NUR 417 - Exam 2 Practice Questions
Which action would the nurse take to verify b. Use an end-tidal CO2 monitor.
the correct placement of an oral
endotracheal tube (ET) immediately
after insertion and before securing the
tube?
a.Obtain a portable chest X-ray.
b.Use an end-tidal CO2 monitor.
c.Auscultate for bilateral breath sounds.
d.Observe for symmetrical
chest movement.
Which action would thenurse take to d. Inject air into the cuff until a slight leak is heard only at peak inflation.
maintain proper endotracheal tube (ET)
cuff pressure when a patient is on
mechanical ventilation?
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.
The nurse notes premature ventricular d. Ventilate the patient with 100% oxygen
contractions (PVCs) on the monitor while
suctioning a patient's endotracheal tube.
Which action would the nurse take?
a.Plan to suction the patient
more frequently.
b.Decrease the suction pressure to 80
mm Hg.
c. Give antidysrhythmic medications per
protocol.
d.Ventilate the patient with 100% oxygen
,Which assessment finding for a patient c. The patient's respiratory rate is 32 breaths/min.
receiving mechanical ventilation indicates
the need for suctioning?
a. The patient was last
suctioned 6 hours ago.
b.The patient's oxygen saturation drops to
93%.
c.The patient's respiratory rate is
32 breaths/min.
d.The patient has occasional audible
expiratory wheezes.
The nurse notes thick, white secretions c. Add additional water to the patient's enteral feedings.
in theendotracheal tube (ET) of a patient
who is receiving mechanical ventilation.
Which intervention will most directly
treat this finding?
a.Reposition the patient every 1 to 2 hours.
b.Increase suctioning frequency to every
hour.
c.Add additional water to the
patient's enteral feedings.
d.Instill 5 mL of sterile saline into the
ET before suctioning.
Four hours after mechanical ventilation d. Decrease the respiratory rate.
is initiated, a patient's arterial blood gas
(ABG) results include a pH of 7.51, PaO2
of 82 mm Hg, PaCO of 26 mm Hg, and
HCO3 of 23 mE q/L (23 mmol/L). What
change should the nurse anticipate to the
ventilator settings?
a.Increase the FIO2.
b.Increase the tidal volume.
c. Increase the respiratory rate.
d.Decrease the respiratory rate.
The nurse is weaning a patient who has c. The patient respiratory rate is 32 breaths/min.
chronic obstructive pulmonary disease
(COPD) and weighs 68-kg from mechanical
ventilation. Which finding indicates that the
weaning protocol should be stopped?
a. The patient's heart rate is 97
beats/min.
b.The patient's oxygen saturation is 93%.
c.The patient respiratory rate is
32 breaths/min.
d.The patient's spontaneous tidal volume
is 450 mL.
, The nurse responding to a ventilator alarm d. Manually ventilate the patient with 100% oxygen.
finds the patient lying in bed gasping
and the endotracheal tube on the floor.
Which action would thenurse take next?
a. Activate the rapid response team.
b.Provide reassurance to thepatient.
c. Call the health care provider to
reinsert the tube.
d.Manually ventilate the patient with 100%
oxygen.
The nurse notes that a patient's c. Listen to the patient's breath sounds.
endotracheal tube (ET), which was at
the 22-cm mark, is now at the 25-cm mark,
and the patient is anxious and restless.
Which action would thenurse take
next?
a.Check the O2 saturation.
b.Offer reassurance to the patient.
c. Listen to the patient's breath sounds.
d.Notify the patient's health care provider.
The charge nurse is evaluating the care d. The RN positions the patient with the head of bed at 10 degrees.
that a new registered nurse (RN)
provides to a patient receiving
mechanical ventilation.
Which action by the new RN indicates the
need for more education?
a. The RN increases the FIO2 to
100% before suctioning.
b.The RN secures a bite block in place
using adhesive tape.
c.The RN asks for assistance to re-
secure the endotracheal tube.
d.The RN positions the patient with
the head of bed at 10 degrees.
A patient who is orally intubated and a. Verbally coach the patient to breathe with the ventilator.
receiving mechanical ventilation is anxious
and is "fighting" the ventilator. Which action
would the nurse take first?
a. Verbally coach the patient to
breathe with the ventilator.
b.Sedate the patient with the ordered
PRN lorazepam (Ativan)
c. Manually ventilate the patient with
a bag-valve-mask device.
d.Increase the rate for the
ordered propofol (Diprivan)
infusion.
