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CRITICAL CARE EXAM 1: RESPIRATORY PRACTICE QUESTIONS
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CRITICAL CARE EXAM 1: RESPIRATORY PRACTICE QUESTIONS
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CRITICAL CARE EXAM 1: RESPIRATORY PRACTICEQUESTIONS
1) A nurse is caring for a patient with ARDS. The nurse views the ABG. What value
should the nurse report to the physician?
pH: 7.35
PaCO2: 26mmhg
PaO2:95
HCO3: 22
a) PaCO2
b)pH
c)HCO3
d)PaO2 - answer- a
The normal range for PaCO2 is 35-45. This patient is experiencing a superimposed
respiratory alkalosis likely due to hyperventilation. The nurse should report the PaCO2
to the physician.
2) A nurse must position the patient prone after his diagnosis of acute respiratory
distress syndrome (ARDS). Which of the following is a benefit of using this position?
Select all that apply.
A)Decreased atelectasis
B)Reduced need for endotracheal intubation
c)Mobilization of secretions
d)Decreased pleural pressure
e)Increased response to corticosteroid therapy - answer- a, c, d
Decreased atelectasis", "Mobilization of secretions" and "Decreased pleural pressure"
are correct. Prone positioning, or placing the patient face down with the head turned to
the side, helps with pulmonary function in the patient diagnosed with ARDS. When the
patient is placed in a prone position, the heart and diaphragm are not pressing against
the lungs, which means that pleural pressure is reduced. When there is less pressure
exerted on the lungs, atelectasis decreases. Studies have shown that many patients in
the prone position have increased lung secretions, which improves oxygenation.
-"Reduced need for endotracheal intubation" is incorrect. The prone position has not
been shown to decrease the likelihood of intubation.
-"Increased response to corticosteroid therapy" is incorrect because positioning does
not change the body's response to steroid therapy.
3) A 25-year-old patient in the ICU is being treated for acute respiratory distress
syndrome (ARDS). The patient is on a ventilator and requires 80 percent FiO2. Which
,information would the nurse most likely need to report about the patient to the
respiratory therapist working with her?
a)The patient needs endotracheal suctioning
b)The patient needs more oxygen because of his saturation
c)The patient needs an arterial blood gas drawn
d)The patient needs a hemoglobin level drawn - answer- c
4) A patient who has recovered from ARDS in the ICU is now malnourished and has lost
a significant amount of weight. The physician orders TPN to add nutrition for the patient,
who then develops re-feeding syndrome. Which of the following signs or symptoms
would the nurse expect to see with re-feeding syndrome? Select all that apply.
a. Impaired mental status
b. Insulin resistance
c. Seizures
d. Persistent weight loss
e. Constipation - answer- a,b,c
impaired mental status", "Insulin resistance" and "Seizures" are correct. Re-feeding
syndrome can occur as a response to nutrient reintroduction after a period of starvation.
When an extremely malnourished patient receives TPN, the body has to adjust to
receiving nutrients again, which can cause shifts in electrolytes in the body. These shifts
in electrolytes can result in sudden and often fatal complications. Signs and symptoms
of re-feeding syndrome include confusion and impaired mental status, insulin
resistance, seizures, coma and death.
-"Persistent weight loss" is incorrect because by the time a patient develops re-feeding
syndrome, the onset of symptoms is so sudden that weight loss cannot be measured as
part of the syndrome.
-"Constipation" is incorrect, as it is not a symptom of refeeding syndrome.
5) A nurse is caring for a patient with ARDS. Which of the following clinical indicators
would signify that this client is in respiratory failure? Select all that apply.
a. Pulse oximetry of 94% on room air
b. A PaO2 level below 60 mmHg
c. An ABG pH level of 7.35
d. A pCO2 level over 50 mmHg
e. A respiratory rate of over 16/minute - answer- b, d
Respiratory diseases can cause such compromise that the patient will suffer symptoms;
however, there are certain clinical indicators that can clarify whether the patient is
actually in respiratory failure. Clinical indicators of respiratory failure include pulse
oximetry of less than 91% on room air, PaO2 level less than 60 mmHg, and a pCO2
level of over 50 mmHg.
, 6) A nurse is caring for a patient who is in respiratory distress because of ARDS. Which
of the following nursing diagnoses would most likely be associated with this condition?
a. Ineffective thermoregulation
b. Impaired urinary elimination
c. Ineffective tissue perfusion
d. Disturbed personal identity - answer- c
7) A nurse walks into a client who is in respiratory distress. The client has a tracheal
deviation to the right side. The nurse knows to prepare for which of the following
emergent procedures?
a. Chest tube insertion on the left side.
b. Chest tube insertion on the right side.
c. Intubation
d. Tracheostomy - answer- a
Tracheal deviation indicates a pneumothorax, the direction of the deviation indicates the
side the pneumothorax is on. If the trachea is deviating to the right, then the pneumo is
on the left. The treatment for this is a chest tube on the side of trhe deflated lung.
You are caring for a patient with acute respiratory distress syndrome. As the nurse, you
know that prone positioning can be beneficial for some patients with this condition.
Which findings below indicate this type of positioning was beneficial for your patient with
ARDS?
A. Improvement in lung sounds
B. Development of a V/Q mismatch
C. PaO2 increased from 59 mmHg to 82 mmHg
D. PEEP needs to be titrated to 15 mmHg of water - answer- A and C.
Prone positioning helps improve PaO2 without actually giving the patient high
concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting
the V/Q mismatch).
You're precepting a nursing student who is assisting you to care for a patient on
mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the
PEEP setting is at 10 mmHg. Your response is:
A. "This pressure setting assists the patient with breathing in and out and helps improve
airflow."
B. "This pressure setting will help prevent a decrease in cardiac output and
hyperinflation of the lungs."
C. "This pressure setting helps prevent fluid from filling the alveoli sacs."
D. "This pressure setting helps open the alveoli sacs that are collapsed during
exhalation." - answer- d
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