Sole - Chapter 9: Ventilatory Assistance
A patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital signs and normal arterial blood gases (ABGs), and is placed on a T-piece for ventilatory weaning. What interdisciplinary staff member does the nurse notify to assist in the care of this patient while preparing to give this patient diuretics? A. Respiratory therapist to adjust ventilator B. Social worker to notify family C. Phlebotomy to obtain another set of blood gasses D. Nursing assistant to help reposition the patient
A
A patient's endotracheal tube is not secured tightly. The respiratory care practitioner assists the nurse in taping the tube. After the tube is retaped, the nurse auscultates the patient's lungs and notes that the breath sounds over the left lung fields are absent. The nurse suspects that A. The endotracheal tube is in the right mainstem bronchus. B. The patient has a left pneumothorax. C. The patient has aspirated secretions during the procedure. D. The stethoscope earpiece is clogged with wax.
A
A patient's ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from 0.6 to 0.7, and the positive end-expiratory pressure is increased from 10 to 15 cm H2O. Shortly after these adjustments, the nurse notes that the patient's blood pressure drops from 120/76 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in blood pressure? A. Decrease in cardiac output B. Hypovolemia C. Increase in venous return D. Oxygen toxicity
A
The nurse is caring for a patient who is mechanically ventilated. As part of the nursing care, the nurse understands that A. Communication with intubated patients is often difficult. B. Controlled ventilation is the preferred mode for most patients. C. Patients with chronic obstructive pulmonary disease wean easily from mechanical ventilation. D. Wrist restraints are applied to all patients to avoid self-extubation.
A
The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following? (Select all that apply.) A. Coughing or attempting to talk B. Disconnection from the ventilator C. Kinks in the ventilator tubing D. Need for suctioning E. Spontaneous breathing
A, C, D
The nurse is assisting with endotracheal intubation of the patient and recognizes that the procedure will be done in what order: _______________, _______________, _______________, _______________, _______________? A. Assess balloon on endotracheal tube for symmetry and leaks B. Assess lung fields for bilateral expansion C. Inflate balloon of endotracheal tube D. Insert endotracheal tube with laryngoscope and blade E. Suction oropharynx
A, E, D, C, B
A patient is admitted to the cardiac surgical intensive care unit after cardiac surgery with the following arterial blood gas (ABG) levels. What action by the nurse is best? pH: 7.4 PaCO2: 40 mm Hg Bicarbonate: 24 mEq/L PaO2: 95 mm Hg O2 saturation: 97% Respirations: 20 breaths/min A. Call the provider to request rapid intubation. B. Document the findings and continue to monitor. C. Request that another set of ABGs be drawn and run. D. Correlate the patient's O2 saturation with the ABGs.
B
A patient is admitted to the progressive care unit with a diagnosis of community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease and diabetes. A set of arterial blood gases obtained on admission without supplemental oxygen shows pH 7.35; PaCO2 55 mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. These blood gases reflect: A. Hypoxemia and compensated metabolic alkalosis. B. Hypoxemia and compensated respiratory acidosis. C. Normal oxygenation and partly compensated metabolic alkalosis. D. Normal oxygenation and uncompensated respiratory acidosis.
B
A patient is having difficulty weaning from mechanical ventilation. The nurse assesses the patient for which potential cause of this difficult weaning? A. Cardiac output of 6 L/min. B. Hemoglobin of 8 g/dL. C. Negative sputum culture and sensitivity. D. White blood cell count of 8000.
B
One of the early signs of hypoxemia on the nervous system is A. Cyanosis. B. Restlessness. C. Agitation. D. Tachypnea.
B
Oxygen saturation (SaO2) represents A. Alveolar oxygen tension. B. Oxygen that is chemically combined with hemoglobin. C. Oxygen that is physically dissolved in plasma. D. Total oxygen consumption.
B
The nurse is assisting with endotracheal intubation and understands that correct placement of the endotracheal tube in the trachea would be identified by which of the following? (Select all that apply.) A. Auscultation of air over the epigastrium B. Equal bilateral breath sounds upon auscultation C. Position above the carina verified by chest x-ray D. Positive detection of carbon dioxide (CO2) through CO2 detector devices E. Fogging of the endotracheal tube
B, C, D
Select all of the factors that may predispose the patient to respiratory acidosis. (Select all that apply.) A. Anxiety and fear B. Central nervous system depression C. Diabetic ketoacidosis D. Nasogastric suctioning E. Overdose of sedatives
B, E
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives a dose of morphine sulfate, and his spontaneous respirations decrease to 4 breaths/min. Which acid-base disturbance will likely occur? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
C
The nurse is caring for a patient with an endotracheal tube. The nurse understands that endotracheal suctioning is needed to facilitate removal of secretions and that the procedure A. Decreases intracranial pressure. B. Depresses the cough reflex. C. Is done as indicated by patient assessment. D. Is more effective if preceded by saline instillation.
