1. What keeps alveoli from collapsing?

a. Carina
b. Surfactant
c. Empyema
d. Thoracic cage

2. A 73-year-old patient has an SpO2 of 70%. What other assessment should the nurse consider
before making a judgment about the adequacy of the patient's oxygenation?
a. What the oxygenation status is with a stress test
b. Trend and rate of development of the hyperkalemia
c. Comparison of patient's SpO2 values with the normal values
d. Comparison of patient's current vital signs with normal vital signs

3. What is a primary nursing responsibility after obtaining a blood specimen for ABGs?
a. Add heparin to the blood specimen.
b. Apply pressure to the puncture site for 2 full minutes.
c. Take the specimen immediately to the laboratory in an iced container.
d. Avoid any changes in oxygen intervention for 15 minutes following the procedure.

4. What should the nurse do when preparing a patient for a pulmonary angiogram?
a. Assess the patient for iodine allergy.
b. Implement NPO orders for 6 to 12 hours before the test.
c. Explain the test before the patient signs the informed consent form.
d. Inform the patient that radiation isolation for 24 hours after the test is necessary.

5. Gas exchange and carbon dioxide diffusion takes place in:

a. The capillaries
b. The alveoli
c. The pulmonary vein
d. The pulmonary artery

6. TRACK YOUR PULOMNARY CIRCULATION

1. The right and left pulmonary arteries carry deoxygenated blood from the right side of the heart
to the lungs.
2. Venules—the end branches of the pulmonary veins—collect oxygenated blood from the
capillaries and transport it to larger vessels, which carry it to the pulmonary veins.
3. The pulmonary veins enter the left side of the heart, where oxygenated blood is distributed
throughout the body.
4. These arteries divide to form distal branches called arterioles, which terminate as a
concentrated capillary network in the alveoli and alveolar sac, where gas exchange occurs.
a. 1,4,2,3
b. 1,2,4,3
c. 2,3,4,1
d. 4,1,3,2

7. Which of the following term is referred to as hardening of the arteries?

a. Arteriosclerosis
b. Atherosclerosis
c. Thrombus
d. Embolus

NCM 118 | hrestorque
8. You are the nurse on duty, while doing the physical assessment you noticed that your patient
has SOB, increased depth of breaths and becomes cyanotic. What will be your appropriate
action?
a. Notify the physician immediately.
b. Continue and finish the physical assessment as this is important for the plan of care of the
patient.
c. Administer oxygen at 2L/min.
d. Call for a code.

9. Lower levels of oxygen saturation may indicate hypoxemia, which means?

a. There is less oxygenation in the blood
b. There is less oxygenation in the bodily tissues
c. There is less oxygenation in the brain
d. There is less oxygenation in the lungs

10. For continuous pulse oximetry, your primary nursing consideration is:
a. Appropriate placement of the pulse oximeter.
b. Protect the sensor away from strong light exposure.
c. Rotate the sensor site.
d. Monitoring of readings.

11. Which values indicate a need for the use of continuous oxygen therapy?
a. SpO2 of 92%; PaO2 of 65 mm Hg
b. SpO2 of 95%; PaO2 of 70 mm Hg
c. SpO2 of 90%; PaO2 of 60 mm Hg
d. SpO2 of 88%; PaO2 of 55 mm Hg

12. A patient's ABGs include a PaO2 of 88 mm Hg and a PaCO2 of 38 mm Hg, and mixed venous
blood gases include a PvO2 of 40 mm Hg and PvCO2 of 46 mm Hg. What do these findings
indicate?
a. Impaired cardiac output
b. Unstable hemodynamics
c. Inadequate delivery of oxygen to the tissues
d. Normal capillary oxygen–carbon dioxide exchange

13. A 75-year-old patient who is breathing room air has the following arterial
blood gas (ABG) results: pH 7.40, PaO2 74 mm Hg, SaO2 92%, PaCO2 40 mm Hg. What is the
most appropriate action by the nurse?
a. Document the results in the patient's record.
b. Repeat the ABGs within an hour to validate the findings.
c. Encourage deep breathing and coughing to open the alveoli.
d. Initiate pulse oximetry for continuous monitoring of the patient's oxygen status.

