Respiratory

The patient intubated in the intensive care unit has the following arterial blood gas results: pH 7.21 PCO2 51 PaO2 38 HCO3 16 Base Excess -7 Which action does the nurse take first?

Which arterial blood gas result is most indicative that the intubated and mechanically ventilated patient is ready to have the ventilator rate weaned?

The nurse is reviewing the lab results of a patient in the intensive care unit and finds the patient’s lactate to be 5.4 mmol/L. Which additional value is most responsible for this value?

The patient has hyperlactatemia. Which lab value concerns the nurse the most about the patient’s risk for long-term sequelae?

Following an accidental overdose of acetaminophen, the patient has a lactate level of 5.6 mmol/L. Which compensatory change in the patient will the nurse observe first?

The patient’s arterial blood gas and serum electrolyte results are as follows: pH 7.28, PCO2 = 32, PaO2 = 59, HCO3- = 16, SaO2 = 88%, Sodium = 149, Potassium 3.9, Chloride 112. Calculate this patient’s anion gap. Enter your answer using a whole number.

The patient with metabolic acidosis is determined to have an anion gap of 11 mmol/L. The nurse advocates for which additional lab test?

The 56-year-old intubated and sedated patient’s arterial blood gas results are as follows: pH = 7.25, PCO2 = 36, PaO2 = 50, HCO3- = 15, SaO2 = 86%. Other lab values are notable for a hemoglobin of 7.9 mg/dL, albumin of 2.5 g/dL, sodium of 152 mEq/L, potassium of 2.1 mEq/L, chloride of 118 mEq/L. Vital signs are notable for a heart rate of 118 bpm, blood pressure of 86/38 mmHg, temperature of 102°F, and pulse oximetry of 85% on room air. The nurse advocates for which order?

During routine tracheostomy care, the nurse notes increased drainage from the stoma and a fruity, grape juice odor. The nurse obtains a culture of the secretions and anticipates the results will reveal which organism?

During routine tracheostomy cleaning and care, the nurse notes a strong smell of dirty gym socks coming from the dressing around the stoma. Which action by the nurse is most appropriate?

Which patient does the nurse assess first?

A nurse is caring for a patient who is recovering from total hip replacement surgery. The patient has required increasing doses of IV morphine for pain control. The patient is again reporting 10/10 pain despite receiving 10 mg of morphine from the nurse, which is the top of the range ordered by the physician. The nurse monitors which of the following most closely?

The nurse is teaching the child with asthma how to use a metered-dose inhaler. Which instructions does the nurse include? Select all that apply.

The patient with chronic obstructive pulmonary disease (COPD) is brought to the post-anesthesia care unit (PACU) after abdominal surgery. Which symptom alerts the nurse to an impending complication?

The nurse is caring for a patient with pneumonia and fulminant pulmonary arterial hypertension. The patient is intubated and mechanically ventilated receiving inhaled nitric oxide (iNO). Additionally, the patient has a central line with multiple continuous infusions, including norepinephrine, vecuronium, morphine, and propofol. During the shift, the nurse begins to have difficulty breathing, a dry throat, syncope, and chest pain. Which action does the nurse take first?

The patient receiving inhaled nitric oxide (iNO) is at risk for which adverse event?

The unconscious patient presents with the following respiratory pattern: The nurse anticipates further testing will reveal which condition?

Following a motor vehicle accident, the unconscious patient presents with a respiratory rate of 28 and the following respiratory pattern: The nurse expects which acid-base derangement?

The patient with severely elevated intracranial pressure that has been well-controlled with medication and CSF drainage is intubated and sedated; the most recent arterial blood results are as follows: pH = 7.32, pCO2 = 35 mm Hg, PaO2 = 58, HCO3- = 16, Base excess = -7. The nurse advocates for which order to change ventilatory support?

What is the rationale for using hyperventilation as management for acute elevated intracranial pressure?

The patient presents to the emergency department (ED) with significant respiratory distress. Decreases in which patient characteristics support a diagnosis of restrictive pulmonary disease? Select all that apply.

