NURSING HESI MED SURG PROCTORED EXAM. Document 28th November 2022
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Course
NUR 1025
Institution
The University Of Bradford (UoB)
A nurse is following the Ventilator Bundle standards to prevent
ventilator-associated pneumonia. Which strategies is the nurse using? (Select
all that apply.)
a. Head of bed elevation to 90 degrees at all times
b. Daily oral care with chlorhexidine
c. Cuff monitoring for adequate seal
1. A nurse is following the Ventilator Bundle standards to prevent
ventilator-associated pneumonia. Which strategies is the nurse using? (Select
all that apply.)
a. Head of bed elevation to 90 degrees at all times
b. Daily oral care with chlorhexidine
c. Cuff monitoring for adequate seal
d. Clean technique when suctioning
e. Daily “sedation vacations”
f. Heart failure prophylaxis
ANS: B, C, E
The key components of the Institute for Healthcare Improvement (IHI)
Ventilator Bundle are: Elevation of the head of the bed (HOB)—elevation is
30 to 45 degrees
Daily “sedation vacations” and assessment of readiness to extubate Peptic
ulcer disease prophylaxis
Deep venous thrombosis prophylaxis Daily oral care with chlorhexidine
Monitor cuff pressure frequently to ensure that there is an adequate seal to
prevent aspiration of secretions is also included. Sterile technique is used for
suctioning when on ventilators. Heart failure prophylaxis is not a component.
2. A nurse is teaching a community health promotion class and discusses
the flu vaccine. Which information will the nurse include in the teaching
session? (Select all that apply.)
a. It is given yearly.
1
, b. It is given in a series of four doses.
c. It is safe for children allergic to eggs.
d. It is safe for adults with acute febrile illnesses.
e. The nasal spray is given to people over 50.
f. The inactivated flu vaccine is given to people over 50.
ANS: A, F
Annual (yearly) flu vaccines are recommended for all people 6 months and
older. The inactivated flu vaccine should be given to these individuals with
chronic health problems and those 50 and older. People with a known
hypersensitivity to eggs or other components of the vaccine should consult
their health care provider before being vaccinated. There is a flu vaccine made
without egg proteins that is approved for adults 18 years of age and older.
Adults with an acute febrile illness should schedule the vaccination after they
have recovered. The live, attenuated nasal spray vaccine is given to people
from 2 through 49 years of age if they are not pregnant or do not have certain
long-term health problems such as asthma; heart, lung, or kidney disease;
diabetes; or anemia.
3. A nurse is caring for a patient with sleep apnea. Which types of
ventilator support should the nurse be prepared to administer for this patient?
(Select all that apply.)
a. Assist-control (AC)
b. Pressure support ventilation (PSV)
c. Bilevel positive airway pressure (BiPAP)
d. Continuous positive airway pressure (CPAP)
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