NCIV Acid Base and Mechanical Ventilator CoursePoint Quiz - Exam 1

The nurse should monitor a client receiving mechanical ventilation for which of the following complications? A. Gastrointestinal hemorrhage B. Immunosuppression C. Increased cardiac output D. Pulmonary emboli

A 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.

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)? A. Cleaning the client's mouth with chlorhexidine daily B. Maintaining the client in a high Fowler's position C. Ensuring that the client remains sedated while intubated D. Turning and repositioning the client every 4 hours

A 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.

Arterial blood gases should be obtained how often after initiating continuous mechanical ventilation? A. 10 minutes B. 15 minutes C. 20 minutes D. 25 minutes

C ABGs should be obtained to measure carbon dioxide partial pressure (PaCO2), pH, and PaO2 after 20 minutes of continuous mechanical ventilation.

A nurse is providing care to a client who is to receive mechanical ventilation. The client weighs 165 lb (75 kg). The nurse checks the prescribed tidal volume. Which tidal volume would the nurse identify as appropriate for this client? A. 250 mL B. 325 mL C. 425 mL D. 585 mL

C The tidal volume (TV) is the amount of air given in each breath. This is usually between 5 and 7 mL of air per kilogram of body weight. For a client weighing 75 kg, the appropriate tidal volume would range from 375 mL to 525 mL.

A client with emphysema is at a greater risk for developing which acid-base imbalance? A. Chronic respiratory acidosis B. Metabolic alkalosis C. Metabolic acidosis D. Respiratory alkalosis

A Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is associated with disorders such as emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis.

A client diagnosed with pulmonary edema has a PaCO2 of 72 mm Hg and an oxygen saturation of 84%. What method of oxygen delivery would best meet the needs of this client? A. Intubation and mechanical ventilation B. Face mask with nonrebreather C. Oxygen cannula at 6 L/minute D. Venturi mask at 35%

A The client's respiratory status is severely compromised and has developed signs of respiratory failure. When respiratory failure occurs, the client is intubated and oxygen is administered under continuous positive airway pressure or with mechanical ventilation with positive end-expiratory pressure. A face mask, cannula, or Venturi mask will not deliver the concentration or ventilatory support that an endotracheal tube with mechanical ventilation will provide.

A nurse is caring for a client diagnosed with Guillain-Barré syndrome. The client states, "It's getting harder to take a deep breath." Which action by the nurse is most appropriate? A. Call the physician and prepare for intubation. B. Explain the progression of the syndrome. C. Assess lung sounds. D. Encourage the client to cough.

A The progression of Guillain-Barré syndrome leads to neuromuscular respiratory failure in a large proportion of the people affected. Changes in vital capacity and negative inspiratory force are usually key indicators to be monitored for early intervention. The nurse should be alert to the earliest signs that a client may be heading toward respiratory failure. Explaining the progression of the syndrome will not change the potential need for mechanical ventilation due to respiratory failure. Because the respiratory failure is caused by neurologic changes, assessing the lung sounds, although appropriate, is not the highest priority . Encouraging the client to cough will not change the progression of the syndrome.

Which finding would indicate a decrease in pressure with mechanical ventilation? A. Kinked tubing B. Increase in compliance C. Decrease in lung compliance D. Plugged airway tube

B 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.

A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? A. Check for an apical pulse. B. Suction the client's artificial airway. C. Increase the oxygen percentage. D. Ventilate the client with a handheld mechanical ventilator.

B A high-pressure alarm on a continuous mechanical ventilator indicates an obstruction in the flow of gas from the machine to the client. The nurse should suction the client's artificial airway to remove respiratory secretions that could be causing the obstruction. The sounding of a ventilator alarm has no relationship to the apical pulse. Increasing the oxygen percentage and ventilating with a handheld mechanical ventilator wouldn't correct the airflow blockage. Reference:

A client is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube? A. To drain copious sputum secretions B. To monitor bleeding around the lungs C. To assist with mechanical ventilation D. To remove air from the pleural space

D Chest tubes and closed drainage systems are used to re-expand the lung involved and to remove excess air, fluid, and blood. The primary purpose of a chest tube is not to drain sputum secretions, monitor bleeding, or assist with mechanical ventilation.

A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced? A. The kidneys will excrete increased quantities of acid. B. Bicarbonate will be released from the adrenal medulla. C. Alveoli in the lungs will synthesize new bicarbonate. D. Renal tubular cells will generate new bicarbonate.

