Respiratory
Failure
Failure
A 62-year-old COPD patient on 2L O₂ suddenly becomes restless and confused. ABGs show PaO₂ 55 mmHg, PaCO₂ 65 mmHg. What complication is the nurse most concerned about?
A. Pulmonary embolism
B. Respiratory failure
C. Myocardial infarction
D. Metabolic alkalosis
Answer: B. Respiratory failure
Rationale: PaO₂ < 60 and PaCO₂ > 50 with restlessness indicates acute respiratory failure. The body can no longer maintain adequate gas exchange even at rest.
Which disorder is a common cause of ARDS?
A. Hypertension
B. Sepsis
C. Hyperthyroidism
D. Diabetes
Answer: B. Sepsis
Rationale: Sepsis is the leading cause of ARDS due to systemic inflammation.
A high-pressure alarm sounds. The nurse’s first action is to:
A. Silence the alarm
B. Check tubing for kinks or secretions
C. Decrease sedation
D. Call respiratory therapy
Answer: B. Check tubing for kinks or secretions
Rationale: High pressure = obstruction → check for kinks/secretions first.
During extubation prep, the nurse suctions the patient. Why?
A. To prevent aspiration during tube removal
B. To check for low-pressure alarms
C. To sedate the patient
D. To assess vocal cords
Answer: A. To prevent aspiration
Rationale: Suctioning removes secretions above the cuff to prevent aspiration.
Which intervention helps prevent VAP?
A. Supine positioning
B. Frequent oral care
C. Limiting suctioning
D. Restricting fluids
Answer: B. Frequent oral care
Rationale: Oral care and HOB elevation reduce risk of ventilator-associated pneumonia.
A patient’s ABGs show PaO₂ 55, PaCO₂ 52, pH 7.29. What does this indicate?
A. Respiratory insufficiency
B. Respiratory failure
C. Metabolic acidosis
D. Hyperventilation
Answer: B. Respiratory failure
Rationale: PaO₂ <60 and PaCO₂ >50 with acidosis = acute respiratory failure.
Early signs of ARDS include:
A. Severe cyanosis and crackles
B. Restlessness and subtle changes in orientation
C. Bradypnea and confusion
D. Pulmonary edema on chest X-ray
Answer: B. Restlessness and subtle orientation changes
Rationale: Early ARDS presents with subtle mental status and VS changes before hypoxemia worsens.
A low-pressure alarm is sounding. Which is the most likely cause?
A. Secretions in ETT
B. Patient coughing
C. Disconnected tubing
D. Pneumothorax
Answer: C. Disconnected tubing
Rationale: Low pressure = loss of connection or leak in the system.
A patient being weaned develops HR 122, RR 32, PaO₂ 58. What should the nurse do?
A. Continue weaning
B. Return to ventilator support
C. Increase FiO₂
D. Administer opioids
Answer: B. Return to ventilator support
Rationale: Signs of weaning intolerance require immediate ventilator support.
A ventilated patient develops subcutaneous emphysema and absent breath sounds on one side. The nurse suspects:
A. VAP
B. Pulmonary embolism
C. Pneumothorax
D. Pleural effusion
Answer: C. Pneumothorax
Rationale: Barotrauma from ventilation can cause pneumothorax.
Which assessment finding best indicates hypoxia at the tissue level?
A. ABG PaO₂ 59
B. Cyanosis and mottling
C. Respiratory rate 32
D. PaCO₂ 48
Answer: B. Cyanosis and mottling
Rationale: Hypoxia = poor tissue oxygenation → mottling, cyanosis, and risk for dysrhythmias.
In ARDS, mechanical ventilation is used with PEEP primarily to:
A. Increase FiO₂ to 100%
B. Keep alveoli open for gas exchange
C. Decrease respiratory rate
D. Prevent infection
Answer: B. Keep alveoli open
Rationale: PEEP prevents alveolar collapse, improving oxygenation and surface area for gas exchange.
