Critical Care exam 1: respiratory
Practice questions
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 - ✔️✔️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.
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 - ✔️✔️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.
,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 - ✔️✔️c
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 - ✔️✔️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.
A 26-year-old patient is admitted to the hospital in severe respiratory distress. His
oxygen saturations are 80% despite supplemental oxygen provided by a facemask. The
provider decides to intubate the patient to help with his breathing oxygenation. Which
medication would the nurse most likely administer when assisting with intubation?
a. Modafinil (Provigil)
b. Phentermine (Adipex-P)
c. Etomidate (Amidate)
d. Zolpidem (Ambien) - ✔️✔️c
"Etomidate (Amidate)" is correct. Intubation is most often performed by inserting a tube
into the mouth and passing it into the trachea in order to provide support for a patient's
breathing. Most registered nurses do not perform endotracheal intubation, but they can
assist the provider or respiratory therapist with placing the tube. The nurse may give
medications to sedate the patient during the procedure, since it can be traumatic for the
patient. Some medications given for sedation include etomidate, ketamine or
midazolam. Midazolam (Versed) is used less often due to its need for titration based on
weight, which is an extra step that is undesirable during rapid intubation. This extra step
can cause delays and errors during intubation.
-"Zolpidem (Ambien)" is incorrect because this is an oral tablet used to induce sleep for
the patient suffering from insomnia. This medication is not potent or rapid enough to be
used for intubation.
-"Phentermine (Adipex-P)" is incorrect because this is a stimulant, not a sedative and
would not be used during intubation.
, -"Modafinil (Provigil)" is incorrect because this is a stimulant drug. Stimulants produce
the opposite effect of what is necessary for patient intubation.
:
A 64-year-old man with moderate chronic obstructive pulmonary disease presents to
your office complaining that for the past 5 days, he has been experiencing worsening
shortness of breath. He denies having fevers or chills, but he does report increasing
purulent sputum production. He visited his 6-year-old grandson this past weekend, and
the child had symptoms of an upper respiratory infection. The patient's vital signs are
normal except that oxygen saturation on room air is 88%. Examination reveals bilateral
expiratory wheezing. A chest radiograph is normal. Results of laboratory testing are as
follows: white blood cell count, 12,500/mm3; arterial blood gas pH, 7.35; arterial oxygen
tension (PaO2), 65 mm Hg; and carbon dioxide tension (PCO2), 60 mm Hg. You
arrange for hospital admission.
Which of the following is the most appropriate step to take next for this patient after he
is admitted to the hospital?
a. - ✔️✔️c
A 73-year-old man with hypertension, coronary artery disease, and diabetes mellitus
presents to your office complaining of a cough and shortness of breath. He reports that
for the past 3 or 4 days, he has been experiencing progressive dyspnea on exertion,
and he now has mild dyspnea at rest. He also states that he has been having fevers,
chills, and purulent sputum production over this period. He denies having come into
contact with anyone who was sick. Results of physical examination are as follows: blood
pressure, 124/87 mm Hg; heart rate, 95 beats/min; respiratory rate, 26 breaths/min;
temperature, 101.3° F (38.5° C); and oxygen saturation on room air, 88%. The patient
exhibits tachypnea without the use of accessory muscles. Bronchial breath sounds are
noted over the right lower lung zones consistent with consolidation. A chest radiograph
in the office confirms a right lower lobe infiltrate. You plan to admit the - ✔️✔️c
You're providing care to a patient who is being treated for aspiration pneumonia. The
patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign
and symptom that the patient is developing acute respiratory distress syndrome
(ARDS)?
A. The patient is experiencing bradypnea.
B. The patient is tired and confused.
C. The patient's PaO2 remains at 45 mmHg.
D. The patient's blood pressure is 180/96. - ✔️✔️c
A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where
that although the patient is receiving a high amount of oxygen the patient is STILL
hypoxic
