Mechanical Ventilation Practice Questions
A client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. The client is placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. What setting would be the best maximum FIO2 setting? -0.21 -0.7 -0.5 -0.35
-0.5 Explanation: An FIO2 greater than 0.5 for as little as 16 to 24 hours can be toxic and can lead to decreased gas diffusion and surfactant activity. Clients with respiratory disorders are given oxygen therapy only to increase the partial pressure of oxygen (PaO2) back to the patient's normal baseline, which may vary from 60 to 95 mm Hg. In terms of the oxyhemoglobin dissociation curve, arterial hemoglobin at these levels is 80% to 98% saturated with oxygen; higher FiO2 flow values add no further significant amounts of oxygen to the red blood cells or plasma. Instead of helping, increased amounts of oxygen may produce toxic effects on the lungs and central nervous system or may depress ventilation. The ideal oxygen source is room air FIO2 0.21.
The nurse is caring for a client in the ICU who required emergent endotracheal (ET) intubation with mechanical ventilation. The nurse receives an order to obtain arterial blood gases (ABGs) after the procedure. The nurse recognizes that ABGs should be obtained how long after mechanical ventilation is initiated? -25 minutes -10 minutes -15 minutes -20 minutes
-20 minutes Explanation: The nurse records minute volume and obtains ABGs to measure carbon dioxide partial pressure (PaCO2), pH, and PaO2 after 20 minutes of continuous mechanical ventilation.
Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? -Assist control -SIMV -Pressure support -IMV
-Assist control Explanation: Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. IMV provides a combination of mechanically assisted breaths and spontaneous breaths. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the patient can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the client-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing.
Which is an adverse reaction that would require the process of weaning from a ventilator to be terminated? -Vital capacity of 12 mL/kg -Heart rate <100 bpm -PaO2 60 mmHg with an FiO2 <40% -Blood pressure increase of 20 mm Hg
-Blood pressure increase of 20 mm Hg Explanation: Criteria for terminating the weaning process include heart rate increase of 20 beats/min and systolic blood pressure increase of 20 mm Hg. A normal vital capacity is 10 to 15 mL/kg.
The health care provider has prescribed continuous positive airway pressure (CPAP) with the delivery of a client's high-flow oxygen therapy. The client asks the nurse what the benefit of CPAP is. What would be the nurse's best response? -CPAP allows for the elimination of bacterial growth in oxygen delivery systems. -CPAP allows for greater humidification of the oxygen that is given. -CPAP allows a lower percentage of oxygen to be used with a similar effect. -CPAP allows a higher percentage of oxygen to be safely used.
-CPAP allows a lower percentage of oxygen to be used with a similar effect. Explanation: Prevention of oxygen toxicity is achieved by using oxygen only as prescribed. Often, positive end-expiratory pressure (PEEP) or CPAP is used with oxygen therapy to reverse or prevent microatelectasis, thus allowing a lower percentage of oxygen to be used. Oxygen is moistened by passing through a humidification system. Changing the tubing on the oxygen therapy equipment is the best technique for controlling bacterial growth.
The nurse is caring for a client in the ICU who is receiving mechanical ventilation. Which nursing measure is implemented in an effort to reduce the client's risk of developing ventilator-associated pneumonia (VAP)? -Cleaning the client's mouth with chlorhexidine daily -Ensuring that the client remains sedated while intubated -Maintaining the client in a high Fowler's position -Turning and repositioning the client every 4 hours
-Cleaning the client's mouth with chlorhexidine daily Explanation: The five key elements of the VAP bundle include elevation of the head of the bed (30 to 45 degrees [semi-Fowler's position)], daily "sedation vacations," and assessment of readiness to extubate; peptic ulcer disease prophylaxis (with histamine-2 receptor antagonists); deep venous thrombosis prophylaxis; and daily oral care with chlorhexidine (0.12% oral rinses). The client should be turned and repositioned every 2 hours to prevent complications of immobility and atelectasis and to optimize lung expansion.
