A client is admitted to the emergency department with increasing shortness of breath and fatigue. The nurse places the client on a pulse oximeter. Which oxygen saturation level indicates a need for immediate intervention?

What is the primary purpose of mechanical ventilation in a patient with respiratory failure and signs of respiratory muscle fatigue?

A nurse is assessing a patient who is unresponsive following blunt chest trauma. The nurse notes paradoxical chest movement. What is the priority nursing action?

Which arterial blood gas (ABG) value on a diagnostic chart indicates a hallmark of acute respiratory distress syndrome (ARDS)?

7. Pin on

A client with ARDS is showing signs of worsening condition. Which of the following findings should the nurse expect?

Which method should the nurse use to provide immediate ventilation to an apneic client?

A trauma patient presents with no breath sounds on the right side. What is the most likely cause?

A patient in respiratory distress has an RR of 32 and unequal chest wall expansion. What should the nurse suspect?

The nurse is caring for a client with acute respiratory distress syndrome (ARDS) following chest trauma. Which of the following findings would most concern the nurse and indicate a worsening condition?

The nurse is caring for a patient who sustained multiple injuries in a motor vehicle accident. The client is receiving high-flow oxygen, but their PaO2 remains critically low. Which of the following findings is most indicative of acute respiratory distress syndrome (ARDS)?

Which ICU client is most likely to need mechanical ventilation due to acute respiratory distress syndrome? (ARDS)

Which ventilator adjustment helps improve oxygenation in ARDS patients?

Which chest tube drainage amount requires immediate reporting to the healthcare provider?

A client in the ICU suddenly develops JDV and absent breath sounds on the left side, tachycardia, and distended neck veins. What does the nurse suspect?

What should the nurse do if continuous bubbling is observed in the water seal chamber of a chest tube?

Tell if the following are Anticipated, Contraindicated, or Non essential for thoracentesis: A. IV line B. ABG (arterial blood gas) C. Chest tube insertion D. CT scan of the chest E. Thoracentesis

Which of the following requires immediate intervention?

A trauma patient is reporting severe rib pain. What is the best initial nursing action?

What is the priority goal for a patient with respiratory distress?

Which combination is most effective for DVT prevention in post-op patients?

A ventilated patient is hyperventilating. What ventilator setting should be adjusted?

A ventilated patient is becoming agitated. What should the nurse do first?

A trauma patient involved in a motor vehicle accident presents with multiple rib fractures on one side of the chest. The nurse observes that the affected area of the chest moves inward during inspiration and outward during expiration. What is this finding most indicative of?

A nurse is reviewing the pathophysiology of acute respiratory distress syndrome (ARDS) with a group of students. Which of the following best describes the primary problem occurring at the alveolar level in ARDS?

The nurse is assessing a client suspected of having acute respiratory distress syndrome (ARDS). Which of the following findings support this diagnosis? Select all that apply.

The nurse is caring for a client being mechanically ventilated. The PEEP has been increased several times throughout the day. The client’s blood pressure suddenly drops from 124/78 to 80/54 and the oxygen saturation (SpO2) drops from 98% to 82%. At 1000, considering the data below what is the priority action?

A client has an oral endotracheal tube (ETT) inserted to relieve an upper airway obstruction and to facilitate removing secretions. What is the first responsibility of the nurse immediately following tube placement?

A client diagnosed with acute respiratory distress syndrome is having increased difficulty breathing. The arterial blood gas indicates and arterial oxygen saturation of 54% on oxygen at 10 l per minute. What intervention should the nurse implement first?

The nurse is caring for a client who has fractured ribs due to a motor vehicle accident. The nurse notes the client’s respirations are shallow with spinning of right chest wall. What intervention should the nurse initiate first?

What is a potential complication of mechanical ventilation?

What type of shock can result from a pneumothorax?

A Trauma patient has JVD, muffled heart sounds, and BP 79/50. What should the nurse prepare for?

What is the priority goal for a patient with a pneumothorax and chest tube?

What instruction should the nurse give during chest tube removal?

The nurse is caring for a client being mechanically ventilated. When the high-pressure alarm sounds, with no obvious cause, what is the priority intervention?

A nurse needs to administer 8 mL/hr using a tubing with a drop factor of 15 gtt/mL. What is the correct flow rate?

Which of the following is a potential cause of ventilator-associated pneumonia (VAP) in an ICU patient?

When filling the humidification chamber of a ventilator, what fluid should the nurse use?

Which set of arterial blood gas findings is most consistent with ARDS?

Which instruction should the nurse give a patient with a recent pulmonary embolism?

Which ventilator alarm change is most likely caused by patient coughing or airway secretions?

A patient with infiltrates on chest x-ray is increasingly dyspneic. Which interventions are appropriate? Select all that apply.

A client with severe ARDS is on 100% FiO₂. What interventions may be required to improve oxygenation? Select all that apply.

Which action should the nurse question in ventilator care?

A client receiving oxygen has a PaO₂ of 25 mmHg. What does this indicate?

Which finding may indicate a complication from prolonged mechanical ventilation?

A patient not on mechanical ventilation has low oxygen saturation. What intervention should the nurse implement?

A patient with ARDS remains hypoxemic despite receiving high levels of oxygen. What does this indicate?

A ventilated ARDS patient has an oxygen saturation of 89%. What is the nurse’s priority action?

Which of the following patients is most at risk for pulmonary embolism?

A trauma patient is increasingly hypoxic, tachypneic, and restless. Chest x-ray shows bilateral infiltrates. What complication should the nurse anticipate?

The nurse is caring for a client being mechanically ventilated. When the high-pressure alarm sounds, with no obvious cause, what is the priority intervention?

