NUR 203 RESPIRATORY
"Detailed Answer Keys with Thorough
Explanations"
What is the purpose of the *cuff* on an ET tube? - -correct ans- -when inflated it forms a *seal* that
keeps air from leaking back out through the mouth & *allows lungs to be expanded*
What are the 2 most common artificial airways? - -correct ans- -ET tube & trache
*used when pt can't breathe adequately on their own/if airway is impaired, obstructed, incompetent*
*RNs DO NOT INTUBATE*
(ex. surgery/gen anesthesia, trauma, disease, anaphylaxis, inhalation injuries, etc.)
Why is it important to remove dentures before inserting an ET tube? - -correct ans- -to reduce aspiration
risk
The chest tube of a client 16 hours post-op from a lobectomy is accidentally pulled out by a portable x-
ray machine. What is the nurse's best *first* action?
a) clamp the tubing with the padded clamps as close as possible to the insertion site
b) reposition the client on the non-operative side and support the tube(s) with pillows
c) cover the insertion site with a sterile occlusive dressing and tape down on three sides
d) don sterile gloves and attempt to reinsert the chest tube at the original insertion site - -correct ans- -c
,The RN caring for a client who is intubated and receiving mechanical ventilation notes that her oxygen
saturation is 89%, HR=120, and she is increasingly agitated and restless. On auscultation, the RN finds
that the lung sounds are diminished on one side. Which action does the RN perform *first*?
a) notify the HCP, and prepare for re-intubation or repositioning the tube
b) document the findings, and request sedation from the HCP
c) call respiratory therapy to obtain a set of ABG's
d) reposition the tube, and call radiology STAT for a chest x-ray - -correct ans- -a
A student nurse is working with a client in the ICU on a pt who is intubated and being mechanically
ventilated. What action by the student causes the RN to intervene?
a) repositioning the client q2hr
b) providing oral care with chlorhexidene rinse
c) checking tube placement at the client's incisor
d) turning off ventilator alarms while working in the room - -correct ans- -d
What position are patients placed in prior to intubation? - -correct ans- -laying flat with their head tilted
back
*may also see a towel roll behind their shoulders --> opens airway*
Where does the ET tube stop in the patient's airway? - -correct ans- -3-5 cm above the carina (so air can
go into both lungs)
What are the different methods used for determining correct ETT placement? - -correct ans- -- end-tidal
CO2
,- equal rise and fall of the chest when breathing for pt
- auscultating lung sounds bilaterally
- chest x-ray (blue line shows up)
*after placement is confirmed, then secure it (don't wait for chest x-ray to confirm*
What are the 3 most common mechanical vent settings? - -correct ans- -- CMV (controlled mandatory
ventilation)
- ACV (assist control)
- SIMV (synchronized intermittent mandatory vent)
Which mechanical vent setting requires the patient to be completely sedated so that it can completely
control pt. breathing? - -correct ans- -CMV (used for pt's who are *sedated* or who have been given
*paralytics*) --> gives a prescribed *rate, tidal volume, and % of O2 to the pt.* (alarms will go off if the
pt tries to breathe over the vent)
*the diaphragm is not used at all*
(if they are breathing on this setting they need more meds or to step down to ACV)
Ex:
RR = 12 (spaced evenly over 1 minute)
TV = 450 mL
FiO2 = 0.8 (80% oxygen w/ each breath)
True or False:
, Older adults or those who have decreased muscle tone are harder to wean off the ventilator - -correct
ans- -true
What is the term used to describe how much air is being pushed into the lungs with each breath? - -
correct ans- -tidal volume (400-500 mL is used for adults)
What is the biggest difference between CMV and ACV? - -correct ans- -CMV --> the patient does *NOT*
help breathe
ACV --> the patient helps breathe with the vent
What mechanical vent setting is used when the pt is beginning to breathe on their own but may still
require additional help by the machine? - -correct ans- -*ACV* --> the pt is still receiving a prescribed
rate, TV, and FiO2 amount but is able to breathe over the vent on their own
*the machine still controls TV for the breaths that the pt. breathes on their own*
Your pt. is on the ACV setting with a prescribed R of 12. You assess them and find that their RR = 20.
