NUR 425 EVALUATION EXAMS SET QUESTIONS
AND ANSWERS SURE A+
✔✔List some causes of low alarms. - ✔✔-Tube disconnected
-Cuff deflation
-ET tube displaced
-Low tracheal cuff pressure
-Vent malfunction
-Leak in circuitry
✔✔-FiO2 and PEEP only settings
-This is used to only keep alveoli open
-Pt. makes own tidal volume and takes their own breath - ✔✔CPAP (Continuous
Positive Airway Pressure)
✔✔-No set RR
-Supports with pressure setting when it senses the pt. starting to take a breath
-This is only meant for someone with a normal respiratory rate and good respiratory
drive. - ✔✔PS (Pressure Support) mode
✔✔What are we worried about with pressure modes? - ✔✔They don't assist with RR, so
can result in hypoventilation
✔✔-Set RR
-Set Vt with every breath
-Pt. can take breath, but there is no support with Vt, so the volume of spontaneous
breaths varies - ✔✔SIMV (Synchronized Intermittent Mandatory Ventilation)
✔✔-Set RR
-Set Vt with every breath
-Pt. can take additional breaths, and that breath is supported with same programmed
tidal volume - ✔✔AC (Assist Control)
,✔✔What are we worried about with volume modes? - ✔✔Volutrauma and respiratory
alkalosis
✔✔Air in mL for each breath - ✔✔Tidal volume (Vt)
✔✔How do we calculate Vt? - ✔✔8-10 mL/kg for ideal body weight
✔✔Pressure of each breath in cm H20. - ✔✔Pressure support (PS or PSV)
✔✔Keeps alveoli open end of expiration and increases functional residual capacity.
Since the tube bypasses the epiglottis, we have to create artificial residual volume. So
alveoli don't collapse. Units are cmH20. Normal is 5-20 cmH20. - ✔✔PEEP (Positive
End Expiratory Pressure)
✔✔List some risks associated with mechanical ventilation. - ✔✔-Pneumonia (usually
more at risk 48 hours or later)
-Right mainstream bronchus intubation
-Unplanned extubation, ETT malposition, extubation
-Laryngeal/tracheal injury, damage to oral/nasal mucosa
-Oxygen toxicity-hyperoxia-causes damage to lining of alveoli
-Acid-base disturbances
-Anxiety, stress, depression
-Peptic ulcer disease
-Hemodynamic compromise; PEEP causes decreased CO and BP due to increased
pressure on heart
-Too much stress on lungs and alveoli-volutrauma (too much tidal volume) and
barotrauma (too much pressure on lungs), possibly causing alveolar rupture
-Broken teeth during intubation
✔✔List manifestations of ventilator associated pneumonia. - ✔✔-Purulent sputum
-Fever
-Increased WBC
-Crackles or rhonchi
✔✔What are some indications of readiness to wean from mechanical ventilation? - ✔✔-
Underlying cause for mechanical ventilation is resolves/resolving
-The patient is hemodynamically stable; adequate cardiac output to provide tissue
perfusion
-Adequate respiratory muscle strength and RR <30
-the PaO2 is greater than or equal to 80 mmHg
-Acceptable VS
-Acceptable CXR and ABGs
-Adequate oxygenation without a high FiO2 (>50% too high) and/or high PEEP (>8cm
H20 too high)
, -Absence of any factors that impair weaning such as infection, anemia, fever, sleep
deprivation, pain, abdominal distention
-Mental readiness
-Minimal need for medications that cause respiratory depression.
✔✔What acid base imbalance should we watch for with a patient on a pressure mode
(CPAP + PS)? - ✔✔Respiratory acidosis because there is no set RR with these
settings.
✔✔What acid base imbalance should we watch for with a patient on a volume mode?
(AC + SIMV)? - ✔✔Respiratory alkalosis because of the set tidal volume
✔✔List the four common paralytics used for the mechanically ventilated patient. - ✔✔-
Pancuronium
-Vecuronium
-Rocuronium
-Neostigmine
✔✔Test where we send an electrical impulse to test their personal neuromuscular
activation. Typically placed on ulnar nerve. If four twitches, they are not paralyzed
enough. 2 twitches is perfect. 0 twitches means too much paralytics. - ✔✔Train of Four
✔✔You are caring for a 69 year old male with pneumonia who was just admitted from
the ED. Which of the following symptoms indicate early respiratory failure?
a. Face appears purple
b. Feet are cold to the touch
c. He keeps trying to get out of bed
d. He does not respond when you call his name - ✔✔C (This is an early sign and is due
to poor oxygenation to his brain. A is a late sign. B is a late sign and is a potential sign
of shock. D is a late sign because he most likely has lost consciousness at this point.)
✔✔Your patient is now only speaking to you in one-word sentences and doesn't look up
when you come in the room. Which of the following are signs of respiratory distress?
(SELECT ALL THAT APPLY)
a. Diaphoresis
b. HR: 120
c. Auscultating scattered crackles in the bases of his lungs
d. BP: 160/95
e. RR: 12
f. ABG shows a PaO2 of 80mmHg - ✔✔A B D (Auscultating scattered crackles in the
lungs might be a problem, but it does not definitively tell you that he is in respiratory
distress. You have probably had scattered crackles in your lungs while you had a cold-
but you weren't in distress.)
