VENTILATORS NCLEX PRACTICE EXAM
QUESTIONS WITH CORRECT ANSWERS
LATEST UPDATE WITH RATIONALES
The nurse is caring for a patient with an endotracheal tube. The nurse
understands that endotracheal suctioning is needed to facilitate removal of
secretions and that the procedure
a. decreases intracranial pressure.
b. depresses the cough reflex.
c. is done as indicated by patient assessment.
d. is more effective if preceded by saline instillation. --ANSWER--ANS: C
Suctioning is performed as indicated by patient assessment. Suctioning is
associated with increases in intracranial pressure; therefore, it is important to
hyperoxygenate the patient before suctioning to reduce this complication.
Suctioning can stimulate the cough reflex rather than depress this reflex. Saline
instillation is associated with negative physiological outcomes and is not
recommended as part of the suctioning procedure; it does not loosen secretions,
which is a common misperception.
A patient is admitted to the progressive care unit with a diagnosis of
community-acquired pneumonia. The patient has a history of chronic
obstructive pulmonary disease and diabetes. A set of arterial blood gases
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,obtained on admission without supplemental oxygen shows pH 7.35; PaCO2 55
mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. These blood gases reflect:
a. hypoxemia and compensated metabolic alkalosis.
b. hypoxemia and compensated respiratory acidosis.
c. normal oxygenation and partly compensated metabolic alkalosis.
d. normal oxygenation and uncompensated respiratory acidosis. --ANSWER--
ANS: B
The PaO2 of 65 mm Hg is lower than normal range (80 to 100 mm Hg),
indicating hypoxemia. The high PaCO2 indicates respiratory acidosis. The
elevated bicarbonate indicates metabolic alkalosis. Because the pH is normal,
the underlying acid-base alteration is compensated. Given the patient's history
of chronic pulmonary disease and a pH that is at the lower end of normal range,
it can be determined that this patient is hypoxemic with fully compensated
respiratory acidosis.
A patient's status worsens and needs mechanical ventilation. The pulmonologist
wants the patient to receive 10 breaths/min from the ventilator but wants to
encourage the patient to breathe spontaneously between the mechanical breaths
at his own tidal volume. This mode of ventilation is called
a. assist/control ventilation.
b. controlled ventilation.
c. intermittent mandatory ventilation.
d. positive end-expiratory pressure. --ANSWER--ANS: C
The intermittent mandatory ventilation mode allows the patient to breathe
spontaneously between breaths. The patient will receive a preset tidal volume at
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,a preset rate. Any additional breaths that he initiates will be at his spontaneous
tidal volume, which will likely be lower than the ventilator breaths. In
assist/control ventilation, spontaneous effort results in a preset tidal volume
delivered by the ventilator. Spontaneous effort during controlled ventilation
results in patient/ventilator dyssynchrony. Positive end-expiratory pressure
(PEEP) is application of positive pressure to breaths delivered by the ventilator.
PEEP is an adjunct to both intermittent mandatory and assist/control ventilation.
A patient has coronary artery bypass graft surgery and is transported to the
surgical intensive care unit at noon and is placed on mechanical ventilation.
Interpret the initial arterial blood gas levels
pH: 7.31
PaCO2: 48 mm Hg
Bicarbonate: 22 mEq/L
PaO2: 115 mm Hg
O2 saturation: 99%
a. Normal arterial blood gas levels with a high oxygen level
b. Partly compensated respiratory acidosis; normal oxygen
c. Uncompensated metabolic acidosis with high oxygen levels
d. Uncompensated respiratory acidosis; hyperoxygenated --ANSWER--ANS: D
The high PaO2 level reflects hyperoxygenation; the PaCO2 and pH levels show
respiratory acidosis. The respiratory acidosis is uncompensated as indicated by
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, a pH of 7.31 (acidosis) and a normal bicarbonate level. No metabolic
compensation has occurred.
The provider orders the following mechanical ventilation settings for a patient
who weighs 75 kg. The patient's spontaneous respiratory rate is 22 breaths/min.
Which arterial blood gas abnormality may occur if the patient continues to be
tachypneic at these ventilator settings?
Settings:
Tidal volume: 600 mL (8 mL per kg)
FiO2: 0.5
Respiratory rate: 14 breaths/min
Mode assist/control
Positive end-expiratory pressure: 10 cm H2O
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis --ANSWER--ANS: D
Assist/control ventilation may result in respiratory alkalosis, especially when
the
patient is breathing at a higher rate that the ventilator rate. Each time the patient
initiates a spontaneous breath—in this case 22 times per minute—the ventilator
will deliver 600 mL of volume.
