Mechanical Ventilation NCLEX questions

Mechanical Ventilation NCLEX questions ScienceMedicineNursing haannahson Save NCLEX Mechanical Ventilation Ques...Teacher 6 terms emeltineRNPreview

Exam 2: Mechanical Ventilation (NC...

62 terms LayalOverline Preview Mechanical Ventilation NCLEX quest...Teacher 20 terms Tori_McBroom2 Preview Ventila 61 terms rica The peak pressure alarm is sounding on the ventilator of the client with a recent tracheostomy. What intervention should be done first?

• Assess the client's respiratory status
• Decrease the sensitivity of the alarm
• Ensure that the connecting tubing is not kinked
• Suction the client

A The client must always be assessed before attention is turned to equipment.The acute medical nurse is preparing to wean a patient from the ventilator. Which assessment parameter is most important for the nurse to assess?

• Fluid intake for the last 24 hours
• Baseline arterial blood gas (ABG) levels
• Prior outcomes of weaning
• Electrocardiogram (ECG) results

B The nursing management of a patient with an artificial airway includes

• maintaining the ET tube cuff pressure at 30 cm H20
• routine suctioning of the tube at least every 2 hours
• observing for cardiac dysrhythmias during suctioning
• preventing tube dislodgment by limiting mouth care to lubrication of the lips

C

Which patient's medical diagnoses should the nurse know are most likely to need mechanical ventilation? Select all that apply

• sleep apnea
• cystic fibrosis
• acute kidney injury
• type 2 DM
• acute respiratory distress syndrome (ARDS)

BE When planning care for a patient on a mechanical ventilator, the nurse understands that the application of positive end-expiratory pressure (PEEP) to the ventilator settings has which therapeutic effect?

• Increased inflation of the lungs
• Prevention of barotrauma to the lung tissue
• Prevention of alveolar collapse during expiration
• Increased fraction of inspired oxygen concentration (FIO2) administration

C Which assessment information obtained by the nurse when caring for a patient receiving mechanical ventilation indicates the need for suctioning?

• The respiratory rate is 32 breaths/min.
• The pulse oximeter shows a SpO2 of 93%.
• The patient has not been suctioned for the last 6 hours.
• The lungs have occasional audible expiratory wheezes.

A Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patients arterial blood gas (ABG) results include a pH of 7.50, PaO2 of 80 mm Hg, PaCO2 of 29 mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to

• increase the FIO2.
• decrease the respiratory rate.
• increase the tidal volume (VT).
• leave the ventilator at the current settings.

B bc PaCO2 is LOW high CO2 --> inc resp rate

A nurse is caring for a client who is experiencing respiratory distress. Which of the following early manifestations of hypoxemia should the nurse recognize? Select all that apply

• confusion
• pale skin
• bradycardia
• hypotension
• elevated blood pressure

BE late = confusion & would experience tachy NOT brady The nurse is caring for a patient with emphysema and respiratory failure who is receiving mechanical ventilation through an endotracheal tube.To prevent ventilator-associated pneumonia (VAP), which action is most important to include in the plan of care?

• Administer ordered antibiotics as scheduled.
• Hyperoxygenate the patient before suctioning.
• Maintain the head of bed at a 30- to 45-degree angle.
• Suction the airway when coarse crackles are audible

C Elevation of the head decreases the risk for aspiration. PEEP is frequently needed to improve oxygenation in patients receiving mechanical ventilation. Suctioning should be done only when the patient assessment indicates that it is necessary. Enteral feedings should provide adequate calories for the patient's high energy needs.**How to prevent? → HOB @30 degrees, daily oral care, early mobiltiy The nurse caring for a client who is mechanically ventilated is monitoring for complications of mechanical ventilation. Which assessment finding, if noted by the nurse, indicates the need for follow-up?

1.Muscle weakness in the arms and legs 2.A temperature of 98.6° F decreased from 99.0° F 3.A blood pressure of 90/60 mm Hg decreased from 112/78 mm Hg 4.A heart rate of 80 beats per minute decreased from 85 beats per minute 3 Complications of mechanical ventilation include the following: (1) hypotension caused by application of positive pressure, which increases intrathoracic pressure and inhibits blood return to the heart; (2) pneumothorax or subcutaneous emphysema as a result of positive pressure; (3) gastrointestinal alterations such as stress ulcers; (4) malnutrition if nutrition is not maintained; (5) infections; (6) muscular deconditioning; and (7) ventilator-dependence or inability to wean. Some muscle weakness is expected. Options 1, 2, and 4 present normal assessment findings.

A client who is intubated and receiving mechanical ventilation has a problem of risk for infection. The nurse should include which measures in the care of this client? Select all that apply.

1.Monitor the client's temperature.

2.Use sterile technique when suctioning.

3.Use the closed-system method of suctioning.

4.Monitor sputum characteristics and amounts.

5.Drain water from the ventilator tubing into the humidifier bottle.1234 While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's oxygen saturation (SpO2) from 94% to 88%. The nurse will

• increase the oxygen flow rate.
• suction the patient's oropharynx.
• assist the patient to cough and deep breathe.
• help the patient to sit in a more upright position.

ANS: A

Increasing oxygen flow rate usually will improve oxygen saturation in patients with ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with perfusion, actions that improve ventilation, such as deep-breathing and coughing, sitting upright, and suctioning, are not likely to improve oxygenation.A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. The nurse will anticipate assisting with

• administration of 100% oxygen by non-rebreather mask.
• endotracheal intubation and positive pressure ventilation.
• insertion of a mini-tracheostomy with frequent suctioning.
• initiation of bilevel positive pressure ventilation (BiPAP).

ANS: B

The patient's lethargy, low respiratory rate, and SpO2 indicate the need for mechanical ventilation with ventilator-controlled respiratory rate.Administration of high flow oxygen will not be helpful because the patient's respiratory rate is so low. Insertion of a mini-tracheostomy will facilitate removal of secretions, but it will not improve the patient's respiratory rate or oxygenation. BiPAP requires that the patient initiate an adequate respiratory rate to allow adequate gas exchange.Which assessment finding by the nurse when caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased?

• The patient has subcutaneous emphysema.
• The patient has a sinus bradycardia with a rate of 52.
• The patient's PaO2 is 50 mm Hg and the SaO2 is 88%.
• The patient has bronchial breath sounds in both the lung fields.

ANS: A

The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be addressed, but they are not indications that PEEP should be reduced.