Which action would the nurse take to verify b. Use an end-tidal CO2 monitor.
the correct placement of an oral
endotracheal tube (ET) immediately
after insertion and before securing the
tube?
a.Obtain a portable chest X-ray.
b.Use an end-tidal CO2 monitor.
c.Auscultate for bilateral breath sounds.
d.Observe for symmetrical
chest movement.
Which action would thenurse take to d. Inject air into the cuff until a slight leak is heard only at peak inflation.
maintain proper endotracheal tube (ET)
cuff pressure when a patient is on
mechanical ventilation?
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.
The nurse notes premature ventricular d. Ventilate the patient with 100% oxygen
contractions (PVCs) on the monitor while
suctioning a patient's endotracheal tube.
Which action would the nurse take?
a.Plan to suction the patient
more frequently.
b.Decrease the suction pressure to 80
mm Hg.
c. Give antidysrhythmic medications per
protocol.
d.Ventilate the patient with 100% oxygen
,Which assessment finding for a patient c. The patient's respiratory rate is 32 breaths/min.
receiving mechanical ventilation indicates
the need for suctioning?
a. The patient was last
suctioned 6 hours ago.
b.The patient's oxygen saturation drops to
93%.
c.The patient's respiratory rate is
32 breaths/min.
d.The patient has occasional audible
expiratory wheezes.
The nurse notes thick, white secretions c. Add additional water to the patient's enteral feedings.
in theendotracheal tube (ET) of a patient
who is receiving mechanical ventilation.
Which intervention will most directly
treat this finding?
a.Reposition the patient every 1 to 2 hours.
b.Increase suctioning frequency to every
hour.
c.Add additional water to the
patient's enteral feedings.
d.Instill 5 mL of sterile saline into the
ET before suctioning.
Four hours after mechanical ventilation d. Decrease the respiratory rate.
is initiated, a patient's arterial blood gas
(ABG) results include a pH of 7.51, PaO2
of 82 mm Hg, PaCO of 26 mm Hg, and
HCO3 of 23 mE q/L (23 mmol/L). What
change should the nurse anticipate to the
ventilator settings?
a.Increase the FIO2.
b.Increase the tidal volume.
c. Increase the respiratory rate.
d.Decrease the respiratory rate.
The nurse is weaning a patient who has c. The patient respiratory rate is 32 breaths/min.
chronic obstructive pulmonary disease
(COPD) and weighs 68-kg from mechanical
ventilation. Which finding indicates that the
weaning protocol should be stopped?
a. The patient's heart rate is 97
beats/min.
b.The patient's oxygen saturation is 93%.
c.The patient respiratory rate is
32 breaths/min.
d.The patient's spontaneous tidal volume
is 450 mL.
, The nurse responding to a ventilator alarm d. Manually ventilate the patient with 100% oxygen.
finds the patient lying in bed gasping
and the endotracheal tube on the floor.
Which action would thenurse take next?
a. Activate the rapid response team.
b.Provide reassurance to thepatient.
c. Call the health care provider to
reinsert the tube.
d.Manually ventilate the patient with 100%
oxygen.
The nurse notes that a patient's c. Listen to the patient's breath sounds.
endotracheal tube (ET), which was at
the 22-cm mark, is now at the 25-cm mark,
and the patient is anxious and restless.
Which action would thenurse take
next?
a.Check the O2 saturation.
b.Offer reassurance to the patient.
c. Listen to the patient's breath sounds.
d.Notify the patient's health care provider.
The charge nurse is evaluating the care d. The RN positions the patient with the head of bed at 10 degrees.
that a new registered nurse (RN)
provides to a patient receiving
mechanical ventilation.
Which action by the new RN indicates the
need for more education?
a. The RN increases the FIO2 to
100% before suctioning.
b.The RN secures a bite block in place
using adhesive tape.
c.The RN asks for assistance to re-
secure the endotracheal tube.
d.The RN positions the patient with
the head of bed at 10 degrees.
A patient who is orally intubated and a. Verbally coach the patient to breathe with the ventilator.
receiving mechanical ventilation is anxious
and is "fighting" the ventilator. Which action
would the nurse take first?
a. Verbally coach the patient to
breathe with the ventilator.
b.Sedate the patient with the ordered
PRN lorazepam (Ativan)
c. Manually ventilate the patient with
a bag-valve-mask device.
d.Increase the rate for the
ordered propofol (Diprivan)
infusion.
