NURS 4350 Final Exam UPDATED
ACTUAL QUESTIONS AND CORRECT
ANSWERS
How do nurses assess the need for intubation in a critically ill patient? - CORRECT
ANSWER Ineffective gas exchange
Excessive work of breathing
Inability to mobilize secretions
Inability to maintain a patent airway
What basic equipment and medications do you need to have ready? - CORRECT
ANSWER Suction equipment
Medications (sedative, pain, paralytics)-- rocuronium, Propofol, succinylcholine
Ambu bag
List 3 potential complications of the intubation procedure. - CORRECT
ANSWER Laryngospasm (give succinylcholine to open airway)
Hypoxemia
Vomiting
Trauma
Tube malplacement
Ventilator Complications - CORRECT ANSWER Ventilator Induced Lung Injury-
Barotrauma, pneumothorax
Intubation of right mainstem bronchus
ETT out of position; unplanned extubation
Tracheal damage, vocal cord damage (Pressure necrosis; tracheal stenosis)
Damage to oral, nasal mucosa, lips
,Lung damage from high FiO2 (100% O2 →damage by oxygen radicals & atelectasis)
Aspiration (Oral secretions, Gastric contents, tube feeding)
Inability to wean from ventilator
Decreased cardiac output
Stress ulcers and GI bleeding
Ventilator-Associated Pneumonia (VAP)
Psychosocial problems- Communication, Stress, anxiety, discomfort, Noise and frequent
suctioning, Psychological dependence on the vent
How are the basic vent settings such as Vt (tidal volume) determined? - CORRECT
ANSWER 6 mL/kg of ideal body weight (MUST KNOW)
Average about 450 ml
Lower if decreased lung compliance
How deep the breaths are
If the patient's CO2 is high, increase respiration rate not tidal volume
How is respiratory rate on vent determined? - CORRECT ANSWER Adjusted to
maintain pH, PaCO2
How is FiO2 determined on the ventilator? - CORRECT ANSWER Adjusted between
.21 - 1.0 based on PaO2
(button on vent allows: delivery of 100% O2 for 2 minutes)
Delivered with humidity
, How does the nurse check for proper ET tube placement? - CORRECT
ANSWER CXR is gold standard
Auscultation
Aspirate tube
Chest movement
CO2 detector on tube: if it changes color to yellow, placement is correct
Condensation
P-F ratio - CORRECT ANSWER PaO2/FiO2
for ARDS
room is is 21% FiO2
<200 meets ARDS criteria
How often should patients be suctioned? - CORRECT ANSWER PRN
Indications: coarse crackles over trachea, coughing, visible secretions, decreased oxygen
saturation, ARDS
What is pressure support? - CORRECT ANSWER Preset positive pressure used to
augment patient's inspiratory efforts; patient controls rate, inspiratory flow, and tidal volume
Patient receives a boost of pressure with each breath
PEEP - CORRECT ANSWER Positive pressure is applied at the end of the expiration
of ventilator breaths.
Prevents collapse of small airways, keeps alveoli open, increases oxygenation
can increase PaO2 without having to change the patient's vent settings
standard is 5 but it can be increased
ACTUAL QUESTIONS AND CORRECT
ANSWERS
How do nurses assess the need for intubation in a critically ill patient? - CORRECT
ANSWER Ineffective gas exchange
Excessive work of breathing
Inability to mobilize secretions
Inability to maintain a patent airway
What basic equipment and medications do you need to have ready? - CORRECT
ANSWER Suction equipment
Medications (sedative, pain, paralytics)-- rocuronium, Propofol, succinylcholine
Ambu bag
List 3 potential complications of the intubation procedure. - CORRECT
ANSWER Laryngospasm (give succinylcholine to open airway)
Hypoxemia
Vomiting
Trauma
Tube malplacement
Ventilator Complications - CORRECT ANSWER Ventilator Induced Lung Injury-
Barotrauma, pneumothorax
Intubation of right mainstem bronchus
ETT out of position; unplanned extubation
Tracheal damage, vocal cord damage (Pressure necrosis; tracheal stenosis)
Damage to oral, nasal mucosa, lips
,Lung damage from high FiO2 (100% O2 →damage by oxygen radicals & atelectasis)
Aspiration (Oral secretions, Gastric contents, tube feeding)
Inability to wean from ventilator
Decreased cardiac output
Stress ulcers and GI bleeding
Ventilator-Associated Pneumonia (VAP)
Psychosocial problems- Communication, Stress, anxiety, discomfort, Noise and frequent
suctioning, Psychological dependence on the vent
How are the basic vent settings such as Vt (tidal volume) determined? - CORRECT
ANSWER 6 mL/kg of ideal body weight (MUST KNOW)
Average about 450 ml
Lower if decreased lung compliance
How deep the breaths are
If the patient's CO2 is high, increase respiration rate not tidal volume
How is respiratory rate on vent determined? - CORRECT ANSWER Adjusted to
maintain pH, PaCO2
How is FiO2 determined on the ventilator? - CORRECT ANSWER Adjusted between
.21 - 1.0 based on PaO2
(button on vent allows: delivery of 100% O2 for 2 minutes)
Delivered with humidity
, How does the nurse check for proper ET tube placement? - CORRECT
ANSWER CXR is gold standard
Auscultation
Aspirate tube
Chest movement
CO2 detector on tube: if it changes color to yellow, placement is correct
Condensation
P-F ratio - CORRECT ANSWER PaO2/FiO2
for ARDS
room is is 21% FiO2
<200 meets ARDS criteria
How often should patients be suctioned? - CORRECT ANSWER PRN
Indications: coarse crackles over trachea, coughing, visible secretions, decreased oxygen
saturation, ARDS
What is pressure support? - CORRECT ANSWER Preset positive pressure used to
augment patient's inspiratory efforts; patient controls rate, inspiratory flow, and tidal volume
Patient receives a boost of pressure with each breath
PEEP - CORRECT ANSWER Positive pressure is applied at the end of the expiration
of ventilator breaths.
Prevents collapse of small airways, keeps alveoli open, increases oxygenation
can increase PaO2 without having to change the patient's vent settings
standard is 5 but it can be increased
