Exam 2 EAQs Ch. 65 - Mechanical Ventilation questions and answers

A nurse is caring for a patient undergoing mechanical ventilation who is also receiving positive end-expiratory pressure (PEEP). What is the outcome that the nurse hopes to achieve with PEEP? Expand collapsed alveoli Decrease alveolar volume Decrease bronchospasms Prevent spontaneous breathing Expand collapsed alveoli Positive end-expiratory pressure (PEEP) expands collapsed alveoli and improves resting lung volume by keeping the alveoli open and preventing them from collapsing during expiration. PEEP increases, not decreases, alveolar volume by keeping the alveoli expanded. PEEP has no direct effect on bronchospasms. PEEP allows, not prevents, spontaneous breathing of a patient undergoing mechanical respiration. A feeding tube is placed in a patient receiving positive pressure ventilation to prevent inadequate nutrition. What should the nurse avoid while verifying the placement of the feeding tube? Listening for air after injection X-ray confirmation before initial use Review of routine x-rays and aspirate Marking and assessing the tube's exit site Listening for air after injection While verifying the placement of feeding tube, the nurse should avoid listening for air after injection, because it is not a reliable method for verification of its placement. X-ray confirmation before initial use, review of routine x-rays, and marking and assessing the tube's exit site are all reliable methods for verifying the feeding tube placement. A patient is receiving mechanical ventilation after having a stroke. The nurse determines that the ventilator settings are based on which patient status? Ideal body weight, vital signs, and family preference Ethics committee results, current physiologic state, and ideal body weight Respiratory muscle strength, ethics committee results, and family preference Arterial blood gases (ABGs), current physiologic state, and respiratory muscle strength Arterial blood gases (ABGs), current physiologic state, and respiratory muscle strength Settings on mechanical ventilators are based on the patient's physiologic status, such as ABGs, ideal body weight, current physiologic state, level of consciousness, and respiratory strength. Ethics committee results and family preference are psychosocial in nature and are not criteria used to determine mechanical ventilation settings. When assessing the settings of a patient's ventilator, the nurse knows that which parameter is abnormal? PaO 2 of 66 mm Hg PEEP of 5 cm H 2O Tidal volume of 12 mL/kg Respiratory rate of 20 breaths/minute Tidal volume of 12 mL/kg Usual tidal volume is 6-10 mL/kg; a tidal volume of 12 ml/kg is abnormally high. A respiratory rate of 20 breaths/minute is within normal; usual settings are 6-20 breaths/minute. A PaO 2 level of 66 mm Hg is normal; the usual is greater than 60 mm Hg. PEEP of 5 cm H 2O is the usual setting. The nurse working in the intensive care unit (ICU) is taking care of a patient on a mechanical ventilator who had a motor vehicle accident two weeks ago. What does the nurse know about this situation? The patient has severe hypoxia due to acute respiratory failure. The ventilator will support the patient until he or she can breathe on his or her own. The patient suffered from a chronic pulmonary disease before the accident. The patient will be on long-term ventilation until the family decides to withdraw ventilator support. The ventilator will support the patient until he or she can breathe on his or her own. Mechanical ventilation is not curative. It is a means of supporting patients until they recover the ability to breathe independently. The decision to use, withhold, or withdraw mechanical ventilation will be made carefully, involving the agency's ethics committee for assistance. The patient's medical history or diagnosis is not known; the nurse does not know if the patient suffered from chronic pulmonary disease or if he has severe hypoxia. When planning care for a patient on a mechanical ventilator, the nurse understands that the application of positive end-expiratory pressure (PEEP) to the ventilator settings has which therapeutic effect? Increased inflation of the lungs Prevention of barotrauma to the lung tissue Prevention of alveolar collapse during expiration Increased fraction of inspired oxygen concentration (FIO 2) administration Prevention of alveolar collapse during expiration PEEP is positive pressure that is applied to the airway during exhalation. This positive pressure prevents the alveoli from collapsing, improving oxygenation and enabling a reduced FIO 2 requirement. PEEP does not cause increased inflation of the lungs or prevent barotrauma. Auto-PEEP resulting from inadequate exhalation time may contribute to barotrauma. An older adult patient reports having used an "iron lung" after contracting polio as a child. The nurse knows this patient is referring to which type of mechanical ventilation? Positive pressure Negative pressure Volume ventilation Pressure ventilation Negative pressure The "iron lung" was the first form of negative pressure ventilation, developed during the polio epidemic. Negative pressure uses the chambers encasing the chest and surrounding it with intermittent negative pressure; expiration is passive, and the negative pressure is delivered by noninvasive measures. Pressure ventilation means the peak inspiratory pressure is predetermined and the tidal volume delivered varies based on the patient. Volume ventilation has a predetermined tidal volume delivered with each inspiration and the