Which patients are at risk for restrictive pulmonary disease? Select all that apply.

The patient is hospitalized with severe asthma. Which assessment prompts the nurse to call the rapid response team?

Which vital sign is most indicative of severe air trapping?

The patient with severe asthma is found to be pale, diaphoretic, and agitated. Which assessment is most concerning?

The 64-year-old male patient with chronic obstructive pulmonary disease related to a 42-pack-year history of smoking is receiving ipratropium bromide. Which symptom indicates the patient is experiencing an adverse effect of this medication?

Which statement by the patient with asthma indicates a need for further teaching?

The nurse plans care for the patient who is receiving theophylline for the treatment of refractory asthma. Which nursing intervention does the nurse include to assess for complications of the drug?

The patient receiving inhaled nitric oxide (iNO) for severe pulmonary hypertension experiences an abrupt decrease in oxygen saturation. Which action does the nurse take first?

The condition of the patient with a pulmonary hypertensive crisis due to pneumonia has improved. Which order does the nurse question?

The 66-year-old patient with congestive heart failure is brought to the emergency department (ED) via ambulance with complaints of respiratory distress and increasing oxygen requirement. Which assessment indicates the patient is experiencing acute respiratory distress syndrome (ARDS) rather than a congestive heart failure (CHF) exacerbation?

Which are indirect causes of acute respiratory distress syndrome (ARDS)? Select all that apply.

The patient with acute respiratory distress syndrome (ARDS) experiences destruction of type II pneumocytes. This damage first results in which pathophysiological event?

The destruction of type I pneumocytes caused by acute respiratory distress syndrome (ARDS) is associated with which assessment characteristic?

Upon auscultation of the anterior chest wall, the nurse notes a rubbing sound. Which action does the nurse take next?

The patient presents with concern for a respiratory virus with a cough. The nurse uses which question to assess the “Q” in the PQRST mnemonic?

Which patient does the emergency department nurse assess first?

Which instruction does the nurse give the patient during preoperative teaching prior to a middle ear surgery?

In the post-anesthesia care unit (PACU) 30 minutes after surgery, the patient is noted to have a blue tinge around the lips. Which action does the nurse take first?

The nurse is called to the intubated patient’s room by the patient's child who reports a large gush of red-tinged fluid from a transverse abdominal wound after the patient coughed. While calling for help, the nurse ensures the patients bed is set to which degree angle?

On day four postop following an open abdominal surgery, the patient develops a cough. During an assessment, the patient coughs, and the wound dehisces. The nurse notes intestinal loops are visible outside of the wound. Which initial intervention by the nurse is appropriate?

The elderly patient receiving a continuous morphine infusion for the treatment of cancer pain is at risk for opioid-induced respiratory depression. The nurse selects which monitoring device to most quickly detect a change in the patient’s respiratory drive?

The patient receiving a continuous hydromorphone infusion for severe cancer pain is found to be unconscious with a respiratory rate of 7 breaths per minute. Which action does the nurse take first?

Which patient is at greatest risk for respiratory depression due to the inability to adequately excrete fentanyl?

The nurse is evaluating discharge teaching for the patient receiving hydrocodone/acetaminophen for the treatment of acute pain due to femur fracture. Which statement by the patient indicates teaching was effective?

What is the main rationale for prescribing hydrocodone with acetaminophen?

The patient has right-sided hemiplegia following a cerebrovascular accident. Interventions to prevent which complication are the priority of care?

The nurse is educating the student nurse on the management of the patient who is mechanically ventilated via an endotracheal tube in the intensive care unit. Which information does the nurse provide to the student nurse?

Which is a late sign of hypoxemia?

The hospitalized patient is found unresponsive and the cardiopulmonary monitor shows ventricular fibrillation. Upon assessment, no pulse or respiratory effort are appreciated. A code blue is called and the defibrillator is being brought to the room. Which initial intervention is appropriate?