Deck 7: Mechanical Ventilation

Question 1

A patient who is endotracheally intubated and on mechanical ventilation has a decreasing oxygen saturation level with an increasing heart rate.What is the nurse's priority action?

A)Ensure the airway is clear.
B)Auscultate lung sounds.
C)Reposition the patient.
D)Reposition the endotracheal tube.

Answer 1

Ensure the airway is clear.

Question 2

The nurse manager teaches newly hired nurses about findings associated with barotrauma.The manager would include that this complication is most common in which type of mechanical ventilation?

A)Volume
B)Time
C)Pressure
D)Flow

Answer 2

Volume

Question 3

The nurse notes these ventilator setting change orders.What nursing intervention is indicated? Mode: Assist control
FIO₂: 0.60
Rate: 12
Tidal volume: 1600 ml

A)Carry out the orders as written.
B)Verify the respiratory rate.
C)Verify the mode.
D)Verify the tidal volume.

Answer 3

Verify the tidal volume.

Question 4

The nurse is admitting a patient who sustained a traumatic brain injury and who is now deeply sedated.The nurse would anticipate managing which mode of ventilation during this patient's initial care?

A)Pressure support ventilation
B)Assist-control ventilation
C)Pressure support ventilation (PSV)
D)Synchronized intermittent mandatory ventilation (SIMV)

Question 5

The nurse monitors all mechanically ventilated patients for the development of oxygen toxicity.Which patient would the nurse determine to be at highest risk?

A)The patient has required FiO₂ of 0.7 for the first 2 hours after being intubated.
B)A patient has required FiO₂ of 1.0 for the last 8 hours.
C)The patient's ventilator was set at FiO₂ of 0.4 for the last 2 days.
D)The patient has required FiO₂ of 0.8 for 24 hours after intubation.

Question 6

A patient who has been extubated postoperatively is retaining carbon dioxide.To avoid reintubating this patient the nurse would expect to manage which intervention?

A)Insertion of an oral airway
B)Insertion of a nasal airway
C)Use of noninvasive intermittent positive pressure ventilation (NIPPV)
D)Use of continuous positive airway ventilation (CPAP)

Question 7

A patient's ventilator settings are going to be modified to include positive end expiratory pressure (PEEP).What nursing action is most important?

A)Suction the patient before and after the change.
B)Monitor vital signs frequently.
C)Notify the physician of abrupt increases in oxygenation.
D)Monitor breath sounds at least every 15 minutes.

Question 8

The nurse is preparing to care for a patient returning from elective surgery who will require mechanical ventilation for a few more hours.The nurse would initiate which ventilator setting orders without question?

A)SIMV with a rate of 12,tidal volume 750 mL,FIO₂ 0.60
B)Assist-control with a rate of 16,tidal volume 1000 mL,FIO₂ 0.40
C)Assist-control with a rate of 20,tidal volume 1200 mL,FIO₂ 0.60
D)SIMV with a rate of 4,tidal volume 1200 mL,FIO₂ 0.60

Question 9

A patient who will require long-term mechanical ventilation has had a tracheostomy for 2 weeks.The nurse is concerned that stoma erosion is occurring.Which nursing assessment would support the nurse's concern?

A)Secretions are present at the stoma opening.
B)Granulation tissue is noted at the stoma site.
C)The patient has developed a dry cough.
D)The skin at the stoma opening is flaky.

Question 10

An adult patient has suffered a respiratory arrest and requires endotracheal intubation.The nurse should obtain which equipment for this procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Topical anesthetic
B)Magill forceps
C)Cuffless endotracheal tube (ET)
D)Oxygen cannula
E)Water-soluble lubricant

Question 11

A patient is being admitted to the intensive care unit after being resuscitated in the emergency department.The patient is being mechanically ventilated.Which information provided by the transferring nurse would the nurse evaluate as increasing this patient's risk of developing ventilator-associated pneumonia (VAP)? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)"The patient is intubated nasally."
B)"The patient arrested after having a myocardial infarction."
C)"The patient required placement of a nasogastric tube to relieve persistent gastric distention."
D)"The patient's home medications include a proton pump inhibitor."
E)"The patient has a history of chronic obstructive pulmonary disease (COPD)."

Question 12

The nurse responds to a ventilator pressure alarm by going to the patient's room.What should be the nurse's first action?

A)Turn off the ventilator alarm to help calm the patient.
B)Administer intravenous sedation according to prn prescription.
C)Assess for the cause of the alarm.
D)Manually bag the patient until the cause of the alarm is detected.

Question 13

A patient aspirated while eating and suffered a respiratory arrest.A code blue was called,the obstruction was removed,but the patient required endotracheal intubation.Postintubation,the nurse hears breath sounds bilaterally,but the carbon dioxide monitor indicates a higher than expected level.Which patient history could account for this discrepancy?

A)The patient's original admittance diagnosis was dehydration.
B)The patient's wife reports,"We were talking and laughing when he choked."
C)The patient has history of calcium deficiency requiring dietary supplementation.
D)The patient's wife says,"He had some heartburn earlier,so the nurse had given him a lemon-lime soda to drink with his supper."

Question 14

Which nursing intervention will help to decrease the risk of tracheal and laryngeal injuries in an intubated patient?

A)Use an endotracheal tube equipped for continuous removal of subglottic secretions.
B)Deflate the cuff for 5 minutes every 8 hours.
C)Use the minimal occluding pressure technique to maintain cuff pressure at 20 to 25 mmHg.
D)Test cuff pressure by assessing firmness of the inflation balloon.

Question 15

A patient is being manually weaned from mechanical ventilation.What nursing intervention is indicated?

A)Suction the patient once the ventilator is removed.
B)Have intubation equipment at the bedside.
C)Project a calm and confident manner.
D)Change the ventilator settings so the patient can breathe spontaneously between set breaths.

Question 16

The nurse caring for a patient who is ventilated via the assist-control mode monitors for which complication specifically related to this intervention?

A)Pneumonia
B)Anxiety
C)Pneumothorax
D)Respiratory alkalosis

Question 17

A patient who is mechanically ventilated requires a high level of positive end expiratory pressure (PEEP).The nurse would monitor for which findings indicating possible barotrauma? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Sudden increase in systolic blood pressure.
B)Absent breath sounds.
C)Subcutaneous emphysema across the anterior chest.
D)Patient is somnolent.
E)Sudden deterioration of arterial blood gas (ABGs).

Question 18

A patient in the emergency department (ED)becomes suddenly unresponsive.CPR is initiated.Arterial blood gas results reveal pH 7.225,PaCO₂ 55,HCO₃ 15,PaO₂ 45,SaO₂ 76%.The nurse would prepare for which priority intervention?

A)Call for a rapid response team.
B)Auscultate the patient's lungs.
C)Place the patient on a 50% humidified mask.
D)Administer endotracheal intubation.