A patient with respiratory failure has a respiratory rate of 26 breaths/min and an oxygen saturation (SpO2) of 80%. The patient is increasingly pale and restless but follows commands. Which intervention will the nurse anticipate?

Initiation of continuous positive pressure ventilation (CPAP)

Endotracheal intubation and positive pressure ventilation

Insertion of a mini-tracheostomy with frequent suctioning

Administration of 100% O2 by non-rebreather mask

Answer and Explanation

The Correct Answer is B

B. Endotracheal intubation and positive pressure ventilation are indicated in patients with respiratory failure who are unable to maintain adequate oxygenation or ventilation with non-invasive interventions. Intubation allows for the delivery of positive pressure ventilation, oxygenation, and airway protection. It also facilitates the clearance of secretions and administration of medications. Given the patient's severe hypoxemia, impending respiratory distress, and deteriorating condition, endotracheal intubation and positive pressure ventilation are the most appropriate interventions to ensure adequate oxygenation and prevent further deterioration.

A. CPAP is a non-invasive ventilation modality that provides a continuous positive pressure to the airways throughout the respiratory cycle. While CPAP may be beneficial in certain cases of respiratory failure, it may not be sufficient for a patient with severe hypoxemia (SpO2 of 80%) and impending respiratory distress. CPAP is typically indicated for patients with conditions such as obstructive sleep apnea or mild to moderate respiratory failure.

C. Mini-tracheostomy may be considered in certain cases of upper airway obstruction or inadequate airway clearance. However, in this scenario, the patient's hypoxemia is likely due to severe respiratory failure rather than upper airway obstruction. While suctioning may be necessary to clear secretions, it does not address the underlying cause of hypoxemia or provide ventilatory support.

D. While administration of supplemental oxygen is important in the management of hypoxemia, a non- rebreather mask may not be sufficient for a patient with severe hypoxemia and impending respiratory distress. Non-rebreather masks can deliver high concentrations of oxygen but may not provide adequate positive pressure support or airway protection. In this case, endotracheal intubation and positive pressure ventilation are more appropriate to ensure adequate oxygenation and ventilation.

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Correct Answer is A

Explanation

A. Elective cardioversion involves the synchronized delivery of a therapeutic electrical shock to the heart to restore normal sinus rhythm in a patient with a tachyarrhythmia, such as atrial fibrillation or atrial flutter. However, ventricular tachycardia (VT) is a life-threatening arrhythmia characterized by a rapid heart rate originating from the ventricles, and it requires immediate intervention due to the risk of deteriorating into ventricular fibrillation (VF) and cardiac arrest. Therefore, elective cardioversion is not appropriate for treating VT.

B. Defibrillation involves the unsynchronized delivery of a high-energy electrical shock to the heart to terminate life-threatening arrhythmias, such as ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). In the case of a conscious patient with pulse-sustaining ventricular tachycardia, immediate defibrillation may not be necessary. However, if the patient deteriorates into pulseless VT or VF, prompt defibrillation is required to restore normal cardiac rhythm and circulation.

C. Radiofrequency catheter ablation is a procedure performed in a cardiac catheterization lab to treat certain cardiac arrhythmias by delivering radiofrequency energy to the specific area of the heart responsible for the abnormal rhythm. While radiofrequency catheter ablation may be considered for certain types of sustained ventricular tachycardia that are refractory to medical therapy or deemed to be originating from a specific site in the heart, it is not the immediate intervention for hemodynamically unstable ventricular tachycardia.

D. CPR is an emergency procedure performed on individuals experiencing cardiac arrest or a life- threatening medical emergency. In the case of ventricular tachycardia (VT) with a pulse, the patient is still perfusing, and CPR is not indicated. However, if the patient deteriorates into pulseless VT or ventricular fibrillation (VF), CPR may be initiated along with immediate defibrillation.

A. Tell the patient to bare down B. Administer Lidocaine drip C. Administer Amiodarone drip D. Administer a beta blocker

Correct Answer is C

Explanation

C. Amiodarone is a Class III antiarrhythmic medication commonly used for the acute management of atrial fibrillation with a rapid ventricular rate. It works by blocking multiple ion channels, prolonging the action potential duration, and slowing conduction in the atria and ventricles. Amiodarone is often used when other interventions such as vagal maneuvers or beta blockers are ineffective or contraindicated. In this scenario, where the patient is hypotensive and symptomatic, intravenous amiodarone may be administered to control the ventricular rate and stabilize hemodynamics

A. Bearing down, or the Valsalva maneuver, is a vagal maneuver that can sometimes help slow the heart rate in certain arrhythmias by increasing parasympathetic tone. However, it may not be effective or safe in all situations, especially if the patient is hypotensive or confused. In this scenario, immediate pharmacological intervention is likely needed to control the heart rate and stabilize hemodynamics.

B. Lidocaine is not typically used to treat atrial fibrillation with a rapid ventricular rate. Lidocaine is a Class IB antiarrhythmic medication primarily used for the treatment of ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. It is not considered a first-line agent for atrial fibrillation and may not effectively control the ventricular rate in this situation.

D. While beta blockers are commonly used for rate control in atrial fibrillation, they may not be the best choice in this scenario where the patient is hypotensive and symptomatic. Beta blockers can further decrease blood pressure and exacerbate hypotension, especially in patients with compromised hemodynamics. In such cases, other rate-controlling agents like calcium channel blockers or amiodarone may be preferred.

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A patient with respiratory failure has a respiratory rate of 26 breaths/min and an oxygen saturation (SpO2) of 80%. The patient is increasingly pale and restless but follows commands. Which intervention will the nurse anticipate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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