Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
41. A client sustains multiple fractures following a motor vehicle accident. The client is intubated and on a mechanical ventilator. Chest x-ray reveals diffuse bilateral pulmonary infiltrates. The ratio of fractional concentration of inspired oxygen to arterial oxygen concentration (PaO2/FIO2 ratio) is 174, central venous pressure (CVP) is 5 mm Hg, and pulmonary capillary wedge pressure (PCWP) is 10 mm Hg. What interventions would be most appropriate for the client? Select all that apply.
Choices
. Antibiotic therapy.
. Addition of positive end-expiratory pressure (PEEP) to ventilator.
. Prone positioning of client.
. Inotropic or vasopressor drugs.
. Heparin drip.
. Neuromuscular blockade with pancuronium (Pavalon).
Question Hint
Test-Taking Tip
Eliminate the options that do not improve oxygenation.
Content Area: Adult Health, Respiratory; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Physiological Adaptation/Medical Emergencies
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Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
. . . .
Answer 1 is incorrect because the client has acute respiratory distress syndrome (ARDS), not an infection, which would call for antibiotic therapy. Answer 2 is correct because PEEP improves ventilation to the atelectatic alveoli, improving oxygenation. Answer 3 is correct because prone positioning, if not contraindicated, improves oxygenation because more even distribution of ventilation occurs. Answer 4 is correct because these drugs increase contractility of the heart and raise blood pressure, improving perfusion. Answer 5 is incorrect because the client has ARDS, not a coagulation problem that would call for anticoagulant therapy. Answer 6 is correct because neuromuscular blockade decreases oxygen demand.
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