NR 341/ NR341 EXAM 1: (NEW 2025/ 2026 UPDATE) COMPLEX ADULT HEALTH REVIEW | QUESTIONS & ANSWERS| GRADE A| 100% CORRECT (VERIFIED SOLUTIONS)- CHAMBERLAIN

1 NR NR 341 NR 341/ NR341 EXAM 1: (NEW 2025/ 2026 UPDATE) COMPLEX ADULT HEALTH REVIEW | QUESTIONS & ANSWERS| GRADE A| 100% CORRECT (VERIFIED SOLUTIONS)- CHAMBERLAIN 1. What drug to give during asthma exacerbations ? - ANS Short acting bronchodilator- albuterol epi, 02, fluids 2. Describe the signs & symptoms of PE ? - ANS feeling of impending doom pressure or pain in the chest dyspnea cough, w/ OR w/out blood Diagnostics for PE ? 3. Labs for PE ? - ANS CT scan or chest xray aPTT/PT 4. Monitoring oxygenation of the lungs involves ? - ANS an assessment & monitoring ABG's, spo2, s/s, & hypoxemia "D" on the graph of ETCO2, measure ? The goal for chest compressions ? What would the etco2 shows ? 5. The lower the lines are, then the more ? - ANS the inhalation & exhalation of the co2 get to ROSC (return of spontaneous circulation ) & make the cells byproduct (co2) 2-2.4inchs (5-6cm) = GOOD less than 2inches (less than 5cm) = BAD the more obstruction2 NR NR 341 When is a pt suctioned ? Why would a pt. be suctioned? What are the potential complications of suctioning? 6. If dysrhythmias start to occur, what would you want to do ? - ANS *as needed NOT routinely *secretions in ET tube, sudden resp. distress, suspected aspiration of secretions, ↑resp. rate w/ or without sustained coughing & sudden decrease in SpO2 hypoxemia, dysrhythmias (most common), bronchospasm, ↑ICP, hypertension, hypotension, mucosal damage, pulmonary bleeding, pain, & infection stop & hyperoxygenate 7. Prevent hypoxemia by hyperoxygenating the patient before & after each suctioning pass & limiting EACH suctioning pass to ? - ANS 10 seconds or less 8. Oral care for pt. on artificial airway ? How often? With what specific items ? - ANS at least twice a day soft toothbrush WITH 0.12% chlorohex oral rinse twice daily* 1.5% hydrogen peroxide q 2-4hrs 9. Two MAJOR complications of intubation ? - ANS unplanned extubation (removal of ET tube from trachea) aspiration 10. Some signs of unplanned extubation ? - ANS 1. patient talking 2. low pressure ventilator alarm going off like cray 3. diminished or ABSENT breath sounds 4. resp. distress 11. What if pt. gets accidentally extubated - what do you as a nurse do ? - ANS ambuu bag them on 15L (100% o2) stay w/pt. call for help !3 NR NR 341 12. What are you going to do to PREVENT dislodgment of ET tube ? - ANS make sure it's secure on the side of mouth soft wrist restraints (if ordered by physician) make sure pt. has adequate pain med & sedation 13. How can we prevent aspiration if pt. has ET tube ? - ANS • HOB elevated 30-45 degrees •patient positioning (physician order) •proper cuff inflation •yankauer (tonsil tip) to suction secretions •NG or OG tube to decompress the tummy after putting all that air into the person Positive pressure ventilation are utilized for which pt's ? How does it work ? How many types are there ? 14. What reasons would someone need a mechanical ventilation ? - ANS acutely ill patients delivers gas into lungs under positive pressure during inspiration & expiration occurs passively 2 main types PPV: Volume & Pressure supporting patients until they recover the ability to breathe independently. 15. Describe the break down of positive pressure ventilation (PPV) - ANS It is broken down into volume AND pressure Volume has two modes: assist control & simv Pressure has three modes: pressure support, control, & non-invasive 16. With PPV there are two modes. What are they ? - ANS ACV & SIMV The normal tidal volume ?4 NR NR 341 17. Average ? - ANS Vt, volume of a normal breath 500mL Describe volume ventilation. Two main types (modes) of volume ventilation. 18. Describe them. - ANS predetermined tidal volume (VT) is delivered w/ each inspiration ------------------------------------------------------ assist control vent (ACV) synchronized intermittent mandatory ventilation (SIMV) What are the ventilator settings? 19. Which is only applied to SIMV ? - ANS resp rate = # of breaths ventilator deliver per min. tidal volume = vol. of gas delivered to pt. during each breath FiO2 = fraction of inspired air (21% - 100%) PEEP = positive pressure given at the end of expiration of ventilator breaths Pressure support = ONLY with SIMV; pos. pressure used to augment pt. inspiratory pressure The usual tidal volume is ? & It is based off of ? The FiO2 is usually adjusted to maintain pao2 above OR SpO2 above ? The usual PEEP setting is ? The usual pressure support is ? 