**The Ventilator Crosswalk: Safeguarding
Airway & Breathing in Critical Illness**
Question 1
A client on mechanical ventilation has a sudden drop in SpO₂ to 84% and high-pressure alarm activation.
What is the nurse's priority action?
A. Sedate the client
B. Manually ventilate with a bag-valve mask
C. Suction the endotracheal tube
D. Increase the FiO₂ to 100%
---
💫RATIONALE✔️✔️: Manual ventilation allows immediate assessment of lung compliance and airway
patency while disconnecting from the ventilator to troubleshoot.
💫ANSWER✔️✔️: B. Manually ventilate with a bag-valve mask
Question 2
A client with acute respiratory distress syndrome (ARDS) has a PaO₂ of 55 mm Hg on FiO₂ 0.8. Which
ventilator adjustment does the nurse anticipate?
A. Decrease PEEP to 5 cm H₂O
B. Increase PEEP to 15 cm H₂O
C. Decrease respiratory rate to 10 breaths/min
D. Switch to pressure support ventilation
---
💫RATIONALE✔️✔️: Higher PEEP recruits collapsed alveoli in ARDS, improving oxygenation and allowing
lower FiO₂ to prevent oxygen toxicity.
💫ANSWER✔️✔️: B. Increase PEEP to 15 cm H₂O
Question 3
,A client receiving pressure-controlled ventilation has a tidal volume of 350 mL (set 450 mL). Which
finding is the most likely cause?
A. Increased lung compliance
B. Decreased airway resistance
C. Decreased lung compliance
D. Ventilator circuit disconnection
---
💫RATIONALE✔️✔️: In pressure control, tidal volume varies inversely with lung compliance; decreased
compliance (stiff lungs) reduces delivered volume.
💫ANSWER✔️✔️: C. Decreased lung compliance
Question 4
A nurse is caring for a client with a cuffed endotracheal tube. Which finding indicates the cuff pressure is
too high?
A. Minimal air leak heard at end-inspiration
B. Cuff pressure reading of 22 cm H₂O
C. The client can speak words
D. Absent breath sounds over the left lung field
---
💫RATIONALE✔️✔️: Overinflated cuff can herniate into the trachea, occluding the left mainstem
bronchus, causing absent left breath sounds.
💫ANSWER✔️✔️: D. Absent breath sounds over the left lung field
Question 5
A client on synchronized intermittent mandatory ventilation (SIMV) with pressure support has
spontaneous breaths at 20/min and mandatory breaths at 6/min. The client is tachypneic and using
accessory muscles. What action should the nurse take?
A. Decrease pressure support
B. Increase the SIMV rate
C. Switch to continuous mandatory ventilation
D. Sedate the client
,---
💫RATIONALE✔️✔️: Tachypnea and accessory muscle use indicate inadequate ventilatory support;
increasing mandatory breaths reduces work of breathing.
💫ANSWER✔️✔️: B. Increase the SIMV rate
Question 6
A client with COPD on a ventilator has an end-tidal CO₂ (ETCO₂) of 32 mm Hg and an arterial PaCO₂ of 58
mm Hg. What does this indicate?
A. Normal ETCO₂ monitoring
B. Increased dead space ventilation
C. Metabolic alkalosis
D. Ventilator circuit leak
---
💫RATIONALE✔️✔️: Large ETCO₂-PaCO₂ gradient (>10 mm Hg) suggests high V/Q mismatch or increased
dead space, common in COPD.
💫ANSWER✔️✔️: B. Increased dead space ventilation
Question 7
A client is being weaned from mechanical ventilation using a T-piece trial. After 15 minutes, the client's
respiratory rate increases from 22 to 34 breaths/min, heart rate from 90 to 120 bpm, and SpO₂ drops to
86%. What is the priority action?
A. Increase FiO₂ on the T-piece
B. Reconnect the client to the ventilator
C. Suction the endotracheal tube
D. Obtain an ABG
---
💫RATIONALE✔️✔️: Rapid shallow breathing, tachycardia, and hypoxemia indicate weaning failure;
immediate rest on ventilator prevents respiratory muscle fatigue.
💫ANSWER✔️✔️: B. Reconnect the client to the ventilator
, Question 8
A client with a traumatic brain injury has a PaCO₂ of 30 mm Hg on the ventilator. Which complication is
the nurse most concerned about?
A. Increased intracranial pressure
B. Cerebral vasodilation
C. Cerebral vasoconstriction and ischemia
D. Metabolic acidosis
---
💫RATIONALE✔️✔️: Hypocapnia causes cerebral vasoconstriction, reducing cerebral blood flow and
potentially causing brain ischemia.
💫ANSWER✔️✔️: C. Cerebral vasoconstriction and ischemia
Question 9
A client on volume-controlled ventilation has a peak inspiratory pressure (PIP) of 48 cm H₂O (baseline
28). The plateau pressure is 30 cm H₂O. What is the most likely cause?
A. Decreased lung compliance
B. Increased airway resistance
C. Pneumothorax
D. Ventilator asynchrony
---
💫RATIONALE✔️✔️: High PIP with normal plateau pressure indicates increased airway resistance
(bronchospasm, secretions, kinked tube).
💫ANSWER✔️✔️: B. Increased airway resistance
Question 10
A nurse is caring for a client with a new tracheostomy tube. Which finding requires immediate action?
