C HAPTER 15: P ULMONARY T HERAPEUTIC
M ANAGEMENT
Urden: Priorities in Critical Care Nursing, 8th E dition
MULTIPLE CHOICE
1. A nurse is teaching a nursing student about the modes of volume
ventilation. Which statement regarding the assist -control (AC) mode
indicates th e student understood the information?
a. “It delivers gas at preset volume, at a set rate, and in response to
the patient’s inspiratory efforts.”
b. “It delivers gas at a preset volume, allowing the patient to breathe
spontaneousl y at his or her own volume.”
c. “It applies positive pressure during both ventilator breaths and
spontaneous breaths.”
d. “It delivers gas at preset rate and tidal volume regardless of the
patient’s inspiratory efforts.”
ANS: A
AC ventilation delivers gas at preset tidal volume in response t o
patient’s inspiratory efforts and initiates breath if patient fails to do so
within preset time. The other statements describe other modes of
mechanical ventilation.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Implementation TOP: Pulmonary
, Therapeutic Management MSC: NC LEX:
Physiological Integrity: Reduction of Risk Potential
2. To limit respiratory muscle fatigue, the practitioner would like to
augment the patient’s inspiratory effort. The nurse should anticipate the
addition of which therapy?
a. Positive end-expiratory pressure (PEEP)
b. Continuous positive airway pressure (CPAP)
c. Pressure control ventilation (PCV)
d. Pressure support ventilation (PSV)
ANS: D
Preset positive pressure used to augment the patient’s inspiratory
efforts is known as pressure support ventilation. With continuous
positive airway pressure, positive pressure is applied during
spontaneous breaths; the patient controls rate, inspiratory flow, and
tidal volume. Positive end -expiratory pressure is positive pressur e
applied at the end of expiration of ventilator breaths.
PTS: 1 DIF: Cognitive Level: Appl ying OBJ: Nursing
Process Step: Planning TOP: Pulmonary
Therapeutic Management MSC: NC LEX: Physiological
Integrit y: Reduction of Risk Potential
3. The practitioner has ordered the addition of positive end -expiratory
pressure (PEEP) to the current mechanical ventilation settings. Which
effect will this change have on the patient’s hemodynamics?
a. PEEP increases intrathoracic pressure, which increases venous
return and cardiac output.
, b. PEEP decreases venous return, which increases preload and
cardiac output.
c. PEEP increases venous return, which decreases preload and
cardiac output.
d. PEEP increases intrathoracic pressure, which decreases venous
return and cardiac output.
ANS: D
Positive-pressure ventilation increases intrathoracic pressure, which
decreases venous return to the right side of the heart. Impaired venous
return decreases preload, which results in a decrease in cardiac output.
PTS: 1 DIF: Cognitive Level: Evaluating OBJ: Nursing
Process Step: Evaluation TOP: Pulmonary Therapeutic
Management MSC: NC LEX: Physiological Integrit y:
Reduction of Risk Potential
4. A patient with acute lung failure has been mechanicall y ventilated for 3
days and is being evaluat ed for a spontaneous breathing trial. When the
nurse enters the room, the ventilator inoperative alarm sounds. Which
action should the nurse perform FIRST?
a. Troubleshoot the ventilator until the problem is found.
b. Take the patient off the ventilator and man uall y ventilate the
patient.
c. Call the respiratory therapist for help.
d. Silence the ventilator alarms until the problem is resolved.
ANS: B
M ANAGEMENT
Urden: Priorities in Critical Care Nursing, 8th E dition
MULTIPLE CHOICE
1. A nurse is teaching a nursing student about the modes of volume
ventilation. Which statement regarding the assist -control (AC) mode
indicates th e student understood the information?
a. “It delivers gas at preset volume, at a set rate, and in response to
the patient’s inspiratory efforts.”
b. “It delivers gas at a preset volume, allowing the patient to breathe
spontaneousl y at his or her own volume.”
c. “It applies positive pressure during both ventilator breaths and
spontaneous breaths.”
d. “It delivers gas at preset rate and tidal volume regardless of the
patient’s inspiratory efforts.”
ANS: A
AC ventilation delivers gas at preset tidal volume in response t o
patient’s inspiratory efforts and initiates breath if patient fails to do so
within preset time. The other statements describe other modes of
mechanical ventilation.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Implementation TOP: Pulmonary
, Therapeutic Management MSC: NC LEX:
Physiological Integrity: Reduction of Risk Potential
2. To limit respiratory muscle fatigue, the practitioner would like to
augment the patient’s inspiratory effort. The nurse should anticipate the
addition of which therapy?
a. Positive end-expiratory pressure (PEEP)
b. Continuous positive airway pressure (CPAP)
c. Pressure control ventilation (PCV)
d. Pressure support ventilation (PSV)
ANS: D
Preset positive pressure used to augment the patient’s inspiratory
efforts is known as pressure support ventilation. With continuous
positive airway pressure, positive pressure is applied during
spontaneous breaths; the patient controls rate, inspiratory flow, and
tidal volume. Positive end -expiratory pressure is positive pressur e
applied at the end of expiration of ventilator breaths.
PTS: 1 DIF: Cognitive Level: Appl ying OBJ: Nursing
Process Step: Planning TOP: Pulmonary
Therapeutic Management MSC: NC LEX: Physiological
Integrit y: Reduction of Risk Potential
3. The practitioner has ordered the addition of positive end -expiratory
pressure (PEEP) to the current mechanical ventilation settings. Which
effect will this change have on the patient’s hemodynamics?
a. PEEP increases intrathoracic pressure, which increases venous
return and cardiac output.
, b. PEEP decreases venous return, which increases preload and
cardiac output.
c. PEEP increases venous return, which decreases preload and
cardiac output.
d. PEEP increases intrathoracic pressure, which decreases venous
return and cardiac output.
ANS: D
Positive-pressure ventilation increases intrathoracic pressure, which
decreases venous return to the right side of the heart. Impaired venous
return decreases preload, which results in a decrease in cardiac output.
PTS: 1 DIF: Cognitive Level: Evaluating OBJ: Nursing
Process Step: Evaluation TOP: Pulmonary Therapeutic
Management MSC: NC LEX: Physiological Integrit y:
Reduction of Risk Potential
4. A patient with acute lung failure has been mechanicall y ventilated for 3
days and is being evaluat ed for a spontaneous breathing trial. When the
nurse enters the room, the ventilator inoperative alarm sounds. Which
action should the nurse perform FIRST?
a. Troubleshoot the ventilator until the problem is found.
b. Take the patient off the ventilator and man uall y ventilate the
patient.
c. Call the respiratory therapist for help.
d. Silence the ventilator alarms until the problem is resolved.
ANS: B
