Mechanical Ventilation
Which of the following is a priority intervention during post-extubation follow-up?
Encouraging coughing and deep breathing
A mechanically ventilated patient suddenly triggers a ventilator alarm and has a noticeable decrease in oxygen saturation. What should the nurse prioritize?
Assess the patient and airway. The patient’s condition takes priority. A ventilator alarm accompanied by a drop in oxygen saturation requires immediate assessment of the patient, airway, breathing, and equipment to determine the cause of the problem
A patient with a chest tube for a pneumothorax has intermittent bubbling in the water-seal chamber. Which interpretation by the nurse is most appropriate?
A. This indicates a malfunction of the chest drainage system.
B. This is expected and may indicate that air is still leaving the pleural space.
C. The suction pressure should immediately be increased.
D. The chest tube should be clamped immediately.
B—This is expected and may indicate that air is still leaving the pleural space. Intermittent bubbling in the water-seal chamber can be expected in a patient with a pneumothorax because it indicates that air is still moving out of the pleural space. The nurse should continue to monitor the patient and drainage system. Constant vigorous bubbling, however, may indicate an air leak.
A patient has a decreased right atrial pressure and is suspected of having hypovolemia. Which assessment finding is most consistent with this condition?
A. JVD while sitting upright
B. Bounding peripheral pulses
C. Weak, thready pulse
D. Generalized
C—a decreased RAP indicates decreased venous return/preload, commonly caused by hypovolemia. The patient may develop tachycardia, hypotension, weak or thready pulses, flat neck veins, thirst, poor skin turgor, dry mucous membranes and decreased urine output
Which of the following is NOT a common complication of NIPPV?
Increased airway obstruction from an endotracheal tube
A patient has been experiencing persistent vomiting and is receiving continuous nasogastric suction. Which acid-base imbalance is the patient most at risk for developing?
Metabolic alkalosis—vomiting and NG suction cause the loss of gastric acid. Loss of acid from the GI tract can result in metabolic alkalosis
The nurse is performing a comprehensive assessment of a patient with a chest tube. Which finding requires the most immediate follow-up?
A. Mild pain at the insertion site
B. Tidaling in the water-seal chamber
C. Subcutaneous emphysema around the insertion site
D. An occlusive dressing that is dry and intact
C—Subcutaneous emphysema around the insertion site. Subcutaneous emphysema occurs when air enters the tissues beneath the skin. In a patient with a chest tube, this can indicate an air leak and requires further assessment. Mild pain, tidaling, and a dry, intact occlusive dressing are generally expected findings.
The nurse is caring for a patient with dehydration and hypovolemic shock. Following IV fluid administration, which finding best indicates restoration of organ perfusion?
A. MAP increases from 60-65mmHg
B. Peripheral pulses are 2+
C. Urine output increases to 30mL/hr
D. JVD and ankle edema develop
C—urine output increases to 30mL/hr. the kidneys are highly sensitive to changes in perfusion. An increase in urine output to approximately 30mL/hr in an adult suggests that renal blood flow and overall tissue perfusion have improved.
Which patient is most likely to benefit from NIPPV?
A patient with COPD and hypercapnia who can still breathe spontaneously
A mechanically ventilated patient develops an increasing PaCO2 level. Which problem does this finding most directly indicate?
Inadequate ventilation. PaCO2 reflects the patient’s ability to eliminate carbon dioxide through ventilation. Increasing PaCO2 indicates CO2 retention and inadequate alveolar ventilation (remember PaCO2=ventilation, PaO2=oxygenation)
Which patient finding would best support the healthcare provider's decision to remove a chest tube?
A. Drainage of 250 mL during the previous 24 hours
B. Persistent air leak with each respiratory cycle
C. Improved and stable patient status with decreased drainage
D. Evidence of a worsening pneumothorax on chest x-ray
C—improved and stable patient status with decreased drainage. Chest tube removal may be considered when the patient's condition is improved and stable, drainage has decreased (the slides specify less than 100 mL/24 hours), the air leak has resolved, and the lung has re-expanded on chest x-ray while on water seal.
A patient has an elevated RAP with JVD, generalized edema, and ascites. Which intervention should the nurse anticipate?
