NUR 417 EXAM 2 PART 1 NURSING COURSE EXAM PREPARATION MATERIAL PRACTICE
QUESTIONS WITH ANSWERS A+ VERIFIED LATEST UPDATE
1. Which action would the nurse take to verify the correct placement of an oral
endotracheal tube (ET) immediately after insertion and before securing the
tube?
1. Obtain a portable chest x-ray.
2. Use an end-tidal CO2 monitor.
3. Auscultate for bilateral breath sounds.
4. Observe for symmetrical chest movement.: 2. Use an end-tidal CO2 monitor.
End-tidal CO2 monitors are currently recommended for rapid verification of ET placement. Auscultation for bilateral
breath sounds and checking chest expansion are also used, but they are not as accurate as end-tidal CO2 monitoring.
A chest x-ray confirms the placement but is done after the tube is secured.
2. Which action would the nurse take to maintain proper endotracheal tube
(ET) cuff pressure when a patient is on mechanical ventilation?
1. Inflate the cuff with a minimum of 10 mL of air.
2. Inflate the cuff until the pilot balloon is firm on palpation.
3. Inject air into the cuff until a manometer shows 15 mm Hg pressure.
4. Inject air into the cuff until a slight leak is heard only at peak inflation.: 4. Inject
air into the cutt until a slight leak is heard only at peak inflation.
The minimal occluding volume technique involves injecting air into the cutt until an air leak is present only at peak
inflation. The volume to inflate the cutt varies with the ET and the patient's size. Cutt pressure should be maintained
at 20 to 30 mm Hg. An accurate assessment of cutt pressure cannot be obtained by palpating the pilot balloon.
3. The nurse notes premature ventricular contractions (PVCs) on the monitor
while suctioning a patient's endotracheal tube. Which action would the nurse
take?
1. Plan to suction the patient more frequently.
2. Decrease the suction pressure to 80 mm Hg.
3. Give antidysrhythmic medications per protocol.
4. Ventilate the patient with 100% oxygen.: 4. Ventilate the patient with 100% oxygen.
, NUR 417 EXAM 2 PART 1 NURSING COURSE EXAM PREPARATION MATERIAL PRACTICE
QUESTIONS WITH ANSWERS A+ VERIFIED LATEST UPDATE
Dysrhythmias during suctioning may indicate hypoxemia or sympathetic nervous system stimulation. the nurse should
stop suctioning and ventilate the patient with 100% O2. There is no indication that more frequent suctioning is needed.
Lowering the suction pressure will decrease the ettectiveness of suctioning without improving the hypoxemia. Because
the PVCs occurred during suctioning, there is no need for antidysrhythmic medications (which may have adverse
ettects) unless they recur when the suctioning is stopped, and patient is well oxygenated.
4. Which assessment finding for a patient receiving mechanical ventilation
indicates the need for suctioning?
1. The patient was last suctioned 6 hours ago.
2. The patient's oxygen saturation drops to 93%.
3. The patient's respiratory rate is 32 breaths/min.
4. The patient has occasional audible expiratory wheezes.: 3. The patient's respiratory
rate is 32 breaths/min.
The increase in respiratory rate indicates that the patient may have decreased airway clearance and requires
suctioning. Suctioning is done when patient assessment data indicate that it is needed and not on a scheduled
basis. Occasional expiratory wheezes do not indicate poor airway clearance. Suctioning the patient may induce
bronchospasm and increase wheezing. An O2 saturation of 93% is acceptable and does not suggest that immediate
suctioning is needed.
5. The nurse notes thick, white secretions in the endotracheal tube (ET) of a
patient who is receiving mechanical ventilation. Which intervention will most
directly treat this finding?
1. Reposition the patient every 1 to 2 hours.
2. Increase suctioning frequency to every hour.
3. Add additional water to the patient's enteral feedings.
4. Instill 5 mL of sterile saline into the ET before suctioning.: 3. Add additional water to
the patient's enteral feedings.
