NUR 417 FINAL EXAM (Lewis Evolve) Questions With
Complete Solutions
Which factor indicates that tracheostomy placement would
be preferable to endotracheal intubation?
A. The patient is unable to clear secretions.
B. The patient is at high risk for aspiration.
C. A long-term airway is probably necessary.
D. An upper airway obstruction is impairing the patient's
ventilation.
C
A tracheostomy is indicated when the need for an artificial
airway is expected to be long term. Aspiration risk, an inability
to clear secretions, and upper airway obstruction are indications
for an artificial airway, but these are not specific indications for
tracheostomy.
The nurse is caring for a patient intubated and on a
mechanical ventilator for several days. Which weaning
parameter would tell the nurse if the patient has enough
muscle strength to breathe without assistance?
A. Tidal volume
B. Minute ventilation
C. Forced vital capacity
D. Negative inspiratory force
,D
The negative inspiratory force measures inspiratory muscle
strength. Tidal volume and minute ventilation assess the
patient's respiratory endurance. Forced vital capacity is not used
as a measure to determine weaning from a ventilator.
When planning care for a patient on a mechanical ventilator,
the application of positive end-expiratory pressure (PEEP)
to the ventilator settings has which therapeutic effect?
A. Increased inflation of the lungs
B. Prevention of barotrauma to the lung tissue
C. Prevention of alveolar collapse during expiration
D. Increased fraction of inspired O2 concentration (FIO2)
administration
C
PEEP is positive pressure that is applied to the airway during
exhalation. This positive pressure prevents the alveoli from
collapsing, improving oxygenation and enabling a reduced FIO2
requirement. PEEP does not cause increased inflation of the
lungs or prevent barotrauma. Auto-PEEP resulting from
inadequate exhalation time may contribute to barotrauma.
The nurse is caring for a patient with acute respiratory
distress syndrome (ARDS) who is on pressure support
ventilation (PSV), fraction of inspired oxygen (FIO2) at
80%, and positive end-expiratory pressure (PEEP) at 15 cm
H2O. The patient weighs 72 kg. What finding would indicate
that treatment is effective?
,A. PaO2 of 60 mm Hg
B. Tidal volume of 700 mL
C. Cardiac output of 2.7 L/min
D. Inspiration to expiration ratio of 1:2
A
Severe hypoxemia (PaO2 less than 40 mm Hg) occurs with
ARDS, and PEEP is increased to improve oxygenation and
prevent oxygen toxicity by reducing FIO2. A PaO2 level of 60
mm Hg indicates that treatment is effective and oxygenation
status has improved. Decreased cardiac output is a complication
of PEEP. Normal cardiac output is 4 to 8 L/minute. Normal tidal
volume is 6 to 10 mL/kg. PSV delivers a preset pressure, but the
tidal volume varies with each breath. I:E ratio is usually set at
1:2 to 1:1.5 and does not indicate patient improvement.
A patient with sepsis is orally intubated on mechanical
ventilation. Which nursing action is most important?
A. Giving morphine for discomfort
B. Clustering nursing care activities
C. Using an open-suctioning technique
D. Elevating the head of the bed 30 degrees
D
The major complications of endotracheal intubation are
unplanned extubation and aspiration. To prevent aspiration, all
intubated patients and patients receiving enteral feedings must
have the head of the bed elevated a minimum of 30 to 45
, degrees unless medically contraindicated. Closed-suction
technique is preferred because oxygenation and ventilation are
maintained during suctioning, and exposure to secretions is
reduced. The nurse should provide comfort measures, such as
morphine, to relieve anxiety and pain associated with intubation.
To promote rest and sleep, the nurse should limit noise and
cluster activities.
A patient admitted to the critical care unit for
gastrointestinal hemorrhage reports feeling tense and
nervous. The nurse notes the patient appears restless with
increased blood pressure and pulse. If the physical
assessment shows no other changes, it is most important for
the nurse to take which action?
A. Give prescribed IV dose of lorazepam (Ativan)
B. Stay with the patient and encourage expression of concerns.
C. Ask a family member to remain at the bedside with the
patient.
D. Teach the patient how to use guided imagery to reduce
anxiety.
B
Anxiety is a common problem for critically ill patients. The
nurse should first stay with the patient and encourage the patient
to express concerns and needs. After expression of feelings, the
nurse should determine the appropriate intervention if needed
(e.g., lorazepam, guided imagery, family presence). In addition,
staying with the patient will allow the nurse to continue to assess
Complete Solutions
Which factor indicates that tracheostomy placement would
be preferable to endotracheal intubation?
