Chapter 10: Ventilatory Assistance
The nurse is caring for a patient who is mechanically ventilated. The nurse understands that what statement should be considered when determining appropriate nursing interventions? 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. Communication with intubated patients is often difficult.
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. Coughing or attempting to talk C. Kinks in the ventilator tubing D. Need for suctioning
A patient's ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from.60 to.70, 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. Decrease in cardiac output
Which of the following devices is best suited to deliver 65% oxygen to a patient who is spontaneously breathing? A. Face mask with non-rebreathing reservoir B. Low-flow nasal cannula C. Simple face mask D. Venturi mask
A. Face mask with non-rebreathing reservoir
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous respirations are 12 breaths/min. The patient receives a dose of morphine sulfate, and now respirations decrease to 4 breaths/min. What adjustments may need to be made to the patient's ventilator settings? A. Add positive end-expiratory pressure (PEEP). B. Add pressure support. C. Change to assist/control ventilation at a rate of 4 breaths/min. D. Increase the synchronized intermittent mandatory ventilation respiratory rate.
D. Increase the synchronized intermittent mandatory ventilation respiratory rate.
The nurse is caring for a patient whose ventilator settings include 15 cm H2O of positive end-expiratory pressure (PEEP). The nurse understands that although beneficial, PEEP may result in what possible problem? 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. Low cardiac output secondary to increased intrathoracic pressure
The nurse caring for a mechanically ventilated patient notes the high pressure alarm sounding but cannot quickly identify the cause of the alarm. The nurse notes the patient's oxygen saturation is decreasing and heart rate and respiratory rate are increasing. What is the nurse's priority action? 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. Manually ventilate the patient while calling for a respiratory therapist
What does pulse oximetry measure? A. Arterial blood gases B. Hemoglobin values C. Oxygen consumption D. Oxygen saturation
D. Oxygen saturation
. The primary care provider orders the following mechanical ventilation settings for a patient who weighs 75 kg and whose spontaneous respiratory rate is 22 breaths/min. What 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. Respiratory alkalosis
What risk is the rationale for the recommendation of endotracheal rather than nasotracheal intubation? A. Basilar skull fracture B. Cervical hyperextension C. Impaired ability to "mouth" words D. Sinusitis and infection
D. Sinusitis and infection
The nurse is caring for a mechanically ventilated patient. The primary care 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 greatest risk after a percutaneous tracheostomy is accidental decannulation.
Positive end-expiratory pressure (PEEP) is a mode of ventilatory assistance that produces which of the following conditions 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. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O.
After coronary artery bypass graft surgery a patient is transported to the surgical intensive care unit at noon and placed on mechanical ventilation. How should the nurse interpret the patient's initial arterial blood gas levels? pH 7.31 PaCO2 48 mm Hg Bicarbonate 22 mEq/L PaO2 115 mm HgO2 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. Uncompensated respiratory acidosis; hyperoxygenated
A patient presents to the emergency department demonstrating agitation and reporting numbness and tingling in the fingers. Arterial blood gas levels reveal the following: pH 7.51, PaCO2 25, HCO3 25. How should the nurse interprets these blood gas values? A. Compensated metabolic alkalosis B. Normal values C. Uncompensated respiratory acidosis D. Uncompensated respiratory alkalosis
D. Uncompensated respiratory alkalosis
The amount of effort needed to maintain a given level of ventilation is referred to using what term? A. Compliance B. Resistance C. Tidal volume D. Work of breathing
D. Work of breathing
The nurse is assisting with endotracheal intubation and understands 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. 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
A patient is having difficulty weaning from mechanical ventilation. The nurse assesses the patient and notes what 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. Hemoglobin of 8 g/dL
A PaCO2 of 48 mm Hg is associated with what outcome? A. Hyperventilation B. Hypoventilation C. Increased absorption of O2 D. Increased excretion of HCO3
B. Hypoventilation
A 65-year-old patient admitted to the progressive care unit with a diagnosis of community-acquired pneumonia, 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 what condition? 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. Hypoxemia and compensated respiratory acidosis.
What is an early signs of the effect of hypoxemia on the nervous system? a. Cyanosis b. Restlessness c. Tachycardia d. Tachypnea
b. Restlessness
The nurse is assessing the exhaled tidal volume (EVT) in a mechanically ventilated patient. What is the rationale for this assessment? A. Assess for tension pneumothorax. B. Assess the level of positive end-expiratory pressure. C. Compare the tidal volume delivered with the tidal volume prescribed. D. Determine the patient's work of breathing.
