,NUR 265 Exam 2
1. A patient has just been intubated and connected to a mechanical ventilator. The
nurse must verify correct endotracheal tube (ET tube) placement using a systematic
assessment from the first confirmation method through the final definitive
confirmation. What is the correct sequence for confirming ET tube placement?
Correct Answer: Assess for exhaled ETCO₂, observe for bilateral chest
symmetry/rise, auscultate the left and right lung fields and abdomen, and obtain a
chest X-ray.
The nurse first assesses for exhaled carbon dioxide using ETCO₂ monitoring because
the presence of exhaled CO₂ supports tracheal placement rather than esophageal
placement. Bilateral chest symmetry and rise provide additional evidence that
ventilation is occurring in both lungs. Auscultation over the left and right lung fields
and the abdomen helps identify unequal ventilation or possible esophageal
placement. A chest X-ray is then used to confirm the final position and depth of the
ET tube; normal ETCO₂ is generally about 35–45 mmHg in a ventilated adult, although
clinical targets vary.
2. A patient with severe respiratory failure is placed on assist/control (A/C)
mechanical ventilation. The nurse explains to the family that this mode provides
substantial ventilatory support even when the patient is unable to initiate
adequate breaths independently. How should the nurse describe the A/C ventilator
mode?
Correct Answer: The ventilator does the work for the patient by delivering a
set number of breaths per minute and providing the prescribed support with each
breath.
In A/C mode, the ventilator guarantees a minimum respiratory rate and delivers the
prescribed ventilatory support with each mandatory breath. If the patient initiates an
additional breath, the ventilator generally provides the set assistance for that breath
as well. This allows the patient to receive consistent ventilatory support when
respiratory effort is inadequate. The nurse should closely monitor respiratory rate,
tidal volume, oxygenation, ventilation, and patient tolerance.
, 3. A mechanically ventilated patient is beginning to initiate spontaneous breaths
while still requiring assistance from the ventilator. The respiratory therapist has
selected synchronized intermittent mandatory ventilation (SIMV) so that the
patient can contribute to their own ventilation while receiving scheduled ventilator
support. How should the nurse describe SIMV?
Correct Answer: The patient attempts to breathe spontaneously, and the
ventilator provides the prescribed mandatory breaths and assists with spontaneous
breathing as appropriate.
SIMV allows the patient to initiate spontaneous breaths while the ventilator provides
a set number of synchronized mandatory breaths. The mandatory breaths are
synchronized with the patient's respiratory effort to improve comfort and
coordination. Depending on the specific SIMV configuration, pressure support may
be added to assist spontaneous breaths. This mode can be useful when gradually
reducing ventilator support and encouraging spontaneous respiratory effort.
4. A patient is receiving mechanical ventilation in the intensive care unit, and the
nurse is reviewing the ventilator settings during the assessment. Several
parameters determine how oxygen and ventilation are delivered to the patient.
What are the major ventilator settings the nurse should identify?
Correct Answer: Mode, FiO₂, respiratory rate, tidal volume (Vt), and PEEP.
The mode determines how the ventilator interacts with the patient's spontaneous
and mandatory breaths. FiO₂ determines the concentration of oxygen delivered,
while the respiratory rate establishes the number of mandatory breaths delivered per
minute. Tidal volume determines the amount of gas delivered with each supported
breath. PEEP maintains positive pressure at the end of expiration to help prevent
alveolar collapse and improve oxygenation.
5. A patient with acute respiratory failure is receiving positive end-expiratory
pressure (PEEP) on a mechanical ventilator. The nurse explains that PEEP continues
to apply pressure at the end of expiration rather than allowing the airways and
alveoli to completely return to atmospheric pressure. What is the purpose of PEEP?
1. A patient has just been intubated and connected to a mechanical ventilator. The
nurse must verify correct endotracheal tube (ET tube) placement using a systematic
assessment from the first confirmation method through the final definitive
confirmation. What is the correct sequence for confirming ET tube placement?
Correct Answer: Assess for exhaled ETCO₂, observe for bilateral chest
symmetry/rise, auscultate the left and right lung fields and abdomen, and obtain a
chest X-ray.
The nurse first assesses for exhaled carbon dioxide using ETCO₂ monitoring because
the presence of exhaled CO₂ supports tracheal placement rather than esophageal
placement. Bilateral chest symmetry and rise provide additional evidence that
ventilation is occurring in both lungs. Auscultation over the left and right lung fields
and the abdomen helps identify unequal ventilation or possible esophageal
placement. A chest X-ray is then used to confirm the final position and depth of the
ET tube; normal ETCO₂ is generally about 35–45 mmHg in a ventilated adult, although
clinical targets vary.
2. A patient with severe respiratory failure is placed on assist/control (A/C)
mechanical ventilation. The nurse explains to the family that this mode provides
substantial ventilatory support even when the patient is unable to initiate
adequate breaths independently. How should the nurse describe the A/C ventilator
mode?
Correct Answer: The ventilator does the work for the patient by delivering a
set number of breaths per minute and providing the prescribed support with each
breath.
In A/C mode, the ventilator guarantees a minimum respiratory rate and delivers the
prescribed ventilatory support with each mandatory breath. If the patient initiates an
additional breath, the ventilator generally provides the set assistance for that breath
as well. This allows the patient to receive consistent ventilatory support when
respiratory effort is inadequate. The nurse should closely monitor respiratory rate,
tidal volume, oxygenation, ventilation, and patient tolerance.
, 3. A mechanically ventilated patient is beginning to initiate spontaneous breaths
while still requiring assistance from the ventilator. The respiratory therapist has
selected synchronized intermittent mandatory ventilation (SIMV) so that the
patient can contribute to their own ventilation while receiving scheduled ventilator
support. How should the nurse describe SIMV?
Correct Answer: The patient attempts to breathe spontaneously, and the
ventilator provides the prescribed mandatory breaths and assists with spontaneous
breathing as appropriate.
SIMV allows the patient to initiate spontaneous breaths while the ventilator provides
a set number of synchronized mandatory breaths. The mandatory breaths are
synchronized with the patient's respiratory effort to improve comfort and
coordination. Depending on the specific SIMV configuration, pressure support may
be added to assist spontaneous breaths. This mode can be useful when gradually
reducing ventilator support and encouraging spontaneous respiratory effort.
4. A patient is receiving mechanical ventilation in the intensive care unit, and the
nurse is reviewing the ventilator settings during the assessment. Several
parameters determine how oxygen and ventilation are delivered to the patient.
What are the major ventilator settings the nurse should identify?
Correct Answer: Mode, FiO₂, respiratory rate, tidal volume (Vt), and PEEP.
The mode determines how the ventilator interacts with the patient's spontaneous
and mandatory breaths. FiO₂ determines the concentration of oxygen delivered,
while the respiratory rate establishes the number of mandatory breaths delivered per
minute. Tidal volume determines the amount of gas delivered with each supported
breath. PEEP maintains positive pressure at the end of expiration to help prevent
alveolar collapse and improve oxygenation.
5. A patient with acute respiratory failure is receiving positive end-expiratory
pressure (PEEP) on a mechanical ventilator. The nurse explains that PEEP continues
to apply pressure at the end of expiration rather than allowing the airways and
alveoli to completely return to atmospheric pressure. What is the purpose of PEEP?
