Question 1

A patient is receiving a tracheostomy. The nurse has which of the following ready in case of a potential complication?

Accepted Answer

A chest tube set up is necessary in case of a pneumothorax, which is a potential complication during a tracheostomy procedure.

Question 2

A patient being mechanically ventilated is receiving PEEP of 10 cm of H₂O. The nurse ensures that which of the following is utilized for this patient?

Accepted Answer

Patients receiving mechanical ventilation with PEEP require closed system suctioning to prevent derecruitment of the lungs and maintain optimal oxygenation. Oral care is also important, but it is not specific to the use of PEEP. Open system suctioning can cause a drop in PEEP, so it should be avoided. Vital signs should be monitored more frequently than every shift for a patient on mechanical ventilation.

Question 3

Which of the following items in order will the physician require to successfully intubate a patient demonstrating respiratory failure?

Accepted Answer

The correct sequence includes all necessary items: gloves, stylet, endotracheal tube, lubricant, laryngoscope handle and blade, resuscitation bag with a swivel adapter, and a syringe for inflating the cuff of the endotracheal tube.

Question 4

A patient being mechanically ventilated is demonstrating hypoxia, with a pulse oximeter reading of 88%. After ensuring the integrity of the ventilator tubing and assessing the patient, the nurse auscultates adventitious lung sounds. Which action should the nurse take next?

Accepted Answer

Suctioning the patient can help remove secretions that may be obstructing the airway, potentially improving oxygenation and resolving the hypoxia indicated by the pulse oximeter reading.

Question 5

A patient being mechanically ventilated and suddenly develops cardiac arrhythmias from increasingly higher PEEP most likely has an underlying issue from which of the following?

Accepted Answer

Increasing PEEP can decrease cardiac output due to decreased venous return and increased pulmonary artery pressure, which can lead to acidosis. This can trigger cardiac arrhythmias in susceptible patients. Therefore, the underlying issue in this scenario is likely to be decreased cardiac output and acidosis.

Question 6

A patient being mechanically ventilated has the following ventilator settings: SIMV 16, PEEP 20 cm of H₂O, FiO₂ 45%, tidal volume .450 liters. What concerns will the nurse have for this patient?

Accepted Answer

The high PEEP and tidal volume may increase the risk of barotrauma, which is a condition that occurs when high pressure damages the lungs. The FiO2 is within a safe range and does not indicate a concern for oxygen toxicity. Volutrauma refers to lung injury caused by excessive tidal volumes, which may be a concern with higher settings, but is not necessarily present in this case. Sinusitis is not directly related to the ventilator settings and is therefore less likely to be a concern for the nurse.

Question 7

A patient being mechanically ventilated requires increasing PEEP for worsening ARDS. The order for PEEP is now at 20 cm of H₂O. The nurse will need to contact the physician immediately if the patient develops which of the following?

Accepted Answer

Unequal lung sounds may indicate a pneumothorax, a potential complication of high PEEP, requiring immediate physician notification.

Question 8

The chest x-ray of a patient who was recently intubated shows the endotracheal tube located in the right bronchus. The nurse recognizes that the correct intervention for this problem is which of the following?

Accepted Answer

The endotracheal tube should be located in the trachea and not in one of the main bronchi. The fact that the tube is located in the right bronchus indicates that it is not correctly placed. The correct intervention in this case is to withdraw the tube slightly until it is properly positioned in the trachea.

Question 9

A patient is being mechanically ventilated with SIMV at a rate of 2

Accepted Answer

SIMV stands for synchronized intermittent mandatory ventilation, which means that the ventilator delivers a set number of breaths per minute while allowing the patient to take spontaneous breaths in between. A rate of 2 may not provide adequate support for the patient's ventilation needs, and the respiratory therapist or physician might need to adjust the settings.

Question 10

The family of a mechanically ventilated patient receiving a chest tube asks why the tube is necessary. The nurse responds with which of the following?

Accepted Answer

The chest tube is necessary to decompress the lung and prevent further complications, such as a tension pneumothorax or hemothorax, which can cause significant respiratory distress and compromise the patient's ventilation.

Question 11

Which of the following physician's orders should the nurse question for a patient who is intubated and being mechanically ventilated?

Accepted Answer

Endotracheal suctioning every hour may be too frequent and could potentially cause trauma to the patient's airway. The frequency of suctioning should be based on the patient's individual needs and should be determined by the healthcare provider.

Question 12

A patient being mechanically ventilated develops hypotension after the respiratory therapist implements the most recent physician orders. The nurse suspects which ventilator mode might be the cause?

Accepted Answer

PEEP (Positive End-Expiratory Pressure) can increase intrathoracic pressure, which may decrease venous return to the heart, leading to hypotension.

Question 13

Which of the following patients should the nurse assess first?

Accepted Answer

The patient with a chest tube complaining of difficulty breathing should be assessed first as it may indicate a potentially life-threatening complication such as a tension pneumothorax. This requires immediate intervention.

Question 14

A patient that is intubated is demonstrating rhonchi, has a pulse oximeter of 92%, soft abdomen, heart rate 88 bpm, and blood pressure 98/54 mmHg. Which of the following is the nurse's first priority?

Accepted Answer

Rhonchi indicate possible airway congestion or obstruction, and suctioning is a priority to ensure adequate ventilation. Contacting the physician may be necessary, but addressing the immediate respiratory concern should take priority. Increasing oxygen may also be necessary, but suctioning should come first. Dopamine may be necessary for hypotension, but the priority in this situation is addressing the respiratory concern.

Quiz 37: Nursing Care of Patient with Gas Exchange Disorders