14. Which of the following procedures is done to evaluate pulmonary hypertension?

a. ABG
b. Pulmonary Capillary Wedge Pressure
c. Pulmonary Angiography
d. V/Q Scan

NCM 118 | hrestorque
15. Which of the following procedures is done to evaluate pulmonary circulation?
a. ABG
b. Pulmonary Capillary Wedge Pressure
c. Pulmonary Angiography
d. V/Q Scan

16. Which of the following is a post procedure nursing consideration following a pulmonary
angiogram?
a. Assessment of allergies.
b. Administration of anti-allergies to reduce reaction to dye.
c. Evaluate kidney functions.
d. Keep compression device at the bedside.

17. Which of the following is the main cause of impaired gas exchange?
a. V/Q mismatch
b. Perfusion inadequacy
c. Ventilation inadequacy
d. None of the above

18. Reduced perfusion to a lung unit occurs when alveoli don’t have adequate blood supply for gas
exchange to occur, such as with pulmonary emboli and pulmonary infarction.
a. Shunting
b. Dead Space Ventilation
c. Silent Unit
d. Normal V/Q

19. Reduced ventilation to a lung unit causes unoxygenated blood to move from the right side of the
heart to the left side of the heart and into systemic circulation.
a. Shunting
b. Dead Space Ventilation
c. Silent Unit
d. Normal V/Q

20. Occurs when little or no ventilation and perfusion are present.

a. Shunting
b. Dead Space Ventilation
c. Silent Unit
d. Normal V/Q

21. Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of
impaired gas exchange based on which finding?
a. SpO2 of 86%
b. Crackles in both lower lobes
c. Temperature of 101.4° F (38.6° C)
d. Production of greenish purulent sputum

22. ARDS is described as:

a. Infection that causes inflammation of the airsacs of the lungs
b. A life threatening injury that allows fluid to leak into the lungs
c. Collapse of the lungs brought about by the leak of air into the pleural cavity
d. Refers to a group of disease that causes air flow blockage

NCM 118 | hrestorque
23 – 25. What are the 3 hallmark signs of ARDS?

23. Bilateral patch infiltrates on chest X-ray

24. No signs or symptoms of heart failure

25. No improvement in Pao2 despite increasing oxygen delivery

26. This phase of ARDS is characterized by accumulation of excessive fluids in the lungs due to leaking of
fluids and acute injury.

a. Exudative
b. Proliferative
c. Fibrotic
d. Stage IV

27. Which phase of ARDS is considered to be critical and may require for the use of a mechanical
ventilator?

a. Exudative
b. Proliferative
c. Fibrotic
d. Stage IV

28. In this phase, inflammation resolves and oxygenation improves.

a. Exudative
b. Proliferative
c. Fibrotic
d. Stage IV

29. The terms stiff lung or shock lung is used to describe this phase.

a. Exudative
b. Proliferative
c. Fibrotic
d. Stage IV

30. Patient Kiko who is suffering from ARDS started diuretic therapy. As the nurse assigned, your nursing
responsibility is to:

a. Monitor vital signs

b. Measure intake and output
c. Maintain a normothermic environment to reduce oxygen consumption.
d. Position patient for optimal breathing.

31. Why should the critical care nurse include caregivers of the patient in the ICU as part of the

health care team?

a. The costs of critical care will affect the entire family.

b. Caregivers play a valuable role in the patient's recovery.

c. Caregivers are responsible for making health care decisions for the patient.

d. Caregivers who are ignored are more likely to question the patient's quality of care.

32. When the nurse is explaining respiratory failure to the patient's family, what is the most accurate

description to use?

a. The absence of ventilation

b. Any episode in which part of the airway is obstructed

c. Inadequate gas exchange to meet the metabolic needs of the body

d. An episode of acute hypoxemia caused by a pulmonary dysfunction

NCM 118 | hrestorque
33. When teaching the patient about what is happening when experiencing an intrapulmonary shunt,

which explanation is accurate?

a. This occurs when an obstruction impairs the flow of blood to the ventilated areas of the lung.

b. This occurs when blood passes through an anatomic channel in the heart and bypasses the

lungs.

c. This occurs when blood flows through the capillaries in the lungs without participating in
gas exchange.

d. Gas exchange across the alveolar capillary interface is compromised by thickened or damaged

alveolar membranes.