✔✔The healthcare team decides to get an ABG on your patient. Interpret the results:
AND ANSWERS SURE A+
✔✔List some causes of low alarms. - ✔✔-Tube disconnected
-Cuff deflation
-ET tube displaced
-Low tracheal cuff pressure
-Vent malfunction
-Leak in circuitry
✔✔-FiO2 and PEEP only settings
-This is used to only keep alveoli open
-Pt. makes own tidal volume and takes their own breath - ✔✔CPAP (Continuous
Positive Airway Pressure)
✔✔-No set RR
-Supports with pressure setting when it senses the pt. starting to take a breath
-This is only meant for someone with a normal respiratory rate and good respiratory
drive. - ✔✔PS (Pressure Support) mode
✔✔What are we worried about with pressure modes? - ✔✔They don't assist with RR, so
can result in hypoventilation
✔✔-Set RR
-Set Vt with every breath
-Pt. can take breath, but there is no support with Vt, so the volume of spontaneous
breaths varies - ✔✔SIMV (Synchronized Intermittent Mandatory Ventilation)
✔✔-Set RR
-Set Vt with every breath
-Pt. can take additional breaths, and that breath is supported with same programmed
tidal volume - ✔✔AC (Assist Control)
,✔✔What are we worried about with volume modes? - ✔✔Volutrauma and respiratory
alkalosis
✔✔Air in mL for each breath - ✔✔Tidal volume (Vt)
✔✔How do we calculate Vt? - ✔✔8-10 mL/kg for ideal body weight
✔✔Pressure of each breath in cm H20. - ✔✔Pressure support (PS or PSV)
✔✔Keeps alveoli open end of expiration and increases functional residual capacity.
Since the tube bypasses the epiglottis, we have to create artificial residual volume. So
alveoli don't collapse. Units are cmH20. Normal is 5-20 cmH20. - ✔✔PEEP (Positive
End Expiratory Pressure)
✔✔List some risks associated with mechanical ventilation. - ✔✔-Pneumonia (usually
more at risk 48 hours or later)
-Right mainstream bronchus intubation
-Unplanned extubation, ETT malposition, extubation
-Laryngeal/tracheal injury, damage to oral/nasal mucosa
-Oxygen toxicity-hyperoxia-causes damage to lining of alveoli
-Acid-base disturbances
-Anxiety, stress, depression
-Peptic ulcer disease
-Hemodynamic compromise; PEEP causes decreased CO and BP due to increased
pressure on heart
-Too much stress on lungs and alveoli-volutrauma (too much tidal volume) and
barotrauma (too much pressure on lungs), possibly causing alveolar rupture
-Broken teeth during intubation
✔✔List manifestations of ventilator associated pneumonia. - ✔✔-Purulent sputum
-Fever
-Increased WBC
-Crackles or rhonchi
✔✔What are some indications of readiness to wean from mechanical ventilation? - ✔✔-
Underlying cause for mechanical ventilation is resolves/resolving
-The patient is hemodynamically stable; adequate cardiac output to provide tissue
perfusion
-Adequate respiratory muscle strength and RR <30
-the PaO2 is greater than or equal to 80 mmHg
-Acceptable VS
-Acceptable CXR and ABGs
-Adequate oxygenation without a high FiO2 (>50% too high) and/or high PEEP (>8cm
H20 too high)
, -Absence of any factors that impair weaning such as infection, anemia, fever, sleep
deprivation, pain, abdominal distention
-Mental readiness
-Minimal need for medications that cause respiratory depression.
✔✔What acid base imbalance should we watch for with a patient on a pressure mode
(CPAP + PS)? - ✔✔Respiratory acidosis because there is no set RR with these
settings.
✔✔What acid base imbalance should we watch for with a patient on a volume mode?
(AC + SIMV)? - ✔✔Respiratory alkalosis because of the set tidal volume
✔✔List the four common paralytics used for the mechanically ventilated patient. - ✔✔-
Pancuronium
-Vecuronium
-Rocuronium
-Neostigmine
✔✔Test where we send an electrical impulse to test their personal neuromuscular
activation. Typically placed on ulnar nerve. If four twitches, they are not paralyzed
enough. 2 twitches is perfect. 0 twitches means too much paralytics. - ✔✔Train of Four
✔✔You are caring for a 69 year old male with pneumonia who was just admitted from
the ED. Which of the following symptoms indicate early respiratory failure?
a. Face appears purple
b. Feet are cold to the touch
c. He keeps trying to get out of bed
d. He does not respond when you call his name - ✔✔C (This is an early sign and is due
to poor oxygenation to his brain. A is a late sign. B is a late sign and is a potential sign
of shock. D is a late sign because he most likely has lost consciousness at this point.)
✔✔Your patient is now only speaking to you in one-word sentences and doesn't look up
when you come in the room. Which of the following are signs of respiratory distress?
(SELECT ALL THAT APPLY)
a. Diaphoresis
b. HR: 120
c. Auscultating scattered crackles in the bases of his lungs
d. BP: 160/95
e. RR: 12
f. ABG shows a PaO2 of 80mmHg - ✔✔A B D (Auscultating scattered crackles in the
lungs might be a problem, but it does not definitively tell you that he is in respiratory
distress. You have probably had scattered crackles in your lungs while you had a cold-
but you weren't in distress.)
✔✔The healthcare team decides to get an ABG on your patient. Interpret the results:
