Exam 2: Mechanical Ventilation (NCLEX)

What characteristics describe positive pressure ventilators? Select all that apply a. require an artificial airway b. applied to outside of body c. most similar to physiologic ventilation d. most frequently used with critically ill patients e. frequently used in the home for neuromuscular or nervous system disorders

AD

Which patient's medical diagnoses should the nurse know are most likely to need mechanical ventilation? Select all that apply a. sleep apnea b. cystic fibrosis c. acute kidney injury d. type 2 DM e. acute respiratory distress syndrome (ARDS)

BE

The client with respiratory failure has been intubated and placed on a ventilator and is requiring 100% oxygen delivery to maintain adequate oxygenation. Twenty-four hours later, the nurse notes new-onset crackles and decreased breath sounds, and the most recent ABGs show a PaO2 level of 95 mm Hg. The ventilator is not set to provide positive end-expiratory pressure (PEEP). Why is the nurse concerned? A. The low PaO2 level may result in oxygen toxicity B. The 100% oxygen delivery requirement indicates immediate extubation C. Lung sounds may indicate absorption atelectasis D. The level of oxygen delivery may indicate absorption atelectasis

C High levels of oxygen delivery can result in collapsed alveoli and absorption atelectasis. PEEP can help alveoli remain properly inflated.

The nurse caring for a client who is mechanically ventilated is monitoring for complications of mechanical ventilation. Which assessment finding, if noted by the nurse, indicates the need for follow-up? 1.Muscle weakness in the arms and legs 2.A temperature of 98.6° F decreased from 99.0° F 3.A blood pressure of 90/60 mm Hg decreased from 112/78 mm Hg 4.A heart rate of 80 beats per minute decreased from 85 beats per minute

3 Complications of mechanical ventilation include the following: (1) hypotension caused by application of positive pressure, which increases intrathoracic pressure and inhibits blood return to the heart; (2) pneumothorax or subcutaneous emphysema as a result of positive pressure; (3) gastrointestinal alterations such as stress ulcers; (4) malnutrition if nutrition is not maintained; (5) infections; (6) muscular deconditioning; and (7) ventilator-dependence or inability to wean. Some muscle weakness is expected. Options 1, 2, and 4 present normal assessment findings.

A client who is diagnosed with acute respiratory distress syndrome​ (ARDS) requires mechanical ventilation. Which ventilator mode should the nurse expect to implement to promote pressure throughout the respiratory​ cycle? A. Positive​ end-expiratory pressure​ (PEEP) B. Sensitivity C. Flow rate D. Tidal volume​ (TV)

A

A nurse is caring for a client who is experiencing respiratory distress. Which of the following early manifestations of hypoxemia should the nurse recognize? Select all that apply a. confusion b. pale skin c. bradycardia d. hypotension e. elevated blood pressure

BE

In the patient using Controlled Mandatory Ventilation, what drug are they on to suppress respiratory effort? A. Morphine, Fentanyl, or Hydromorphone B. Propofol C. Rocuronium, Pancuronium, or Nimbex D. Formoterol, Salmeterol, or Arformoterol

C Rocuronium, Pancuronium, & Nimbex are all non-Depolarizing Neuromuscular Blocking Agents. But, be considerate that the patient recieving this type of ventilation will also require sedation and opioids.

A nurse is caring for a client on a mechanical ventilator. The high-pressure alarm on the ventilator sounds. The nurse suspects that the most likely cause of the alarm is which finding? 1.A disconnection of the ventilator tubing 2.An exaggerated client inspiratory effort 3.Accumulation of respiratory secretions 4.Generation of extreme negative pressure by the client

3

The critical care nurse and the other members of the care team are assessing the patient to see if he is ready to be weaned from the ventilator. What are the most important predictors of successful weaning that the nurse should identify? A) Stable vital signs and ABGs B) Pulse oximetry above 80% and stable vital signs C) Stable nutritional status and ABGs D) Normal orientation and level of consciousness

