Deck 18: Advanced Respiratory Management

Question 1

A client has just been intubated. What action by the nurse is best to verify tube placement?

A) Listen to lung sounds.
B) Facilitate a chest x-ray.
C) Assess oxygenation.
D) Secure the ET tube.

Answer 1

Facilitate a chest x-ray.

Question 2

The nurse measures an intubated client's endotracheal tube (ETT) cuff volume at 23 mmH₂O. What does the nurse interpret this finding to indicate?

A) The ETT cuff is underinflated.
B) The ETT cuff is overinflated.
C) The ETT cuff is properly inflated.
D) Client is at high risk from tissue damage.

Answer 2

The ETT cuff is properly inflated.

Question 3

A nurse is caring for a client on mechanical ventilation. What action by the nurse takes priority?

A) Ensure correct ventilator settings.
B) Monitor end-tidal CO₂ readings.
C) Assess lung sounds every 2 hours.
D) Maintain a patent airway.

Answer 3

Maintain a patent airway.

Question 4

A client has suffered a cardiopulmonary arrest. Spontaneous circulation was restored but the client remains apneic. What form of mechanical ventilation would this client require?

A) Controlled mandatory ventilation (CMV)
B) Synchronized intermittent mandatory ventilation (SIMV)
C) Assist-control ventilation (A-C)
D) Intermittent mandatory ventilation (IMV)

Question 5

A client is on pressure-controlled mechanical ventilation. Faculty asks the student assigned to the client which parameters are most important to monitor. What answer given by the student indicates the need to review the information?

A) Mean airway pressure (MAP)
B) Tidal volume (V_t)
C) Peak inspiratory pressure (PIP)
D) Positive end-expiratory pressure (PEEP)

Question 6

A client's ventilator continues to alarm; however, the oxygen saturation is 98% and the client's capnography readings have not changed. The nurse is unable to determine the cause for the alarms. After notifying respiratory therapy to come to the room, what action by the nurse is best?

A) Alert the charge nurse to the situation.
B) Stay in the room with the client.
C) Provide breaths with a resuscitation bag.
D) Request the provider order ABGs.

Question 7

A nurse is caring for a client in the Intensive Care Unit (ICU) who is on mechanical ventilation and has a tube feeding. What assessment by the nurse indicates a priority goal for this client has been met?

A) Weight gain of 1 pound in a week
B) Increase in albumin and pre-albumin
C) Lung sounds clear bilaterally
D) Head of bed remains elevated at 30 degrees

Question 8

A client is on a ventilator and the high-pressure limit alarm is sounding. What does the nurse interpret this to mean?

A) The ventilator can't deliver enough oxygen to lower the pressure against the alveolar capillary membrane.
B) The client cannot generate enough pressure on inhalation to trigger the ventilator.
C) The ventilator has reached the maximum amount of pressure it can generate to inflate the lungs.
D) The time set for inhalation and exhalation have been exceeded due to pressure in the lungs.

Question 9

An ICU client is anemic. What action by the nurse is best?

A) Ask the provider for a consultation with the registered dietitian.
B) Sample the arterial line using blood conservation strategies.
C) Perform hemoccult tests on all stools, urine, and other output.
D) Request an order for an iron supplement from the provider.

Question 10

Which statement by the student indicates an incorrect understanding of chest tubes?

A) "My client has a pneumothorax, so the chest tube will be high on the chest."
B) "Tidaling in the water seal chamber indicates a leak in the chest tube system."
C) "The amount of water in the water seal chamber actually controls the suction."
D) "Crepitus indicates that some air has escaped and is trapped in subcutaneous tissue."

Question 11

The student is caring for a client who has a chest tube. What action by the student requires the faculty to intervene?

A) Milks the chest tube gently to keep it free of clots
B) Keeps the drainage system below the level of the client's chest
C) Loops the extension tubing on the bed
D) Changes the dressing on the insertion site daily

Question 12

A client's chest tube was dislodged during transfer. What action does the nurse take first?

