Deck 9: Ventilatory Assistance

Question 1

A 65-year-old patient is admitted to the progressive care unit with a diagnosis of community-acquired pneumonia.The patient has a history of chronic obstructive pulmonary disease and diabetes.A set of arterial blood gases obtained on admission without supplemental oxygen shows pH 7.35; PaCO₂ 55 mm Hg; bicarbonate 30 mEq/L; PaO₂ 65 mm Hg.These blood gases reflect:

A) hypoxemia and compensated metabolic alkalosis.
B) hypoxemia and compensated respiratory acidosis.
C) normal oxygenation and partly compensated metabolic alkalosis.
D) normal oxygenation and uncompensated respiratory acidosis.

Answer 1

hypoxemia and compensated respiratory acidosis.

Question 2

A patient's status worsens and needs mechanical ventilation.The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously in between the mechanical breaths at his own tidal volume.This mode of ventilation is called:

A) assist/control ventilation
B) controlled ventilation
C) intermittent mandatory ventilation
D) positive end-expiratory pressure

Answer 2

intermittent mandatory ventilation

Question 3

The nurse notes that the patient's arterial blood gas levels indicate hypoxemia.The patient is not intubated and has a respiratory rate of 22 breaths/min.The nurse's first intervention to relieve hypoxemia is to:

A) call the physician for an emergency intubation procedure.
B) obtain an order for bilevel positive airway pressure (BiPAP).
C) notify the provider of values and obtain order for oxygen.
D) suction secretions from the oropharynx.

Answer 3

notify the provider of values and obtain order for oxygen.

Question 4

Oxygen saturation (SaO?)represents:

A) alveolar oxygen tension.
B) oxygen that is chemically combined with hemoglobin.
C) oxygen that is physically dissolved in plasma.
D) total oxygen consumption.

Question 5

A patient presents to the emergency department demonstrating agitation and complaining of numbness and tingling in his fingers.His arterial blood gas levels reveal the following: pH 7.51,PaCO? 25,HCO? 25.The nurse interprets these blood gas values as:

A) compensated metabolic alkalosis.
B) normal values.
C) uncompensated respiratory acidosis.
D) uncompensated respiratory alkalosis.

Question 6

A patient has coronary artery bypass graft surgery and is transported to the surgical intensive care unit at noon.He is placed on mechanical ventilation.Interpret his initial arterial blood gas levels: pH 7.31
PaCO₂ 48 mm Hg
Bicarbonate 22 mEq/L
PaO₂ 115 mm Hg
O₂ saturation 99%

A) Normal arterial blood gas levels with a high oxygen level
B) Partly compensated respiratory acidosis, normal oxygen
C) Uncompensated metabolic acidosis with high oxygen levels
D) Uncompensated respiratory acidosis; hyperoxygenated

Question 7

Pulse oximetry measures:

A) arterial blood gases.
B) hemoglobin values.
C) oxygen consumption.
D) oxygen saturation.

Question 8

The physician orders the following mechanical ventilation settings for a patient who weighs 75 kg.The patient's spontaneous respiratory rate is 22 breaths/min.What arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings? Settings:
Tidal volume: 600 mL (8 mL per kg)
FiO₂: 0.5
Respiratory rate: 14 breaths/min
Mode assist/control
Positive end-expiratory pressure: 10 cm H₂O

A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis

Question 9

A PaCO₂ of 48 mm Hg is associated with:

A) hyperventilation.
B) hypoventilation.
C) increased absorption of O₂.
D) increased excretion of HCO₃.

Question 10

A mode of pressure-targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through the endotracheal tube is:

A) continuous positive airway pressure.
B) positive end-expiratory pressure.
C) pressure support ventilation.
D) T-piece adapter.

Question 11

Which of the following devices is best suited to deliver 65% oxygen to a patient who is spontaneously breathing?

A) Face mask with non-rebreathing reservoir
B) Low-flow nasal cannula
C) Simple face mask
D) Venturi mask

Question 12

One of the early signs of the effect of hypoxemia on the nervous system is:

A) cyanosis.
B) restlessness.
C) tachycardia.
D) tachypnea.

Question 13

Neuromuscular blocking agents are used in the management of some ventilated patients.Their primary mode of action is:

A) analgesia.
B) anticonvulsant.
C) paralysis.
D) sedation.

Question 14

The amount of effort needed to maintain a given level of ventilation is termed:

A) compliance.
B) resistance.
C) tidal volume.
D) work of breathing.

Question 15

A patient's endotracheal tube is not secured tightly.The respiratory care practitioner assists the nurse in taping the tube.After the tube is retaped,the nurse auscultates the patient's lungs and notes that the breath sounds over the left lung fields are absent.The nurse suspects that:

A) the endotracheal tube is in the right mainstem bronchus.
B) the patient has a left pneumothorax.
C) the patient has aspirated secretions during the procedure.
D) the stethoscope earpiece is clogged with wax.

