1. The nurse is caring for a patient who is hyperventilating. Which acid-base imbalance is the patient at risk for developing due to hyperventilation? A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. 2. The nurse is caring for a trauma patient. How should the nurse interpret the patient’s arterial blood gas (ABG) results: pH 7.26, PaCO2 38 mm Hg, HCO3 11 mEq/L? A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. 3. The nurse is caring for a patient who is short of breath. How should the nurse interpret the patient’s arterial blood gas (ABG) results: pH 7.21, PaCO2 64 mm Hg, HCO3 24 mEq/L? A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. 4. The nurse is caring for a patient in acute respiratory failure who is receiving mechanical ventilation. Which assessment is priority for the nurse to use to evaluate the effectiveness of the mechanical ventilation? A. Heart rate. B. Capillary refill. C. Blood pressure. D. Arterial blood gas. 5. Which laboratory findings should the nurse expect for a patient in acute respiratory failure? A. SaO2 92%. B. PaO2 58 mm Hg. C. Arterial pH 7.50. D. PaCO2 25 mm Hg. 6. The nurse is caring for a patient who has labored respirations, an irregular breathing pattern, and asymmetrical chest movement. Which device should the nurse use to provide the highest level of oxygen via a low-flow system in this patient? A. Nasal cannula. B. Simple face mask. C. Non-rebreather mask. D. Partial rebreather mask. 7. A patient comes to the emergency department after experiencing trauma to the chest. The patient is restless and the nurse auscultates diminished breath sounds unilaterally and observes a deviation in the patient’s trachea. Which condition should the nurse anticipate the patient has developed? A. Bronchitis. B. Pneumothorax. C. Pulmonary embolism. D. Exacerbation of asthma. 8. The nurse is caring for a patient diagnosed with acute exacerbation of COPD. The patient begins to have shallow breathing, using accessory muscles, and begins to gasp for air. The patient’s respiratory rate is 8 breaths per minute and SpO2 is 89%. Which procedure should the nurse anticipate for the client? A. Chest tube insertion. B. 100% oxygen via non-rebreather mask. C. Tracheostomy insertion with frequent suctioning. D. Endotracheal intubation and positive pressure ventilation. Could also use NPPV 9. The nurse is caring for a patient diagnosed with right lung pneumonia. In which position should the nurse place the patient in to facilitate maximum gas exchange? A. Trendelenburg position B. Right side-lying position. C. Supine with head elevated 15 degrees. D. Positioned with the left side dependent. 10. The nurse is caring for a patient diagnosed with a pulmonary embolism. Which action should the nurse take first if the patient’s SpO2 decreases from 96% to 88%? A. Increase the rate of oxygen. B. Provide nasopharyngeal suctioning. C. Auscultate the patient’s lung sounds. D. Encourage the patient to cough and deep breathe. Review • What are safety actions taken in complex adult health? o Take care of lines, VAP protocol, surveillance/isolation, central lines and surgical sites clean, get rid of foley’s as soon as we can, IV patency before flushing lines o Wash hands, keep lines clean, be meticulous about prep lines • NPPV contraindicated- ex. facial fractures, overdose, claustrophobia • When do you intubate vs use NPPV- respiratory arrest, slow and shallow breathing • High vs. low pressure alarms- what is the difference and how do you trouble shoot? o High- Increased secretions, wheezing, bronchospasm causing decreased airway, displaced ETT, ventilator tubing is blocked because of water or kink in tubing, Client cough/gag/bite, Client is anxious and “fights” ventilator o Low- disconnected, dislocated, leak o Trace the circuit back to other end, they sound the same have to go and look o If a circuit is disconnected- connect it back asap • Which lung situation would you use high levels of PEEP? Why? o ARDS o Lungs stiff, alveoli not exchanging gas appropriately • How do we treat MODS?