A) Call the charge nurse for assistance.
B) Cover the insertion site with a gloved hand.
C) Notify the provider immediately.
D) Place a sterile gauze dressing on the insertion site.

Question 13

The nurse notes persistent bubbling in the water seal chamber of a client's chest tube. What action by the nurse is best?

A) Assess the client's lung sounds.
B) Palpate the neck for crepitus.
C) Clamp the chest tube and reassess.
D) Check the system for an air leak.

Question 14

A nurse accidentally kicks a client's chest tube drainage system and it falls over. What action by the nurse is best?

A) Change the entire collection system and extension tubing.
B) Replace fluid as needed to maintain prescribed fluid levels.
C) Assess and tape all connections in the system securely.
D) Ensure the drainage collection device is secured to the side rail.

Question 15

The nurse brings a student along to observe a modified Allen's test. What response is best when the nurse is asked for the test's rationale?

A) It assesses circulation to the hand from the ulnar artery.
B) It measures the pressure in the ET tube cuff.
C) The score determines if a client is ready for an awakening trial.
D) We use it to assess for and grade ICU delirium.

Question 16

A nurse reviewing a client's arterial blood gasses would be most concerned about which finding?

A) pH: 3.37
B) PaO₂: 74 mm Hg
C) PaCO₂: 57 mm Hg
D) HCO₃: 25 mEq/L

Question 17

The nurse has assessed a large clot blocking the flow of drainage in a client's chest tube. What action by the nurse is best?

A) Strip the tube vigorously.
B) Increase the amount of suction.
C) Squeeze or twist the tubing.
D) Milk the tubing upward.

Question 18

The charge nurse gets a page to go to a client room where the client's nurse states "The client has just self-extubated!" What does the charge nurse understand has happened?

A) The client dislodged the ventilator circuitry.
B) The client tuned off the ventilator pressure support.
C) The client poked a hole in the tubing.
D) The client pulled out his or her own ET tube.

Question 19

The nurse caring for a client on mechanical ventilation implements the ABCDEF bundle. What activities are most appropriate? (Select all that apply.)

A) Assess, prevent, and manage pain.
B) Provide spontaneous Breathing trials.
C) Remove Catheters as soon as possible.
D) Do not restrain unless absolutely necessary.
E) Engage the client by talking normally.
F) Family engagement and empowerment.

Question 20

A client is on a ventilator and the low-pressure alarm is sounding. What actions by the nurse are most appropriate? (Select all that apply.)

A) Ensure the ventilator tubing is connected to the ET tube.
B) Attempt to re-inflate the cuff if it is underinflated.
C) Administer analgesics to prevent fighting the ventilator.
D) Insert a bite block if the client is biting the ET tube.
E) Assess for holes in the ventilator circuitry.

Question 21

A nurse is caring for a patient receiving mechanical ventilation. What actions by the nurse indicate a need to review the ventilator bundle? (Select all that apply.)

A) Elevates the head of the bed 20 degrees
B) Administers a proton-pump inhibitor
C) Applies sequential compression devices
D) Maintains the client's sedation at all times
E) Provides frequent oral care per facility policy

Question 22

The new Intensive Care Unit (ICU) nurse is frustrated that the intubated client is not sedated "enough" and wants to request a higher dose from the provider. What does the charge nurse teach about the benefits of lighter sedation? (Select all that apply.)

A) Easier communication
B) Facilitates spontaneous breathing
C) Allows early mobilization
D) Improved outcomes
E) Less self-extubation

Question 23

The critical care nurse understands that which of the following are risk factors for critically ill clients to develop medical device related pressure injuries (MDRPIs)? (Select all that apply.)

A) Nutritional deficiencies
B) Altered level of consciousness
C) Vasoactive medications
D) Impaired sensation
E) Increased cardiac output

Question 24

After a client has been intubated, what actions does the nurse take to evaluate correct placement of the oral endotracheal tube? (Select all that apply.)

A) Listens for equal, bilateral lung sounds
B) Observes for equal chest movement
C) Monitors the client's oxygen saturation
D) Documents tube placement at the teeth
E) Evaluates end-tidal CO₂ readings