A. The patient is unable to clear secretions.
B. The patient is at high risk for aspiration.
C. A long-term airway is probably necessary.
D. An upper airway obstruction is impairing the patient's
ventilation.
C
A tracheostomy is indicated when the need for an artificial
airway is expected to be long term. Aspiration risk, an inability
to clear secretions, and upper airway obstruction are indications
for an artificial airway, but these are not specific indications for
tracheostomy.
The nurse is caring for a patient intubated and on a
mechanical ventilator for several days. Which weaning
parameter would tell the nurse if the patient has enough
muscle strength to breathe without assistance?
A. Tidal volume
B. Minute ventilation
C. Forced vital capacity
D. Negative inspiratory force
,D
The negative inspiratory force measures inspiratory muscle
strength. Tidal volume and minute ventilation assess the
patient's respiratory endurance. Forced vital capacity is not used
as a measure to determine weaning from a ventilator.
When planning care for a patient on a mechanical ventilator,
the application of positive end-expiratory pressure (PEEP)
to the ventilator settings has which therapeutic effect?
A. Increased inflation of the lungs
B. Prevention of barotrauma to the lung tissue
C. Prevention of alveolar collapse during expiration
D. Increased fraction of inspired O2 concentration (FIO2)
administration
C
PEEP is positive pressure that is applied to the airway during
exhalation. This positive pressure prevents the alveoli from
collapsing, improving oxygenation and enabling a reduced FIO2
requirement. PEEP does not cause increased inflation of the
lungs or prevent barotrauma. Auto-PEEP resulting from
inadequate exhalation time may contribute to barotrauma.
The nurse is caring for a patient with acute respiratory
distress syndrome (ARDS) who is on pressure support
ventilation (PSV), fraction of inspired oxygen (FIO2) at
80%, and positive end-expiratory pressure (PEEP) at 15 cm
H2O. The patient weighs 72 kg. What finding would indicate
that treatment is effective?
,A. PaO2 of 60 mm Hg
B. Tidal volume of 700 mL
C. Cardiac output of 2.7 L/min
D. Inspiration to expiration ratio of 1:2
A
Severe hypoxemia (PaO2 less than 40 mm Hg) occurs with
ARDS, and PEEP is increased to improve oxygenation and
prevent oxygen toxicity by reducing FIO2. A PaO2 level of 60
mm Hg indicates that treatment is effective and oxygenation
status has improved. Decreased cardiac output is a complication
of PEEP. Normal cardiac output is 4 to 8 L/minute. Normal tidal
volume is 6 to 10 mL/kg. PSV delivers a preset pressure, but the
tidal volume varies with each breath. I:E ratio is usually set at
1:2 to 1:1.5 and does not indicate patient improvement.
A patient with sepsis is orally intubated on mechanical
ventilation. Which nursing action is most important?
A. Giving morphine for discomfort
B. Clustering nursing care activities
C. Using an open-suctioning technique
D. Elevating the head of the bed 30 degrees
D
The major complications of endotracheal intubation are
unplanned extubation and aspiration. To prevent aspiration, all
intubated patients and patients receiving enteral feedings must
have the head of the bed elevated a minimum of 30 to 45
, degrees unless medically contraindicated. Closed-suction
technique is preferred because oxygenation and ventilation are
maintained during suctioning, and exposure to secretions is
reduced. The nurse should provide comfort measures, such as
morphine, to relieve anxiety and pain associated with intubation.
To promote rest and sleep, the nurse should limit noise and
cluster activities.
A patient admitted to the critical care unit for
gastrointestinal hemorrhage reports feeling tense and
nervous. The nurse notes the patient appears restless with
increased blood pressure and pulse. If the physical
assessment shows no other changes, it is most important for
the nurse to take which action?
A. Give prescribed IV dose of lorazepam (Ativan)
B. Stay with the patient and encourage expression of concerns.
C. Ask a family member to remain at the bedside with the
patient.
D. Teach the patient how to use guided imagery to reduce
anxiety.
B
Anxiety is a common problem for critically ill patients. The
nurse should first stay with the patient and encourage the patient
to express concerns and needs. After expression of feelings, the
nurse should determine the appropriate intervention if needed
(e.g., lorazepam, guided imagery, family presence). In addition,
staying with the patient will allow the nurse to continue to assess