20. What TWO settings can ONLY be adjusted ? - ANS 6-10ml/kg weight based -------------------------------- PaO2 = above 60 mmHg SpO2 = above 90% -------------------------------- 5cm H2O -------------------------------- 6-18cm H2O -------------------------------- respiratory rate & tidal volume5 NR NR 341 21. If a pt. comes into the ER w/a head injury and blood gases of ph 7.15, PCO2 90. What settings do you think this person would be on ? - ANS high vent settings to BLOW off that CO2 ! the pt. is retaining too much CO2, so it needs something to remove it from the body... The two settings that deals with the ventilation (CO2 22. ) on vent settings are ___________________ & _________________. - ANS resp rate & tidal volume What is minute ventilation? 23. Equation ? - ANS the vol. of gas inhaled & exhaled in a minute MV = RR x Vt in L/min. 24. When tidal volume & respiratory rate is multiplied, what is the result of that ? - ANS minute volume 25. Mechanical vent settings are based on ? - ANS patient's status (e.g., ABGs, ideal body weight, current physiologic state, level of consciousness, respiratory muscle strength). 26. What can cause ↑HIGH pressure alarms in mechanical vent ? - ANS •pt fighting the vent (dysynchrony)* •kinked or compressed tubing (pt. biting on ET tube) •secretions, coughing, or gagging •condensate (water) in tubing •↑resistance (e.g., bronchospasm) •↓ compliance (e.g., pulmonary edema, pneumothorax) 27. What can cause LOW↓ pressure alarms on a vent ? - ANS •total or partial ventilator disconnect* •loss of airway (e.g., total or partial extubation) •ET tube/trach cuff leak (e.g., patient speaking, grunting)** 28. What can cause apnea problem on a vent ? - ANS •Respiratory arrest6 NR NR 341 •Oversedation •Change in pt. condition •Loss of airway (e.g., total or partial extubation) 29. What can cause low tidal volume or minute ventilation ? - ANS •change in patient's breathing efforts (e.g., rate and volume) LOSING VOLUME •pt is disconnected, loose connection, or leak in circuit •ET tube/trach cuff leak (e.g., patient speaking, grunting) •insufficient gas flow 30. What ever is coming into the lungs, should NOT be a difference of ? - ANS there SHOULD not be more than 50 mL (the difference) Explain Assist-Control Ventilation. How is tidal volume delivered ? This pt. is potentially at risk for ? 31. This pt. requires which meds ? - ANS the pt. will be on a preset tidal volume & RR/preset freq. VT is delivered w/ own breaths = when the pt initiates a spontaneous breath, the preset VT is delivered! -- hyperoxygenate issue may arise Can breathe faster but NOT slower Risk for hyperventilation Sedation & analgesia Explain synchronized intermittent mandatory ventilation (SIMV). When is this used ? 32. The pt. is at risk for ? - ANS the vent delivers a preset VT at a preset freq. in synchrony w/ the pt's spontaneous breathing7 NR NR 341 pt receives the preset Fio2 during the spontaneous breaths BUT self-regulates the rate & VT of those breaths ---------------------------------------------------- continuous ventilation & during weaning from the ventilator ---------------------------------------------------- risk for hypoventilation Why is pressure support needed with SIMV ? 33. PEEP prevents ? - ANS pressure support will assist the pt. in spontaneous breaths when breathing in (ONLY on inspiration) -so it helps them take their own breathe alveolar collapse- a little bit of air is kept in the lungs , not everything is exhaled & it ease the work of breathing when on the vent Explain exactly HOW the pt. is at risk for hypotension during SIMV (w/addition of PEEP) ? 34. Another complication that this relates to is ? - ANS the PEEP will cause the lungs to work harder & expand more & not fully deflate--- with this, it will cause problems on the heart since it is in between & will ↓CO ↑ICP, there will be too much pressure on jugular veins Describe continuous positive airway pressure (CPAP). Is this invasive or non-invasive ? 35. Which pt'? - ANS pressure delivered continuously during spontaneous breathing non-invasive w/ mask, ET, or tracheal tube prevents the pt's airway pressure from falling to zero OSA Describe bilevel positive airway pressure (BiPAP). Is this invasive or non-invasive ? The pt. must be able to ? Indications ? Who will this be likely seen in ? 