the oropharynx – That’s for secretions or airway blockage. Not the issue here. This isn’t a mucus problem.
• c. Assist the client to cough and deep breathe – Helpful sometimes, but not during a PE. That clot isn’t getting coughed out like a popcorn kernel.
• d. Help the client sit more upright – A good supportive move, yes. But not as immediately impactful as cranking up that oxygen
The nurse is caring for a client with respiratory failure who has a respiratory rate of 8/min and a SpO₂ of 89%. The client is increasingly lethargic. Which of the following actions should the nurse anticipate?
a. Administration of 100% oxygen by non-rebreather mask
b. Endotracheal intubation and positive pressure ventilation
c. Insertion of mini-trachostomy with frequent suctioning
d. Initation of bilevel positive pressure ventilation (BiPAP)
b. Endotracheal intubation and positive pressure ventilation
The patient:
• Respiratory rate: 8/min = way too slow. Normal is 12–20. They’re not ventilating.
• SpO₂: 89% = they’re not oxygenating either. (We want at least 92–94%.)
• Lethargic = their brain is starting to give up. Could be from low oxygen, high CO₂, or both.
This isn’t someone you throw a mask on and hope for the best. They’re slipping into respiratory failure, and their body is tapping out.
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So, why is b. correct?
b. Endotracheal intubation and positive pressure ventilation
Because:
• You need to take over the airway, now.
• Intubation allows total control over oxygen delivery and CO₂ removal.
• They’re too out of it to breathe on their own or protect their airway.
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Why not the others?
• a. Non-rebreather mask – Pointless if they’re breathing 8 times a minute. That oxygen’s just sitting there like, “Well, I tried.”
• c. Mini-trach with suctioning – That’s for airway clearance, not respiratory support.
• d. BiPAP – It’s helpful if the patient is alert, breathing spontaneously, and able to cooperate. This patient is lethargic = can’t protect airway = unsafe
The pulse oximetry for a client with right lower lobe pneumonia indicates an oxygen saturation of 90%. The client has rhonchi, a weak cough effort, and complains of fatigue. Which of the following actions is best for the nurse to take?
a. Position the client on the right side
b. Place a humidifier in the clients room
c. Assist the client with staged coughing
d. Schedule a 2-hour rest period for the client
c. Assist the client with staged coughing
Because when you’ve got right lower lobe pneumonia, weak coughing, and low-ish oxygen saturation, what you need is to clear that junk out of your lungs. Helping them cough in a controlled, energy-saving way actually does something useful—unlike flopping them on their pneumonia-filled lung or misting the room like you’re growing orchids.
“Staged coughing” isn’t just a dramatic performance by the lungs, it’s a real technique to help patients cough more effectively without passing out from exhaustion. Very considerate.
The nurse is caring for an obese client with left lower lobe pneumonia. Which of the following positions should the nurse place the client in for optimal gas exchange?
a. Left lateral
b. Right lateral
c. Tripod position
d. High Fowler’s position
b. Right lateral
The “Good Lung Down” Principle
This is real. It even rhymes. That’s how you know it’s science.
When a patient has pneumonia in one lung, you lay them on the opposite side so the healthy lung is down. Why?
Because:
• Gravity pulls blood toward the dependent (lower) lung.
• You want that blood to go to the better-functioning lung (aka the one not filled with inflammatory goo).
• This way, oxygen actually gets into the bloodstream, instead of just sloshing around uselessly in the junk lung.
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Why not the other positions?
• a. Left lateral = puts the bad lung down. We don’t reward underperformance.
• c. Tripod = great for COPD or when someone’s trying to look really intense in a chair, but not ideal for unilateral pneumonia.
• d. High Fowler’s = good for general breathing issues, but still doesn’t redirect blood flow away from the junky lung.
The nurse is admitting a client who is in possible respiratory failure with a high PaCO₂. Which of the following assessment information will be of most concern to the nurse?
a. The client is somnolent
b. The client’s SpO2 is 90%
c. The client complains of weakness.
d. The client’s BP is 162/94
a. The client is somnolent
High PaCO₂ = Hypercapnia
That means too much carbon dioxide in the blood. The lungs aren’t blowing it off properly, which could be due to respiratory failure, COPD, sedation, or just the lungs being lazy under pressure.
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Why somnolence is a code-red symptom:
• CO₂ is a sedative. Seriously. It makes the brain sluggish, then sleepy, then not breathing at all.
• When a patient starts drifting off, it’s not because they’re bored — their brainstem is getting suppressed.
• If you wait too long, they’ll stop responding entirely. And then their diaphragm retires without notice.
So yeah:
Somnolence + High PaCO₂ = impending doom
Aka respiratory failure, which is not ideal unless you’re auditioning for ICU admissions
Chest physiotherapy is indicated for which of the following clients?
a. Takes a bronchodilator
b. Produces 40 mL of sputum per 24 hours
c. Has an increased PCO2 level
d. Is taking vancomycin
b. Produces 40 mL of sputum per 24 hours
The nurse is caring for a client who develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. To determine whether the client has acute respiratory distress syndrome or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with which of the following actions?
a. Inserting a pulmonary artery catheter
b. Obtaining a ventilation-perfusion scan
c. Drawing blood for arterial blood gases
d. Positioning the client for a chest radiograph
a. Inserting a pulmonary artery catheter
Which of the following assessment findings by the nurse when caring for a client with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased?
a. The client has subcutaneous emphysema
b. The client has a sinus bradycardia with a rate of 52
c. The client’s PaO2 is 50 mm Hg and the SaO2 is 88%
d. The client has bronchial breath sounds in both the lung fields
a. The client has subcutaneous emphysema
Which of the following statements by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a client with ARDS is correct?
a. “PEEP will prevent fibrosis of the lung from occurring.”
b. “PEEP will push more air into the lungs during inhalation.”
c. “PEEP allows the ventilator to deliver 100% oxygen to the lungs.”
d. “PEEP prevents the lung air sacs from collapsing during exhalation.”
d. “PEEP prevents the lung air sacs from collapsing during exhalation.”
