NUR 254 TEST 3 Ch.2
- The nurse would carefully assess a pt with for the development of
ARDS?
Answer Sepsis ( & aspiration are the most likely to develop ARDS)
- A pt with ARDS are anxious all morning. They are now less responsive & difficult to
arouse.This is likely due to?
Answer Hypercapnia (hypercarbia) = increase in carbon dioxide in the bloodstream
- The nurse inspects the chest of a patient with ARDS and notices the musculature in between
the ribs "dipping in" with breathing. This would be accurately documented as?
Answer Intercostal retractions
- What is the reason a pt would receive Rocoronium or Succinylcholine?
- They are non-sedating, non-amnesic and non-analgesic drugs. Sometimes used in severe
Answer
ARDs pt who are mechanically ventilated and who need paralytic agents to prevent barotrauma and have better respirations with the vent.
**Typically found in Rapid Sequence Intubation (RSI) kits and used for initial intubation
- PEEP is increased from 5 to 10 for a pt w/ ARDS. What is a major pulmonary complication
the nurse should assess for related to this change?
Answer Barotrauma (such as pneumothorax)
- Which clinical manifestation is highly indicative of ARDS (as opposed to some other
complication)? 1 / 2
Answer
Refractory hypoxemia
- The nurse should implement which of the following interventions for a mechanically
ventilated pt?
Answer Explain all care activities
- What are the expected outcomes of mechanical ventilation for a pt w/ ARDS for the O2
saturation measurement & the PaO2 measurement?
Answer O2 sat >90% & PaO2 > 60mmHg
- The nurse is assessing a pt on a ventilator who started a "weaning trial" 30 min ago. Provide 3
assessment findings that indicate the trial is unsuccessful & needs to be stopped?
Answer Tachypnea
Tachycardia Labored breathing O2 saturation dropping Any other signs of increasing respiratory distress
- Shock is a SYNDROME resulting from a decrease in , that
causes inadequate resulting in ischemic organs/tissues that cannot carry out cellular metabolism?
Answer blood flow;oxygenation
- When monitoring for effectiveness of treatment, which value is often used to titrate
medications such as norepinepherine as it is an indicator of tissue perfusion?
Answer MAP
- What finding indicated progression from early to intermediate shock?
- / 2