SOLVED

 Question 11 A patient who has been extubated postoperatively is retaining carbon dioxide. In order to avoid reintubating this patient the nurse would expect to manage which intervention? 1. Insertion of an oral airway 2. Insertion of a nasal airway 3. Use of noninvasive intermittent positive pressure ventilation (NIPPV) 4. Use of continuous positive airway ventilation (CPAP) Question 12 A patient in respiratory failure has a heart rate of 124, respirations of 24, blood pressure of 168/98, blood pH of 7.28 and oxygen saturation of 84%. The patient is can be aroused, but returns to sleep quickly. Noninvasive intermittent positive pressure (NIPPV) is initiated. On reassessment, which findings would the nurse evaluate as indicating that this therapy is having the desired outcomes? 1. Respiratory rate is 22. 2. The patient is not using accessory muscles. 3. The patient is somnolent. 4. Blood pH is 7.26. 5. O2 saturation is 90%. Question 13 A patient who is mechanically ventilated requires a high level of PEEP. The nurse would monitor for which findings indicating possible barotrauma? 1. Sudden increase in systolic blood pressure. 2. Absent breath sounds. 3. Subcutaneous emphysema across the anterior chest. 4. Patient is somnolent. 5. Sudden deterioration of ABGs. Question 14 The nurse monitors all mechanically ventilated patients for the development of oxygen toxicity. Which patient would the nurse determine to be at highest risk? 1. The patient has required FiO2 of 0.7 for the first 2 hours after being intubated. 2. A patient has required FiO2 of 1.0 for the last 8 hours. 3. The patient’s ventilator was set at FiO2 of 0.4 for the last 2 days. 4. The patient has required FiO2 of 0.8 for 24 hours after intubation. Question 15 A patient is being admitted to the intensive care unit after being resuscitated in the emergency department. The patient is being mechanically ventilated. Which information provided by the transferring nurse would the nurse evaluate as increasing this patient’s risk of developing ventilator associated pneumonia (VAP)? 1. “The patient is intubated nasally.” 2. “The patient arrested after having a myocardial infarction.” 3. “The patient required placement of a nasogastric tube to relieve persistent gastric distention.” 4. “The patient’s home medications include a proton pump inhibitor.” 5. “The patient has a history of COPD.” Question 16 Which nursing intervention will help to decrease the risk of tracheal and laryngeal injuries in an intubated patient? 1. Use an endotracheal tube equipped for continuous removal of subglottic secretions. 2. Deflate the cuff for 5 minutes every 8 hours. 3. Use the minimal occluding pressure technique to maintain cuff pressure at 20 to 25 mm Hg. 4. Test cuff pressure by assessing firmness of the inflation balloon. Question 17 A patient who is endotracheally intubated and on mechanical ventilation has a decreasing oxygen saturation level with an increasing heart rate. What is the nurse’s priority action? 1. Ensure the airway is clear. 2. Auscultate lung sounds. 3. Reposition the patient. 4. Reposition the endotracheal tube. Question 18 The health care team has planned to begin weaning a patient from the mechanical ventilator in the morning. The nurse should alert the team to which situations that could decrease the chance of successful weaning? 1. The patient has developed a fever. 2. The patient was suctioned twice during the night for a small amount of thin secretions. 3. ABGs reveal a pH of 7.34. 4. The patient is constipated. 5. The patient’s serum sodium level is 138 mEq/L. Question 19 A patient is being manually weaned from mechanical ventilation. What nursing intervention is indicated? 1. Suction the patient once the ventilator is removed. 2. Have intubation equipment at the bedside. 3. Project a calm and confident manner. 4. Change the ventilator settings so the patient can breathe spontaneously between set breaths. Question 20 A patient who will require long-term mechanical ventilation has had a tracheostomy for 2 weeks. The nurse is concerned that stoma erosion is occurring. Which nursing assessment would support the nurse’s concern? 1. Secretions are present at the stoma opening. 2. Granulation tissue is noted at the stoma site. 3. The patient has developed a dry cough. 4. The skin at the stoma opening is flaky.