Ventilator Practice Questions

A client with a pulmonary embolus is intubated and placed on mechanical ventilation. When suctioning the endotracheal tube, what should the nurse do? A. Hyperoxygenate with 100% oxygen before and after suctioning B. Suction two or three times in quick succession to remove secretions C. Use the technique of short, pushing movements when applying suction D. Apply suction for no more than 10 seconds while inserting the catheter

Hyperoxygenate with 100% oxygen before and after suctioning (*Rationale*: Suctioning removes not only secretions but also oxygen, which can cause cardiac dysrhythmias; the nurse should try to prevent this by hyperoxygenating the client before and after [1] [2]. Suction should be performed only as needed to maintain a patent airway; excessive suctioning irritates the mucosa, which increases secretion production. Short, pushing movements can cause tracheal damage. To prevent trauma to the trachea, suction should be applied only while removing the catheter, not while inserting)

After an anterior fossa craniotomy, a client is placed on controlled mechanical ventilation. To ensure adequate cerebral blood flow, which action should the nurse take? A. Clear the ear of draining fluid. B. Discontinue anticonvulsant therapy. C. Elevate the head of the bed 30 degrees. D. Monitor serum carbon dioxide levels routinely.

Monitor serum carbon dioxide levels routinely (*Rationale:* Carbon dioxide levels must be maintained since carbon dioxide can cause vasodilation, increasing intracranial pressure, and decreasing blood flow. The fluid may be cerebrospinal fluid; clearing the ear may cause further damage. Because of manipulation during a craniotomy, anticonvulsants are given prophylactically to prevent seizures. Elevating the head of the bed 30 degrees will not increase cerebral blood flow.)

When caring for an intubated client receiving mechanical ventilation, the nurse hears the high-pressure alarm. Which action is most appropriate? A. Remove secretions by suctioning. B. Lower the setting of the tidal volume. C. Check that tubing connections are secure. D. Obtain a specimen for arterial blood gases (ABGs).

Remove secretions by suctioning. (*Rationale*: Secretions in the airway will increase pressure by blocking air flow and must be removed. The nurse must identify/correct the problem so that the set tidal volume can be delivered. Connections that are not intact would cause a low-pressure alarm. ABGs are used to assess client status, but they are not taken each time a pressure alarm is heard.)

A client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breath sounds in the right upper lobe of the lung. The nurse immediately assesses for other signs of: A. Right pneumothorax B. Pulmonary Embolism C. Displaced endotracheal tube D. Acute respiratory distress syndrome

Right pneumothorax (*Rationale*: Pneumothorax is characterized by restlessness, tachycardia, dyspnea, pain with respiration, asymmetrical chest expansion and diminished or absent breath sounds on the affected side. Pneumothorax can cause increased airway pressure because of resistance to lung inflation. ARDS and PE are not characterized by absent breath sounds. An endotracheal tube that is inserted too far can cause absent breath sounds, but the lack of breath sounds most likely would be on the left side because of the degree of curvature of the right and left main stem bronchi)

The low-pressure alarm sounds on a ventilator. A nurse assess the client and then attempts to determine the cause of the alarm. The nurse is unsuccessful in determining the cause of the alarm and takes what initial action? A. Checks the client's vital signs. B. Ventilates the client manually. C. Administers oxygen. D. Starts cardiopulmonary resuscitation.

Ventilates the client manually. (*Rationale:* If at any time an alarm is sounding and the nurse cannot quickly ascertain the problem, the client is disconnected from the ventilator and manual resuscitation is used to support respirations until the problem can be corrected. No reason is given to begin CPR. Checking vital signs is not the initial action. Although oxygen is helpful, it will not provide ventilation to the client)

A client is on a ventilator. A nurse asks another nurse, "What should be done when condensation resulting from humidity collects in the ventilator tubing?" What is the nurse's best response? A. "Notify the respiratory therapist." B. "Empty the fluid from the tubing." C. "Decrease the amount of humidity." D. "Document the output on the record."

"Empty the fluid from the tubing." (*Rationale*: Emptying the fluid from the tubing is necessary to prevent fluid from entering the trachea; some systems have receptacles attached to the tubing to collect fluid; others have to be temporarily disconnected while fluid is emptied. This circumstance does not require assistance from a respiratory therapist. Decreasing the amount of humidity is unsafe; humidity is necessary to preserve moistness of the respiratory tract and to liquefy secretions. The amount of condensation is irrelevant to intake and output.)

A nurse is working with a client immediately after removal of the endotracheal tube following a radical neck dissection. The nurse reports which of the following signs immediately if experienced by the client. A. Stridor B. Occasional pink-tinged sputum C. Respiratory rate of 24 breaths per minute D. A few basilar crackles on the right.

Stridor