lOMoARcPSD|46354221
Chapter 09: Ventilatory Assistance Sole: Introduction to
Critical Care Nursing, 7th Edition
Critical Care Paramedic (Lone Star College System)
, lOMoARcPSD|46354221
INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK
Chapter 09: Ventilatory Assistance
Sole: Introduction to Critical Care Nursing, 7th Edition
MULTIPLE CHOICE
1. A patient has coronary artery bypass graft surgery and is transported to the surgical intensive
care unit at noon and is placed on mechanical ventilation. Interpret the initial arterial blood
gas levels
pH: 7.31
PaCO2: 48 mm Hg
Bicarbonate: 22 mEq/L
PaO2: 115 mm Hg
O2 saturation: 99%
a. Normal arterial blood gas levels with a high oxygen level
b. Partly compensated respiratory acidosis; normal oxygen
c. Uncompensated metabolic acidosis with high oxygen levels
d. Uncompensated respiratory acidosis; hyperoxygenated
ANS: D
The high PaO2 level reflects hyperoxygenation; the PaCO 2 and pH levels show respiratory
acidosis. The respiratory acidosis is uncompensated as indicated by a pH of 7.31 (acidosis)
and a normal bicarbonate level. No metabolic compensation has occurred.
DIF: Cognitive Level: Analyze/Analysis REF: Box 9-3 | Table 9-3
OBJ: Describe methods for assessing the respiratory system, including physical assessment,
interpretation of arterial blood gases, and noninvasive techniques.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
2. The provider orders the following mechanical ventilation settings for a patient who weighs 75
kg. The patient’s spontaneous respiratory rate is 22 breaths/min. Which arterial blood gas
abnormality may occur if the patient continues to be tachypneic at these ventilator settings?
Settings:
Tidal volume: 600 mL (8 mL per kg)
FiO2: 0.5
Respiratory rate: 14 breaths/min
Mode assist/control
Positive end-expiratory pressure: 10 cm H2O
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
ANS: D
Assist/control ventilation may result in respiratory alkalosis, especially when the
patient is breathing at a higher rate that the ventilator rate. Each time the patient initiates a
spontaneous breath—in this case 22 times per minute—the ventilator will deliver 600 mL of
volume.
DIF: Cognitive Level: Analyze/Analysis REF: p. 186
, lOMoARcPSD|46354221
INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK
OBJ: Relate complications associated with mechanical ventilation.
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
3. A patient’s ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen
is increased from 0.6 to 0.7, and the positive end-expiratory pressure is increased from 10 to
15 cm H2O. Shortly after these adjustments, the nurse notes that the patient’s blood pressure
drops from 120/76 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in
blood pressure?
a. Decrease in cardiac output
b. Hypovolemia
c. Increase in venous return
d. Oxygen toxicity
ANS: A
Positive end-expiratory pressure increases intrathoracic pressure and may result in decreased
venous return. Cardiac output decreases as a result, and is reflected in the lower blood
pressure. It is essential to assess the patient to identify optimal positive end-expiratory
pressure—the highest amount that can be applied without compromising cardiac output.
Although hypovolemia can result in a decrease in blood pressure, there is no indication that
this patient has hypovolemia. As noted, higher levels of positive end-expiratory pressure may
cause a decrease, not an increase, in venous return. Oxygen toxicity can occur in this case
secondary to the high levels of oxygen needed to maintain gas exchange; however, oxygen
toxicity is manifested in damage to the alveoli.
DIF: Cognitive Level: Analyze/Analysis REF: p. 184 | p. 196
OBJ: Relate complications associated with mechanical ventilation.
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
4. The nurse is caring for a patient with an endotracheal tube. The nurse understands that
endotracheal suctioning is needed to facilitate removal of secretions and that the procedure
a. decreases intracranial pressure.
b. depresses the cough reflex.
c. is done as indicated by patient assessment.
d. is more effective if preceded by saline instillation.
ANS: C
Suctioning is performed as indicated by patient assessment. Suctioning is associated with
increases in intracranial pressure; therefore, it is important to hyperoxygenate the patient
before suctioning to reduce this complication. Suctioning can stimulate the cough reflex rather
than depress this reflex. Saline instillation is associated with negative physiological outcomes
and is not recommended as part of the suctioning procedure; it does not loosen secretions,
which is a common misperception.
DIF: Cognitive Level: Understand/Comprehension REF: p. 180
OBJ: Discuss methods for maintaining an open airway.