A. Small amount of bloody drainage at the stoma site
B. Client coughing pink, frothy sputum
C. Tracheostomy tube pulsating with heartbeat
D. Suction catheter passes easily into the left lung
Airway & Breathing in Critical Illness**
Question 1
A client on mechanical ventilation has a sudden drop in SpO₂ to 84% and high-pressure alarm activation.
What is the nurse's priority action?
A. Sedate the client
B. Manually ventilate with a bag-valve mask
C. Suction the endotracheal tube
D. Increase the FiO₂ to 100%
---
💫RATIONALE✔️✔️: Manual ventilation allows immediate assessment of lung compliance and airway
patency while disconnecting from the ventilator to troubleshoot.
💫ANSWER✔️✔️: B. Manually ventilate with a bag-valve mask
Question 2
A client with acute respiratory distress syndrome (ARDS) has a PaO₂ of 55 mm Hg on FiO₂ 0.8. Which
ventilator adjustment does the nurse anticipate?
A. Decrease PEEP to 5 cm H₂O
B. Increase PEEP to 15 cm H₂O
C. Decrease respiratory rate to 10 breaths/min
D. Switch to pressure support ventilation
---
💫RATIONALE✔️✔️: Higher PEEP recruits collapsed alveoli in ARDS, improving oxygenation and allowing
lower FiO₂ to prevent oxygen toxicity.
💫ANSWER✔️✔️: B. Increase PEEP to 15 cm H₂O
Question 3
,A client receiving pressure-controlled ventilation has a tidal volume of 350 mL (set 450 mL). Which
finding is the most likely cause?
A. Increased lung compliance
B. Decreased airway resistance
C. Decreased lung compliance
D. Ventilator circuit disconnection
---
💫RATIONALE✔️✔️: In pressure control, tidal volume varies inversely with lung compliance; decreased
compliance (stiff lungs) reduces delivered volume.
💫ANSWER✔️✔️: C. Decreased lung compliance
Question 4
A nurse is caring for a client with a cuffed endotracheal tube. Which finding indicates the cuff pressure is
too high?
A. Minimal air leak heard at end-inspiration
B. Cuff pressure reading of 22 cm H₂O
C. The client can speak words
D. Absent breath sounds over the left lung field
---
💫RATIONALE✔️✔️: Overinflated cuff can herniate into the trachea, occluding the left mainstem
bronchus, causing absent left breath sounds.
💫ANSWER✔️✔️: D. Absent breath sounds over the left lung field
Question 5
A client on synchronized intermittent mandatory ventilation (SIMV) with pressure support has
spontaneous breaths at 20/min and mandatory breaths at 6/min. The client is tachypneic and using
accessory muscles. What action should the nurse take?
A. Decrease pressure support
B. Increase the SIMV rate
C. Switch to continuous mandatory ventilation
D. Sedate the client
,---
💫RATIONALE✔️✔️: Tachypnea and accessory muscle use indicate inadequate ventilatory support;
increasing mandatory breaths reduces work of breathing.
💫ANSWER✔️✔️: B. Increase the SIMV rate
Question 6
A client with COPD on a ventilator has an end-tidal CO₂ (ETCO₂) of 32 mm Hg and an arterial PaCO₂ of 58
mm Hg. What does this indicate?
A. Normal ETCO₂ monitoring
B. Increased dead space ventilation
C. Metabolic alkalosis
D. Ventilator circuit leak
---
💫RATIONALE✔️✔️: Large ETCO₂-PaCO₂ gradient (>10 mm Hg) suggests high V/Q mismatch or increased
dead space, common in COPD.
💫ANSWER✔️✔️: B. Increased dead space ventilation
Question 7
A client is being weaned from mechanical ventilation using a T-piece trial. After 15 minutes, the client's
respiratory rate increases from 22 to 34 breaths/min, heart rate from 90 to 120 bpm, and SpO₂ drops to
86%. What is the priority action?
A. Increase FiO₂ on the T-piece
B. Reconnect the client to the ventilator
C. Suction the endotracheal tube
D. Obtain an ABG
---
💫RATIONALE✔️✔️: Rapid shallow breathing, tachycardia, and hypoxemia indicate weaning failure;
immediate rest on ventilator prevents respiratory muscle fatigue.
💫ANSWER✔️✔️: B. Reconnect the client to the ventilator
, Question 8
A client with a traumatic brain injury has a PaCO₂ of 30 mm Hg on the ventilator. Which complication is
the nurse most concerned about?
A. Increased intracranial pressure
B. Cerebral vasodilation
C. Cerebral vasoconstriction and ischemia
D. Metabolic acidosis
---
💫RATIONALE✔️✔️: Hypocapnia causes cerebral vasoconstriction, reducing cerebral blood flow and
potentially causing brain ischemia.
💫ANSWER✔️✔️: C. Cerebral vasoconstriction and ischemia
Question 9
A client on volume-controlled ventilation has a peak inspiratory pressure (PIP) of 48 cm H₂O (baseline
28). The plateau pressure is 30 cm H₂O. What is the most likely cause?
A. Decreased lung compliance
B. Increased airway resistance
C. Pneumothorax
D. Ventilator asynchrony
---
💫RATIONALE✔️✔️: High PIP with normal plateau pressure indicates increased airway resistance
(bronchospasm, secretions, kinked tube).
💫ANSWER✔️✔️: B. Increased airway resistance
Question 10
A nurse is caring for a client with a new tracheostomy tube. Which finding requires immediate action?
A. Small amount of bloody drainage at the stoma site
B. Client coughing pink, frothy sputum
C. Tracheostomy tube pulsating with heartbeat
D. Suction catheter passes easily into the left lung
