Med-Surge Nursing Respiratory Care
Prep U ch. 21
An adult client with cystic fibrosis is admitted to an acute care facility with
an acute respiratory infection. Ordered respiratory treatment includes
✅✅
chest physiotherapy. When should the nurse perform this procedure? -
-At bedtime
The nurse should perform chest physiotherapy at bedtime to reduce
secretions in the client's lungs during the night. Performing it
immediately before a meal may tire the client and impair the ability to
eat. Percussion and vibration, components of chest physiotherapy, may
worsen bronchospasms; therefore, the procedure is contraindicated in
clients with bronchospasms. Secretions that have mobilized (especially
when suction equipment isn't available) are a contraindication for
postural drainage, another component of chest physiotherapy.
✅✅
Which is the most reliable and accurate method for delivering precise
concentrations of oxygen through noninvasive means? - -Venturi
mask
The Venturi mask is the most reliable and accurate method for delivering
a precise concentration of oxygen through noninvasive means. The
mask is constructed in a way that allows a constant flow of room air
blended with a fixed flow of oxygen. Nasal cannula, T-piece, and
partial-rebreathing masks are not the most reliable and accurate
methods of oxygen administration.
Which is a correct endotracheal tube cuff pressure? - ✅✅-22 mm Hg
Cuff pressures should be checked with a calibrated aneroid manometer
device every 6 to 8 hours to maintain cuff pressures between 20 and 25
mm Hg. The other values are not within the normal range for adequate
cuff pressure.
✅✅
Which ventilator mode provides full ventilatory support by delivering a
preset tidal volume and respiratory rate? - -Assist control
,Assist-control ventilation provides full ventilator support by delivering a
preset tidal volume and respiratory rate. Intermittent mandatory
ventilation (IMV) provides a combination of mechanically assisted
breaths and spontaneous breaths. SIMV delivers a preset tidal volume
and number of breaths per minute. Between ventilator-delivered breaths,
the client can breathe spontaneously with no assistance from the
ventilator for those extra breaths. Pressure support ventilation assists
SIMV by applying a pressure plateau to the airway throughout the
client-triggered inspiration to decrease resistance within the tracheal
tube and ventilator tubing.
✅✅
Which finding would indicate a decrease in pressure with mechanical
ventilation? - -Increase in compliance
A decrease in pressure in the mechanical ventilator may be caused by
an increase in compliance. Kinked tubing, decreased lung compliance,
and a plugged airway tube cause an increase in peak airway pressure.
✅✅
The nurse should monitor a client receiving mechanical ventilation for
which of the following complications? - -Gastrointestinal
hemorrhage
Gastrointestinal hemorrhage occurs in approximately 25% of clients
receiving prolonged mechanical ventilation. Other possible complications
include incorrect ventilation, oxygen toxicity, fluid imbalance, decreased
cardiac output, pneumothorax, infection, and atelectasis.
Immunosuppression and pulmonary emboli are not direct consequences
of mechanical ventilation.
The nurse is assisting a client with postural drainage. Which of the
✅✅
following demonstrates correct implementation of this technique? -
-Instruct the client to remain in each position of the postural
drainage sequence for 10 to 15 minutes.
Postural drainage is usually performed two to four times daily, before
meals (to prevent nausea, vomiting, and aspiration) and at bedtime.
, Prescribed bronchodilators, water, or saline may be nebulized and
inhaled before postural drainage to dilate the bronchioles, reduce
bronchospasm, decrease the thickness of mucus and sputum, and
combat edema of the bronchial walls. The nurse instructs the client to
remain in each position for 10 to 15 minutes and to breathe in slowly
through the nose and out slowly through pursed lips to help keep the
airways open so that secretions can drain while in each position. If the
sputum is foul-smelling, it is important to perform postural drainage in a
room away from other patients or family members. (Deodorizers may be
used to counteract the odor. Because aerosol sprays can cause
bronchospasm and irritation, they should be used sparingly and with
caution.)
✅✅
Which of the following are indicators that a client is ready to be weaned
from a ventilator? Select all that apply. - -1. Vital capacity of 13
mL/kg
2. Tidal volume of 8.5 mL/kg
3. PaO2 of 64 mm Hg
Weaning criteria for clients are as follows: Vital capacity 10 to 15 mL/kg;
Maximum inspiratory pressure at least -20 cm H2; Tidal volume: 7 to 9
mL/kg; Minute ventilation: 6 L/min; Rapid/shallow breathing index below
100 breaths/min; PaO2 > 60 mm Hg; FiO2 < 40%
A patient is brought into the emergency department with carbon
✅✅
monoxide poisoning after escaping a house fire. What should the nurse
monitor this patient for? - -Anemic hypoxia
Anemic hypoxia is a result of decreased effective hemoglobin
concentration, which causes a decrease in the oxygen-carrying capacity
of the blood. It is rarely accompanied by hypoxemia. Carbon monoxide
poisoning, because it reduces the oxygen-carrying capacity of
hemoglobin, produces similar effects but is not strictly anemic hypoxia,
because hemoglobin levels may be normal.
A client with emphysema informs the nurse, "The surgeon will be
removing about 30% of my lung so that I will not be so short of breath
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