Because the patient's secretions are thick, better hydration is indicated. Suctioning every hour without any specific
evidence for the need will increase the incidence of mucosal trauma and would not address the etiology of the inef-
, NUR 417 EXAM 2 PART 1 NURSING COURSE EXAM PREPARATION MATERIAL PRACTICE
QUESTIONS WITH ANSWERS A+ VERIFIED LATEST UPDATE
fective airway clearance. Instillation of saline does not liquefy secretions and may decrease the SpO2. Repositioning
the patient is appropriate but will not decrease the thickness of secretions.
6. Four hours after mechanical ventilation is initiated, a patient's arterial blood
gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg,
and HCO3- of 23 mEq/L (23 mmol/L). What change should the nurse anticipate
to the ventilator settings?
1. Increase the FIO2.
2. Increase the tidal volume.
3. Increase the respiratory rate.
4. Decrease the respiratory rate.: 4. Decrease the respiratory rate.
The patient's PaCO2 and pH indicate respiratory alkalosis caused by too high a respiratory rate. the PaO2 is appropriate
for a patient with COPD and increasing the respiratory rate and tidal volume would further lower the PaCO2.
7. The nurse is weaning a patient who has chronic obstructive pulmonary
disease (COPD) and weighs 68-kg from mechanical ventilation. Which finding
indicates that the weaning protocol should be stopped?
1. The patient's heart rate is 97 beats/min.
2. The patient's oxygen saturation is 93%.
3. The patient respiratory rate is 32 breaths/min.
4. The patient's spontaneous tidal volume is 450 mL.: 3. The patient respiratory rate is 32
breaths/min.
Tachypnea is a sign that the patient's work of breathing is too high to allow weaning to proceed. the patient's heart
rate is within normal limits, but the nurse should continue to monitor it. An O2 saturation of 93% is acceptable for a
patient with COPD. A spontaneous tidal volume of 450 mL is within the acceptable range.
8. The nurse responding to a ventilator alarm finds the patient lying in bed
gasping and the endotracheal tube on the floor. Which action would the nurse
take next?
1. Activate the rapid response team.
2. Provide reassurance to the patient.
, NUR 417 EXAM 2 PART 1 NURSING COURSE EXAM PREPARATION MATERIAL PRACTICE
QUESTIONS WITH ANSWERS A+ VERIFIED LATEST UPDATE
3. Call the health care provider to reinsert the tube.
4. Manually ventilate the patient with 100% oxygen.: 4. Manually ventilate the patient with
100% oxygen.
The nurse should ensure maximal patient oxygenation by manually ventilating with a bag-valve-mask system. Ottering
reassurance to the patient, notifying the health care provider about the need to reinsert the tube, and activating the
rapid response team are also appropriate after the nurse has stabilized the patient's oxygenation.
9. The nurse notes that a patient's 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 the nurse take next?
1. Check the O2 saturation.
2. Offer reassurance to the patient.
3. Listen to the patient's breath sounds.
4. Notify the patient's health care provider.: 3. Listen to the patient's breath sounds.
The nurse should first determine whether the ET tube has been displaced into the right mainstem bronchus by
listening for unilateral breath sounds. If so, assistance will be needed to reposition the tube immediately. the other
actions are also appropriate, but detection and correction of tube malposition are the most critical actions.
10. The charge nurse is evaluating the care 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?
1. The RN increases the FIO2 to 100% before suctioning.
2. The RN secures a bite block in place using adhesive tape.
3. The RN asks for assistance to resecure the endotracheal tube.
4. The RN positions the patient with the head of bed at 10 degrees.: 4. The RN
positions the patient with the head of bed at 10 degrees.
The head of the patient's bed should be positioned at 30 to 45 degrees to prevent ventilator-associated pneumonia.
the other actions by the new RN are appropriate.