How many times per minute are they breathing on their own? - -correct ans- -8
What alarm will sound when the ventilator meets resistance while trying to push air in? - -correct ans- -
*high pressure alarm*
- increased amount of secretions (*suction PRN*)
- pt coughs, gags, or bites the ET tube
- anxious or fighting the ventilator (*re-orient them so you don't have to admin meds --> least invasive
options first*)
- pneumothorax occurs
- artificial airway is displaced (may have slipped into the right bronchus)
"Detailed Answer Keys with Thorough
Explanations"
What is the purpose of the *cuff* on an ET tube? - -correct ans- -when inflated it forms a *seal* that
keeps air from leaking back out through the mouth & *allows lungs to be expanded*
What are the 2 most common artificial airways? - -correct ans- -ET tube & trache
*used when pt can't breathe adequately on their own/if airway is impaired, obstructed, incompetent*
*RNs DO NOT INTUBATE*
(ex. surgery/gen anesthesia, trauma, disease, anaphylaxis, inhalation injuries, etc.)
Why is it important to remove dentures before inserting an ET tube? - -correct ans- -to reduce aspiration
risk
The chest tube of a client 16 hours post-op from a lobectomy is accidentally pulled out by a portable x-
ray machine. What is the nurse's best *first* action?
a) clamp the tubing with the padded clamps as close as possible to the insertion site
b) reposition the client on the non-operative side and support the tube(s) with pillows
c) cover the insertion site with a sterile occlusive dressing and tape down on three sides
d) don sterile gloves and attempt to reinsert the chest tube at the original insertion site - -correct ans- -c
,The RN caring for a client who is intubated and receiving mechanical ventilation notes that her oxygen
saturation is 89%, HR=120, and she is increasingly agitated and restless. On auscultation, the RN finds
that the lung sounds are diminished on one side. Which action does the RN perform *first*?
a) notify the HCP, and prepare for re-intubation or repositioning the tube
b) document the findings, and request sedation from the HCP
c) call respiratory therapy to obtain a set of ABG's
d) reposition the tube, and call radiology STAT for a chest x-ray - -correct ans- -a
A student nurse is working with a client in the ICU on a pt who is intubated and being mechanically
ventilated. What action by the student causes the RN to intervene?
a) repositioning the client q2hr
b) providing oral care with chlorhexidene rinse
c) checking tube placement at the client's incisor
d) turning off ventilator alarms while working in the room - -correct ans- -d
What position are patients placed in prior to intubation? - -correct ans- -laying flat with their head tilted
back
*may also see a towel roll behind their shoulders --> opens airway*
Where does the ET tube stop in the patient's airway? - -correct ans- -3-5 cm above the carina (so air can
go into both lungs)
What are the different methods used for determining correct ETT placement? - -correct ans- -- end-tidal
CO2
,- equal rise and fall of the chest when breathing for pt
- auscultating lung sounds bilaterally
- chest x-ray (blue line shows up)
*after placement is confirmed, then secure it (don't wait for chest x-ray to confirm*
What are the 3 most common mechanical vent settings? - -correct ans- -- CMV (controlled mandatory
ventilation)
- ACV (assist control)
- SIMV (synchronized intermittent mandatory vent)
Which mechanical vent setting requires the patient to be completely sedated so that it can completely
control pt. breathing? - -correct ans- -CMV (used for pt's who are *sedated* or who have been given
*paralytics*) --> gives a prescribed *rate, tidal volume, and % of O2 to the pt.* (alarms will go off if the
pt tries to breathe over the vent)
*the diaphragm is not used at all*
(if they are breathing on this setting they need more meds or to step down to ACV)
Ex:
RR = 12 (spaced evenly over 1 minute)
TV = 450 mL
FiO2 = 0.8 (80% oxygen w/ each breath)
True or False:
, Older adults or those who have decreased muscle tone are harder to wean off the ventilator - -correct
ans- -true
What is the term used to describe how much air is being pushed into the lungs with each breath? - -
correct ans- -tidal volume (400-500 mL is used for adults)
What is the biggest difference between CMV and ACV? - -correct ans- -CMV --> the patient does *NOT*
help breathe
ACV --> the patient helps breathe with the vent
What mechanical vent setting is used when the pt is beginning to breathe on their own but may still
require additional help by the machine? - -correct ans- -*ACV* --> the pt is still receiving a prescribed
rate, TV, and FiO2 amount but is able to breathe over the vent on their own
*the machine still controls TV for the breaths that the pt. breathes on their own*
Your pt. is on the ACV setting with a prescribed R of 12. You assess them and find that their RR = 20.
How many times per minute are they breathing on their own? - -correct ans- -8
What alarm will sound when the ventilator meets resistance while trying to push air in? - -correct ans- -
*high pressure alarm*
- increased amount of secretions (*suction PRN*)
- pt coughs, gags, or bites the ET tube
- anxious or fighting the ventilator (*re-orient them so you don't have to admin meds --> least invasive
options first*)
- pneumothorax occurs
- artificial airway is displaced (may have slipped into the right bronchus)
