Module 3 - Vent Flashcards
The provider orders the following mechanical ventilation settings for a patient who weighs 75 kg. The patient’s spontaneous respiratory rate is 22 breaths/min. Which 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
Metabolic Alkalosis
Respiratory Alkalosis
Respiratory Acidosis
Metabolic Acidosis
Respiratory Alkalosis
The nurse is assisting with endotracheal intubation and understands that correct placement of the endotracheal tube in the trachea would be identified by which of the following (select all that apply)?
Fogging of the endotracheal tube
Equal bilateral breath sounds upon auscultation
Position above the carina verified by CXR
Auscultation of air over the epigastrium
Positive detection of CO2 through CO2 detector devices
Equal bilateral breath sounds upon auscultation
Position above the carina verified by CXR
Positive detection of CO2 through CO2 detector devices
A patient is admitted to the progressive care unit with a diagnosis of community-acquired pneumonia. The patient 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:
normal oxygenation and partly compensated metabolic alkalosis
hypoxemia and compensated metabolic alkalosis
normal oxygenation and uncompensated respiratory acidosis
hypoxemia and compensated respiratory acidosis
hypoxemia and compensated respiratory acidosis
Positive end-expiratory pressure (PEEP) is a mode of ventilatory assistance that produces the following condition:
There is pressure remaining in the lungs at the end of expiration that is measured in cm H20
Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume
For each spontaneous breath taken by the patient, the tidal volume is determined by the patient’s ability to generate negative pressure
The patient must have a respiratory drive, or no breaths will be delivered
Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives a dose of morphine sulfate, and his respirations decrease to 4 breaths/min. What adjustments may need to be made to the patient’s ventilator settings?
Increase the synchronized intermittent mandatory ventilation respiratory rate
Add positive end-expiratory pressure (PEEP)
Change to assist/control ventilation at a rate of 4 breaths/min
Add pressure support
Increase the synchronized intermittent mandatory ventilation respiratory rate
The nurse is caring for a mechanically ventilated patient and notes the high pressure alarm sounding. The nurse cannot quickly identify the cause of the alarm and notes the patient’s oxygen saturation is decreasing and heart rate and respiratory rate are increasing. The nurse’s priority action is to:
Ask the respiratory therapist to get a new ventilator
Call the RRT to assess the patient
Manually ventilate the patient while calling for a respiratory therapist
Continue to find the cause of the alarm and fix it
Manually ventilate the patient while calling for a respiratory therapist
The nurse is caring for a patient with an endotracheal tube. The nurse understands that endotracheal suctioning is needed to facilitate removal of secretions and that the procedure:
decreases intracranial pressure.
is done as indicated by patient assessment.
depresses the cough reflex.
is more effective if preceded by saline instillation.
is done as indicated by patient assessment
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. The nurse’s first intervention to relieve hypoxemia is to:
Notify the provider of values and obtain a prescription for oxygen
Obtain an order for bilevel positive airway pressure (BiPAP)
Call the provider for an emergency intubation procedure
Suction secretions from the oropharynx
Notify the provider of values and obtain a prescription for oxygen
One of the early signs of hypoxemia on the nervous system is
Restlessness
Cyanosis
Agitation
Tachypnea
Restlessness
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)?
Disconnection from the ventilator
Need for suctioning
Kinks in the ventilator tubing
Coughing or attempting to talk
Need for suctioning
Kinks in the ventilator tubing
Coughing or attempting to talk
A PaCO2 of 48 mm Hg is associated with
Hypoventilation
Hyperventilation
Increased excretion of HCO3
Increased absorption of O2
Hypoventilation
Oxygen saturation (SaO2) represents
Alveolar oxygen tension
Oxygen that is chemically combined with hemoglobin
Total oxygen consumption
Oxygen that is physically dissolved in plasma
Oxygen that is chemically combined with hemoglobin
Current guidelines recommend the oral route for endotracheal intubation. The rationale for this recommendation is that nasotracheal intubation is associated with a greater risk for:
Impaired ability to “mouth” words
Basilar skull fracture
Sinusitis and infection
Cervical hyperextension
Sinusitis and infection
The nurse is caring for a patient whose ventilator settings include 15 cm H2O of positive end-expiratory pressure (PEEP). What complication does the nurse assess the patient for?
Low cardiac output secondary to increased intrathoracic pressure
Fluid overload secondary to decreased venous return
High cardiac index secondary to more efficient ventricular function
Hypoxemia secondary to prolonged positive pressure at expiration
Low cardiac output secondary to increased intrathoracic pressure
A patient’s status worsens and needs mechanical ventilation. The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously between the mechanical breaths at his own tidal volume. This mode of ventilation is called:
intermittent mandatory ventilation
controlled ventilation
assist/control ventilation
positive end-expiratory pressure
intermittent mandatory ventilation