pressure varies based on the patient. Positive pressure ventilation is the primary method used with acutely ill patients, where air is pushed into the lungs during inspiration under positive pressure. When taking care of a patient diagnosed with respiratory failure on a mechanical ventilator, the nurse hears the apnea alarm beeping. What assessment data should be gathered to determine the cause of the alarm? Pain or anxiety Partial ventilator disconnect Secretions, coughing, or gagging Oversedation with opioid analgesics Oversedation with opioid analgesics The apnea alarm on mechanical ventilation may be caused by respiratory arrest, oversedation, change in patient condition, or loss of airway (total or partial extubation). The high-pressure limit alarm is caused by secretions, coughing, or gagging. The low tidal volume alarm can be caused by partial ventilator disconnect. The high tidal volume alarm can be caused by pain or anxiety. The nurse working in a critical care unit understands that tidal volume is an important setting in a mechanical ventilator. Which statement appropriately describes tidal volume? Number of breaths the ventilator delivers per minute Volume of gas delivered to patient during each ventilator breath Positive pressure used to augment patient's inspiratory pressure Positive pressure applied at the end of expiration of ventilator breaths Volume of gas delivered to patient during each ventilator breath Tidal volume is the volume of gas delivered to a patient during each ventilator breath. The number of breaths the ventilator delivers per minute is called the respiratory rate. The positive pressure used to augment the patient's inspiratory pressure is called pressure support. The positive pressure applied at the end of expiration of ventilator breaths is called positive end-expiratory pressure. An endotracheal (ET) tube is inserted in a patient. The nurse inflates the cuff to stabilize the tube. How much cuff pressure should be maintained to keep it inflated and ensure adequate tracheal perfusion? 10-15 cm H 2O 20-25 cm H 2O 30-35 cm H 2O 40-45 cm H 2O 20-25 cm H 2O To ensure adequate tracheal perfusion, the nurse should maintain cuff pressure at 20 to 25 cm H 2O. Excess cuff pressure can damage the tracheal mucosa. Lesser cuff pressure may cause the ET tube to become destabilized and extubate. A patient is to be intubated for respiratory failure. Which factor indicates that tracheotomy would be preferable to endotracheal intubation? The patient is at high risk for aspiration. The patient is unable to clear secretions. A long-term airway is probably necessary. An upper airway obstruction is impairing the patient's ventilation. A long-term airway is probably necessary. A tracheotomy is indicated when the need for an artificial airway is expected to be long term. Aspiration risk, an inability to clear secretions, and upper airway obstruction are indications for an artificial airway, but these are not specific indications for tracheotomy. A patient is being mechanically ventilated. A high-pressure ventilation alarm sounds. The nurse should assess for what cause of this type of alarm? Power failure Insufficient gas flow Condensate in tubing Tracheotomy cuff leak Condensate in tubing Presence of condensate or water in tubing triggers a high-pressure ventilation alarm. Power failure triggers ventilator inoperative or low battery alarm. Insufficient gas flow and tracheotomy cuff leak triggers low tidal volume or minute ventilation alarm. The nurse is teaching the patient's caregiver about receiving positive pressure ventilation. What movements should the nurse tell the caregiver to avoid doing to the patient? Arm circles Knee bends Quadriceps setting External rotation of the hip External rotation of the hip The nurse should advise the caregiver to avoid external rotation of the patient's hip; this movement can be avoided by properly positioning the patient and by the use of specialized mattresses and beds. Simple maneuvers such as arm circles, knee bends and quadriceps setting should be performed, because they maintain the muscle tone in the upper and lower extremities of the patient. The nurse is caring for a group of patient's in the intensive care unit. Which patient is a candidate for bilevel positive airway pressure (BiPAP)? Patient with shock Patient with sleep apnea Patient with altered mental status Patient with increased airway secretions Patient with sleep apnea Bilevel positive airway pressure (BiPAP) is used for patients with sleep apnea. Patients with shock, altered mental status and/or increased airway secretions are not candidates for BiPAP because of the risk of aspiration and the inability to remove the mask. While evaluating a mechanically ventilated patient, the nurse notes that the auto-PEEP has been activated. Which mode of mechanical ventilation does the nurse suspect? Volume mode Pressure mode Continuous positive airway pressure Positive end-expiratory pressure mode Pressure mode The auto-PEEP is a pressure mode that provides a pressure-limited breath delivered at a set rate that may permit spontaneous breathing. The positive end-expiratory pressure (PEEP) mode is a ventilator maneuver in which positive pressure is applied to the airway during exhalation. Continuous positive airway pressure (CPAP) is similar to PEEP, but the pressure is delivered continuously during spontaneous breathing, preventing the patient's airway pressure from falling to zero. Volume modes require that rate, tidal volume, inspiratory time, sensitivity, and/or PEEP are set for the patient.