36. Contraindications ? - ANS provides two levels of positive pressure support: higher inspiratory positive airway pressure & lower expiratory positive airway pressure.8 NR NR 341 noninvasive modality & is delivered through a tight-fitting face mask, nasal mask, or nasal pillows. -------------------------------------------------------- breathe spontaneously & cooperate COPD pt's HF pt's acute respiratory failure pt's pt's w/sleep apnea. may also be used after extubation to prevent reintubation*** --mainly -------------------------------------------------------- Contraindications - shock, altered mental status, or ↑airway secretions (risk of aspiration & the inability to remove the mask) Who is NOT candidate for non-invasive positive pressure 37. ? - ANS pts who have EXCESSIVE secretions ↓LOC ↑O2reqs facial trauma hemodynamic instability 38. What should you as a nurse make sure of if your pt. is on a BiPap or CPap mask ? - ANS *the skin is in good condition *two fingers can go under the straps *the pt. should be able to remove it themselves * * 39. Describe the cardiovascular system complications of ventilation. - ANS thoracic vessels are compressed:: ↓venous return to the heart ↓left ventricular end-diastolic volume (preload) ↓CO ↓BP ↑ mean airway pressure = ↑PEEP (greater than 5 cm H2O) •Barotrauma -↑airway pressure distends the lungs & possibly ruptures fragile alveoli or emphysematous blebs pts w/ compliant lungs (e.g., COPD) are at greater risk for barotrauma & even ARDS pt's9 NR NR 341 •Air can escape into the pleural space from alveoli or interstitium and become trapped. Pleural pressure increases and collapses the lung, causing pneumothorax. •Low-volume ventilation rather than pressure ventilation should be used in ARDS patients to protect the lungs. What is ventilator-associated pneumonia (VAP)? What nursing interventions will you plan to specifically prevent ventilator-associated pneumonia (VAP)? What other nursing interventions could be done to prevent VAP ? 40. Clinical manifestations you'll see ? - ANS pneumonia that occurs 48hrs after being intubated -------------------------------------------------------- the 5 element VAP bundle will be done to prevent VAP:: -minimize sedation including daily spontaneous awakening trials (SATs) & daily spontaneous breathing trials (SBTs) -early exercise & mobilization -use of ET tubes w/ subglottic secretion drainage ports for patients likely to be intubated greater than 48 to 72 hours, -HOB elevation at a min. of 30-45 degrees unless medically contraindicated -no routine changes of the patient's ventilator circuit tubing -------------------------------------------------------- strict hand washing before & after suctioning, whenever ventilator equipment is touched, & after contact w/ any respiratory secretions change gloves between activities (e.g., emptying urinary catheter drainage, hanging an IV drug). always drain the water that collects in the ventilator tubing away from the patient as it collects -------------------------------------------------------- •fever (↑WBC), purulent or odorous sputum, crackles or wheezes on auscultation & pulmonary infiltrates on chest x-ray PIP pressure should not be more than ___________cm of water.10 NR NR 341 41. If it's above this, what does this mean ? - ANS should not be more than 30cm of water PIP ARDS may be developing 42. How would you know if ARDS is developing on your pt, ? - ANS The Peak Inspiratory Pressure would be more than 30 The process of decreasing ventilator support & resuming spontaneous breaths is called ? 43. How could this be done ? - ANS weaning & extubation cpap, t-piece Soemone who is ready to be weaned off of the vent; how does that pt. look ? How should their oxygen look ? How should their chest x-ray look ? Upon ausculation of lungs sounds, what should you hear ? How should their blood gas look ? What should they be able to do w/their neck ? 44. How would their hemoglobin look ? - ANS resolution of the primary problem that prompted patient admission to the ICU o2 greater than 90% chest x-ray clear breath sounds upon auscultation clear pH greater than 7.25 hemodynamically stable vitals should be stable ! need to be able to take inspiratory breaths ! lift head & neck off the bed hemo: 7-1011 NR NR 341 45. What are the priority assessments AFTER extubation? - ANS carefully monitor the pt's VS, resp. status, & oxygenation immediately following extubation, within 1 hour, & per agency policy NO dysrthymias ABG's stable HR stable NO stridor 46. When the resp. therapist is ready to extubate, you'll see them auscultate the pt. neck for ? - ANS any stridor OR to see if NO air pass through. if NO air pass through then there is inflammation in the neck ! NOT GOOD! Post-procedure of tracheostomy pt. what do you need at the bedside ? T-piece could be on a __________ or _______. Cuff pressure should not exceed ? &Why is this ? 