Lewis's chapter 28 (12 edition) Exam Practice Questions and Answers

Lewis's chapter 28 (12 edition) Exam Practice Questions and Answers 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? 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 - Ans:-ANS: B 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? ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/22 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. - Ans:-ANS: D The minimal occluding volume technique involves injecting air into the cuff until an air leak is present only at peak inflation. the volume to inflate the cuff varies with the ET and the patient's size. Cuff pressure should be maintained at 20 to 30 mm Hg. An accurate assessment of cuff 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? 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. - Ans:-ANS: D Dysrhythmias during suctioning may indicate hypoxemia or sympathetic nervous system ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/22 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 effectiveness of suctioning without improving the hypoxemia. Because the PVCs occurred during suctioning, there is no need for antidysrhythmic medications (which may have adverse effects) unless they recur when the suctioning is stopped, and patient is well oxygenated. Which assessment finding for a patient 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. - Ans:-ANS: C 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 ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/22 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? 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. - Ans:-ANS: C 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 ineffective airway clearance. Instillation of saline does not liquefy secretions and may decrease theSpO2. Repositioning the patient is appropriate but will not decrease the thickness of secretions. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/22 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? a. Increase theFIO2. b. Increase the tidal volume. c. Increase the respiratory rate. d. Decrease the respiratory rate. - Ans:-ANS: D The patient's PaCO2 and pH indicate respiratory alkalosis caused by too high a respiratory rate. thePaO2 is appropriate for a patient with COPD and increasing the respiratory rate and tidal volume would further lower thePaCO2. 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? 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. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/22 d. The patient's spontaneous tidal volume is 450 mL. - Ans:-ANS: C 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? a. Activate the rapid response team. b. Provide reassurance to the patient. c. Call the health care provider to reinsert the tube. d. Manually ventilate the patient with 100% oxygen. - Ans:-ANS: D The nurse should ensure maximal patient oxygenation by manually ventilating with a bag-valve-mask system. Offering 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.