Question 1

The nurse is assisting with endotracheal intubation and understands correct placement of the endotracheal tube in the trachea would be identified by which of the following? (Select all that apply.)

Accepted Answer

The position of the tube is assessed after intubation through auscultation of breath sounds,carbon dioxide testing,and chest x-ray.Auscultation of air over the epigastrium indicates placement in the esophagus rather than the trachea.

Question 2

When assessing the patient for hypoxemia,the nurse recognizes that an early sign of the effect of hypoxemia on the cardiovascular system is:

Accepted Answer

Tachycardia can occur as a compensatory mechanism to increase cardiac output and oxygenation.Dysrhythmias may occur; however,they are not an early sign and tend to be premature ventricular contractions.Restlessness is an early neurological sign,whereas tachypnea is an early respiratory sign.

Question 3

The nurse is caring for a mechanically ventilated patient.The physicians are considering performing a tracheostomy because the patient is having difficulty weaning from mechanical ventilation.Related to tracheostomy,the nurse understands which of the following?

Accepted Answer

Optimal timing of tracheostomy is not yet known.Percutaneous procedures done at the bedside are not associated with any higher risks than those done in the operating room.Trained physicians safely perform percutaneous tracheostomies at the bedside.The greatest risk for percutaneous tracheostomy is accidental decannulation because the trachea is not surgically attached.

Question 4

The nurse is caring for a mechanically ventilated patient and notes the high pressure alarm sounding.The nurse cannot quickly identify the cause of the alarm and notes the patient's oxygen saturation is decreasing and heart rate and respiratory rate are increasing.The nurse's priority action is to:

Accepted Answer

The nurse must quickly assess the patient and determine possible causes of the alarm.If the cause is not assessed within seconds,the nurse must manually ventilate the patient and secure assistance in troubleshooting the problem.The patient must be treated while the causes are being assessed by the nurse and respiratory therapist.Continuing to assess for the cause without manually ventilating the patient can result in patient compromise.The respiratory therapist,not the rapid response team,will assess and remedy the problem.A new ventilator may be needed,but that would be determined after the respiratory therapist has assessed the situation.

Question 5

A 53-year-old,80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery.Four hours after admission to the surgical intensive care unit at 4 PM,the patient has stable vital signs and normal arterial blood gases (ABGs),and is placed on a T-piece for ventilatory weaning.During the nurse's 7 PM (1900)assessment,the patient is restless,heart rate has increased to 110 beats/min,respirations are 36 breaths/min,and blood pressure is 156/98 mm Hg.The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs)per minute.Pulmonary artery pressures are elevated.The nurse suctions the patient and obtains pink,frothy secretions.Loud crackles are audible throughout lung fields.The nurse notifies the physician,who orders an ABG analysis,electrolyte levels,and a portable chest x-ray study.How does the nurse interpret the following blood gas levels? pH 7.28 PaCO₂ 46 mm Hg Bicarbonate 22 mEq/L PaO₂ 58 mm Hg O₂ saturation 88%

Accepted Answer

These levels show respiratory acidosis.The bicarbonate is normal; therefore,no compensation has occurred.This patient is also hypoxemic.

Question 6

The nurse is caring for a patient whose ventilator settings include 15 cm H?O of positive end-expiratory pressure (PEEP).The nurse understands that although beneficial,PEEP may result in:

Accepted Answer

Positive end-expiratory pressure,especially at higher levels,can result in a decreased cardiac output and index secondary to increased intrathoracic pressure,which impedes venous return.Fluid overload is not an expected finding.The cardiac index would likely decrease,not increase,along with cardiac output.PEEP is used to treat hypoxemia; it does not cause it.

Question 7

Positive end-expiratory pressure (PEEP)is a mode of ventilatory assistance that produces the following condition:

Accepted Answer

PEEP is the addition of positive pressure into the airways during expiration.PEEP is measured in centimeters of water.

Question 8

The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm.Recognizing possible causes for the alarm,the nurse assesses for which of the following? (Select all that apply.)

Accepted Answer

Coughing,kinks,and mucus in the airway can cause the inspiratory pressure to increase; ventilator disconnects result in low-volume alarms.A disconnection from the ventilator would result in a low exhaled volume alarm,not a high-pressure alarm.

