Chapter 21 Respiratory Care Modalities
The nurse is assigned to care for a client with a chest tube. The nurse should ensure that which item is kept at the client's bedside?
A bottle of sterile water
A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation?
Endotracheal suctioning
Which ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths?
IMV
Which oxygen administration device has the advantage of providing a high oxygen concentration?
Nonrebreather mask
Positive end-expiratory pressure (PEEP) therapy has which effect on the heart?
Reduced cardiac output
A client is receiving mechanical ventilation. How frequently should the nurse auscultate the client's lungs to check for secretions?
every 2-4 hours
The nurse is caring for a client who is scheduled for a lobectomy. Following the procedure, the nurse will plan care based on the client
returning to the nursing unit with two chest tubes.
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:
synchronized intermittent mandatory ventilation (SIMV).
A client who must begin oxygen therapy asks the nurse why this treatment is necessary? What would the nurse identify as the goals of oxygen therapy? Select all that apply.
-To provide adequate transport of oxygen in the blood -To decrease the work of breathing -To reduce stress on the myocardium
A client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. The client is placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. What setting would be the best maximum FIO2 setting?
0.5
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:
5 to 20 minutes
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:
5 to 20 minutes.
A client is prescribed postural drainage because secretions are accumulating in the upper lobes of the lungs. The nurse instructs the client to:
Take prescribed albuterol (Ventolin) before performing postural drainage.
In general, chest drainage tubes are not used for a patient undergoing
pneumonectomy.
A patient with COPD requires oxygen administration. What method of delivery does the nurse know would be best for this patient?
venturi mask
The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.)
-Decreases hypoxemia -Decreases patient anxiety -Sustains positive end expiratory pressure (PEEP)
Which statements would be considered appropriate interventions for a client with an endotracheal tube? Select all that apply.
-The cuff is deflated before the tube is removed. -Cuff pressures should be checked every 6 to 8 hours. -Humidified oxygen should always be introduced through the tube.
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?
20 minutes
A client in the intensive care unit has a tracheostomy with humidified oxygen being instilled through it. The client is expectorating thick yellow mucus through the tracheostomy tube frequently. The nurse
Assesses the client's tracheostomy and lung sounds every 15 minutes
Which is an adverse reaction that would require the process of weaning from a ventilator to be terminated?
Blood pressure increase of 20 mm Hg
The nurse assesses a patient with a heart rate of 42 and a blood pressure of 70/46. What type of hypoxia does the nurse determine this patient is displaying?
Circulatory hypoxia
A nurse is attempting to wean a client after 2 days on the mechanical ventilator. The client has an endotracheal tube present with the cuff inflated to 15 mm Hg. The nurse has suctioned the client with return of small amounts of thin white mucus. Lung sounds are clear. Oxygen saturation levels are 91%. What is the priority nursing diagnosis for this client?
Impaired gas exchange related to ventilator setting adjustments
A client is recovering from thoracic surgery needed to perform a right lower lobectomy. Which of the following is the most likely postoperative nursing intervention?
Encourage coughing to mobilize secretions.
Which ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths?
Intermittent mandatory ventilation (IMV)
A client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which oxygen delivery method would give the greatest level of inspired oxygen?
Nonrebreather mask
The nurse is assessing a patient with chest tubes connected to a drainage system. What should the first action be when the nurse observes excessive bubbling in the water seal chamber?
Notify the physician
A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a severe stroke. What action does the nurse anticipate the physician will take now that the patient has been intubated for this length of time?
The patient will have an insertion of a tracheostomy tube.
Constant bubbling in the water seal of a chest drainage system indicates which problem?
air leak
Which is a potential complication of a low pressure in the endotracheal tube cuff?
aspiration pneumonia