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
Chapter 09: Ventilatory Assistance Sole: Introduction to
Critical Care Nursing, 7th Edition
Critical Care Paramedic (Lone Star College System)
, lOMoARcPSD|46354221
INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK
Chapter 09: Ventilatory Assistance
Sole: Introduction to Critical Care Nursing, 7th Edition
MULTIPLE CHOICE
1. A patient has coronary artery bypass graft surgery and is transported to the surgical intensive
care unit at noon and is placed on mechanical ventilation. Interpret the initial arterial blood
gas levels
pH: 7.31
PaCO2: 48 mm Hg
Bicarbonate: 22 mEq/L
PaO2: 115 mm Hg
O2 saturation: 99%
a. Normal arterial blood gas levels with a high oxygen level
b. Partly compensated respiratory acidosis; normal oxygen
c. Uncompensated metabolic acidosis with high oxygen levels
d. Uncompensated respiratory acidosis; hyperoxygenated
ANS: D
The high PaO2 level reflects hyperoxygenation; the PaCO 2 and pH levels show respiratory
acidosis. The respiratory acidosis is uncompensated as indicated by a pH of 7.31 (acidosis)
and a normal bicarbonate level. No metabolic compensation has occurred.
DIF: Cognitive Level: Analyze/Analysis REF: Box 9-3 | Table 9-3
OBJ: Describe methods for assessing the respiratory system, including physical assessment,
interpretation of arterial blood gases, and noninvasive techniques.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
2. The provider orders the following mechanical ventilation settings for a patient who weighs 75
kg. The patient’s spontaneous respiratory rate is 22 breaths/min. Which arterial blood gas
abnormality may occur if the patient continues to be tachypneic at these ventilator settings?
Settings:
Tidal volume: 600 mL (8 mL per kg)
FiO2: 0.5
Respiratory rate: 14 breaths/min
Mode assist/control
Positive end-expiratory pressure: 10 cm H2O
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
ANS: D
Assist/control ventilation may result in respiratory alkalosis, especially when the
patient is breathing at a higher rate that the ventilator rate. Each time the patient initiates a
spontaneous breath—in this case 22 times per minute—the ventilator will deliver 600 mL of
volume.
DIF: Cognitive Level: Analyze/Analysis REF: p. 186
, lOMoARcPSD|46354221
INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK
OBJ: Relate complications associated with mechanical ventilation.
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
3. A patient’s ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen
is increased from 0.6 to 0.7, and the positive end-expiratory pressure is increased from 10 to
15 cm H2O. Shortly after these adjustments, the nurse notes that the patient’s blood pressure
drops from 120/76 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in
blood pressure?
a. Decrease in cardiac output
b. Hypovolemia
c. Increase in venous return
d. Oxygen toxicity
ANS: A
Positive end-expiratory pressure increases intrathoracic pressure and may result in decreased
venous return. Cardiac output decreases as a result, and is reflected in the lower blood
pressure. It is essential to assess the patient to identify optimal positive end-expiratory
pressure—the highest amount that can be applied without compromising cardiac output.
Although hypovolemia can result in a decrease in blood pressure, there is no indication that
this patient has hypovolemia. As noted, higher levels of positive end-expiratory pressure may
cause a decrease, not an increase, in venous return. Oxygen toxicity can occur in this case
secondary to the high levels of oxygen needed to maintain gas exchange; however, oxygen
toxicity is manifested in damage to the alveoli.
DIF: Cognitive Level: Analyze/Analysis REF: p. 184 | p. 196
OBJ: Relate complications associated with mechanical ventilation.
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
4. The nurse is caring for a patient with an endotracheal tube. The nurse understands that
endotracheal suctioning is needed to facilitate removal of secretions and that the procedure
a. decreases intracranial pressure.
b. depresses the cough reflex.
c. is done as indicated by patient assessment.
d. is more effective if preceded by saline instillation.
ANS: C
Suctioning is performed as indicated by patient assessment. Suctioning is associated with
increases in intracranial pressure; therefore, it is important to hyperoxygenate the patient
before suctioning to reduce this complication. Suctioning can stimulate the cough reflex rather
than depress this reflex. Saline instillation is associated with negative physiological outcomes
and is not recommended as part of the suctioning procedure; it does not loosen secretions,
which is a common misperception.
DIF: Cognitive Level: Understand/Comprehension REF: p. 180
OBJ: Discuss methods for maintaining an open airway.
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