When prone positioning is used in the care of a client with acute respiratory distress syndrome (ARDS), which of the following information obtained by the nurse indicates that the positioning is effective?
a. The client’s PaCO₂ is 90 mm Hg, and the SaO₂ is 92%
b. Endotracheal suctioning results in minimal mucous return.
c. Sputum and blood cultures show no growth after 24 hours.
d. The skin on the clients back is intact and without redness.
a. The client’s PaO2 is 90 mm Hg, and the SaO2 is 92%
The nurse obtains vital signs for a client admitted 2 days ago with gram negative spesis: T-38.4, BP-90/56, HR-92, R-24. Which of the following actions should the nurse take next?
a. Administer the scheduled IV antibiotics
b. Give the PRN acetaminophen 650mg
c. Obtain oxygen saturation using pulse oximetry
d. Notify the health care provider of the client’s vital signs.
c. Obtain oxygen saturation using pulse oximetry
To decrease the risk for ventilator-associated penumonia, which of the following actions should the nurse include in the plan of care for a client who requires intubation and mechanical ventilation?
a. Avoid use of positive end-expiratory pressure (PEEP).
b. Suction every 2 hours
c. Elevate head of bed to 45 degrees
d. Give enteral feedings at no more than 10 mL/hour.
c. Elevate head of bed to 45 degrees
The nurse is caring for a client who has a nursing diagnosis of ineffective airway clearance related to thick, secretions. Which of the following actions should the nurse include in the plan of care
a. Encourage use of the incentive spirometer
b. Offer the client fluids at frequent intervals
c. Teach the client the importance of coughing
d. Increase oxygen level to keep O2 saturation >95%.
b. Offer the client fluids at frequent intervals
The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is intubated, receiving mechanical ventilation and has developed a pneumothorax. Which of the following actions will the nurse anticipate taking?
a. Lower the positive end-expiratory pressure (PEEP)
b. Increase the fraction of inspired oxygen
c. Suction more frequently
d. Increase the tidal volume
a. Lower the positive end-expiratory pressure (PEEP)
After receiving change-of-shift report, which of the following clients should the nurse assess first?
a. A client with cystic fibrosis who has thick, green-coloured sputum
b. A client with pneumonia who has coarse crackles in both lung bases
c. A client with emphysema who has an oxygen saturation of 91-92%.
d. A client with septicemia who has intercostal and suprasternal retractions
d. A client with septicemia who has intercostal and suprasternal retractions
The nurse is admitting a client with COPD who has shortness of breath and dyspnea. Which of the following assessment findings is most important to report to the health care provider?
a. The client has bibasilar lung crackles
b. The client is sitting in the tripod position
c. The client’s respiratory rate has decreased from 30 to 10 breaths/minute
d. The client’s pulse oximetry indicates an O2 saturation of 91%.
c. The client’s respiratory rate has decreased from 30 to 10 breaths/minute
The nurse is assessing a client with chronic lung disease and finds a sudden onset of agitation and confusion. Which of the following actions should the nurse take first?
a. Check pupil reaction to light
b. Notify the health care provider
c. Attempt to calm and reassure the client
d. Assess oxygenation using pulse oximetry
d. Assess oxygenation using pulse oximetry
The nurse is caring for a client who came to the emergency department with acute respiratory distress. Which of the following information requires the most rapid action by the nurse?
a. Respiratory rate is 32 breaths/minute
b. Pattern of breathing is shallow.
c. The client’s PaO₂ is 45 mm Hg.
d. The client’s PaCO₂ is 34 mm Hg.
c. The client’s PaO₂ is 45 mm Hg.
The nurse is caring for a client who was hospitalized 2 days earlier with aspiration pneumonia. Which of the following assessment information is most important to communicate to the health care provider?
a. Cough that is productive of blood-tinged sputum
b. Scattered crackles throughout the posterior lung bases
c. Temperature of 38.6°C after 2 days of IV antibiotic therapy
d. Oxygen saturation has dropped to 90% with administration of 100% o2 by non-rebreather mask
d. Oxygen saturation has dropped to 90% with administration of 100% O₂ by non-rebreather mask
The nurse is caring for a client with hypoxemia and a PaO₂/FiO₂ ratio of 170 while being administered oxygen 8 L/minute via mask. Which of the following information is accurate in relation to the client’s situation?
a. Is at risk for ARDS
b. Also has an increased PaCO₂ level
c. Should be prepared for mechanical ventilation
d. Requires packed red cells as soon as possible
a. Is at risk for ARDS
A client with ARDS who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation has settings of fraction of inspired oxygen (FIO₂) 80%, tidal volume 500, rate of 18, and positive end expiratory pressure (PEEP) 5 cm. Which of the following assessment findings is most important for the nurse to report to the health care provider?
a. Oxygen saturation 99%
b. Client respiratory rate of 22 breaths/minute
c. Crackles audible at lung bases
d. Apical pulse rate of 104 breaths/minute
a. Oxygen saturation 99%
The nurse is caring for a client with chronic hypercapnia and is to receive supplemental oxygen. Which of the following prescribed actions should the nurse implement?
a. Venturi mask at 48%
b. Nasal Cannula at 1-2 L/minute
c. Noninvasive ventilation
d. Face mask at 4-5 L/minute
b. Nasal Cannula at 1-2 L/minute
