NCLEX MEChaNiCaL VENtiLatioN EXaM 2 with
aNswErs 100% CorrECt GradEd a+
A nurse is caring for a client on a mechanical ventilator. The high-pressure alarm on the
ventilator sounds. The nurse suspects that the most likely cause of the alarm is which finding?
1.A disconnection of the ventilator tubing
2.An exaggerated client inspiratory effort
3.Accumulation of respiratory secretions
4.Generation of extreme negative pressure by the client ✔✔ 3
A client being mechanically ventilated after experiencing a fat embolism is visibly anxious. What
is the best nursing action?
1.Ask a family member to stay with the client at all times.
2.Ask the health care provider for a prescription for succinylcholine.
3.Encourage the client to sleep until arterial blood gas results improve.
4.Provide reassurance to the client and give small doses of morphine sulfate intravenously as
prescribed. ✔✔ 4
You are caring for Ms. Y. She is scheduled to begin weaning from mechanical ventilation today.
Which assessment would be the best indicator of her readiness to be weaned?
A) Minute ventilation greater than 10 L/min
B) Respiratory rate at least 30/min
C) FiO2 less than 50%
D) Rapid shallow breathing index (RSBI) ✔✔ D
,Strategies to prevent ventilator associated pneumonia include:
A) rotating the patient's position every 2 hours with HOB at 10 degrees.
B) daily oral care with peroxide.
C) peptic ulcer disease prophylaxis.
D) biweekly assessment of readiness to extubate. ✔✔ C
Mr. G requires neuromuscular blockade to facilitate mechanical ventilation. Which is not a true
statement when providing nursing care to paralyzed patients?
A) Because patients under neuromuscular blockade are unable to react to the environment,
special safety precautions are not needed.
B) Pain medication is required because neuromuscular blocking agents do not have an analgesic
effect.
C) Patients under the influence of neuromuscular blocking agents are fully aware of activity
around them.
D) The nurse must be alert for complications of immobility such as deep vein thrombosis,
pressure ulcers, and atelectasis. ✔✔ A
The nurse is caring for a patient who was just placed on mechanical ventilation and is observing
the patient's vital signs because positive-pressure ventilation can lead to: (Select all that apply.)
A) decreased cardiac output.
B) decreased venous return.
C) increased renal function.
D) decreased intracranial pressure.
E) increased hepatic function. ✔✔ ABD
, What is the advantage of using Volume Cycled Ventilation? (SATA)
A. the ventilator pushes air into lungs until a preset airway pressure is reached
B. the ventilator pushes air into the lungs until a preset volume is reached
C. a constant tidal volume is delivered regardless of pressure needed to deliver the tidal volume
D. limits excessive pressure being exerted on the lungs
E. allows the health care team to determine if intubation is really neccessary ✔✔ BCD
In what ventilation setting does the vent deliver tidal volume at a preset rate because the
patient is not breathing spontaneously?
A. Controlled Mandatory Ventilation
B. Assisted Control
C. Synchronized Intermittent Mandatory Ventilation
D. Continuous Positive Airway Pressure ✔✔ A
In the patient using Controlled Mandatory Ventilation, what drug are they on to suppress
respiratory effort?
A. Morphine, Fentanyl, or Hydromorphone
B. Propofol
C. Rocuronium, Pancuronium, or Nimbex
D. Formoterol, Salmeterol, or Arformoterol ✔✔ C
Rocuronium, Pancuronium, & Nimbex are all non-Depolarizing Neuromuscular Blocking Agents.
But, be considerate that the patient recieving this type of ventilation will also require sedation
and opioids.
aNswErs 100% CorrECt GradEd a+
A nurse is caring for a client on a mechanical ventilator. The high-pressure alarm on the
ventilator sounds. The nurse suspects that the most likely cause of the alarm is which finding?
1.A disconnection of the ventilator tubing
2.An exaggerated client inspiratory effort
3.Accumulation of respiratory secretions
4.Generation of extreme negative pressure by the client ✔✔ 3
A client being mechanically ventilated after experiencing a fat embolism is visibly anxious. What
is the best nursing action?
1.Ask a family member to stay with the client at all times.
2.Ask the health care provider for a prescription for succinylcholine.
3.Encourage the client to sleep until arterial blood gas results improve.
4.Provide reassurance to the client and give small doses of morphine sulfate intravenously as
prescribed. ✔✔ 4
You are caring for Ms. Y. She is scheduled to begin weaning from mechanical ventilation today.
Which assessment would be the best indicator of her readiness to be weaned?
A) Minute ventilation greater than 10 L/min
B) Respiratory rate at least 30/min
C) FiO2 less than 50%
D) Rapid shallow breathing index (RSBI) ✔✔ D
,Strategies to prevent ventilator associated pneumonia include:
A) rotating the patient's position every 2 hours with HOB at 10 degrees.
B) daily oral care with peroxide.
C) peptic ulcer disease prophylaxis.
D) biweekly assessment of readiness to extubate. ✔✔ C
Mr. G requires neuromuscular blockade to facilitate mechanical ventilation. Which is not a true
statement when providing nursing care to paralyzed patients?
A) Because patients under neuromuscular blockade are unable to react to the environment,
special safety precautions are not needed.
B) Pain medication is required because neuromuscular blocking agents do not have an analgesic
effect.
C) Patients under the influence of neuromuscular blocking agents are fully aware of activity
around them.
D) The nurse must be alert for complications of immobility such as deep vein thrombosis,
pressure ulcers, and atelectasis. ✔✔ A
The nurse is caring for a patient who was just placed on mechanical ventilation and is observing
the patient's vital signs because positive-pressure ventilation can lead to: (Select all that apply.)
A) decreased cardiac output.
B) decreased venous return.
C) increased renal function.
D) decreased intracranial pressure.
E) increased hepatic function. ✔✔ ABD
, What is the advantage of using Volume Cycled Ventilation? (SATA)
A. the ventilator pushes air into lungs until a preset airway pressure is reached
B. the ventilator pushes air into the lungs until a preset volume is reached
C. a constant tidal volume is delivered regardless of pressure needed to deliver the tidal volume
D. limits excessive pressure being exerted on the lungs
E. allows the health care team to determine if intubation is really neccessary ✔✔ BCD
In what ventilation setting does the vent deliver tidal volume at a preset rate because the
patient is not breathing spontaneously?
A. Controlled Mandatory Ventilation
B. Assisted Control
C. Synchronized Intermittent Mandatory Ventilation
D. Continuous Positive Airway Pressure ✔✔ A
In the patient using Controlled Mandatory Ventilation, what drug are they on to suppress
respiratory effort?
A. Morphine, Fentanyl, or Hydromorphone
B. Propofol
C. Rocuronium, Pancuronium, or Nimbex
D. Formoterol, Salmeterol, or Arformoterol ✔✔ C
Rocuronium, Pancuronium, & Nimbex are all non-Depolarizing Neuromuscular Blocking Agents.
But, be considerate that the patient recieving this type of ventilation will also require sedation
and opioids.