A client who is intubated for mechanical ventilation has met the criteria for weaning. Which additional assessment findings indicate to the nurse that the client is eligible for a T-piece? Select all that apply. -Suctioned every 2 hours -Cough reflex intact -Gag reflex intact -Breathing without difficulty -Awake and alert
-Cough reflex intact -Gag reflex intact -Breathing without difficulty -Awake and alert Explanation: Respiratory weaning, the process of withdrawing the client from dependence on the ventilator, occurs in stages. Weaning from mechanical ventilation is performed at the earliest possible time according to client safety. Weaning is started when the client is physiologically and hemodynamically stable, demonstrates spontaneous breathing capability, is recovering from the acute stage of medical and surgical problems, and when the cause of respiratory failure is sufficiently reversed. Weaning through the use of a T-piece is conducted by disconnecting the client from the ventilator so that the client performs all the work of breathing. This method of weaning is used when the client is awake and alert, has intact gag and cough reflexes, and is breathing without difficulty. The frequency of suctioning is not among the criteria used to determine if a client is eligible for weaning with a T-piece.
The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.) -Prevents aspiration -Decreases hypoxemia -Sustains positive end expiratory pressure (PEEP) -Increases oxygen consumption -Decreases patient anxiety
-Decreases hypoxemia -Sustains positive end expiratory pressure (PEEP) -Decreases patient anxiety Explanation: An in-line suction device allows the patient to be suctioned without being disconnected from the ventilator circuit. In-line suctioning (also called closed suctioning) decreases hypoxemia, sustains PEEP, and can decrease patient anxiety associated with suctioning (Sole et al., 2013).
The nurse hears the patient's ventilator alarm sound and attempts to find the cause. What is the priority action of the nurse when the cause of the alarm is not able to be determined? -Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved. -Call respiratory therapy and wait until they arrive to determine what is happening. -Stop the ventilator by pressing the off button, wait 15 seconds, and then turn it on again to see if the alarm stops. -Suction the patient since the patient may be obstructed by secretions.+
-Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved. Explanation: If the cause of an alarm cannot be determined, the nurse should disconnect the patient from the ventilator and manually ventilate the patient, because leaving the patient on the mechanical ventilator may be dangerous.
A client is receiving mechanical ventilation. How frequently should the nurse auscultate the client's lungs to check for secretions? -Every 1 to 2 hours -Every 30 to 60 minutes -Every 4 to 6 hours -Every 2 to 4 hours
-Every 2 to 4 hours Explanation: Continuous positive-pressure ventilation increases the production of secretions regardless of the patient's underlying condition. The nurse assesses for the presence of secretions by lung auscultation at least every 2 to 4 hours.
The nurse should monitor a client receiving mechanical ventilation for which of the following complications? -Increased cardiac output -Pulmonary emboli -Gastrointestinal hemorrhage -Immunosuppression
-Gastrointestinal hemorrhage Explanation: Gastrointestinal hemorrhage occurs in approximately 25% of clients receiving prolonged mechanical ventilation. Other possible complications include incorrect ventilation, oxygen toxicity, fluid imbalance, decreased cardiac output, pneumothorax, infection, and atelectasis. Immunosuppression and pulmonary emboli are not direct consequences of mechanical ventilation.
A nurse is attempting to wean a client after 2 days on the mechanical ventilator. The client has an endotracheal tube present with the cuff inflated to 15 mm Hg. The nurse has suctioned the client with return of small amounts of thin white mucus. Lung sounds are clear. Oxygen saturation levels are 91%. What is the priority nursing diagnosis for this client? -Impaired physical mobility related to being on a ventilator -Risk for infection related to endotracheal intubation and suctioning -Risk for trauma related to endotracheal intubation and cuff pressure -Impaired gas exchange related to ventilator setting adjustments
-Impaired gas exchange related to ventilator setting adjustments Explanation: All the nursing diagnoses are appropriate for this client. Per Maslow's hierarchy of needs, airway, breathing, and circulation are the highest priorities within physiological needs. The client has an oxygen saturation of 91%, which is below normal. This places impaired gas exchange as the highest prioritized nursing diagnosis.