A

What is the advantage of using Volume Cycled Ventilation? (SATA) A. the ventilator pushes air into lungs until a preset airway pressure is reached B. the ventilator pushes air into the lungs until a preset volume is reached C. a constant tidal volume is delivered regardless of pressure needed to deliver the tidal volume D. limits excessive pressure being exerted on the lungs E. allows the health care team to determine if intubation is really neccessary

BCD

A 19 year-old patient being administered PEEP begins to have copious amounts of secretions that she says she "just cannot cough up." Which of the following nursing actions is most appropriate at this time? 1) Assess the patient further and utilize bedside suction equipment. 2) Assess O2 sats and continue to monitor patient if results are 95% or above. 3) Obtain respiratory therapy consult. 4) Obtain an order for a mucolytic agent from the physician.

3 At this time, the nurse should obtain a respiratory therapy consult. Any break in the closed ventilator system causes the loss of PEEP, so respiratory therapy needs to be consulted to add in-line suctioning.

A patient in acute respiratory failure is receiving ACV with a positive end-expiratory pressure (PEEP) of 10 cm H20. What sign alerts the nurse to undesirable effects of increased airway and thoracic pressure? a. decreased BP b. decreased PaO2 c. increased crackles d. decreased spontaneous respirations

A

In what ventilation setting does the vent deliver tidal volume at a preset rate because the patient is not breathing spontaneously? A. Controlled Mandatory Ventilation B. Assisted Control C. Synchronized Intermittent Mandatory Ventilation D. Continuous Positive Airway Pressure

A

Mr. G requires neuromuscular blockade to facilitate mechanical ventilation. Which is not a true statement when providing nursing care to paralyzed patients? A) Because patients under neuromuscular blockade are unable to react to the environment, special safety precautions are not needed. B) Pain medication is required because neuromuscular blocking agents do not have an analgesic effect. C) Patients under the influence of neuromuscular blocking agents are fully aware of activity around them. D) The nurse must be alert for complications of immobility such as deep vein thrombosis, pressure ulcers, and atelectasis.

A

The nurse is caring for a 65-yr-old man with acute respiratory distress syndrome (ARDS) who is on pressure support ventilation (PSV), fraction of inspired oxygen (FIO2) at 80%, and positive end-expiratory pressure (PEEP) at 15 cm H2O. The patient weighs 72 kg. What finding would indicate that treatment is effective? a. PaO2 of 60 mm Hg b. Tidal volume of 700 mL c. Cardiac output of 2.7 L/min d. Inspiration to expiration ratio of 1:2

A

The nurse is caring for a patient who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning the patient from a ventilator, the nurse is aware that the weaning of the patient will progress in what order? A) Removal from the ventilator, tube, and then oxygen B) Removal from oxygen, ventilator, and then tube C) Removal of the tube, oxygen, and then ventilator D) Removal from oxygen, tube, and then ventilator

A

The purpose of adding PEEP to positive pressure ventilation is to a. increase functional residual capacity and improve oxygenation b. increase FIO2 in an attempt to wean the patient and avoid O2 toxicity c. determine if the patient is in synchrony with the ventilator or needs to be paralyzed d. determine is the patient is able to be weaned and avoid the risk of pneumomediastinum

A

Which assessment information obtained by the nurse when caring for a patient receiving mechanical ventilation indicates the need for suctioning? a. The respiratory rate is 32 breaths/min. b. The pulse oximeter shows a SpO2 of 93%. c. The patient has not been suctioned for the last 6 hours. d. The lungs have occasional audible expiratory wheezes.