34. Which assessment finding should cause the nurse to suspect the early onset of hypoxemia?

a. Restlessness

b. Hypotension

c. Central cyanosis

d. Cardiac dysrhythmias

35. What type of cells in the lungs produces the necessary substance for lubrication?

a. Type I

b. Type II

c. Serotonin

d. Bradykinin

NCM 118 | hrestorque
II. CASE ANALYSIS

Ms. Carson, a 30-year-old 59 KG (130 lb.) black female had a perforated appendix two days ago.
She had an open appendectomy and was placed on antibiotics to prevent peritonitis. She had
an uneventful postoperative course the first two postoperative days. She was monitored
closely for infection, wound drainage and pain management.. At 10 PM on the third
postoperative day she began to complain of not feeling “right”. Her urinary output was 100cc
over the past 8 hours. She appeared pale confused and short of breath. Blood gases and vital
signs were as follows.

BP 70/40
HR 120/min.
Respirations 32/min
Temperature 37 ˚C
pH 7.48
PaCO2 32 mm Hg
Pa02 65
HCO3 22

Her shortness of breath worsened (she began gasping of air).

Ms. Carson is intubated she transferred to the ICU with a possible diagnosis of adult respiratory
distress syndrome (ARDS)
1. Analyze Ms. Carson’s vital signs.
BP - 70/40
Ms. Carson is experiencing hypovolemic shock because of her low bp,
HR - 120/min. low urine output, and rapid heart rate and respiration. She is also
Respirations - 32/min pale and confused. Her low bp is a sign of rapid blood loss related to
her recent appendectomy.
Temperature - 37 ˚C

2. Analyze Ms. Carson’s blood gases. Give rationale for your analysis.

Respiratory Alkalosis Uncompensated

pH: 7.48 – high
pH is high which is alkaline, PaCO2 is low also alkaline, Pao2 is low means
PaCO2: 32 – low that Ms. Carson is not getting enough oxygen and HSO3 is normal.
Signifies that Ms. Carson is losing too much Carbon dioxide and causes pH
PaO2: 65 – low
of the blood rise and become alkaline as evidenced by Ms. Carson’s
HCO3: 22 – Normal hyperventilation.

3. Briefly and concisely discuss the pathophysiology of ARDS.

ARDS take place as a result of diffuse alveolar damage. Inflammatory triggers initiate the
release of cellular and chemical mediators that causes injury to the alveolar capillary membrane
to other structural damage to the lungs. Severe ventilation–perfusion mismatching occurs.
Alveoli collapse because of the inflammatory infiltrate, blood, fluid, and surfactant dysfunction.
Small airways are also narrowed because of interstitial fluid and bronchial obstruction. Lung

NCM 118 | hrestorque
compliance may decrease, resulting in decreased functional residual capacity and severe
hypoxemia. The blood returning to the lung for gas exchange is pumped through the non-
ventilated, non-functioning areas of the lung that causes shunting. It means that blood is
interfacing with non-functioning alveoli and gas exchange is impaired, resulting in severe
hypoxemia.

4. What is/are possible precipitating event/s leading to Ms. Carson’s ARDS?

Ms. Carson had an emergency appendectomy because of her perforated appendix and then
days later she complained about not feeling right. The possible precipitating event leading to
Ms. Carson’s ARDS is sepsis because sepsis is a common cause of ARDS and it is a serious and
widespread infection in the bloodstream. The severe inflammatory responses induced by sepsis
can lead to ARDS by altering vascular permeability.

5. What radiological changes are seen with ARDS?

 Bilateral, predominantly peripheral, and assymetrical consolidation with air

bronchograms, septal lines and pleurl effusions.

6. Identify two appropriate nursing diagnoses seen with ARDS and give your rationale for
choosing each diagnosis.
 Ineffective breathing pattern
RATIONALE: When the breathing pattern is ineffective, the depth, timing, and
rhythm of breathing si altered and the body is not getting enough oxygen.

 Impaired gas exchange

RATIONALE: ARDS causes collapse of the alveoli and increased alveolar dead
space explains the alteration of CO2 clearance. Lungs can’t easily move oxygen into
the blood and remove carbon dioxide.

NCM 118 | hrestorque
GOOD LUCK!

NCM 118 | hrestorque