D To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body. The lungs and adrenal glands do not synthesize bicarbonate. Excretion of acid compensates for a lack of bicarbonate, but it does not actively replace it.

Which homeostatic mechanism would the body of a critically ill client use to maintain normal pH? A. The lungs eliminate carbonic acid by blowing off more CO2. B. The lungs increase respiratory volume. C. The lungs retain more CO2 to lower the pH. D. The kidneys retain more HCO3 to raise the pH.

A To maintain normal pH in critically ill clients, the lungs eliminate carbonic acid by blowing off more CO2. To maintain normal pH in critically ill clients, the lungs conserve CO2 by slowing respiratory volume. The lungs would retain more CO2 during an acid-base imbalance in cases of metabolic alkalosis. The kidneys would retain more HCO3 to compensate during an acid-base imbalance in cases of metabolic acidosis.

The nurse is caring for a client who has just been intubated and started on mechanical ventilation in the intensive care unit. The nurse recognizes that it is possible to inadvertently intubate the right lung only. What nursing assessment and monitoring is required to determine if this complication has occurred? Select all that apply. A. Auscultate both sides of the chest B. Mark the endotracheal tube at the corner of the mouth and nose C. Monitor for both high and low pressure alarms D. Apply suctioning to clear the airway E. Re-set the ventilator rate as needed

A, B, C It is important to remember that the right main bronchus is wider, shorter, and more vertical than the left. This physiologic difference may lead to inadvertent intubation of the right lung only. It is essential to listen to both sides of the chest for bilateral breath sounds, mark the correct endotracheal tube (ETT) placement at lip or nares, and monitor for high- and low-pressure alarms. Although suctioning the airway to remove secretions is an essential part of the nurse's responsibility when caring for a ventilated client, this action will not help the nurse determine if the tube has been placed only into the right lung only. The ventilator settings are determined by the client's primary health provider and any changes would require an order. These settings are specific to the client's individualized needs. Despite this, the re-setting the ventilator would not help determine incorrect placement of the endotracheal tube.

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? A. Respiratory alkalosis B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis

B A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

What would the critical care nurse recognize as a condition that may indicate a client's need to have a tracheostomy? A. A client has a respiratory rate of 10 breaths per minute. B. A client requires permanent ventilation. C. A client exhibits symptoms of dyspnea. D. A client has respiratory acidosis.

B A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of oral and gastric secretions in the unconscious or paralyzed client. Indications for a tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of dyspnea, or respiratory acidosis.

The acute medical nurse is preparing to wean a client 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 Before weaning a client from mechanical ventilation, it is most important to have baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are relevant, but less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client's record, and the nurse can refer to them before the weaning process begins

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: A. Pressure support ventilation (PSV). B. Synchronized intermittent mandatory ventilation (SIMV). C. Assist-control (AC) ventilation. D. Continuous positive airway pressure (CPAP).

B 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.

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? A. Respiratory alkalosis B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis

B Metabolic alkalosis results in increased plasma pH because of an accumulated base bicarbonate or decreased hydrogen ion concentration. Factors that increase base bicarbonate include excessive oral or parenteral use of bicarbonate-containing drugs, a rapid decrease in extracellular fluid volume and loss of hydrogen and chloride ions as with gastric suctioning. Acidotic states are from excess carbonic acid and hydrogen ions in the system. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary.

A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? A. Sequestering free hydrogen ions in the nephrons B. Returning bicarbonate to the body's circulation C. Returning acid to the body's circulation D. Excreting bicarbonate in the urine

B The kidney performs two major functions to assist in acid-base balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.

A nurse is providing care to a client receiving mechanical ventilation when the high pressure alarm sounds on the ventilator. The nurse troubleshoots the problem. Which assessment would the nurse identify as a possible cause for the alarm? Select all that apply A. Airway displacement B. Kinked tubing C. Client experiencing bronchospasm D. Client biting the endotracheal tube E. Tubing disconnection

B, C, D A high-pressure alarm usually indicates resistance to or obstruction of airflow from biting on the ETT, a kink in the tubing, or something as severe as bronchospasm or pneumothorax. Pressure alarms on the ventilator may indicate a dangerous situation. Low-pressure alarms may indicate disconnection from the machine or displacement of the airway.

Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? A. IMV B. SIMV C. Assist control D. Pressure support

C 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 ventilator mode provides full ventilatory support by delivering a preset tidal volume and respiratory rate? A. IMV B. SIMV C. Assist control D. Pressure support

C Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. Intermittent mandatory ventilation (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 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.

A client is receiving mechanical ventilation. How frequently should the nurse auscultate the client's lungs to check for secretions? A. Every 30 to 60 minutes B. Every 1 to 2 hours C. Every 2 to 4 hours D. Every 4 to 6 hours

C 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.

A client in the ICU has had an endotracheal tube in place for 3 weeks. The health care provider has ordered that a tracheostomy tube be placed. The client's family wants to know why the endotracheal tube cannot be left in place. What would be the nurse's best response? A. "The physician may feel that mechanical ventilation will have to be used long-term." B. "Long-term use of an endotracheal tube diminishes the normal breathing reflex." C. "When an endotracheal tube is left in too long it can damage the lining of the windpipe." D. "It is much harder to breathe through an endotracheal tube than a tracheostomy."

C Endotracheal intubation may be used for no longer than 2 to 3 weeks, 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. The need for long-term ventilation would not be the primary rationale for this change in treatment. Endotracheal tubes do not diminish the breathing reflex.

A client on the unit receiving mechanical ventilation is being prepared to be weaned from the ventilator. When developing this client's plan of care, which ventilator mode would the nurse anticipate using? A. Assist control B. High-frequency C. Pressure support D. Synchronized intermittent mandatory

C Pressure support ventilation (PSV) is a mode of ventilation in which the client breathes spontaneously but uses additional pressure during inspiration to increase air flow through the ventilator tubing and artificial airway. This decreases the work of breathing caused by a narrowed airway. Clients using pressure support are often in the process of being weaned from the ventilator. Assist control (AC) also delivers a set tidal volume but allows clients to set their own respiratory rate. When they take a breath, they receive the entire preset tidal volume, thus decreasing their work of breathing. High-frequency ventilation (HFV), or oscillating ventilators, deliver very small tidal volumes (from 3 to 6 mL/kg or 50 to 80 mL in a range from 60 to over 200 times per minute). This works on the principle of oxygen diffusion gently pulsating throughout the lungs. Clients on this form of ventilation also require sedation. Synchronized intermittent mandatory ventilation (SIMV) delivers a number of breaths at a preset tidal volume to ensure a minimum number of breaths with an adequate tidal volume. Clients may breathe spontaneously but will receive only the tidal volume they are able to inspire on their own. Reference:

The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? A. Kidney and liver B. Heart and lungs C. Lungs and kidney D. Pancreas and stomach

C The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.

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? A. 10 minutes B. 15 minutes C. 20 minutes D. 25 minutes

C 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.

The nurse educator is explaining the difference between indications for nasopharyngeal airway insertion versus endotracheal intubation. Which responses from learners indicate correct reasons for the use of endotracheal tubes in clients? Select all that apply. A. To support ventilation in a client with basal skull trauma B. To provide airway support to a client with facial trauma C. To bypass an upper airway obstruction D. To support connecting to mechanical ventilation E. To facilitate removal of tracheobronchial secretions

C, D, E Endotracheal intubation is indicated to establish an airway for a client who cannot be adequately ventilated with an oropharyngeal or nasopharyngeal airway, bypass an upper airway obstruction, prevent aspiration, permit connection of the client to a resuscitation bag or mechanical ventilator, or facilitate the removal of tracheobronchial secretions. In the case of potential facial trauma or basal skull fracture, the nasopharyngeal airway should not be used because it could enter the brain cavity instead of the pharynx.

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? A. PaO2 B. PO2 C. Carbonic acid D. Bicarbonate

D Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. PaO2 and PO2 are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG. Reference:

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A. A disconnected ventilator circuit B. An ET cuff leak C. A change in the oxygen concentration without resetting the oxygen level alarm D. Kinking of the ventilator tubing

D Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm, pulmonary embolus, mucus plugging, water in the tube, and coughing or biting on the ET tube. The alarm may also be triggered when the client's breathing is out of rhythm with the ventilator. A disconnected ventilator circuit or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm, not the high-pressure alarm.

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? A. Myasthenia gravis B. Type 1 diabetes mellitus C. Opioid overdose D. Extreme anxiety

D Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul respirations) don't cause excessive CO2 loss. Myasthenia gravis and opioid overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.