NCLEX® Review

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Chapter 3

NCLEX® Review

This activity contains 10 questions.

Which of the following would be risk factors of ALI for an older patient to develop? (Select all that apply)

	Blood Urea Nitrogen (BUN) - 35 mg / dl
	Triponin I - 0.45 ng/mL
	Positive Tensilon Test
	Prothrombin Time (PTT) - 15 seconds

Which of the following findings might the nurse identify as an abnormal change in the geriatric patient and are potential risk factors when assessing a patient with ALI / ARDS? (Select all that apply)

	Decreased cough and laryngeal reflex from changes in muscle strength.
	Fewer Ventilator/ perfusion (VQ) Mismatches with increased mucoid escalator functions.
	Increased AP diameter with increased residual volume.
	Decreased laryngeal response with increased work of breathing (WOB).

Which of the following positions would be best for the ventilated patient with Acute Respiratory Distress Syndrome (ARDS) based upon the rationale that is included?

	Semi-fowlers to allow diaphragm to work with gravitation pull to maximize the Work of Breathing (WOB).
	Prone to assist with redistributing blood flow to less damaged areas of the anterior chest of the lungs.
	Supine to allow the ventilator to work without resistance of the body weight when the patient is fully sedated.
	Right lateral rotated every 2 hours with the left lateral to improve drainage of secretions into the central bronchi for easier removal when suctioning.

With a "shift to the right" on the Oxyhemaglobin Dissociation Curve, the nurse would expect to assess for what potential source of the shift?

	Hyperthermia
	Low CO₂ levels
	Peripheral cyanosis
	Septic shock with elevated WBCs

When reviewing the results of Pulmonary Functions Testing, the nurse would understand that which of the following would be present with long-term chronic respiratory disease and would need to be taken into consideration when setting ventilator guidelines?

	Increased Total Lung Capacity (TLC)
	No change in the Tidal Volume (VT)
	Increased Inspiratory Reserve Volume (IRV)
	Increased Residual Volume (RV)

When planning care for the patient who has an order for an invasive mechanical ventilator (IMV), the nurse would understand that IMV is:

	To maximize gas perfusion /exchange.
	To sustain ventilation through a negative pressure ventilation process.
	To relieve respiratory muscle fatigue and artificially maintain the airway and ventilation when the patient is unable to do so.
	To increase work of breathing (WOB) for treatment of a drug overdose.

Which order would the nurse question based upon the various settings and norms for measuring effective mechanical ventilation in an intubated patient?

	Flow rate = 60 L / minute or 4 times the minute volume of tidal volume(VT).
	Sensitivity synchronized to patient's intrinsic respiratory rate to prevent hyperventilation.
	Positive End Expiratory Pressure (PEEP) = 30 cm H2O.
	High Pressure Limit is set within normal ranges for Acute Lung Injury (ALI).

A patient recovering from ALI is on a ventilator set on Continuous Positive Airway Pressure (CPAP) mode. This setting indicates to the nurse that the patient:

	needs to be on an Acetylcholine Blocker drug to promote maximal ventilation/perfusion.
	is receiving a pre-set number of ventilations each minute.
	most likely has a need for high concentrations of oxygen.
	is being weaned and is breathing spontaneously.

The nurse would anticipate the use of which of the following drugs for emergent induction, intubation and sedation of a patient with Acute Respiratory Distress Syndrome (ARDS) that requires ventilation? (Select all that apply)

	Fentanyl (Duragesic, Sublimaze)
	Propofol (Diprivan)
	Midazolam (Versed)
	Nitrous Oxide

When assessing a patient who has a tracheostomy tube for invasive mechanical ventilation (IMV), which assessment would require immediate action by the nurse?

	A sad facial expression and a lack of interest in self-care.
	Oxygen saturation of 89%.
	Cross contamination of the trach tube when the patient continues to cover the opening with a bare unwashed finger to be able to talk.
	Minor red streaks noted in the secretions when being suctioned.

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Some questions in this exercise may have more than one correct answer. To answer such questions correctly, you must select all the correct answers.

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