NURS 4581 Final Exam (Exam 4) | Questions with 100% Verified Answers | Latest Update

NURS 4581 Final Exam (Exam 4) | Questions with 100% Verified Answers |
Latest Update
Question: What are the three buffer systems that maintain acid-base balance, and how fast does each act?
Answer:
Chemical buffers (HCO3-, phosphate, protein) = seconds | Lungs (CO2) = minutes | Kidneys (HCO3-) =
hours to days

Question: What does ROME stand for in ABG interpretation?
Answer:
Respiratory = Opposite (pH up, CO2 down) | Metabolic = Equal (pH up, HCO3- up)

Question: Normal ABG values?
Answer:
pH 7.35-7.45 | PaCO2 35-45 mmHg | HCO3- 22-26 mEq/L | PaO2 80-100 mmHg | SaO2 95%+

Question: ABG: pH 7.28, PaCO2 58, HCO3- 24 - interpretation?
Answer:
Respiratory acidosis, uncompensated. CO2 elevated (hypoventilation). HCO3- normal (no compensation
yet).

Question: ABG: pH 7.30, PaCO2 40, HCO3- 16 - interpretation?
Answer:
Metabolic acidosis, uncompensated. HCO3- low. CO2 normal (no compensation yet - Kussmaul
breathing expected).

Question: ABG: pH 7.48, PaCO2 48, HCO3- 34 - interpretation?
Answer:
Metabolic alkalosis, partially compensated. HCO3- elevated (primary). CO2 elevated (lungs retaining
CO2 to compensate).

Question: What causes respiratory acidosis and how is it treated?
Answer:
Hypoventilation: COPD, opioid OD, NMJ disease, ARDS, pneumonia. Treatment: improve ventilation,
bronchodilators, reversal agents, mechanical ventilation.

Question: What causes metabolic acidosis? Give MUDPILES mnemonic.
Answer:

,Methanol, Uremia, DKA, Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene glycol, Salicylates.
Treatment: treat underlying cause; NaHCO3 if pH <7.1.

Question: When is NaHCO3 given for metabolic acidosis, and what is danger?
Answer:
the Give when pH <7.1 or HCO3- <8. Danger: overuse causes metabolic alkalosis, paradoxical CNS
acidosis, hyperosmolality.

Question: What does tidaling in a chest drainage system mean?
Answer:
Water level in the water-seal chamber fluctuates with breathing. It is NORMAL - confirms tube patency.

Question: What does continuous bubbling in the water-seal chamber mean?
Answer:
Active air leak. Intermittent bubbling post-op is expected; continuous bubbling = ongoing air leak -
check connections, notify MD.

Question: What are the three chambers of a chest drainage unit?
Answer:
Chamber 1: Collection - drainage from patient | Chamber 2: Water seal - one-way valve | Chamber 3:
Suction control - -20 cmH2O typical

Question: What is tension pneumothorax and how is it treated?
Answer:
Air accumulates with one-way valve effect, mediastinal shift. Signs: absent breath sounds, tracheal
deviation AWAY, JVD, hypotension, cyanosis. Treatment: immediate needle decompression (2nd ICS
MCL), then chest tube.

Question: Never do this with a chest drainage unit:
Answer:
Never lift CDU above chest level (backflow risk). Never clamp prolonged. Never increase wall suction
pressure to increase bubbling.

Question: If a chest tube is accidentally removed, what do you do?
Answer:
Cover site immediately with your hand or occlusive petroleum gauze. Notify MD stat. Do NOT reinsert.

Question: What are the two types of acute respiratory failure?
Answer:

, Type I (Hypoxemic): PaO2 <60, oxygenation failure (ARDS, pneumonia, PE). Type II (Hypercapnic):
PaCO2 >50, hypoventilation (COPD, opioid OD, NMJ disease).

Question: What are the earliest signs of impaired ventilation?
Answer:
Restlessness, agitation, anxiety, tachycardia, tachypnea - EARLY. Cyanosis, confusion,
bradycardia/hypotension are LATE/pre-arrest.

Question: What is the correct ETT suctioning procedure?
Answer:
1) Assess need 2) Pre-oxygenate 100% O2 x30-60 sec 3) Sterile technique 4) Insert WITHOUT suction
5) Apply suction while withdrawing - 15 sec max 6) Reassess

Question: What is the normal ETT cuff pressure and why does it matter?
Answer:
20-30 cmH2O (25 mmHg). Too low = aspiration and air leak. Too high = tracheal ischemia, stenosis,
tracheomalacia.

Question: How do you confirm ETT placement after intubation?
Answer:
Direct visualization through cords + bilateral breath sounds + absent epigastric sounds + CO2
capnography + CXR (tip 2-3 cm above carina).

Question: Compare Assist-Control (AC) vs SIMV ventilation modes.
Answer:
AC: every patient trigger gets a FULL breath - full support. SIMV: set number of mandatory breaths +
patient breathes spontaneously between - used for weaning.

Question: What is PEEP and why is it used?
Answer:
Positive End-Expiratory Pressure - maintains positive pressure at end of expiration. Prevents alveolar
collapse, improves oxygenation. Normal: 5 cmH2O. Higher (8-15) in ARDS.

Question: What is the lung-protective ventilation strategy?
Answer:
Tidal volume 6 mL/kg IBW + plateau pressure <30 cmH2O + PEEP titrated to oxygenation. Prevents
volutrauma and barotrauma. Critical in ARDS.

Question: What is the ABCDEF bundle for mechanically ventilated patients?