C
The nurse notes that the patient's arterial blood gas levels indicate hypoxemia. The patient is not intubated and has a respiratory rate of 22 breaths/min. The nurse's first intervention to relieve hypoxemia is to: A. Call the provider for an emergency intubation procedure. B. Obtain an order for bilevel positive airway pressure (BiPAP). C. Notify the provider of values and obtain a prescription for oxygen. D. Suction secretions from the oropharynx.
C
The primary mode of action of neuromuscular blocking agents is A. Analgesia. B. Anticonvulsant. C. Paralysis. D. Sedation.
C
When assessing the patient for hypoxemia, the nurse recognizes that an early sign of the effect of hypoxemia on the cardiovascular system is A. Heart block. B. Restlessness. C. Tachycardia. D. Tachypnea.
C
The nurse is caring for a mechanically ventilated patient and is charting outside the patient's room when the ventilator alarm sounds. What is the priority order for the nurse to complete these actions: _______________, _______________, _______________, _______________? A. Check quickly for possible causes of the alarm that can be fixed B. After troubleshooting, connect back to mechanical ventilator and reassess patient C. Go to patient's bedside D. Manually ventilate the patient while getting a respiratory therapist
C, A, D, B
A patient has coronary artery bypass graft surgery and is transported to the surgical intensive care unit at noon and is placed on mechanical ventilation. Interpret the initial arterial blood gas levels pH: 7.31 PaCO2: 48 mm Hg Bicarbonate: 22 mEq/L PaO2: 115 mm Hg O2 saturation: 99% A. Normal arterial blood gas levels with a high oxygen level B. Partly compensated respiratory acidosis; normal oxygen C. Uncompensated metabolic acidosis with high oxygen levels D. Uncompensated respiratory acidosis; hyperoxygenated
D
A patient presents to the emergency department demonstrating agitation and complaining of numbness and tingling in his fingers. His arterial blood gas levels reveal the following: pH 7.51, PaCO2 25, HCO3 25. The nurse interprets these blood gas values as: A. Compensated metabolic alkalosis. B. Normal values. C. Uncompensated respiratory acidosis. D. Uncompensated respiratory alkalosis.
D
Current guidelines recommend the oral route for endotracheal intubation. The rationale for this recommendation is that nasotracheal intubation is associated with a greater risk for A. Basilar skull fracture. B. Cervical hyperextension. C. Impaired ability to "mouth" words. D. Sinusitis and infection.
D
Positive end-expiratory pressure (PEEP) is a mode of ventilatory assistance that produces the following condition: A. Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume. B. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient's ability to generate negative pressure. C. The patient must have a respiratory drive, or no breaths will be delivered. D. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O.
D
Pulse oximetry measures A. Arterial blood gases. B. Hemoglobin values. C. Oxygen consumption. D. Oxygen saturation.
D
The amount of effort needed to maintain a given level of ventilation is termed A. Compliance. B. Resistance. C. Tidal volume. D. Work of breathing.
D
The nurse is caring for a mechanically ventilated patient and notes the high pressure alarm sounding. The nurse cannot quickly identify the cause of the alarm and notes the patient's oxygen saturation is decreasing and heart rate and respiratory rate are increasing. The nurse's priority action is to A. Ask the respiratory therapist to get a new ventilator. B. Call the rapid response team to assess the patient. C. Continue to find the cause of the alarm and fix it. D. Manually ventilate the patient while calling for a respiratory therapist.
D
The nurse is caring for a mechanically ventilated patient. The providers are considering performing a tracheostomy because the patient is having difficulty weaning from mechanical ventilation. Related to tracheostomy, the nurse understands which of the following? A. Patient outcomes are better if the tracheostomy is done within a week of intubation. B. Percutaneous tracheostomy can be done safely at the bedside by the respiratory therapist. C. Procedures performed in the operating room are associated with fewer complications. D. The greatest risk after a percutaneous tracheostomy is accidental decannulation.
D
The nurse is caring for a patient whose ventilator settings include 15 cm H2O of positive end-expiratory pressure (PEEP). What complication does the nurse assess the patient for? A. Fluid overload secondary to decreased venous return B. High cardiac index secondary to more efficient ventricular function C. Hypoxemia secondary to prolonged positive pressure at expiration D. Low cardiac output secondary to increased intrathoracic pressure
D
The provider orders the following mechanical ventilation settings for a patient who weighs 75 kg. The patient's spontaneous respiratory rate is 22 breaths/min. Which arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO2: 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H2O A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
D
A PaCO2 of 48 mm Hg is associated with A. Hyperventilation. B. Hypoventilation. C. Increased absorption of O2. D. Increased excretion of HCO3.
B
