Acute Respiratory Failure

A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. The nurse will anticipate assisting with:

• Administration of 100% oxygen by non-rebreather mask

• Endotracheal intubation and positive pressure ventilation

• insertion of a mini-tracheostomy with frequent suctioning

• Initiation of bilevel positive pressure ventilation (BiPAP)

What PaO2 value indicates respiratory failure in adults?

• PaO2 below 50

• PaO2 below 60

• PaO2 below 75

• PaO2 below 100

What are symptoms of Respiratory Failure? (Select All That Apply)

• Dyspnea

• Tachypnea

• Acrocyanosis

• Hypercapnia

• Irritability and agitation

When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first?

• Check pupil reaction to light

• Notify the health care provider

• Attempt to calm and reassure patient

• Assess oxygenation using pulse oximetry

The nurse is caring for a 22-year-old patient who came to the emergency department with acute respiratory distress. Which information about the patient requires the most rapid action by the nurse?

• Respiratory rate 32 breaths/min

• Pattern of breathing is shallow

• The patient’s PaO2 is 45 mm Hg

• The patient’s PaCO2 is 32 mm Hg

To evaluate the effectiveness of prescribed therapies for a patient with ventilator failure, which diagnostic test will be most useful to the nurse?

• Chest x-ray

• Pulse oximetry

• Arterial blood gas (ABG) analysis

• Pulmonary artery pressure monitoring

A nurse in an emergency department is assessing a client who was in a motor vehicle crash. Findings include absent breath sounds in left lower lobe with dyspnea, BP 118/68 mm Hg, HR 124/min, RR 38/min, T 101.4 degrees F, and SaO2 at 92% room air. Which of the following actions should the nurse take first?

• Obtain chest x-ray

• Administer oxygen via high flow mask

• Prepare chest tube insertion

• Initiate IV access

Acute Respiratory Failure is cause by:

• Ventilatory Failure

• Oxygenation Failure

• Both A & B

• Ventilatory failure, Oxygenation failure, or a combination of both

A nurse getting the morning shift report, which of the patient’s given should she/he see first?

• Patient who has BP of 100/64, HR of 76, T 99.8, RR 24 with a productive cough, O2 SAT 91%

• Patient who has been on their call light for the last 30 minutes insisting on pain medication

• Patient who is waiting for discharge and wanting IV removed

• Patient who is having dyspnea on exertion or when lying down

A patient admitted to the emergency department with SOB and O2 SAT 90% and dropping. Oxygen is applied at highest capacity and the patient is still in distress, what should the nurse expect to happen next?

• Lay the patient in prone position

• Assist the patient to cough and deep breathe

• Prepare the patient to be intubated

• Administer a mucolytic