47. Free ends taped to skin and leave accessible in case tube is dislodged ? - ANS obturator ET tube or trach 20 to 25 cm H2O --to prevent tracheal necrosis Retention sutures 48. If pt. JUST got a trach & it becomes dislodged- what should you as a nurse do ?! - ANS CALL FOR HELP !!!!!!!! Quickly obtain a hemostat to spread the opening where the tube was displaced. Insert the obturator in the replacement (spare) tracheostomy tube, lubricate with saline, and insert the tube into the stoma. Once the tube is inserted, remove the obturator immediately so that air can flow through the tube. insert a suction catheter to allow passage of air and to serve as a guide for insertion. Thread the tracheostomy tube over the catheter and remove the suction catheter12 NR NR 341 49. If pt. tube becomes dislodged & it is impossible to get that obturator in; what should you do next ? - ANS •assess the level of respiratory distress •position the patient in the semi-Fowler's position to alleviate dyspnea until assistance arrives •cover the stoma w/ a sterile dressing & ventilate the patient w/ bag-mask ventilation over the nose and mouth on 15L ! 50. Two type of resp. failure in ARDS is ? - ANS hypoxia; inadequate o2 to the blood hypercapnia; inadequate co2 removal Hypoxemic respiratory failure is described as ? 51. Hypercapnic respiratory failure is described as ? - ANS oxygenation failure less than 60 mmHg on greater than 60%oxygen ---------------------------------------------------- ventilatory failure co2 is greater than 45 & pH is less than 7.35 Normally, there is more perfusion than ventilation. What is this called ? 52. Absolute shunt ________ ventilation = ? - ANS V/Q ------------------------- NO ventilation 53. When it is partial, how would the V/Q be ? - ANS a mismatch! 54. Dead space in the alveoli is ? - ANS Obstruction to the pulmonary capillary NO perfusion ! 55. Glascow Coma Scale less than 8 ? - ANS Intubate ! Describe what's happening w/ARDS ? What diagnostics would you expect ? What are the 3 criteria ? How would the timing look ?13 NR NR 341 How would the chest xray look ? 56. How would the P/F ratio look ? - ANS alveolar capillary membrane becomes damaged & permeable to intravascular fluid non-cardiogenic pulmonary edema (there's fluid NOT caused by anything w/the heart) 3criteria: timing (identifiable trauma w/in a week) chest x-ray (bilaterally opacity-completely white out) oxygenation P/F ratio - low (under 99) How would you calculate the P/F ratio ? 57. What is the point of this ? - ANS take the PaO2 & divide by FiO2 (always in a decimal) assess the degree of impairment in gas exchange w/someone w/ARDS Mild ARDS is ________ mmHg? Moderate ARDS ? 58. Severe ARDS ? - ANS 200-300 mmHg 100-200 mmHg Less than 100 mmHg 59. Complications of PEEP ? - ANS ↓venous return ↑intrathoracic pressure damage to the alveoli ↓pre-load hypertension ↑ICP Management for someone with ARDS ? 60. What drugs would this person be on ? - ANS ↓ tidal volumes14 NR NR 341 permissive hypercapnia vasopressors/ inotropes, sedation/ analgesia, neuromuscular blockade Extracorporeal Membrane Oxygenation (ECMO) 61. What would you assess in a pt - ANS Positioning of pt. w/PE (upright) Heparin 62. Expected reference range for arterial blood gases ? - ANS pH: 7.35-7.45 PAO2: 80-100 PACO2: 35-45 HCO3: 21-28 SAO2: 95-100% 63. Describe the chambers of the chest tube. - ANS first: drainage collection second: water seal third: suction control (wet or dry) 64. Describe the second chamber of a chest tube. - ANS it is created by adding 2cm of sterile fluid it allows air to exit from the pleural space on exhalation & stops air from entering w/inhalation 65. To maintain the water seal, the chamber must be kept at this position ? - ANS chamber must be upright & below the insertion site 66. Th application of suction in the WET-SUCTION control should be ? - ANS continous BUBBLING in the suction chamber 67. What is expected in the second chamber (water-seal) ? - ANS tidaling (movement of fluid WITH respiration) rises w/inspiration fall w/expiration 68. With positive pressure mechanical vent, how would the water seal chamber look ? - ANS the fluid level will rise w/expiration & fall w/inspiration15 NR NR 341 complete opposite of someone w/out a vent 69. Cessation of tidaling in the water seal chamber signals ? - ANS lung reexpansion OR an obstruction w/in the system 70. Continous bubbling in the water seal chamber indicates ? - ANS an air leak in the system ! 71. When should drainage from a chest tube be reported ? - ANS excess, greater than 70mL/hr Expected findings of the water seal chamber ? 