Question 16

A patient's ventilator settings are adjusted to treat hypoxemia.The fraction of inspired oxygen is increased from .60 to .70,and the positive end-expiratory pressure is increased from 10 to 15 cm H?O.Shortly after these adjustments,the nurse notes that the patient's blood pressure drops from 120/76 mm Hg to 90/60 mm Hg.What is the most likely cause of this decrease in blood pressure?

A) Decrease in cardiac output
B) Hypovolemia
C) Increase in venous return
D) Oxygen toxicity

Question 17

Current guidelines recommend the oral route for endotracheal intubation.The rationale for this recommendation is that nasotracheal intubation is associated with a greater risk for:

A) basilar skull fracture.
B) cervical hyperextension.
C) impaired ability to "mouth" words.
D) sinusitis and infection.

Question 18

The nurse is caring for a patient with an endotracheal tube.The nurse understands that endotracheal suctioning is needed to facilitate removal of secretions and that the procedure:

A) decreases intracranial pressure.
B) depresses the cough reflex.
C) is done as indicated by patient assessment.
D) is more effective if preceded by saline instillation to loosen secretions.

Question 19

A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min.His spontaneous respirations are 12 breaths/min.He receives a dose of morphine sulfate,and his respirations decrease to 4 breaths/min.Which acid-base disturbance will likely occur?

A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis

Question 20

A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min.His spontaneous respirations are 12 breaths/min.He receives a dose of morphine sulfate,and his respirations decrease to 4 breaths/min.What adjustments may need to be made to the patient's ventilator settings?

A) Add positive end-expiratory pressure (PEEP).
B) Add pressure support.
C) Change to assist/control ventilation at a rate of 4 breaths/min.
D) Increase the synchronized intermittent mandatory ventilation respiratory rate.

Question 21

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.)

A) Auscultation of air over the epigastrium
B) Equal bilateral breath sounds upon auscultation
C) Position above the carina verified by chest x-ray
D) Positive detection of carbon dioxide (CO₂) through CO₂ detector devices

Question 22

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

A) heart block.
B) restlessness.
C) tachycardia.
D) tachypnea.

Question 23

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?

A) Patient outcomes are better if the tracheostomy is done within a week of intubation.
B) Percutaneous tracheostomy can be done safely at the bedside by the respiratory therapist.
C) Procedures performed in the operating room are associated with fewer complications.
D) The greatest risk after a percutaneous tracheostomy is accidental decannulation.

Question 24

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:

A) ask the respiratory therapist to get a new ventilator.
B) call the rapid response team to assess the patient.
C) continue to find the cause of the alarm and fix it.
D) manually ventilate the patient while calling for a respiratory therapist.

Question 25

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%

A) Hypoxemia and compensated respiratory alkalosis
B) Hypoxemia and uncompensated respiratory acidosis
C) Normal arterial blood gas levels
D) Normal oxygen level and partially compensated metabolic acidosis

Question 26

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:

A) fluid overload secondary to decreased venous return.
B) high cardiac index secondary to more efficient ventricular function.
C) hypoxemia secondary to prolonged positive pressure at expiration.
D) low cardiac output secondary to increased intrathoracic pressure

Question 27

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

A) Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume.
B) For each spontaneous breath taken by the patient, the tidal volume is determined by the patient's ability to generate negative pressure.
C) The patient must have a respiratory drive, or no breaths will be delivered.
D) There is pressure remaining in the lungs at the end of expiration that is measured in cm H?O.

Question 28

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.)

A) Coughing or attempting to talk
B) Disconnection from the ventilator
C) Kinks in the ventilator tubing
D) Need for suctioning

Question 29

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.

Question 30

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

A) assess for tension pneumothorax.
B) assess the level of positive end-expiratory pressure.
C) compare the tidal volume delivered with the tidal volume prescribed.
D) determine the patient's work of breathing.

Question 31

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

A) Compensated metabolic acidosis
B) Metabolic alkalosis
C) Normal ABG values
D) Respiratory acidosis

Question 32

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.

Question 33

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

A) communication with intubated patients is often difficult.
B) controlled ventilation is the preferred mode for most patients.
C) patients with chronic obstructive pulmonary disease wean easily from mechanical ventilation.
D) wrist restraints are applied to all patients to avoid self-extubation.

Question 34

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

A) cardiac output of 6 L/min.
B) hemoglobin of 8 g/dL.
C) negative sputum culture and sensitivity.
D) white blood cell count of 8000.

Question 35

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

A) Anxiety and fear
B) Central nervous system depression
C) Diabetic ketoacidosis
D) Nasogastric suctioning
E) Overdose of sedatives

Question 36

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?

A) "May we have an order for cardiac enzymes? This patient is exhibiting signs of a myocardial infarction."
B) "My assessment indicates potential fluid overload."
C) "The patient is having frequent PVCs that are compromising the cardiac output."
D) "The patient is having a hypertensive crisis; what medications would you like to order?"