ABGs show pH 7.49, PaCO₂ 30. The nurse should anticipate ventilator changes to:
A. Increase rate
B. Decrease tidal volume or rate
C. Increase FiO₂
D. Add more PEEP
Answer: B. Decrease tidal volume or rate
Rationale: Low CO₂ + alkalosis = over-ventilation → decrease RR or volume.
Which nursing action supports successful weaning?
A. Restricting fluids
B. Giving a high-protein meal before trial
C. Avoiding mouth care
D. Sedating before trial
Answer: B. Giving a high-protein meal
Rationale: High-protein meals help maintain strength and support respiratory muscle function.
Why are patients on vents at risk for fluid retention?
A. Increased ADH and RAAS activation
B. High protein loss
C. Diuretic use
D. Excess IV fluids
Answer: A. Increased ADH and RAAS
Rationale: Positive pressure ventilation decreases venous return, triggering RAAS & ADH.
A patient with pneumonia develops dyspnea, RR 35, and accessory muscle use. Which intervention should the nurse anticipate?
A. Encourage incentive spirometry only
B. Prepare for intubation and mechanical ventilation
C. Increase oral fluid intake
D. Administer antitussive medication
Answer: B. Prepare for intubation
Rationale: Severe tachypnea with poor oxygenation requires mechanical ventilation.
A chest X-ray of an ARDS patient shows diffuse bilateral infiltrates (“white out”). This finding indicates:
A. Pulmonary embolism
B. Worsening alveolar damage
C. Pneumothorax
D. Atelectasis only
Answer: B. Worsening alveolar damage
Rationale: “White-out” = widespread alveolar fluid and collapse typical of ARDS progression.
Which ventilator mode provides full preset volume but allows spontaneous breaths?
A. Pressure support ventilation (PSV)
B. Synchronized intermittent mandatory ventilation (SIMV)
C. CPAP
D. BiPAP
Answer: B. SIMV
Rationale: SIMV = set breaths with volume control, while allowing patient spontaneous breaths.
Which acronym guides extubation assessment?
A. ABC
B. MOVE
C. FAST
D. SBAR
Answer: B. MOVE
Rationale: MOVE = Mental status, Oxygenation, Ventilation, Expectorate → criteria for extubation readiness.
Which nutrition plan best supports a ventilated patient?
A. High-carbohydrate diet
B. High-protein, low-carb formula
C. Low-fat, low-protein
D. Clear liquid diet
Answer: B. High-protein, low-carb
Rationale: High protein preserves muscle strength; low carbs decrease CO₂ load and work of breathing.
Which condition most often causes a transudative pleural effusion?
A. Pneumonia
B. CHF
C. Tuberculosis
D. Lung cancer
Answer: B. CHF
Rationale: Transudative = protein-poor fluid from increased hydrostatic pressure, often due to CHF.
The nurse is titrating oxygen in an ARDS patient. Which goal is most appropriate?
A. SaO₂ 100% on 100% FiO₂
B. SaO₂ > 90% on the lowest FiO₂ possible
C. PaO₂ > 200 mmHg regardless of FiO₂
D. SpO₂ > 80%
Answer: B. SaO₂ > 90% on lowest FiO₂ possible
Rationale: Goal = adequate oxygenation with the least FiO₂ to avoid O₂ toxicity.
While checking vent settings, the nurse notes FiO₂ 80% and PEEP 15 cm H₂O. What is the priority assessment?
A. Blood glucose
B. Signs of barotrauma and hypotension
C. Pupillary response
D. Pain score
Answer: B. Signs of barotrauma and hypotension
Rationale: High PEEP = risk of pneumothorax and ↓ cardiac output due to increased intrathoracic pressure.
What is involved with taking out an ETT
pt takes a deep breath, ETT is pulled out on expiration - air in ballon is pulled out BEFORE ETT is pulled out
Which ICU bundle reduces vent complications, delirium, and immobility?
A. ABCDE Bundle
B. FAST Exam
C. SBAR Report
D. RACE Protocol
Answer: A. ABCDE Bundle
Rationale: ABCDE = Awakening, Breathing trials, Coordination, Delirium monitoring, Early mobility, Family → improves outcomes.