Ventilator Care
In this ventilator mode, every timed or patient-triggered mandatory breath receives the preset tidal volume or pressure.
Correct response: What is assist-control ventilation?
Rationale: Assist-control provides a minimum respiratory rate while also supporting additional patient-triggered breaths with the full preset support.
Sudden dyspnea, pleuritic chest pain, tachycardia, and unexplained hypoxemia form this classic clinical pattern.
Correct response: What is a pulmonary embolism?
Rationale: A pulmonary embolus obstructs pulmonary blood flow and creates ventilation-perfusion mismatch. Symptoms may be subtle, so an acute change in breathing or oxygenation should be evaluated quickly.
Refractory hypoxemia, worsening confusion, exhaustion, and inability to protect the airway indicate the need for this intervention.
Correct response: What is endotracheal intubation with mechanical ventilation?
Rationale: These findings indicate failure of oxygenation, ventilation, or airway protection. The nurse activates the airway team, preoxygenates, prepares suction and backup equipment, and anticipates hemodynamic deterioration.
Sudden unilateral pleuritic pain, dyspnea, decreased chest movement, and absent breath sounds suggest this pleural emergency.
Correct response: What is a pneumothorax?
Rationale: Air in the pleural space disrupts negative pressure and allows the affected lung to partially or completely collapse. Oxygenation, work of breathing, hemodynamics, and progression toward tension physiology require immediate assessment.
This is the normal arterial pH range.
Correct response: What is 7.35 to 7.45?
Rationale: A pH below 7.35 is acidemia and a pH above 7.45 is alkalemia. A normal pH does not exclude a compensated disorder, so PaCO2 and HCO3 must also be interpreted.
Unless contraindicated, this bed position helps reduce aspiration and ventilator-associated pneumonia risk.
Correct response: What is elevating the head of the bed 30 to 45 degrees?
Rationale: Head-of-bed elevation helps decrease aspiration risk. It should be combined with hand hygiene, oral care, secretion management, and daily assessment for ventilator liberation.
For a stable patient without a contraindication to iodinated contrast, this imaging study commonly confirms pulmonary embolism.
Correct response: What is CT pulmonary angiography?
Rationale: CT pulmonary angiography directly visualizes emboli in the pulmonary arteries. A ventilation-perfusion scan may be used when contrast is unsuitable, and echocardiography can help evaluate right-ventricular strain in unstable patients.
Immediately after intubation, this bedside method provides the most reliable continuous evidence that the tube is in the trachea.
Correct response: What is continuous waveform capnography?
Rationale: A persistent exhaled carbon dioxide waveform is the preferred immediate confirmation of tracheal placement. Chest x-ray is then used to verify tube depth and assess the lungs, but it should not replace immediate capnography.
An unstable patient has hypotension, severe hypoxemia, unilateral absent breath sounds, and jugular venous distention. This treatment occurs before waiting for x-ray
Correct response: What is immediate decompression for tension pneumothorax?
Rationale: Tension pneumothorax produces obstructive shock by increasing intrathoracic pressure and reducing venous return. It is diagnosed clinically in an unstable patient and requires immediate decompression followed by definitive chest-tube placement.
Interpret this ABG: pH 7.30, PaCO2 55 mm Hg, HCO3 24 mEq/L.
Correct response: What is uncompensated respiratory acidosis?
Rationale: The pH is acidemic and PaCO2 is elevated, moving in the opposite direction from pH and identifying the respiratory cause. Normal bicarbonate indicates that metabolic compensation has not yet occurred.
A high-pressure alarm sounds while the patient coughs and has coarse breath sounds. This is the nurse's first action.
Correct response: What is assess the patient and airway before troubleshooting the machine?
Rationale: High pressure can result from secretions, coughing, biting, bronchospasm, tubing kinks, or reduced lung compliance. The nurse assesses oxygenation and ventilation first, then checks the airway and circuit and suctions when indicated.
This IV anticoagulant is frequently selected when rapid titration or a possible procedure is anticipated; the nurse monitors aPTT or anti-Xa according to protocol.
Correct response: What is heparin?
Rationale: heparin has a short half-life and can be rapidly adjusted or reversed. The nurse monitors ordered coagulation studies, bleeding, hemoglobin, platelets, and invasive sites.
Interpret this ABG in a tiring patient: pH 7.25, PaCO2 60 mm Hg, HCO3 26 mEq/L, and PaO2 55 mm Hg.
Correct response: What is uncompensated acute respiratory acidosis with hypoxemia?
