H476 - Mechanical ventilation/ARDS

The mechanically ventilates patient is on the following settings: CPAP, FiO2 40%, PEEP +5, and PS +10. The patient's latest ABG reveals the following: pH 7.28, PCO2 50, PO2 72, HCO3 23. The nurse caring for the patient anticipates what changes to the vent settings?

Change to volume control in order to manipulate RR and TV

The mechanically ventilated 60 kg patient is on the following settings: A/C, FiO2 50%, Rate 14, TV 550, and PEEP +5. The patient's latest ABG reveals the following: pH 7.52, PCO2 30, PO2 88, HCO3 24. The nurse caring for the patient anticipates what changes to the vent settings?

Decrease TV

The nurse is caring for a patient on volume assist/control ventilation. The nurse knows that which of the following statements is true regarding volume assist/control? a. The vent will assist ALL breaths to the predetermined tidal volume b. The patient is unable to trigger spontaneous breaths c. The vent will not assist spontaneous breaths by the patient d. This mode is ideal for patients who have a decreased respiratory drive

a. The vent will assist ALL breaths to the predetermined tidal volume

The mechanically ventilated patient is on the following settings: SIMV, FiO2 40%, Rate 10, TV 550, PEEP +5, and PS +10. The patient's latest ABG reveals the following: pH 7.40, PCO2 42, PO2 65, HCO3 25. The nurse caring for the patient anticipates what changes to the vent settings?

Increase FiO2

The mechanically ventilated 85kg patient is on the following settings: SIMV, FiO2 50%, Rate 10, TV 550, PEEP +5, and PS +10. The patient's ABG reveals the following: pH 7.33, PCO2 48, PO2 80, HCO3 25. The nurse caring for the patient anticipates what changes to the vent settings?

Increase RR

The mechanically ventilated 80kg patient is on the following settings: A/C, FiO2 60%, Rate 14, TV 450, and PEEP +5. The patient's latest ABG reveals the following: pH 7.30, PCO2 50, PO2 75, HCO3 25. The nurse caring for the patient anticipates what changes to the vent settings?

Increase TV Increase PEEP

The nurse is caring for a mechanically ventilated patient whose ABG reveals increased CO2 levels. What vent settings can the nurse manipulate to lower the patient's CO2 into the normal range? a. Increase TV and RR b. Increase PEEP and FiO2 c. Decrease TV and RR d. Decrease PEEP and FiO2

a. Increase TV and RR

The nurse is caring for the patient who has developed ARDS. The patient now has an order for mechanical ventilation. The nurse anticipates that the physician will select which mode of mechanical ventilation for the patient? a. Pressure assist/control b. SIMV c. CPAP d. Pressure support

a. Pressure assist/control

The mechanically vented patient becomes septic and spikes a fever of 103 degrees fahrenheit. The nurse knows because of this, what shift will occur on the oxyhemoglobin disassociation curve? a. Shift to the right b. Shift to the left c. Shift upward d. Shift downward

a. Shift to the right

The nurse is caring for a patient who is mechanically ventilated. The nurse enters the room when the high-pressure alarm sounds and alerts the nurse to a PIP of 40. The nurse knows the cause of this alarm could be which of the following? a. The patient has thick secretions clogging the tubing b. The patient has accidentally extubated themselves c. The tubing has become disconnected d. The patient has been oversedated and is no longer participating in the WOB

a. The patient has thick secretions clogging the tubing

The nurse caring for the mechanically ventilated patient is educating the patient's family regarding SIMV. Which statement made by the family indicates the need for further teaching? a. "My family member is receiving a set amount of air no matter what" b. "My family member is not able to take any of their own breaths" c. "The ventilator is set to deliver a certain amount of breaths per minute to my family member" d. "The ventilator will help strengthen my family member's lungs"

b. "My family member is not able to take any of their own breaths"

