Exam 9: Ventilatory Assistance

A patient's endotracheal tube is not secured tightly.The respiratory care practitioner assists the nurse in taping the tube.After the tube is retaped,the nurse auscultates the patient's lungs and notes that the breath sounds over the left lung fields are absent.The nurse suspects that:

The nurse is caring for a mechanically ventilated patient and is charting outside the patient's room when the ventilator alarm sounds.  What is the priority order for the nurse to complete these actions: _______________,_______________,_______________,_______________? (Put a comma and space between each solve choice.) A)Check quickly for possible causes of the alarm that can be fixed. B)After troubleshooting,connect back to mechanical ventilator and reassess patient. C)Go to patient's bedside. D)Manually ventilate the patient while getting respiratory therapist.

Select all of the factors that may predispose the patient to respiratory acidosis.

The nurse is caring for a patient whose ventilator settings include 15 cm H?O of positive end-expiratory pressure (PEEP).The nurse understands that although beneficial,PEEP may result in:

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:

One of the early signs of the effect of hypoxemia on the nervous system is:

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:

A patient is having difficulty weaning from mechanical ventilation.The nurse assesses the patient for a potential cause of this difficult weaning,which includes:

The nurse is assisting with endotracheal intubation and understands correct placement of the endotracheal tube in the trachea would be identified by which of the following? (Select all that apply.)

A patient has coronary artery bypass graft surgery and is transported to the surgical intensive care unit at noon.He is placed on mechanical ventilation.Interpret his initial arterial blood gas levels: pH 7.31 PaCO₂ 48 mm Hg Bicarbonate 22 mEq/L PaO₂ 115 mm Hg O₂ saturation 99%

Neuromuscular blocking agents are used in the management of some ventilated patients.Their primary mode of action is:

The nurse is assessing the exhaled tidal volume (EVT)in a mechanically ventilated patient.The rationale for this assessment is to:

A 53-year-old,80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery with the following arterial blood gas (ABG)levels.What is the nurse's interpretation of these values? pH 7.4 PaCO₂ 40 mm Hg Bicarbonate 24 mEq/L PaO₂ 95 mm Hg O₂ saturation 97% Respirations 20 breaths per minute

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 in between the mechanical breaths at his own tidal volume.This mode of ventilation is called:

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?

A 53-year-old,80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery.Four hours after admission to the surgical intensive care unit at 4 PM,the patient has stable vital signs and normal arterial blood gases (ABGs),and is placed on a T-piece for ventilatory weaning.During the nurse's 7 PM (1900)assessment,the patient is restless,heart rate has increased to 110 beats/min,respirations are 36 breaths/min,and blood pressure is 156/98 mm Hg.The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs)per minute.Pulmonary artery pressures are elevated.The nurse suctions the patient and obtains pink,frothy secretions.Loud crackles are audible throughout lung fields.The nurse notifies the physician,who orders an ABG analysis,electrolyte levels,and a portable chest x-ray study.How does the nurse interpret the following blood gas levels? pH 7.28 PaCO₂ 46 mm Hg Bicarbonate 22 mEq/L PaO₂ 58 mm Hg O₂ saturation 88%

A 53-year-old,80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery.Four hours after admission to the surgical intensive care unit at 4 PM,the patient has stable vital signs and normal arterial blood gases (ABGs)and is placed on a T-piece for ventilatory weaning.During the nurse's 7 PM (1900)assessment,the patient is restless,heart rate has increased to 110 beats/min,respirations are 36 breaths/min,and blood pressure is 156/98 mm Hg.The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs)per minute.Pulmonary artery pressures are elevated.The nurse suctions the patient and obtains pink,frothy secretions.Loud crackles are audible throughout lung fields.The nurse notifies the physician,who orders an ABG analysis,electrolyte levels,and a portable chest x-ray study.In communicating with the physician,which statement indicates the nurse understands what is likely occurring with the patient?

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:

A PaCO₂ of 48 mm Hg is associated with:

A patient's ventilator settings are adjusted to treat hypoxemia.The fraction of inspired oxygen is increased from .60 to .70,and the positive end-expiratory pressure is increased from 10 to 15 cm H?O.Shortly after these adjustments,the nurse notes that the patient's blood pressure drops from 120/76 mm Hg to 90/60 mm Hg.What is the most likely cause of this decrease in blood pressure?