Week 2 ABGs & Sedation

Question 1

How many liters of oxygen can nasal cannula deliver?

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Answer 1

1 - 6 L

Question 2

What oxygen delivery system provides the most ACCURATE delivery of oxygen?

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Answer 2

VENTURI MASK

Question 3

Which mask provides the highest delivery of LOW flow oxygen?

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Answer 3

Non-Rebreather

10 - 15 L

• has a reservoir bag

Question 4

How many liters of oxygen should a non-rebreather mask be set to?

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Answer 4

10 - 15 L

Question 5

What is the reversal agent for benzodiazepines like Versed, Ativan, and Valium?

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Answer 5

Romazicon (flumazelin)

Question 6

What is the reversal agent for opioids like Demerol, fentanyl, morphine, etc.?

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Answer 6

Narcan (naloxone)

Question 7

Explain the four stages of the Mallampati Score

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Answer 7

Stage 1: complete visualization of the soft palate

Stage 2: Complete visualization of the uvula

Stage 3: Visualization of only the base of the uvula

Stage 4: Soft palate is not visible at all

Question 8

If an endotracheal tube is inserted too far, where will there be decreased breath sounds?

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Answer 8

LEFT side

The ET tube is more likely to be accidentally advanced into the Right lung meaning that only the R lung is getting ventilated = decreased / absent breath sounds in the L lung

Question 9

What should the cuff of the ET tube be inflated to?

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Answer 9

20 - 25 mm

Question 10

What is the most important method to prevent ventilator associated pneumonia (VAP)?

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Answer 10

Elevate HOB 30 degrees

Question 11

A post-operative patient has a respiratory rate of 10 breaths per minute with an SpO2 of 95%. Their ABG values are pH 7.32, PaO2 85, PaCO2 51, & HCO3 24. Which acid-base imbalance is the patient experiencing?

a.) Respiratory alkalosis
b.) Respiratory acidosis
c.) Metabolic alkalosis
d.) Metabolic acidosis

Answer 11

b.) Respiratory acidosis

pH 7.32 = acidic (pH = 7.35 - 7.45)

PaCO2 51 = acidic (PaCO2 = 35 - 45)

HCO3 24 = normal (HCO3 = 22 - 26)

Question 12

What does a shift of “bands” to the left, 6% or greater, indicate?

Answer 12

Infection

Question 13

What are rales or crackles indicative of?

Answer 13

fluid overload

Question 14

Which two medications are always moderate/deep sedation in a non-intubated patient?

Answer 14

• Propofol
• Ketamine

Question 15

What is a key intervention that can be used to maintain an airway in emergent situations?

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Answer 15

Chin lift

Question 16

The key to successful monitoring of patients undergoing moderate/deep sedation include all of the following EXCEPT:

a.) Caring for several patients imultaneously during the procedure.
b.) Assessing the patient before the procedure.
c.) Detecting early changes in the patient’s breathing pattern.
d.) Have a thorough knowledge of the pharmacology of the medication used.

Answer 16

a.) Caring for several patients simultaneously during the procedure.

Question 17

In the event that the patient’s breathing must be assisted, which of the following sequences should the nurse proceed with?

a.) Endotracheal intubation, bag-valve mask, reversal agents.
b.) Reversal agents and non-rebreather mask.
c.) Chin lift, bag-valve mask followed by reversal agents, consider intubation if measures are ineffective.
d.) O2 nasal cannula & emotional support.

Answer 17

c.) Chin lift, bag-valve mask followed by reversal agets, consider intubatoin if measures are ineffective

Question 18

The following patient may have a “difficult airway” in the event that endotracheal intubation is necessary: (select all that apply)

a.) Obese with a short neck.
b.) Thin, young patient without any prior medical conditions.
c.) Limited neck extension (severe osteoarthritis).
d.) Mallampati Class IV.
e.) Receding chin, significant malocclusion.
f.) Mallampati Class I

Answer 18

a.) Obese with a short neck.

c.) Limited neck extension (severe osteoarthritis).

d.) Mallampati Class IV.

e.) Receding chin, significant malocclusion.

Question 19

When administering Romazicon (flumazenil), the nurse should recall that all of the following statements are true EXCEPT:

a.) This drug is a benzodiazepine receptor antagonist.
b.) Observation for re-sedation & respiratory depression is essential as the drug action is very short compared with the benzodiazepine.
c.) Titrate more slowly for patients already using benzodiazepine. Monitor for seizures due to sudden withdrawal.
d.) This drug is useful in reversing the effects of opioids (narcotics) such as Demerol (meperidine) or morphine sulfate.

Answer 19

d.) This drug is useful in reversing the effects of opioids (narcotics) such as Demerol (meperidine) or morphine sulfate.

• ROMAZICON (FLUMAZENIL) IS THE REVERSAL AGENT FOR BENZODIAZEPINES LIKE VERSED, VALIUM, & ATIVAN!!!!!!

FALSE – Romazicon (flumazenil) is the reversal agent for benzodiazepines, NOT opioids.

• Narcan (naloxone) is the reversal agent for opioids (narcotics) like Demerol or morphine sulfate.

Question 20

True or False? A pulse oximeter reading of 90% during a moderate/deep sedation procedure indicates adequate patient ventilation.

Answer 20

False: Oxygen saturation will decrease when the patient develops apnea or significant hypoventilation.

Question 21

Which classification system incorporates the patient’s current & past co-morbidities?

a.) Glascow
b.) Braden
c.) ASA
d.) None of the above

Answer 21

c.) ASA (American Society of Anesthesiologists (ASA) Classification)

Question 22

What is the single most important action for the nurse in preventing Ventilator Associated Pneumonia (VAP)?

a.) That the physician is contacted to order an antibiotic.
b.) Avoid oral hygeine as bacteria may be dislodged to the trachea & lungs.
c.) Maintain HOB at or above 30 degrees.
d.) Avoid all tube feeding to prevent the risk of aspiration.

Answer 22

c.) Maintain HOB at or above 30 degrees.

Question 23

Inspection during a respiratory assessment should be expanded to include which of the following? (Select all that apply)

a.) Respiratory rate, rhythm, & depth.
b.) Use of accessory muscle use (sternocleidomastoid & trapezius muscles).
c.) The safety of the respiratory environment: hand position, head elevation, endotracheal tube positioning, ventilator circuits, & cuff pressure.
d.) Last ABG, CXR, WBC, & PFT result.

Answer 23

a.) Respiratory rate, rhythm, & depth.
b.) Use of accessory muscle use (sternocleidomastoid & trapezius muscles).
c.) The safety of the respiratory environment: hand position, head elevation, endotracheal tube positioning, ventilator circuits, & cuff pressure.
d.) Last ABG, CXR, WBC, & PFT result.

Question 24

Which of the following results is a possible indication of infection in a critically ill patient?

a.) Elevated white blood cell (WBC) count.
b.) Decreased oxygen saturation below 90%.
c.) Blasts in the peripheral smear.
d.) Shift to the left with production of bands.

Answer 24

d.) Shift to the left with production of bands.

Question 25

Which of the following signs are possible indicators of hypoxemia in a patient receiving moderate/deep sedation? Select all that apply

a.) Bradycardia
b.) Tachycardia
c.) Restlessness & agitation
d.) Confusion

Answer 25

a.) Bradycardia
b.) Tachycardia
c.) Restlessness & agitation
d.) Confusion