Rationale: The pH is acidemic and the PaCO2 is elevated, identifying a respiratory cause. The nearly normal bicarbonate shows little metabolic compensation, while the low PaO2 confirms significant oxygenation failure
After blunt chest trauma, a segment of the chest wall moves inward during inspiration and outward during expiration. This injury is present.
Correct response: What is flail chest?
Rationale: Multiple adjacent rib fractures create a free-floating segment with paradoxical motion. Pain, pulmonary contusion, impaired ventilation, and fatigue can cause rapid deterioration, so analgesia and pulmonary support are priorities.
Interpret this ABG: pH 7.50, PaCO2 30 mm Hg, HCO3 24 mEq/L.
Correct response: What is uncompensated respiratory alkalosis?
Rationale: The pH is alkalemic and PaCO2 is low, identifying a respiratory cause. Normal bicarbonate means compensation is absent; anxiety, pain, hypoxemia, or excessive ventilation are possible causes.
A suddenly disconnected circuit or leaking endotracheal-tube cuff most commonly produces this type of ventilator alarm.
Correct response: What is a low-pressure or low-exhaled-volume alarm?
Rationale: A leak or disconnection prevents the ventilator from reaching or measuring expected pressure and volume. The nurse immediately assesses the patient, reconnects the circuit if appropriate, and evaluates cuff and tubing integrity.
A platelet count that falls by more than 50% after heparin exposure should make the nurse suspect this immune complication.
Correct response: What is heparin-induced thrombocytopenia, or HIT?
Rationale: HIT is a prothrombotic immune reaction, not simply a bleeding disorder. The nurse stops all heparin when ordered, alerts the provider, avoids platelet transfusion unless specifically indicated, and anticipates a non-heparin anticoagulant.
Rocuronium makes an intubated patient motionless but does not provide these two essential therapies.
Correct response: What are sedation and analgesia?
Rationale: Neuromuscular blockers provide paralysis only. A patient may remain conscious and experience pain but be unable to move, so adequate analgesia and sedation must be established and continuously evaluated
Continuous bubbling in this chamber of a chest-drain system suggests an air leak that requires assessment.
Correct response: What is the water-seal chamber?
Rationale: Intermittent water-seal bubbling may occur while pleural air evacuates, especially with coughing. Continuous bubbling suggests an air leak; the nurse assesses the patient, insertion site, tubing, and connections before reporting persistent findings.
Interpret this ABG: pH 7.28, PaCO2 32 mm Hg, HCO3 15 mEq/L.
Correct response: What is partially compensated metabolic acidosis?
Rationale: The low pH and low bicarbonate identify metabolic acidosis. PaCO2 is also low because the lungs are compensating by removing carbon dioxide, but the pH remains abnormal, so compensation is only partial.
For a patient with ARDS, this strategy uses approximately 4 to 8 mL/kg predicted body weight and limits plateau pressure to reduce ventilator-induced lung injury.
Correct response: What is lung-protective ventilation? or using lower tidal volumes-
Rationale: Lower tidal volumes based on predicted rather than actual body weight reduce volutrauma.
A patient with confirmed PE becomes hypotensive with evidence of cardiopulmonary failure. If bleeding risk is acceptable, this advanced therapy may be required.
Correct response: What is reperfusion therapy, such as systemic thrombolysis?
Rationale: Hemodynamic instability identifies a high-risk PE population in which advanced reperfusion may be lifesaving. Current guidance also includes catheter-based therapy, thrombectomy, or surgical embolectomy for selected patients; the team balances benefit against major bleeding risk
After intubation, blood pressure remains 72/40 mm Hg despite appropriate assessment and fluid resuscitation. This is the commonly preferred first-line vasopressor.
Correct response: What is norepinephrine?
Rationale: Norepinephrine is commonly used to restore vascular tone and perfusion in shock. The nurse also reassesses for medication effects, decreased venous return from positive pressure, tension pneumothorax, bleeding, sepsis, and other reversible causes of post-intubation hypotension
Unless specifically ordered or required by policy, the nurse avoids these two chest-tube actions because they can obstruct air escape or create excessive pressure.
Correct response: What are routine clamping and stripping or milking the tubing?
Rationale: Routine clamping can trap air and contribute to tension physiology, while aggressive stripping or milking can create damaging negative pressure. The system remains upright, below chest level, securely connected, and free of kinks or dependent loops.
Interpret this ABG: pH 7.37, PaCO2 52 mm Hg, HCO3 30 mEq/L.
Correct response: What is fully compensated respiratory acidosis?
Rationale: The pH is within the normal range but leans acidic, PaCO2 is elevated, and bicarbonate is elevated in the compensatory direction. This pattern is consistent with chronic carbon dioxide retention when supported by the clinical picture.