A

A nurse is reviewing the plan of care for a client who is receiving mechanical ventilation. Which of the following ventilator modes will increase the client's work of breathing? Select all that apply a. assist-control b. synchronized intermittent mandatory ventilation c. continuous positive airway pressure d. pressure support ventilation e. independent lung ventilation

BCD

What plan should the nurse use when weaning a patient from a ventilator? a. decrease the delivered FIO2 concentration b. intermittent trials of spontaneous ventilation followed by ventilatory support to provide rest c. substitute ventilator support with manual resuscitation bag if the patient becomes hypoxic d. implement weaning procedures around the clock until the patient does not experience ventilator fatigue

B

What ventilation setting delivers preset tidal volume whenever the patient exerts inspiration, and still ensures that the patient recieves a breath if they do not spontaneously trigger the ventilator? A. Controlled Mandatory Ventilation B. Assisted Control C. Synchronized Intermittent Mandatory Ventilation D. Continuous Positive Airway Pressure

B

The nurse is caring for a client who has been using mechanical ventilation for several months after an episode of sepsis and acute respiratory distress syndrome​ (ARDS). Which ventilator setting should the nurse anticipate the healthcare provider ordering for​ weaning? A. Positive​ end-expiratory pressure​ (PEEP) B. Bilevel ventilation​ (BIPAP) C. Assist-control mode ventilation​ (ACMV) D. Synchronized intermittent mandatory ventilation​ (SIMV)

D

What should the nurse recognize as a factor commonly responsible for sodium and fluid retention in the patient on mechanical ventilation? a. increased release of ADH b. increased release of atrial natriuretic factor c. increased insensible water loss via the airway d. decreased renal perfusion with release of renin

D

You are caring for Ms. Y. She is scheduled to begin weaning from mechanical ventilation today. Which assessment would be the best indicator of her readiness to be weaned? A) Minute ventilation greater than 10 L/min B) Respiratory rate at least 30/min C) FiO2 less than 50% D) Rapid shallow breathing index (RSBI)

D

Strategies to prevent ventilator associated pneumonia include: A) rotating the patient's position every 2 hours with HOB at 10 degrees. B) daily oral care with peroxide. C) peptic ulcer disease prophylaxis. D) biweekly assessment of readiness to extubate.

C

A health care provider writes a prescription to begin to wean the client from the mechanical ventilator by use of intermittent mandatory ventilation/synchronized intermittent mandatory ventilation (IMV/SIMV). The nurse determines that the process of weaning will occur by which mechanism? 1.Gradually decreasing the respiratory rate until the client can assume the work of breathing without ventilatory assistance 2.Attaching a T-piece to the ventilator and providing supplemental oxygen at a concentration that is 10% higher than the ventilator setting 3.Providing pressure support to decrease the workload of breathing and increase the client's ability to initiate spontaneous breathing efforts 4.Removing the ventilator from the client and closely monitoring the client's ability to breathe spontaneously for a predetermined amount of time

1

A nurse is caring for an agitated and anxious patient who was intubated 6 hours ago and is now on mechanical ventilation. Communication efforts to calm the patient have failed, and the nurse is now turning to pharmacological intervention. Which medication does the nurse anticipate administering? 1) Lorazepam 2) Morphine sulfate 3) Pancuronium 4) Fentanyl

1 Although Pancuronium (a neuromuscular blocking agent) CAN be used, it is best to try a sedative first. If satisfactory oxygen levels still cannot be maintained, then a neuromuscular blocking agent (WITH PAIN MEDICATION AND SEDATION!) can be used.

The nurse is caring for a client who is mechanically ventilated, and the high-pressure ventilator alarm is sounding. The nurse understands that which complications may cause this alarm? Select all that apply. 1.Water or a kink in the tubing 2.Biting on the endotracheal tube 3.Increased secretions in the airway 4.Disconnection or leak in the system 5.The client stops spontaneous breathing.

123

A client who is intubated and receiving mechanical ventilation has a problem of risk for infection. The nurse should include which measures in the care of this client? Select all that apply. 1.Monitor the client's temperature. 2.Use sterile technique when suctioning. 3.Use the closed-system method of suctioning. 4.Monitor sputum characteristics and amounts. 5.Drain water from the ventilator tubing into the humidifier bottle.