Which finding would indicate a decrease in pressure with mechanical ventilation? -Increase in compliance -Kinked tubing -Plugged airway tube -Decrease in lung compliance
-Increase in compliance Explanation: A decrease in pressure in the mechanical ventilator may be caused by an increase in compliance. Kinked tubing, decreased lung compliance, and a plugged airway tube cause an increase in peak airway pressure.
Which ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths? -Pressure support -Synchronized intermittent mandatory ventilation (SIMV) -Assist control -Intermittent mandatory ventilation (IMV)
-Intermittent mandatory ventilation (IMV) Explanation: IMV provides a combination of mechanically assisted breaths and spontaneous breaths. Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the client can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the client-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing.
Which ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths? -Pressure support -Synchronized intermittent mandatory ventilation (SIMV) -Intermittent mandatory ventilation (IMV) -Assist control
-Intermittent mandatory ventilation (IMV) Explanation: IMV provides a combination of mechanically assisted breaths and spontaneous breaths. Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the client can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the client-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing.
The decision has been made to discharge a ventilator-dependent client home. The nurse is developing a teaching plan for this client and his family. What would be most important to include in this teaching plan? -Assessment of neurologic status -Managing a power failure -Turning and coughing -Administration of inhaled corticosteroids
-Managing a power failure Explanation: The nurse teaches the client and family about topics including the management of a power failure. Neurologic assessment and turning and coughing are less important than knowing what to do if the ventilator loses power, because this could immediate threaten the client. Inhaled corticosteroids may or may not be prescribed.
A young male client has muscular dystrophy. His PaO2 is 42 mm Hg with a FiO2 of 80%. Which of the following treatments would be least invasive and most appropriate for this client? -Continuous positive airway pressure (CPAP) -Negative-pressure ventilator -Bilevel positive airway pressure (Bi-PAP) -Positive-pressure ventilator
-Negative-pressure ventilator Explanation: This client needs ventilatory support. His PaO2 is low despite receiving a high dose of oxygen. The iron lung or drinker respiratory tank is an example of a negative-pressure ventilator. This type of ventilator is used mainly with chronic respiratory failure associated with neurological disorders, such as muscular dystrophy. It does not require intubation of the client. The most common ventilator is the positive-pressure ventilator, but this involves intubation with an endotracheal tube or tracheostomy. CPAP is used for obstructive sleep apnea. Bi-PAP is used for those with severe COPD or sleep apnea who require ventilatory assistance at night.
The nurse is caring for a client who is intubated for mechanical ventilation. Which intervention(s) will the nurse implement to reduce the client's risk of injury? Select all that apply. -Position with head above the stomach level. -Provide oral hygiene. -Assess for a cuff leak. -Reduce pulling on ventilator tubing. -Monitor cuff pressure every 8 hours.
-Position with head above the stomach level. -Provide oral hygiene. -Assess for a cuff leak. -Reduce pulling on ventilator tubing. -Monitor cuff pressure every 8 hours Explanation: Maintaining the endotracheal or tracheostomy tube is an essential part of airway management. Oral hygiene is provided frequently because the oral cavity is a primary source of lung contamination in the client who is intubated. Assessing for a leak from the cuff of the endotracheal tube needs to be done at the same time as providing other respiratory care. Ventilator tubing should be positioned so that there is minimal pulling or distortion of the tube in the trachea which reduces the risk of trauma to the trachea. Cuff pressure is monitored every 8 hours to maintain the pressure at 20 to 25 mm Hg. The head of the bed should be higher than the stomach to reduce the risk of aspiration.