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QUESTIONS WITH CORRECT ANSWERS
LATEST UPDATE WITH RATIONALES
The nurse is caring for a patient with an endotracheal tube. The nurse
understands that endotracheal suctioning is needed to facilitate removal of
secretions and that the procedure
a. decreases intracranial pressure.
b. depresses the cough reflex.
c. is done as indicated by patient assessment.
d. is more effective if preceded by saline instillation. --ANSWER--ANS: C
Suctioning is performed as indicated by patient assessment. Suctioning is
associated with increases in intracranial pressure; therefore, it is important to
hyperoxygenate the patient before suctioning to reduce this complication.
Suctioning can stimulate the cough reflex rather than depress this reflex. Saline
instillation is associated with negative physiological outcomes and is not
recommended as part of the suctioning procedure; it does not loosen secretions,
which is a common misperception.
A patient is admitted to the progressive care unit with a diagnosis of
community-acquired pneumonia. The patient has a history of chronic
obstructive pulmonary disease and diabetes. A set of arterial blood gases
1|Page
,obtained on admission without supplemental oxygen shows pH 7.35; PaCO2 55
mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. These blood gases reflect:
a. hypoxemia and compensated metabolic alkalosis.
b. hypoxemia and compensated respiratory acidosis.
c. normal oxygenation and partly compensated metabolic alkalosis.
d. normal oxygenation and uncompensated respiratory acidosis. --ANSWER--
ANS: B
The PaO2 of 65 mm Hg is lower than normal range (80 to 100 mm Hg),
indicating hypoxemia. The high PaCO2 indicates respiratory acidosis. The
elevated bicarbonate indicates metabolic alkalosis. Because the pH is normal,
the underlying acid-base alteration is compensated. Given the patient's history
of chronic pulmonary disease and a pH that is at the lower end of normal range,
it can be determined that this patient is hypoxemic with fully compensated
respiratory acidosis.
A patient's status worsens and needs mechanical ventilation. The pulmonologist
wants the patient to receive 10 breaths/min from the ventilator but wants to
encourage the patient to breathe spontaneously between the mechanical breaths
at his own tidal volume. This mode of ventilation is called
a. assist/control ventilation.
b. controlled ventilation.
c. intermittent mandatory ventilation.
d. positive end-expiratory pressure. --ANSWER--ANS: C
The intermittent mandatory ventilation mode allows the patient to breathe
spontaneously between breaths. The patient will receive a preset tidal volume at
2|Page
,a preset rate. Any additional breaths that he initiates will be at his spontaneous
tidal volume, which will likely be lower than the ventilator breaths. In
assist/control ventilation, spontaneous effort results in a preset tidal volume
delivered by the ventilator. Spontaneous effort during controlled ventilation
results in patient/ventilator dyssynchrony. Positive end-expiratory pressure
(PEEP) is application of positive pressure to breaths delivered by the ventilator.
PEEP is an adjunct to both intermittent mandatory and assist/control ventilation.
A patient has coronary artery bypass graft surgery and is transported to the
surgical intensive care unit at noon and is placed on mechanical ventilation.
Interpret the initial arterial blood gas levels
pH: 7.31
PaCO2: 48 mm Hg
Bicarbonate: 22 mEq/L
PaO2: 115 mm Hg
O2 saturation: 99%
a. Normal arterial blood gas levels with a high oxygen level
b. Partly compensated respiratory acidosis; normal oxygen
c. Uncompensated metabolic acidosis with high oxygen levels
d. Uncompensated respiratory acidosis; hyperoxygenated --ANSWER--ANS: D
The high PaO2 level reflects hyperoxygenation; the PaCO2 and pH levels show
respiratory acidosis. The respiratory acidosis is uncompensated as indicated by
3|Page
, a pH of 7.31 (acidosis) and a normal bicarbonate level. No metabolic
compensation has occurred.
The provider orders the following mechanical ventilation settings for a patient
who weighs 75 kg. The patient's spontaneous respiratory rate is 22 breaths/min.
Which arterial blood gas abnormality may occur if the patient continues to be
tachypneic at these ventilator settings?
Settings:
Tidal volume: 600 mL (8 mL per kg)
FiO2: 0.5
Respiratory rate: 14 breaths/min
Mode assist/control
Positive end-expiratory pressure: 10 cm H2O
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis --ANSWER--ANS: D
Assist/control ventilation may result in respiratory alkalosis, especially when
the
patient is breathing at a higher rate that the ventilator rate. Each time the patient
initiates a spontaneous breath—in this case 22 times per minute—the ventilator
will deliver 600 mL of volume.
4|Page