C. Compare the tidal volume delivered with the tidal volume prescribed.
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? (Put a comma and space between each answer choice.) 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 respiratory therapist.
c. Go to patient's bedside. a. Check quickly for possible causes of the alarm that can be fixed. d. Manually ventilate the patient while getting respiratory therapist. b. After troubleshooting, connect back to mechanical ventilator and reassess patient.
A patient's status deteriorates and mechanical ventilation is now required. The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously in between the mechanical breaths at his own tidal volume. This mode of ventilation is referred to by what term? A. Assist/control ventilation B. Controlled ventilation C. Intermittent mandatory ventilation D. Positive end-expiratory pressure
C. Intermittent mandatory ventilation
The nurse caring for a patient with an endotracheal tube understands that endotracheal suctioning is needed to facilitate removal of secretions. What additional information is the nurse aware of concerning this intervention? A. It decreases intracranial pressure. B. It depresses the cough reflex. C. It is done as indicated by patient assessment. D. It is more effective if preceded by saline instillation to loosen secretions.
C. It is done as indicated by patient assessment.
A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery with the following arterial blood gas (ABG) levels. What is the nurse's interpretation of these values?pH 7.4PaCO2 40 mm Hg Bicarbonate 24 mEq/LPaO2 95 mm HgO2 saturation 97%Respirations 20 breaths per minute a. Compensated metabolic acidosis B. Metabolic alkalosis C. Normal ABG values D. Respiratory acidosis
C. Normal ABG values
A mode of pressure-targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through what action by the endotracheal tube? A. Continuous positive airway pressure B. Positive end-expiratory pressure C. Pressure support ventilation D. T-piece adapter
C. Pressure support ventilation
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. what is the nurse's first intervention to relieve hypoxemia? A. Call the physician for an emergency intubation procedure. B. Obtain an order for bilevel positive airway pressure (BiPAP). C. Provide for oxygen administration. D. Suction secretions from the oropharynx.
C. Provide for oxygen administration.
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous respirations are 12 breaths/min. After receiving a dose of morphine sulfate, 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. Respiratory acidosis
When assessing the patient for hypoxemia, the nurse recognizes what as an early sign of the effect of hypoxemia on the cardiovascular system? A. Heart block B. Restlessness C. Tachycardia D. Tachypnea
C. Tachycardia
When it is noted that a patient's endotracheal tube is not secured tightened, he respiratory care practitioner assists t he 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 is the cause of this finding? 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. The endotracheal tube is in the right mainstem bronchus.
A 53-year-old, 80-kg 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. During the nurse's 7 PM (1900) assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretions. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. In communicating with the physician, which statement indicates the nurse understands what is likely occurring with the patient? A. "May we have an order for cardiac enzymes? This patient is exhibiting signs of a myocardial infarction." B. "My assessment indicates potential fluid overload." C. "The patient is having frequent PVCs that are compromising the cardiac output." D. "The patient is having a hypertensive crisis; what medications would you like to order?"
B. "My assessment indicates potential fluid overload."
What factors may predispose a patient to respiratory acidosis? A. Anxiety and fear B. Central nervous system depression C. Diabetic ketoacidosis D. Nasogastric suctioning E. Overdose of sedatives
B. Central nervous system depression E. Overdose of sedatives
A 53-year-old, 80-kg 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. During the nurse's 7 PM (1900) assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretions. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. How does the nurse interpret the following blood gas levels? pH 7.28PaCO2 46 mm Hg Bicarbonate 22 mEq/L PaO2 58 mm HgO2 saturation 88% A. Hypoxemia and compensated respiratory alkalosis B. Hypoxemia and uncompensated respiratory acidosis C. Normal arterial blood gas levels D. Normal oxygen level and partially compensated metabolic acidosis
B. Hypoxemia and uncompensated respiratory acidosis
What does oxygen saturation (SaO2) represent? 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. Oxygen that is chemically combined with hemoglobin.
The nurse is assisting with endotracheal intubation of the patient and recognizes that the procedure will be done in what order? (Put a comma and space between each answer choice.) 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. Assess balloon on endotracheal tube for symmetry and leaks. e. Suction oropharynx. d. Insert endotracheal tube with laryngoscope and blade. c. Inflate balloon of endotracheal tube. b. Assess lung fields for bilateral expansion.
While neuromuscular blocking agents are used in the management of some ventilated patients what is their primary mode of action? a. Analgesia b. Anticonvulsant c. Paralysis d. Sedation
c. Paralysis