Question 9

The nurse is caring for a mechanically ventilated patient and is charting outside the patient's room when the ventilator alarm sounds.  What is the priority order for the nurse to complete these actions: _______________,_______________,_______________,_______________? (Put a comma and space between each solve  choice.) 
A)Check quickly for possible causes of the alarm that can be fixed.
B)After troubleshooting,connect back to mechanical ventilator and reassess patient.
C)Go to patient's bedside.
D)Manually ventilate the patient while getting respiratory therapist.

Accepted Answer

The answer of The nurse is caring for a mechanically...

Question 10

The nurse is assessing the exhaled tidal volume (EVT)in a mechanically ventilated patient.The rationale for this assessment is to:

Accepted Answer

The EVT is assessed to determine if the patient is receiving the tidal volume that is prescribed.Volume may be lost because of leaks in the ventilator circuit,around the endotracheal tube cuff,or around a chest tube.The assessment will not detect a pneumothorax and does not assess positive end-expiratory pressure or work of breathing.

Question 11

A 53-year-old,80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery with the following arterial blood gas (ABG)levels.What is the nurse's interpretation of these values? pH 7.4 PaCO₂ 40 mm Hg Bicarbonate 24 mEq/L PaO₂ 95 mm Hg O₂ saturation 97% Respirations 20 breaths per minute

Accepted Answer

These are normal values.All parameters are within normal limits.

Question 12

The nurse is assisting with endotracheal intubation of the patient and recognizes that the procedure will be done in what order: _______________,_______________,_______________,_______________,_______________? (Put a comma and space between each solve  choice.) 
A)Assess balloon on endotracheal tube for symmetry and leaks.
B)Assess lung fields for bilateral expansion.
C)Inflate balloon of endotracheal tube.
D)Insert endotracheal tube with laryngoscope and blade.
E)Suction oropharynx.

Accepted Answer

The answer of The nurse is assisting with endotracheal intubation...

Question 13

The nurse is caring for a patient who is mechanically ventilated.As part of the nursing care,the nurse understands that:

Accepted Answer

Communication difficulties are common because of the artificial airway.Restraints must be determined individually.Patients with chronic obstructive pulmonary disease often have difficulty weaning.Synchronized intermittent mandatory ventilation and assist/control ventilation are the commonly used modes.

Question 14

A patient is having difficulty weaning from mechanical ventilation.The nurse assesses the patient for a potential cause of this difficult weaning,which includes:

Accepted Answer

The low hemoglobin level will decrease oxygen-carrying capacity and may make weaning difficult.A cardiac output of 6 L/min is normal.A negative sputum culture indicates absence of lower respiratory infection,which should promote rather than hinder weaning.A white blood cell count of 8000 is normal and indicates absence of infection,which should promote rather than hinder weaning.

Question 15

Select all of the factors that may predispose the patient to respiratory acidosis.

Accepted Answer

Central nervous system depression and drug overdose may result in hypoventilation and cause respiratory acidosis.Anxiety is a cause of hyperventilation and respiratory alkalosis.Diabetic ketoacidosis is a cause of metabolic acidosis.Nasogastric suctioning is a cause of metabolic alkalosis.

Question 16

A 53-year-old,80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery.Four hours after admission to the surgical intensive care unit at 4 PM,the patient has stable vital signs and normal arterial blood gases (ABGs)and is placed on a T-piece for ventilatory weaning.During the nurse's 7 PM (1900)assessment,the patient is restless,heart rate has increased to 110 beats/min,respirations are 36 breaths/min,and blood pressure is 156/98 mm Hg.The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs)per minute.Pulmonary artery pressures are elevated.The nurse suctions the patient and obtains pink,frothy secretions.Loud crackles are audible throughout lung fields.The nurse notifies the physician,who orders an ABG analysis,electrolyte levels,and a portable chest x-ray study.In communicating with the physician,which statement indicates the nurse understands what is likely occurring with the patient?

Accepted Answer

The crackles,high pulmonary artery pressure,and pink,frothy sputum indicate fluid volume overload.There are not any cues to suggest a myocardial infarction.The PVCs may be related to the surgery or hypoxemia; however,the blood pressure indicates adequate perfusion.The blood pressure is high secondary to fluid overload; treatment of the fluid overload will result in a decrease in blood pressure.

Quiz 9: Ventilatory Assistance