prep u ch 21
A client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for: You Selected: 15 to 60 seconds.
Correct response: 5 to 20 minutes.
A client is on a ventilator. Alarms are sounding, indicating an increase in peak airway pressure. The nurse assesses first for You Selected: Malfunction of the alarm button
Correct response: A kink in the ventilator tubing
Which is a potential complication of a low pressure in the endotracheal tube cuff? You Selected: Tracheal ischemia
Correct response: Aspiration pneumonia
For a client with an endotracheal (ET) tube, which nursing action is the most important? You Selected: Monitoring serial blood gas values every 4 hours
Correct response: Auscultating the lungs for bilateral breath sounds
A patient with emphysema is placed on continuous oxygen at 2 L/min at home. Why is it important for the nurse to educate the patient and family that they must have No Smoking signs placed on the doors? You Selected: Oxygen is combustible. Correct response: Oxygen supports combustion.
Correct response: Oxygen supports combustion.
A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? You Selected: Check for an apical pulse.
Correct response: Suction the client's artificial airway.
The nurse is preparing to perform tracheostomy care for a client with a newly inserted tracheostomy tube. Which action, if performed by the nurse, indicates the need for further review of the procedure? You Selected: Cleans an infected wound and the plate with a sterile cotton tip moistened with hydrogen peroxide
Correct response: Places clean tracheostomy ties then removes soiled ties after the new ties are in place without a second nurse assisting
Which is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means? You Selected: Partial-rebreathing mask
Correct response: Venturi mask