72. Expected findings of the suction chamber ? - ANS tidaling -water seal continous bubbling -suction 73. If a pt. has a chest tube, what should be by the bed side at all time ? - ANS 2 enclosed hemostats sterile water occlusive dressing 74. If the chest tube comes out of the system; what do you do ? - ANS immerse the end of the chest tube in sterile water 75. What is the difference between PEEP & Pressure Support ? - ANS PEEP; gives a preset pressure during expiration so the gas exchange could be improved & prevent atelectasis -the amount is usually 5-15cm H2o -adjunct therapy Pressure Support; makes the work of breathing easier, works to keep the alveoli from collapsing during expiration, & allows for lower levels of FiO2 -helps w/weaning -the amount is usually 5-20cm H20 *more so focus on slide 47 76. What dressing should be applied upon chest tube removal ? - ANS airtight sterile petroleum jelly gauze dressing16 NR NR 341 77. What are the reasons YOUR pt. may need an artificial airway ? - ANS ●upper airway obstruction (bleeds, tumor, gcs less than 8, burns) ●sx ●trauma ●neuromuscular diseases ●sepsis ●apnea ●high risk for aspiration ●ineffective clearance of secretions ●resp distress 78. When a pt. has a tube in their trachea, what do you need to know as a nurse ? - ANS where was it last marked (@ the teeth or lip) cuff pressure 79. Two real reasons there's a inflated cuff ? - ANS when cuff inflated, prevent secretions from going to lungs (infections) when pt. on ventilator, CERTAIN amount of gas that'll be going through each ventilator. with the cuff inflated, the volume is more accurate. with the cuff slightly deflated, theres no telling how much amount of volume is going to the lungs- BASICALLY prevents escape of ventilating gases Patient needs an artificial airway, how are we going to prepare for this procedure ? What should you do to prepare ? What equipment is needed ? What position should the pt. be in ? 80. What should be done before intubation ? - ANS preparation -dentures & plates NEEDS to be removed *equipment -oxygen, suction tubing, cardiac monitor, yankuer, tonsil tip suction *before intubation -sniffing position (pt. supine with the head extended & the neck flexed) -pre-oxygenate / BVM 100% O2 for 3-5 minutes -meds (sedative, paralytic agent, analgesic) 81. What's the reason behind putting the pt. in a sniffing position ? - ANS to get a better view of vocal cords17 NR NR 341 Describe rapid sequence intubation. 82. When is rapid sequence intubation NOT indicated ? - ANS BOTH sedative & paralytic agent are given to emergency airway pt.s (decrease aspiration, ) crashed airway-unstable pt. (cardiac arrest OR ) if pt. not awake, then this wont be done known difficult airway there is not time for all this. 83. Nursing responsibilities when assigned to a airway pt. ? - ANS maintain correct tube placement maintain proper cuff inflation monitor oxygen & vent maintain tube patency oral care & skin integrity comfort & communication assess for complications How to maintain proper tube placement ? What are OTHER confirmatory methods for tube placement ? 84. BUT how is placement verified & confirmed ? - ANS mark the tube with an exit mark confirm that the mark remains constant throughout the whole shift (rest, positioning, transporting etc.) ----------------------------------------------------------- bilateral chest expansion auscultate lungs & throat ABG's ----------------------------------------------------------- placement is VERIFIED w/ an end-tidal CO2 (ETCO2) detector device (lavender) -how much being exhaled& CONFIRMED by chest x-ray If a dislodged tube is not repositioned soon -minimal oxygen is delivered to the lungs -NO oxygen at all is going to the lungs -the entire Vt (tidal volume) is delivered to one lung18 NR NR 341 85. ALL of these scenarios places the pt. at risk for ? - ANS Pneumothorax Another word for ambu bag ? 86. What should ALWAYS be with you when you have this bag ? - ANS bag valve mask the mask!!!!!!!!!!!!!! w/out the mask, it is useless If the black line is seen in the middle, then the tube is ? Cuff pressure should be at ? 87. If your pt. is on a tube & is talking properly- what's wrong w/this ? - ANS obstructed! 20-25mmHg pt. should NOT be able to talk. the balloon has gone down in size b/c air is passing through the vocal chords Monitoring ventilation of the lungs involves monitoring ? Describe ventilation.. 88. End tidal co2 is also called ? - ANS monitoring the pco2, etco2, & rate/rhythm, & use of accessories how well the pt. is exchanging carbon dioxide (PCO2) capnography 89. What would capnography be used for ? - ANS *used during compressions to see if they are deep enough *to validate placement during ET intubation