The nurse is caring for a client with a chest tube. When the client reports increasing shortness of breath, what is the priority action?

The nurse is caring for a client diagnosed with pulmonary embolism (PE). What goal should be included in the care plan?

The nurse is caring for a client being mechanically ventilated. The PEEP has been increased several times throughout the day. The client’s blood pressure suddenly drops from 124/78 to 80/54 and the oxygen saturation (SpO2) drops from 98% to 82%. At 1000, considering the data below what is the priority action?

A nurse is caring for a client with an extensive pulmonary embolism and a medical history of hemorrhagic stroke. The client has a blood pressure of 78/46 mm/Hg and heart rate of 120 bpm. What is the best treatment option for this client?

The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who becomes hypotensive. What is most likely to be the cause of hypotension in this client?

The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who becomes hypotensive. What is most likely to be the cause of hypotension in this adult?

A nurse is caring for a client diagnosed with acute respiratory distress syndrome (ARDS). The client is intubated and receiving oxygen at 40% (FiO2 0.4). What is the priority laboratory value to report to the healthcare provider?

A client involved in a motor vehicle accident 36 hours ago. The nurse caring for this client plans frequent assessments to monitor for what high-risk complication?

Family members of a client with acute respiratory distress syndrome (ARDS) are very anxious and ask if the client is going to die. What is the best option to address the family’s immediate concerns?

A client has an oral endotracheal tube (ETT) inserted to relieve an upper airway obstruction and to facilitate removing secretions. What is the first responsibility of the nurse immediately following tube placement?

A client with a recent spinal cord injury reports sudden difficulty breathing. What complication should the nurse suspect?

After completing continuous renal replacement therapy (CRRT), when should the nurse anticipate the client will likely resume regular dialysis?

The nurse is caring for a client diagnosed with a pulmonary embolism (PE) what goal should be included in the plan of care?

The client diagnosed with acute respiratory distress syndrome is having increased difficulty breathing, and the arterial blood gas indicates an arterial oxygen saturation of 54% on oxygen at 10 L per minute. What intervention should the nurse implement first?

A patient with respiratory failure has a respiratory rate of 6 breaths/min and an oxygen saturation (SpO2) of 78%. The patient is increasingly lethargic. Which intervention will the nurse anticipate?

The nurse is assessing a client with blunt chest trauma and finds equal breath sounds muffled heart sounds and distended neck veins. The blood pressure is 80/50 and heart rate is 120 based on these findings what is the priority nursing action?

The nurse is caring for clients admitted to the ICU. Which client is most likely to need mechanical ventilation due to acute respiratory distress syndrome?

The nurse is assessing a pt with blunt chest trauma and finds equal breath sounds, muffled heart sounds, and distended neck veins. The BP is 80/50 and hr is 120. Based on these findings, what is the priority nursing action?

The nurse caring for a client with acute respiratory distress syndrome on mechanical ventilation. The spo2 is decreasing despite increasing the fio2 several times. What order from the healthcare provider should the nurse implement first?

A client involved in a motor vehicle accident 36 hour ago. The nurse caring for this client plans frequent assessments to monitor for what high risk complication?

A client is receiving mechanical ventilation via a cuffed tracheostomy tube. The ventilator alarm is activated and the nurse can hear the client speak. What is most likely the problem?

What is the correct action to take regarding the chest drainage system during ambulation?

Here is Bubbling in the water seal chamber, and on the other chamber when the patient breaths it tide up and down with respirations?

Pt on a ventilator drops their O2 SATs and is struggling to breath and the alarms are going off. What do you do?

What is the primary purpose of applying positive end-expiratory pressure (PEEP) in a patient receiving mechanical ventilation?

The nurse is assessing a client suspected of having a pulmonary embolism (PE). Which of the following are common clinical manifestations?

The nurse is caring for a client in the intensive care unit, who develops absent breath sounds on the left side, tachycardia and distended neck veins. What does the nurse suspect is the cause for the change in the client’s condition?

The nurse is caring for a client with chest tube due to pneumothorax. What is the priority goal of care for this client?

The nurse is caring for a client who is about to have the chest tube removed by the health care provider. What would the nurse instruct the client to do when the tube is about to be removed? Rational: During chest tube removal it is important to have the client take a deep breath and hold it while bearing down.

A patient in the ICU with unstable hemodynamics requires dialysis. Which therapy is most appropriate?

A nurse is explaining the pathophysiology of respiratory failure due to a large pulmonary embolism. What mechanism primarily contributes to this complication?

A patient diagnosed with pulmonary embolism has a drop in SpO₂ from 94% to 88%. What is the nurse’s priority intervention?

A patient develops sudden restlessness and dyspnea. Which diagnostic test will most likely confirm a pulmonary embolism?

A nurse notes absent breath sounds in the left upper lung lobe of a trauma patient. What condition does this most likely indicate?

Which symptom is most commonly associated with a pulmonary embolism?

A patient develops ARDS following multiple respiratory infections. What finding is characteristic of this condition?

The nurse assists with endotracheal intubation. After confirming the cuff is inflated, what is the first action the nurse should take?

A client has a SpO₂ of 84% with abnormal ABG values and signs of respiratory distress. What is the nurse’s priority action?

The high-pressure ventilator alarm is activated and the cause is unknown. What is the nurse’s priority action?

Which task is appropriate for the nurse to delegate to a UAP (unlicensed assistive personnel)?

Which of the following is considered a hallmark sign of a pulmonary embolism (PE) that the nurse should assess for?

Which nursing interventions are effective in the prevention of pulmonary embolism in hospitalized patients?

The nurse is caring for a patient receiving mechanical ventilation with PEEP. Which of the following statements about PEEP and ventilation are correct?