Exam (elaborations)
NUR 419 Complex Client Exam 1 Study Guide Correct Answers
- Module
- Institution
NUR 419 Complex Client Exam 1 Study Guide Correct Answers
[Show more]
Content preview
Solution 2024/2025Pepper
NUR 419 Complex Client Exam 1 Study Guide
Correct Answers
DOPE ANS✔✔ Displacement (low pressure), Obstruction (high pressure), Pneumothorax (high pressure), Equipment
(variable)
Ballard suction ANS✔✔ Used to suction a ventilated patient and is sterile system
End tidal CO2 detector ANS✔✔ measures the concentration of exhaled CO2 at the end of expiration. The normal range
is 35-45. Hypercapnia is any CO2 level greater than 50.
Laryngoscope ANS✔✔ is the device used to intubate a patient. Comes with either a Miller (longer and skinnier) or
Macintosh (shorter, more curved, fatter) blade.
Bag valve device ANS✔✔ attach the mask and oxygen if indicated. Squeeze the bag to deliver air to the patient. If the
patient is spontaneously breathing, make sure to line up squeezes with their breaths. Make sure to lift chin of patient to
keep airway open, don't press down on face with mask.
Oral airway ANS✔✔ used for patients who are unable to ventilate themselves or are at risk for their airway being
blocked
Endotracheal tube ANS✔✔ a type of oral airway. Used with the stylet and laryngoscope for intubation.
Yankauer suction device ANS✔✔ used to suction the mouth from secretions. Often used to help with oral care for
ventilated patients. This is NOT used to suction ET tube or tracheostomy.
Stylet ANS✔✔ used during the intubation procedure. It goes into the artificial airway and helps it keep its curved shape
, Solution 2024/2025
Pepper
Restraints ANS✔✔ used to prevent a confused or combative patient from self-injury, reduce the risk of injuries to
others, and is only used when other measures have failed to prevent interruptions in therapy. Two main categories are
physical and chemical
Pharmacological behavioral therapy ANS✔✔ psychotropics (ex. haloperidol), benzodiazepines (lorazepam),
anticholinergic antihistamines (diphenhydramine), general anesthetic (propofol)
Steps before initiating restraints ANS✔✔ must be ordered by a provider who personally sees and evaluates the patient
within a specific time period. They should only be used as an emergency measure or after other treatments have failed.
Orders must be time limited and patients/families need to be informed of the reason for use
What to do if O2% falls below 90% during ETT intubation attempts? ANS✔✔ Stop procedure and apply oxygen and
ambu bag them. May need to suction
What complications may occur if the client's SaO2 falls below 90% without intervention? ANS✔✔ Hypoxemia leading to
brain and tissue damage
What could absent breath sounds indicate? ANS✔✔ The ET tube is not in the correct place (probably esophagus). If
breath sounds are only heard on one side, a pneumothorax may be present.
Potential complications of ETT placement ANS✔✔ Aspiration, intubating to the GI system instead of the lungs, tracheal
perforation, pneumothorax
What methods are used to confirm placement of an ETT? ANS✔✔ You can listen for breath sounds or look for
humidification in the tube but the most accurate way to tell is through capnography reading. Measure the CO2 coming
out of the tube and look for the CO2 waveform on the monitor. Normal range for CO2 is 35-45.
What is the ventilator alarm mnemonic and how would you use it? ANS✔✔ DOPE. (see DOPE definition - displacement,
obstruction, pneumothorax, equipment)
Which type of breathing is for spontaneously breathing patients? ANS✔✔ CPAP (Weaning modes include SIMV, PSV, and
CPAP, idk if they want all of those or just the least supportive)
, Solution 2024/2025
Pepper
What is the cardiovascular impact of positive pressure ventilation? ANS✔✔ Positive pressure ventilation adds more
pressure into the lungs which pushes on the inferior vena cava. This results in less blood flow to the heart and a
decreased cardiac output. Ventilated patients usually show a decrease in blood pressure.
Low Flow ANS✔✔ "a device that doesn't meet all the inspiratory flow demands of the patient. O2 concentrations
delivered vary with patient's breathing pattern"
Nasal cannula
Simple face mask
Non-rebreather mask
Face tent
Tracheostomy collar
High Flow ANS✔✔ "delivers a more precise FiO2 no matter the patient's breathing pattern. Consistent and predictable"
Venturi
What is the difference between flow versus concentration? ANS✔✔ Flow refers to how many liters of air/oxygen,
concentration refers to the concentration of oxygen (ex. Room air is 21% oxygen)
How often do you perform oral care on a ventilated patient? How often do you brush teeth? ANS✔✔ Oral care every 2
hours, brush teeth every 12 hours
When a patient is on a high-risk medication, what are the four questions every nurse should ask themselves? ANS✔✔
What is the medication? What is the correct route? What does it do? What do you need to look out for?
What should be noticed and documented about any medication on an infusion pump? (patient assessment data and
pump settings) ANS✔✔ Check IV pump settings, IV bag, and IV lines. Keep alcohol caps on all unused ports. Check IV site
patency and appearance hourly. Assess patient for adverse effects or therapeutic effects. Assess vitals and I&Os.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Schoolflix. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
80467 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy revision notes and other study material for 14 years now