The nurse is caring for a patient who is hypoxic. The patient is able to initiate his own breaths and his ABGs are otherwise normal. What ventilator setting would the nurse anticipate for this patient? a. SIMV b. CPAP c. Pressure assist/control d. Volume assist/control

b. CPAP

The nurse is caring for a mechanically vented patient. The patient is consistently trying to fight the tube and pull it out. The nurse notifies the health care provider and anticipates them to write which order? a. Stat extubation of patient b. Midazolam 2mg IV c. Bilateral wrist restraints d. Succinylcholine 75mg IV

b. Midazolam 2mg IV

The nurse is caring for the patient who is suspected of having ARDS. The nurse knows that which of the following is NOT characteristic of an ARDS patient? a. Hyperventilation b. Respiratory acidosis c. Infiltrates on lung images d. Hypoxemia

b. Respiratory acidosis

The nurse is caring for the mechanically ventilated patient. The nurse recognizes that which of the following characteristics indicate that the patient is NOT ready to wean from the ventilator? Select all that apply. a. The patient's respiratory rate is 20 breaths/min b. The patient has a fever of 101.5 c. The patient's PEEP is set at 5 d. The patient requests Morphine for pain score of 5 e. The patient's FiO2 is set at 40%

b. The patient has a fever of 101.5 d. The patient requests Morphine for pain score of 5

The nurse is caring for the patient who is preparing for extubation. Once extubated, the nurse should make what initial action? a. Suction the client for secretions that may have pooled behind the tube b. Obtain a set of vital signs c. Ask the patient to cough and speak d. Auscultate the patient's breath sounds

c. Ask the patient to cough and speak

The nurse is caring for a mechanically ventilated patient whose ABG reveals decreased CO2 levels. What vent settings can the nurse manipulate to increase the patient's CO2 into the normal range? a. Increase TV and RR b. Increase PEEP and FiO2 c. Decrease TV and RR d. Decrease PEEP and FiO2

c. Decrease TV and RR

The nurse is caring for the mechanically ventilated patient who remains hypoxic. Unfortunately, the FiO2 is already outside the safe range of 40-60%. What setting can the nurse manipulate in order to increase the patients PO2? a. Increase pressure support b. Decrease pressure support c. Increase PEEP d. Decrease PEEP

c. Increase PEEP

The patient suffering from ARDS asks the nurse why he has to be positioned on his stomach. Which of the following reflects the best statement by the nurse? a. Prone positioning makes it harder for you to hyperventilate b. Prone positioning is required for mechanically vented patients c. Prone positioning allows for better lung expansion d. Prone positioning facilitates drainage of lung secretions

c. Prone positioning allows for better lung expansion

The nurse is suctioning a patient via an endotracheal tube. During the suctioning procedure, the nurse notes that the heart rate is decreasing on the monitor. What nursing intervention is appropriate? a. Continue to suction the patient b. Notify the health care provider immediately c. Stop the procedure and reoxygenate the patient d. Ensure that suctioning is limited to 15 seconds

c. Stop the procedure and reoxygenate the patient

The low-pressure alarm sounds on a ventilator. The nurse assesses the patient and then attempts to determine the cause of the alarm. If unsuccessful, the nurse should take what initial action? a. Administer oxygen b. Check the patient's vital signs c. Ventilate the client manually d. Start cardiopulmonary resuscitation

c. Ventilate the client manually

The nurse is caring for the patient who is currently in the weaning process. The nurse notes that the patient's blood pressure and heart rate are increasing significantly. What is the first action the nurse should make? a. Notify the health care provider of changes b. Administer a beta-blocker per physician order c. Increase the support on ventilator setting d. Discontinue the weaning process

d. Discontinue the weaning process

The nurse is assessing a patient who is at risk for developing acute respiratory distress syndrome (ARDS). The nurse should for which earliest sign of ARDS? a. Bilateral wheezing b. Inspiratory crackles c. Intercostal retractions d. Increased respiratory rate

d. Increased respiratory rate

The nurse knows that the ventilator mode that provides the highest level of lung support is: a. SIMV b. CPAP c. Volume assist/control d. Pressure assist/control

d. Pressure assist/control

The nurse is caring for the patient suspected to have developed ARDS. Which ABG correlates most with the patient in ARDS? a. pH 7.40, PaO2 93, PaCO2 36, HCO3 25 b. pH 7.32, PaO2 62, PaCO2 50, HCO3 22 c. pH 7.50, PaO2 80, PaCO2 45, HCO3 32 d. pH 7.48, PaO2 76, PaCO2 28, HCO3 23

d. pH 7.48, PaO2 76, PaCO2 28, HCO3 23