RESPIRATORY DISORDERS CH 19 & 20 PART 2 (BATEMAN STYLE
LECTURE) FREQUENTLY TESTED ACTUAL EXAM QUESTIONS AND
ANSWERS
Question 1.
Endotracheal Intubation
Correct Answer: Oral ETT placement for airway management and mechanical
ventilation --> Placed in mouth and directed through trachea, (cuff) ballon
expanded at end of inserted portion so that air can properly ventilate --> Cuff
also prevents mucus from entering the lungs from the upper airway --> Newer
versions of ETT have a suction at the end near the cuff
Question 2.
Indications for Endotracheal Intubation (ETT)
Correct Answer: - Respiratory distress not manageable with noninvasive
measures - Inability to protect the airway - Need for mechanical ventilation -
Anticipated deterioration.
Question 3.
Endotracheal Intubation Cuff management -> Cuff Pressure
Correct Answer: - Target cuff pressure = 20 to 25 mmHg - Too high = Tracheal
ischemia, necrosis --> inflation of cuff too high, it starts to rub on trachea,
damages tissue, caus-es inflammation (mucus, swelling), potentially scarring,
ischemia from pressure against tissue, then leads to tissue death/necrosis - Too
low = Microaspiration and VAP risk --> Air leak, microaspiration bc cuff doesnt
block entry of mucus/pathogens, leads to infection (VAP/ventilator associated
pneumonia)
Question 4.
Endotracheal Intubation Nursing Implications
,Correct Answer: - Confirm placement immediately with ETCO₂ and chest x-ray -->
Document centimeter marking at the teeth or lips (used to assess whether tube
placement has moved) - Check cuff pressure every 8 hours and after
repositioning --> maintain 20 to 25 mmHg - Secure the tube and assess for
pressure injury to lips and nares --> reposition the tube daily - Oral care with
chlorhexidine every 2 to 4 hours --> Suction oropharynx before repositioning the
patient - Head of bed 30 to 45 degrees at all times
Question 5.
Tracheostomy
Correct Answer: Surgical airway for long-term ventilatory support or airway
management --> Most commonly used for anaphylaxis bc oral cavity is so
swollen that oral ETT cannot be placed into trachea --> Tracheostomy bypasses
oral enter and goes directly into trachea through incision made at front of neck
Question 6.
Indications for Tracheostomy
Correct Answer: - Long-term mechanical ventilation - Bypass of upper airway
obstruction --> Anaphylaxis - Aspiration prevention. ***Preferred over prolonged
ETT when intubation is expected to extend beyond 10 to 14 days.
Question 7.
Tracheostomy The Obturator
Correct Answer: is the solid inner guide used to insert the tube into the stoma. -
It must be removed immediately after insertion to open the airway. - The
obturator should be kept at the bedside at all times --> it is the first thing
needed if the tube becomes dislodged and must be urgently replaced
Question 8.
Tracheostomy Speaking valve (Passy-Muir)
Correct Answer: - A one-way valve placed over the trach hub that allows air in on
inspiration but diverts airflow up through the vocal cords on expiration,
enabling speech. - Before placing a speaking valve, the trach cuff must be
completely deflated to allow expiratory airflow to pass around the tube and
through the upper airway. - The valve is used only in patients who are breathing
, adequately on their own or with minimal support. - Takes time to learn how to
speak using speaking valve
Question 9.
Tracheostomy Nursing Implications
Correct Answer: - Keep a replacement tracheostomy tube of the same size AND a
size smaller at the bedside at all times, with the obturator --> smaller size in
case irritation causes swelling and narrowing - Suction only when clinically
indicated using sterile technique --> not on a routine schedule - Tracheostomy
care every 8 hours and as needed; keep the stoma clean and dry to prevent
infection - Maintain cuff pressure 20 to 25 mmHg in ventilated patients - Deflate
cuff fully before placing a speaking valve; monitor closely for tolerance
Question 10.
Mechanical ventilation
Correct Answer: Modes, settings, pressure parameters, alarms, and nursing
priorities ***Main goal is to wean patient from fully control ventilation to the
asissted and then patient initiated breaths
Question 11.