1234

The RN is supervising a nursing student who will suction a patient on a mechanical ventilator. Which actions indicate that the student has a correct understanding of this procedure? Select all that apply. 1.) The student nurse uses a sterile catheter and glove. 2.)The student nurse applies suction while inserting the catheter. 3.)The student nurse applies suction during catheter removal. 4.) The student nurses uses a twirling motion when withdrawing the catheter. 5.)The student nurse uses a no. 12 French catheter. 6.)The student nurse applies suction for at least 20 seconds.

1345 The standard size catheter for an adult is a no. 12 or 14 French. Infection is possible because each catheter pass can introduce bacteria into the trachea. In the hospital, use sterile technique for suctioning and for all suctioning equipment (e.g., suction catheters, gloves, saline or water). Apply suction only during catheter withdrawal and use a twirling motion to prevent the catheter from grabbing tracheal mucosa and leading to damage to tracheal tissue. Apply suction for no more than 10 seconds to minimize hypoxemia during suctioning.

The peak pressure alarm is sounding on the ventilator of the client with a recent tracheostomy. What intervention should be done first? A. Assess the client's respiratory status B. Decrease the sensitivity of the alarm C. Ensure that the connecting tubing is not kinked D. Suction the client

A The client must always be assessed before attention is turned to equipment.

A client being mechanically ventilated after experiencing a fat embolism is visibly anxious. What is the best nursing action? 1.Ask a family member to stay with the client at all times. 2.Ask the health care provider for a prescription for succinylcholine. 3.Encourage the client to sleep until arterial blood gas results improve. 4.Provide reassurance to the client and give small doses of morphine sulfate intravenously as prescribed.

4

The low-exhaled volume alarm sounds on a mechanical ventilator of a client with an endotracheal tube. The nurse determines that the cause for alarm activation may be which complication? 1.Excessive secretions 2.Kinks in the ventilator tubing 3.The presence of a mucous plug 4.Displacement of the endotracheal tube

4

Synchronized Intermittent Mechanical Ventilation is best for which patient? A. The patient with sleep apnea B. The patient trying to wean from mechanical ventilation C. The patient who is receiving neuromuscular blocking agents D. The patient who has respiratory drive but cannot sustain normal tidal volume

B

The acute medical nurse is preparing to wean a patient from the ventilator. Which assessment parameter is most important for the nurse to assess? A) Fluid intake for the last 24 hours B) Baseline arterial blood gas (ABG) levels C) Prior outcomes of weaning D) Electrocardiogram (ECG) results

B

The nurse determines that alveolar hypoventilation is occurring in a patient on a ventilator when what happens? a. the patient develops cardiac dysrhythmias b. auscultation reveals an air leak around the ET tube cuff c. ABG results show a PaCO2 of 32 mm Hg and a pH of 7.47 d. the patient tries to breathe faster than the ventilator setting

B

The nurse is assigned to provide nursing care for a patient receiving mechanical ventilation. Which action should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? a. Assessing the patient's respiratory status every 4 hours b. Taking vital signs and pulse oximetry readings every 4 hours c. Checking the ventilator settings to make sure they are as prescribed d. Observing whether the patient's tube needs suctioning every 2 hours

B

The nurse is caring for a client with an endotracheal tube who is on a ventilator. When assessing the client, the nurse knows to maintain what cuff pressure to maintain appropriate pressure on the tracheal wall? A) Between 10 and 15 mm Hg B) Between 15 and 20 mm Hg C) Between 20 and 25 mm Hg D) Between 25 and 30 mm Hg

B

Although his oxygen saturation is above 92%, an orally intubated, mechanically ventilated patient is restless and very anxious. What interventions will most likely decrease the risk of accidental extubation? Select all that apply a. administer sedatives b. have a caregiver stay with the patient c. obtain an order and apply soft wrist restraints d. remind the patient that he needs the tube inserted to breathe e. move the patient to an area close to the nurse's station for closer observation

AB

The nurse is caring for a patient who was just placed on mechanical ventilation and is observing the patient's vital signs because positive-pressure ventilation can lead to: (Select all that apply.) A) decreased cardiac output. B) decreased venous return. C) increased renal function. D) decreased intracranial pressure. E) increased hepatic function.

