NTB LEWIS (ONLY MECHANICAL VENTILATOR RELATED
QUESTIONS ADDED) CHAPTER 66 NURSING MANAGEMENT
CRITICAL CARE & TNP QUESTIONS AND CORRECT ANSWERS
To,verify,the,correct,placement,of,an,oral,endotracheal,tube,(ET),after,insertion,,the,best,initial,action,by
,the,nurse,is,to
a.
auscultate,for,the,presence,of,bilateral,breath,sounds.
b.
obtain,a,portable,chest,x-ray,to,check,tube,placement.
c.
observe,the,chest,for,symmetric,chest,movement,with,ventilation.
d.
use,an,end-tidal,CO2,monitor,to,check,for,placement,in,the,trachea.,,ANS,-,,ANS:,D
End-
tidal,CO2,monitors,are,currently,recommended,for,rapid,verification,of,ET,placement.,Auscultation,for,bi
lateral,breath,sounds,and,checking,chest,expansion,are,also,used,,but,they,are,not,as,accurate,as,end-
tidal,CO2monitoring.,A,chest,x-ray,confirms,the,placement,but,is,done,after,the,tube,is,secured.
To,maintain,proper,cuff,pressure,of,an,endotracheal,tube,(ET),when,the,patient,is,on,mechanical,ventilat
ion,,the,nurse,should
a.
inflate,the,cuff,with,a,minimum,of,10,mL,of,air.
b.
inflate,the,cuff,until,the,pilot,balloon,is,firm,on,palpation.
c.
inject,air,into,the,cuff,until,a,manometer,shows,15,mm,Hg,pressure.
d.
inject,air,into,the,cuff,until,a,slight,leak,is,heard,only,at,peak,inflation.,,ANS,-,,ANS:,D
The,minimal,occluding,volume,technique,involves,injecting,air,into,the,cuff,until,an,air,leak,is,present,onl
y,at,peak,inflation.,The,volume,to,inflate,the,cuff,varies,with,the,ET,and,the,patient's,size.,Cuff,pressure,s
, hould,be,maintained,at,20,to,25,mm,Hg.,An,accurate,assessment,of,cuff,pressure,cannot,be,obtained,by,
palpating,the,pilot,balloon.
The,nurse,notes,premature,ventricular,contractions,(PVCs),while,suctioning,a,patient's,endotracheal,tub
e.,Which,action,by,the,nurse,is,a,priority?
a.
Decrease,the,suction,pressure,to,80,mm,Hg.
b.
Document,the,dysrhythmia,in,the,patient's,chart.
c.
Stop,and,ventilate,the,patient,with,100%,oxygen.
d.
Give,antidysrhythmic,medications,per,protocol.,,ANS,-,,ANS:,C
Dysrhythmias,during,suctioning,may,indicate,hypoxemia,or,sympathetic,nervous,system,stimulation.,The
,nurse,should,stop,suctioning,and,ventilate,the,patient,with,100%,oxygen.,Lowering,the,suction,pressure,
will,decrease,the,effectiveness,of,suctioning,without,improving,the,hypoxemia.,Because,the,PVCs,occurr
ed,during,suctioning,,there,is,no,need,for,antidysrhythmic,medications,(which,may,have,adverse,effects),
unless,they,recur,when,the,suctioning,is,stopped,and,patient,is,well,oxygenated.
Which,assessment,finding,obtained,by,the,nurse,when,caring,for,a,patient,receiving,mechanical,ventilati
on,indicates,the,need,for,suctioning?
a.
The,patient's,oxygen,saturation,is,93%.
b.
The,patient,was,last,suctioned,6,hours,ago.
c.
The,patient's,respiratory,rate,is,32,breaths/minute.
d.
The,patient,has,occasional,audible,expiratory,,ANS,-,,ANS:,C
The,increase,in,respiratory,rate,indicates,that,the,patient,may,have,decreased,airway,clearance,and,requ
ires,suctioning.,Suctioning,is,done,when,patient,assessment,data,indicate,that,it,is,needed,,not,on,a,sche
duled,basis.,Occasional,expiratory,wheezes,do,not,indicate,poor,airway,clearance,,and,suctioning,the,pat