11. A patient who is orally intubated and receiving mechanical ventilation is
anxious and is "fighting" the ventilator. Which action would the nurse take
QUESTIONS WITH ANSWERS A+ VERIFIED LATEST UPDATE
1. Which action would the nurse take to verify the correct placement of an oral
endotracheal tube (ET) immediately after insertion and before securing the
tube?
1. Obtain a portable chest x-ray.
2. Use an end-tidal CO2 monitor.
3. Auscultate for bilateral breath sounds.
4. Observe for symmetrical chest movement.: 2. Use an end-tidal CO2 monitor.
End-tidal CO2 monitors are currently recommended for rapid verification of ET placement. Auscultation for bilateral
breath sounds and checking chest expansion are also used, but they are not as accurate as end-tidal CO2 monitoring.
A chest x-ray confirms the placement but is done after the tube is secured.
2. Which action would the nurse take to maintain proper endotracheal tube
(ET) cuff pressure when a patient is on mechanical ventilation?
1. Inflate the cuff with a minimum of 10 mL of air.
2. Inflate the cuff until the pilot balloon is firm on palpation.
3. Inject air into the cuff until a manometer shows 15 mm Hg pressure.
4. Inject air into the cuff until a slight leak is heard only at peak inflation.: 4. Inject
air into the cutt until a slight leak is heard only at peak inflation.
The minimal occluding volume technique involves injecting air into the cutt until an air leak is present only at peak
inflation. The volume to inflate the cutt varies with the ET and the patient's size. Cutt pressure should be maintained
at 20 to 30 mm Hg. An accurate assessment of cutt pressure cannot be obtained by palpating the pilot balloon.
3. The nurse notes premature ventricular contractions (PVCs) on the monitor
while suctioning a patient's endotracheal tube. Which action would the nurse
take?
1. Plan to suction the patient more frequently.
2. Decrease the suction pressure to 80 mm Hg.
3. Give antidysrhythmic medications per protocol.
4. Ventilate the patient with 100% oxygen.: 4. Ventilate the patient with 100% oxygen.
, NUR 417 EXAM 2 PART 1 NURSING COURSE EXAM PREPARATION MATERIAL PRACTICE
QUESTIONS WITH ANSWERS A+ VERIFIED LATEST UPDATE
Dysrhythmias during suctioning may indicate hypoxemia or sympathetic nervous system stimulation. the nurse should
stop suctioning and ventilate the patient with 100% O2. There is no indication that more frequent suctioning is needed.
Lowering the suction pressure will decrease the ettectiveness of suctioning without improving the hypoxemia. Because
the PVCs occurred during suctioning, there is no need for antidysrhythmic medications (which may have adverse
ettects) unless they recur when the suctioning is stopped, and patient is well oxygenated.
4. Which assessment finding for a patient receiving mechanical ventilation
indicates the need for suctioning?
1. The patient was last suctioned 6 hours ago.
2. The patient's oxygen saturation drops to 93%.
3. The patient's respiratory rate is 32 breaths/min.
4. The patient has occasional audible expiratory wheezes.: 3. The patient's respiratory
rate is 32 breaths/min.
The increase in respiratory rate indicates that the patient may have decreased airway clearance and requires
suctioning. Suctioning is done when patient assessment data indicate that it is needed and not on a scheduled
basis. Occasional expiratory wheezes do not indicate poor airway clearance. Suctioning the patient may induce
bronchospasm and increase wheezing. An O2 saturation of 93% is acceptable and does not suggest that immediate
suctioning is needed.
5. The nurse notes thick, white secretions in the endotracheal tube (ET) of a
patient who is receiving mechanical ventilation. Which intervention will most
directly treat this finding?
1. Reposition the patient every 1 to 2 hours.
2. Increase suctioning frequency to every hour.
3. Add additional water to the patient's enteral feedings.
4. Instill 5 mL of sterile saline into the ET before suctioning.: 3. Add additional water to
the patient's enteral feedings.