ABD

The nurse is caring for a client who is in the process of weaning off of mechanical ventilation. Which assessment finding should the nurse report to the healthcare​ provider?(Select all that​ apply.) A. Agitation B. Pallor C. Oxygen saturation level of​ 98% D. Respiratory rate of 18​ beats/min E. Abdominal breathing

ABE

What is included in the description of positive pressure ventilation? Select all that apply a. peak inspiratory pressure predetermined b. consistent volume delivered with each breath c. increased risk for hyperventilation and hypoventilation d. preset volume of gas delivered with variable pressure based on compliance e. volume delivered varies based on selected pressure and patient lung compliance

ACE

The physician has ordered continuous positive airway pressure (CPAP) with the delivery of a patients high-flow oxygen therapy. The patient asks the nurse what the benefit of CPAP is. What would be the nurses best response? A) CPAP allows a higher percentage of oxygen to be safely used. B) CPAP allows a lower percentage of oxygen to be used with a similar effect. C) CPAP allows for greater humidification of the oxygen that is administered. D) CPAP allows for the elimination of bacterial growth in oxygen delivery systems.

B

A patient who is receiving mechanical ventilation is anxious and is fighting the ventilator. Which action should the nurse take first? a. Ventilate the patient with a manual resuscitation bag. b. Verbally coach the patient to breathe with the ventilator. c. Sedate the patient with the ordered PRN lorazepam (Ativan). d. Increase the rate for the ordered propofol (Diprivan) infusion.

B

Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review? a. Fluid intake for the last 24 hours b. Baseline arterial blood gas (ABG) levels c. Prior outcomes of weaning d. Electrocardiogram (ECG) results

B

Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patients arterial blood gas (ABG) results include a pH of 7.50, PaO2 of 80 mm Hg, PaCO2 of 29 mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to a. increase the FIO2. b. decrease the respiratory rate. c. increase the tidal volume (VT). d. leave the ventilator at the current settings.

B

Beep Beep Beep. The high pressure alarm is sounding in the patient's room. Which of the following is the most likely cause. A) The ventilator tubing has become disconnected B) The patient is trying to talk to his friend C) There is a leak in the cuff D) The patient is c/o pain 9/10

B High pressure alarms sound when anything is blocking the air from going down the tube. Some possible causes include biting the tube, excess secretions, kinking, condensation in tubing, the patient gagging, coughing, or talking, or a more serious complication like pneumothorax or bronchospasm. Disconnected tubing would most likely set off a low pressure alarm. A leak in the cough would prevent all the air to go into the lungs efficiently. Pain itself would not affect the pressure.

A patient receiving mechanical ventilation is very anxious and agitated, and neuromuscular blocking agents are used to promote vasodilation. What should the nurse recognize about the care of this patient? a. the patient will be too sedated to be aware of the details of care b. caregivers should be encouraged to provide stimulation and diversion c. the patient should always be addressed and explanations of care given d. communication will not be possible with the use of neuromuscular blocking agents

C

The low-pressure alarm sounds on a ventilator. The nurse assesses the client and then attempts to determine the cause of the alarm. If unsuccessful in determining the cause of the alarm, the nurse should take what initial action? a. administer oxygen b. check the client's vital signs c. ventilate the client manually d. start CPR

C

The nurse is caring for a patient with emphysema and respiratory failure who is receiving mechanical ventilation through an endotracheal tube. To prevent ventilator-associated pneumonia (VAP), which action is most important to include in the plan of care? a. Administer ordered antibiotics as scheduled. b. Hyperoxygenate the patient before suctioning. c. Maintain the head of bed at a 30- to 45-degree angle. d. Suction the airway when coarse crackles are audible

