ATI MEDSURG 2 NUR 265/ ER/SHOCK/
DISASTER DETAILED ANSWER KEY NEURO-
SHOCK & BURNS PRACTICE EXAM 2024-2026
How is an ET tube placement confirmed?
From first to last
ETCO2 20-40mmHg
Chest symmetry
Listen to left/right/abdomen
Chest X-Ray
Describe the A/C vent mode.
The vent does everything for the patient. It delivers a set amount of breaths per minute
Describe SIMV vent mode.
The pt attempts to breath and the vent assists with their breaths
What are the different ventilator settings?
Mode
FiO2
Rate
Tidal Volume (Vt)
PEEP
What is PEEP?
It is positive pressure that tells the alveoli in the lungs to stay open a little longer. It
helps with gas exchange.
What are some complications of PEEP?
Pneumothorax
SubQ Emphysema (crepatus)
Decreased pre-load
What are the 3 buttons that a nurse is able to touch on a vent?
Silence
Restart
100% Oxygen (before suctioning a patient)
When is it acceptable to shut off a vent alarm?
NEVER
What should be done when a patient is in respiratory distress?
Call for help, disconnect the vent, start bagging the patient, then reassess
What are ways to prevent VAP?
Remove water from circuits
HOB up to 30 degrees
Turn Q2h
Suction
Oral care Q2H
Prevent aspiration
, Lip moisturizer
Percussion
Give examples of what could cause a high pressure alarm.
Blocked airway
Coughing
Tension pneumothorax
Anxiety/Pain: Sedate them
Kinks in tubing
Decreased lung compliance: ARDS
Assess the patient not the monitor
Give examples of what could cause a low pressure alarm.
Not getting enough air (in or out)
Air leak in the cuff: Check the pilot balloon
Disconnected tubing
Low Vt
Assess the patient not the monitor
What are some things we have to do when caring for a vented patient?
Lung assessment
Frequent vital signs (every 4 hours)
I&O (look at balances)
Foley
NPO
Nutrition (NG Tube for all vent patients)
Skin Care
Monitor ABG/labs
VTE prophylaxis
What are some risk factors for a PE?
Immobility
Central Lines
Surgery
Obesity
DVT's
Birth Control Pills
Smoking
What is the best way to prevent a PE?
Move the patient post op.
What should be done immediately after the nurse notes s/s of a PE?
Notify the Rapid Response Team
What are ways to manage the symptoms of a PE?
ABC: might need intubation
Anticoags (heparin/warfarin/fibrinolytics)
High Fowlers
Telemetry
DISASTER DETAILED ANSWER KEY NEURO-
SHOCK & BURNS PRACTICE EXAM 2024-2026
How is an ET tube placement confirmed?
From first to last
ETCO2 20-40mmHg
Chest symmetry
Listen to left/right/abdomen
Chest X-Ray
Describe the A/C vent mode.
The vent does everything for the patient. It delivers a set amount of breaths per minute
Describe SIMV vent mode.
The pt attempts to breath and the vent assists with their breaths
What are the different ventilator settings?
Mode
FiO2
Rate
Tidal Volume (Vt)
PEEP
What is PEEP?
It is positive pressure that tells the alveoli in the lungs to stay open a little longer. It
helps with gas exchange.
What are some complications of PEEP?
Pneumothorax
SubQ Emphysema (crepatus)
Decreased pre-load
What are the 3 buttons that a nurse is able to touch on a vent?
Silence
Restart
100% Oxygen (before suctioning a patient)
When is it acceptable to shut off a vent alarm?
NEVER
What should be done when a patient is in respiratory distress?
Call for help, disconnect the vent, start bagging the patient, then reassess
What are ways to prevent VAP?
Remove water from circuits
HOB up to 30 degrees
Turn Q2h
Suction
Oral care Q2H
Prevent aspiration
, Lip moisturizer
Percussion
Give examples of what could cause a high pressure alarm.
Blocked airway
Coughing
Tension pneumothorax
Anxiety/Pain: Sedate them
Kinks in tubing
Decreased lung compliance: ARDS
Assess the patient not the monitor
Give examples of what could cause a low pressure alarm.
Not getting enough air (in or out)
Air leak in the cuff: Check the pilot balloon
Disconnected tubing
Low Vt
Assess the patient not the monitor
What are some things we have to do when caring for a vented patient?
Lung assessment
Frequent vital signs (every 4 hours)
I&O (look at balances)
Foley
NPO
Nutrition (NG Tube for all vent patients)
Skin Care
Monitor ABG/labs
VTE prophylaxis
What are some risk factors for a PE?
Immobility
Central Lines
Surgery
Obesity
DVT's
Birth Control Pills
Smoking
What is the best way to prevent a PE?
Move the patient post op.
What should be done immediately after the nurse notes s/s of a PE?
Notify the Rapid Response Team
What are ways to manage the symptoms of a PE?
ABC: might need intubation
Anticoags (heparin/warfarin/fibrinolytics)
High Fowlers
Telemetry