Because the patient's secretions are thick, better hydration is indicated. Suctioning every hour without any specific
evidence for the need will increase the incidence of mucosal trauma and would not address the etiology of the inef-
, NUR 417 EXAM 2 PART 1 NURSING COURSE EXAM PREPARATION MATERIAL PRACTICE
QUESTIONS WITH ANSWERS A+ VERIFIED LATEST UPDATE
fective airway clearance. Instillation of saline does not liquefy secretions and may decrease the SpO2. Repositioning
the patient is appropriate but will not decrease the thickness of secretions.
6. Four hours after mechanical ventilation is initiated, a patient's arterial blood
gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg,
and HCO3- of 23 mEq/L (23 mmol/L). What change should the nurse anticipate
to the ventilator settings?
1. Increase the FIO2.
2. Increase the tidal volume.
3. Increase the respiratory rate.
4. Decrease the respiratory rate.: 4. Decrease the respiratory rate.
The patient's PaCO2 and pH indicate respiratory alkalosis caused by too high a respiratory rate. the PaO2 is appropriate
for a patient with COPD and increasing the respiratory rate and tidal volume would further lower the PaCO2.
7. The nurse is weaning a patient who has chronic obstructive pulmonary
disease (COPD) and weighs 68-kg from mechanical ventilation. Which finding
indicates that the weaning protocol should be stopped?
1. The patient's heart rate is 97 beats/min.
2. The patient's oxygen saturation is 93%.
3. The patient respiratory rate is 32 breaths/min.
4. The patient's spontaneous tidal volume is 450 mL.: 3. The patient respiratory rate is 32
breaths/min.
Tachypnea is a sign that the patient's work of breathing is too high to allow weaning to proceed. the patient's heart
rate is within normal limits, but the nurse should continue to monitor it. An O2 saturation of 93% is acceptable for a
patient with COPD. A spontaneous tidal volume of 450 mL is within the acceptable range.
8. The nurse responding to a ventilator alarm finds the patient lying in bed
gasping and the endotracheal tube on the floor. Which action would the nurse
take next?
1. Activate the rapid response team.
2. Provide reassurance to the patient.
, NUR 417 EXAM 2 PART 1 NURSING COURSE EXAM PREPARATION MATERIAL PRACTICE
QUESTIONS WITH ANSWERS A+ VERIFIED LATEST UPDATE
3. Call the health care provider to reinsert the tube.
4. Manually ventilate the patient with 100% oxygen.: 4. Manually ventilate the patient with
100% oxygen.
The nurse should ensure maximal patient oxygenation by manually ventilating with a bag-valve-mask system. Ottering
reassurance to the patient, notifying the health care provider about the need to reinsert the tube, and activating the
rapid response team are also appropriate after the nurse has stabilized the patient's oxygenation.
9. The nurse notes that a patient's 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 the nurse take next?
1. Check the O2 saturation.
2. Offer reassurance to the patient.
3. Listen to the patient's breath sounds.
4. Notify the patient's health care provider.: 3. Listen to the patient's breath sounds.
The nurse should first determine whether the ET tube has been displaced into the right mainstem bronchus by
listening for unilateral breath sounds. If so, assistance will be needed to reposition the tube immediately. the other
actions are also appropriate, but detection and correction of tube malposition are the most critical actions.
10. The charge nurse is evaluating the care 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?
1. The RN increases the FIO2 to 100% before suctioning.
2. The RN secures a bite block in place using adhesive tape.
3. The RN asks for assistance to resecure the endotracheal tube.
4. The RN positions the patient with the head of bed at 10 degrees.: 4. The RN
positions the patient with the head of bed at 10 degrees.
The head of the patient's bed should be positioned at 30 to 45 degrees to prevent ventilator-associated pneumonia.
the other actions by the new RN are appropriate.
11. A patient who is orally intubated and receiving mechanical ventilation is
anxious and is "fighting" the ventilator. Which action would the nurse take