A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? Select all that apply. -Pulse oximeter -Tracheostomy cleaning kit -Hemostat -Water-seal chest drainage set-up -Manual resuscitation bag
-Pulse oximeter -Manual resuscitation bag Explanation: The client with COPD depends on mechanical ventilation for adequate tissue oxygenation. The nurse must keep a manual resuscitation bag at the bedside to ventilate and oxygenate the client in case the mechanical ventilator malfunctions. The nurse needs to keep an oxygen analyzer (pulse oximeter) on hand to evaluate the effectiveness of ventilation. Because the client doesn't have chest tubes or a tracheostomy, keeping a water-seal chest drainage set-up or a tracheostomy cleaning kit or hemostat at the bedside isn't necessary.
Positive end-expiratory pressure (PEEP) therapy has which effect on the heart? -Increased blood pressure -Reduced cardiac output -Bradycardia -Tachycardia
-Reduced cardiac output Explanation: PEEP reduces cardiac output by increasing intrathoracic pressure and reducing the amount of blood delivered to the left side of the heart. It doesn't affect heart rate, but a decrease in cardiac output may reduce blood pressure, commonly causing compensatory tachycardia, not bradycardia. However, the resulting tachycardia isn't a direct effect of PEEP therapy itself.
A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a severe stroke. What action does the nurse anticipate the physician will take now that the patient has been intubated for this length of time? -The patient will be extubated and another endotracheal tube will be inserted. -The patient will begin the weaning process. -The patient will be extubated and a nasotracheal tube will be inserted. -The patient will have an insertion of a tracheostomy tube.
-The patient will have an insertion of a tracheostomy tube. Explanation: Endotracheal intubation may be used for no longer than 14 to 21 days, by which time a tracheostomy must be considered to decrease irritation of and trauma to the tracheal lining, to reduce the incidence of vocal cord paralysis (secondary to laryngeal nerve damage), and to decrease the work of breathing (Wiegand, 2011).
Which of the following are indicators that a client is ready to be weaned from a ventilator? Select all that apply. -Rapid/shallow breathing index of 112 breaths/min -Tidal volume of 8.5 mL/kg -PaO2 of 64 mm Hg -Vital capacity of 13 mL/kg -FiO2 45%
-Tidal volume of 8.5 mL/kg -PaO2 of 64 mm Hg -Vital capacity of 13 mL/kg Explanation: Weaning criteria for clients are as follows: Vital capacity 10 to 15 mL/kg; Maximum inspiratory pressure at least -20 cm H2; Tidal volume: 7 to 9 mL/kg; Minute ventilation: 6 L/min; Rapid/shallow breathing index below 100 breaths/min; PaO2 > 60 mm Hg; FiO2 < 40%
A mechanically ventilated client is receiving a combination of atracurium and the opioid analgesic morphine. The nurse monitors the client for which potential complication? -Venous thromboemboli -Pneumothorax -Cor pulmonale -Pulmonary hypertension
-Venous thromboemboli Explanation: Neuromuscular blockers predispose the client to venous thromboemboli (VTE), muscle atrophy, foot drop, peptic ulcer disease, and skin breakdown. Nursing assessment is essential to minimize the complications related to neuromuscular blockade. The client may have discomfort or pain but be unable to communicate these sensations.
A nurse is caring for a client who was intubated because of respiratory failure. The client is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The client has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as: -pressure support ventilation (PSV). -synchronized intermittent mandatory ventilation (SIMV). -assist-control (AC) ventilation. -continuous positive airway pressure (CPAP).
-synchronized intermittent mandatory ventilation (SIMV). Explanation: In SIMV mode, the ventilator delivers a preset number of breaths at a preset tidal volume. The client can breathe on his own in between the breaths delivered by the ventilator. In PSV, a pressure plateau is added to the ventilator to prevent the airway pressure from falling beneath a preset level. In AC ventilation, the ventilator delivers a preset number of breaths at a preset tidal volume and any breaths that the client takes on his own are assisted by the ventilator so they reach the preset tidal volume. In CPAP, the ventilator provides only positive airway pressure; it doesn't provide any breaths to the client.