C

The nurses monitors the patient with positive pressure mechanical ventilation for a. paralytic ileus because pressure on the abdominal contents affects bowel motility b. diuresis and sodium depletion because of increased release of atrial natriuretic peptide c. signs of cardiovascular insufficiency because pressure in the chest impedes venous return d. respiratory acidosis in a patient with COPD because of alveolar hyperventilation and increased PaO2 levels

C

The nursing management of a patient with an artificial airway includes a. maintaining the ET tube cuff pressure at 30 cm H20 b. routine suctioning of the tube at least every 2 hours c. observing for cardiac dysrhythmias during suctioning d. preventing tube dislodgment by limiting mouth care to lubrication of the lips

C

To decrease the risk for ventilator-associated pneumonia, which action will the nurse include in the plan of care for a patient who requires intubation and mechanical ventilation? a. Avoid use of positive end-expiratory pressure (PEEP). b. Suction every 2 hours. c. Elevate head of bed to 30 to 45 degrees. d. Give enteral feedings at no more than 10 mL/hr.

C

When planning care for a patient on a mechanical ventilator, the nurse understands that the application of positive end-expiratory pressure (PEEP) to the ventilator settings has which therapeutic effect? a. Increased inflation of the lungs b. Prevention of barotrauma to the lung tissue c. Prevention of alveolar collapse during expiration d. Increased fraction of inspired oxygen concentration (FIO2) administration

C

When the nurse is weaning a patient who has chronic obstructive pulmonary disease (COPD) from mechanical ventilation, which patient assessment indicates that the weaning protocol should be discontinued? a. The patient heart rate is 98 beats/min. b. The patients oxygen saturation is 93%. c. The patient respiratory rate is 32 breaths/min. d. The patients spontaneous tidal volume is 500 mL.

C

A 68-yr-old male patient diagnosed with sepsis is orally intubated on mechanical ventilation. Which nursing action is most important? a. Use the open-suctioning technique. b. Administer morphine for discomfort. c. Limit noise and cluster care activities. d. Elevate the head of the bed 30 degrees.

D

A patient recovering from thoracic surgery is on long-term mechanical ventilation and becomes very frustrated when he tries to communicate. What intervention should the nurse perform to assist the patient? A) Assure the patient that everything will be all right and that remaining calm is the best strategy. B) Ask a family member to interpret what the patient is trying to communicate. C) Ask the physician to wean the patient off the mechanical ventilator to allow the patient to speak freely. D) Express empathy and then encourage the patient to write, use a picture board, or spell words with an alphabet board.

D

A patient with a subarachnoid hemorrhage is intubated and placed on a mechanical ventilator. When monitoring the patient, the nurse will need to notify the health care provider if the patient develops a. oxygen saturation of 94%. b. respirations of 18 breaths/min. c. green nasogastric tube drainage. d. increased jugular vein distention (JVD).

D

Assisted Control Ventilation is best for which patient? A. The patient with sleep apnea B. The patient trying to wean from mechanical ventilation C. The patient who is receiving neuromuscular blocking agents D. The patient who has respiratory drive but cannot sustain normal tidal volume

D

The decision has been made to discharge a ventilator-dependent patient home. The nurse is developing a teaching plan for this patient and his family. What would be most important to include in this teaching plan? A) Administration of inhaled corticosteroids B) Assessment of neurologic status C) Turning and coughing D) Signs of pulmonary infection

D

The medical nurse is creating the care plan of an adult patient requiring mechanical ventilation. What nursing action is most appropriate? A) Keep the patient in a low Fowlers position. B) Perform tracheostomy care at least once per day. C) Maintain continuous bedrest. D) Monitor cuff pressure every 8 hours.

D

The nurse and the UAP are helping to take care of the patient who is on a mechanical ventilator. Which of the following, if done by the UAP, requires intervention by the nurse? A) Once a day the UAP moves the ETT tube from one side of the mouth to the other B) The UAP monitors for any alarms coming from the machine C) Performs ROM exercises with the client D) Asks the patient to rate his pain using his marker board

D The nurse is responsible for assessing pain on a patient, not the UAP. All other parts are fully within the UAP's scope of practice.