A. Administer a rapid IV fluid bolus
B. Restrict sodium and fluids
C. Encourage increased oral fluid intake
D. Administer blood products
B—Restrict sodium and fluids. The patient demonstrates signs of fluid volume excess associated with elevated RAP. Treatment focuses on reducing fluid volume through fluid and sodium restriction and when prescribed, diuretics or vasodilators.
Which type of oxygen therapy provides PEEP?
BiPAP
A patient with severe bronchospasm is experiencing hypoxia. Which medication would the nurse expect to administer to help improve airway airflow?
Bronchodilator. Bronchodilators help relax and open narrowed airways. They are useful when bronchospasm contributes to impaired ventilation and hypoxia
Which assessment finding is most consistent with a restrictive pulmonary disorder?
A. Difficulty exhaling due to increased airway resistance
B. Prolonged expiration with wheezing
C. Decreased lung expansion and reduced total lung capacity
D. Air trapping caused by narrowed bronchioles
C—Decreased lung expansion and reduced total lung capacity. Restrictive pulmonary diseases are characterized by difficulty expanding the lungs. This results in decreased lung volumes, including reduced total lung capacity (TLC). Examples include pulmonary fibrosis and other conditions that decrease lung compliance.
The nurse is reviewing assessment findings for two patients. Which finding would the nurse associate with decreased RAP rather than elevated RAP?
A. Ascites
B. Dependent edema
C. Distended neck veins
D. Thirst and dry mucous membranes
D--Thirst and dry mucous membranes: indicate fluid volume deficit, which is associated with decreased RAP
A patient is mechanically ventilated following acute respiratory failure. The nurse is reviewing the ventilator settings and notes that the patient is receiving AC/VC ventilation with a tidal volume of 500 mL, respiratory rate of 14/min, and PEEP of 5 cm H₂O.
The patient becomes increasingly tachypneic and begins taking additional spontaneous breaths at a rate of 24/min.
Which statement by the nursing student demonstrates the BEST understanding of AC/VC ventilation?
A. “The patient’s additional breaths will not receive a full tidal volume because the set respiratory rate has already been reached.”
B. “Each patient-triggered breath will receive the set tidal volume, which may result in a higher minute ventilation.”
C. “The ventilator will limit every breath to a preset inspiratory pressure regardless of the patient’s tidal volume.”
D. “The patient must be sedated because spontaneous breathing is not permitted with AC/VC.”
B. In assist-control volume control (AC/VC), the ventilator delivers the preset tidal volume with each mandatory or patient-triggered assisted breath. If the patient initiates additional breaths, each receives the set tidal volume, potentially increasing minute ventilation and causing respiratory alkalosis if excessive. PCV, in contrast, sets a target inspiratory pressure, while the resulting tidal volume can vary depending on lung compliance and airway resistance.
A client with respiratory failure is being assessed by the nurse. Which combination is most consistent with respiratory failure?
Respiratory failure occurs when the respiratory system cannot adequately oxygenate the blood and/or remove CO2. The slide defines respiratory failure as hypoxemia plus hypercapnia. This means the client has adequate oxygen in the blood and excessive CO2
A patient with ARDS develops worsening hypoxemia despite receiving supplemental oxygen. Which intervention should the nurse anticipate?
A. Decreasing oxygen therapy to prevent hypoventilation
B. Preparing the patient for mechanical ventilation with positive end-expiratory pressure (PEEP)
C. Encouraging the patient to breathe rapidly and shallowly
D. Administering a bronchodilator as the primary treatment
B—Preparing the patient for mechanical ventilation with positive end-expiratory pressure (PEEP). Severe ARDS can cause significant hypoxemia that does not adequately respond to supplemental oxygen alone. PEEP helps keep alveoli open at the end of expiration, improving alveolar recruitment and oxygenation. Mechanical ventilation may therefore be required in patients with worsening respiratory failure.
A patient with elevated RAP is prescribed diuretic therapy. Which finding would best indicate that the treatment is effective?
A. Increased JVD
B. Increased abdominal girth
C. Decreased peripheral edema
D. Development of hypotension and tachycardia
C—Decreased peripheral edema. Diuretics promote the excretion of excess fluid. Decreased peripheral edema indicates that fluid accumulation is improving and that the patient is responding to treatment.