Mechanical ventilation Continuous Mandatory Ventilation (CMV) or Volume control
LECTURE) FREQUENTLY TESTED ACTUAL EXAM QUESTIONS AND
ANSWERS
Question 1.
Endotracheal Intubation
Correct Answer: Oral ETT placement for airway management and mechanical
ventilation --> Placed in mouth and directed through trachea, (cuff) ballon
expanded at end of inserted portion so that air can properly ventilate --> Cuff
also prevents mucus from entering the lungs from the upper airway --> Newer
versions of ETT have a suction at the end near the cuff
Question 2.
Indications for Endotracheal Intubation (ETT)
Correct Answer: - Respiratory distress not manageable with noninvasive
measures - Inability to protect the airway - Need for mechanical ventilation -
Anticipated deterioration.
Question 3.
Endotracheal Intubation Cuff management -> Cuff Pressure
Correct Answer: - Target cuff pressure = 20 to 25 mmHg - Too high = Tracheal
ischemia, necrosis --> inflation of cuff too high, it starts to rub on trachea,
damages tissue, caus-es inflammation (mucus, swelling), potentially scarring,
ischemia from pressure against tissue, then leads to tissue death/necrosis - Too
low = Microaspiration and VAP risk --> Air leak, microaspiration bc cuff doesnt
block entry of mucus/pathogens, leads to infection (VAP/ventilator associated
pneumonia)
Question 4.
Endotracheal Intubation Nursing Implications
,Correct Answer: - Confirm placement immediately with ETCO₂ and chest x-ray -->
Document centimeter marking at the teeth or lips (used to assess whether tube
placement has moved) - Check cuff pressure every 8 hours and after
repositioning --> maintain 20 to 25 mmHg - Secure the tube and assess for
pressure injury to lips and nares --> reposition the tube daily - Oral care with
chlorhexidine every 2 to 4 hours --> Suction oropharynx before repositioning the
patient - Head of bed 30 to 45 degrees at all times
Question 5.
Tracheostomy
Correct Answer: Surgical airway for long-term ventilatory support or airway
management --> Most commonly used for anaphylaxis bc oral cavity is so
swollen that oral ETT cannot be placed into trachea --> Tracheostomy bypasses
oral enter and goes directly into trachea through incision made at front of neck
Question 6.
Indications for Tracheostomy
Correct Answer: - Long-term mechanical ventilation - Bypass of upper airway
obstruction --> Anaphylaxis - Aspiration prevention. ***Preferred over prolonged
ETT when intubation is expected to extend beyond 10 to 14 days.
Question 7.
Tracheostomy The Obturator
Correct Answer: is the solid inner guide used to insert the tube into the stoma. -
It must be removed immediately after insertion to open the airway. - The
obturator should be kept at the bedside at all times --> it is the first thing
needed if the tube becomes dislodged and must be urgently replaced
Question 8.
Tracheostomy Speaking valve (Passy-Muir)
Correct Answer: - A one-way valve placed over the trach hub that allows air in on
inspiration but diverts airflow up through the vocal cords on expiration,
enabling speech. - Before placing a speaking valve, the trach cuff must be
completely deflated to allow expiratory airflow to pass around the tube and
through the upper airway. - The valve is used only in patients who are breathing
, adequately on their own or with minimal support. - Takes time to learn how to
speak using speaking valve
Question 9.
Tracheostomy Nursing Implications
Correct Answer: - Keep a replacement tracheostomy tube of the same size AND a
size smaller at the bedside at all times, with the obturator --> smaller size in
case irritation causes swelling and narrowing - Suction only when clinically
indicated using sterile technique --> not on a routine schedule - Tracheostomy
care every 8 hours and as needed; keep the stoma clean and dry to prevent
infection - Maintain cuff pressure 20 to 25 mmHg in ventilated patients - Deflate
cuff fully before placing a speaking valve; monitor closely for tolerance
Question 10.
Mechanical ventilation
Correct Answer: Modes, settings, pressure parameters, alarms, and nursing
priorities ***Main goal is to wean patient from fully control ventilation to the
asissted and then patient initiated breaths
Question 11.
Mechanical ventilation Continuous Mandatory Ventilation (CMV) or Volume control
