A nurse is caring for a client who is receiving mechanical ventilation when the low-pressure alarm sounds on the ventilator. Which of the following actions should the nurse take?
Suction the client's airway.
Empty water from the client's ventilator tubing.
Increase the client's ventilator flow rate.
Evaluate the client for a cuff leak.
The Correct Answer is D
D. Evaluate the client for a cuff leak is the most appropriate action in response to a low-pressure alarm on the ventilator. A cuff leak can cause a drop in ventilator pressure, triggering the alarm. Assessing the client's cuff for leaks and addressing any identified issues can help resolve the alarm and ensure adequate ventilation.
A. Suctioning the client's airway is not the appropriate action in response to a low-pressure alarm on the ventilator.
B. Emptying water from the client's ventilator tubing could be a valid action to take if there is excess condensation or water buildup in the ventilator tubing causing the low-pressure alarm. However, it's not the first action to consider, as other causes should be ruled out first.
C. Increasing the ventilator flow rate may help maintain adequate pressure in the ventilator circuit and address the low-pressure alarm if the cause is related to insufficient airflow. However, adjusting the flow rate should be done cautiously and based on the client's respiratory status and ventilator settings.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. Sublingual nitroglycerin is intended for the immediate relief of angina symptoms. Clients should take the medication as soon as they experience chest pain or discomfort. Prompt administration can help alleviate symptoms and prevent the progression of angina episodes.
A. If the chest pain persists or worsens after taking the first dose of sublingual nitroglycerin, the client can take a second dose after 5 minutes. However, taking another dose after only 2 minutes may increase the risk of hypotension and other adverse effects.
C. Sublingual nitroglycerin tablets are not meant to be chewed or swallowed. Instead, they should be placed under the tongue and allowed to dissolve completely. Chewing or swallowing the tablet can reduce the medication's effectiveness.
D. Sublingual nitroglycerin should be placed under the tongue, not against the cheek or gum.
Correct Answer is D
Explanation
D. Limiting the time that visitors spend with the client is a reasonable precaution to reduce their overall radiation exposure. Prolonged exposure to radiation can increase the risk of adverse effects. By limiting visitors to a specific time frame, the nurse can help control their exposure while still allowing for social support and companionship.
A. Discarding radioactive materials in regular trash cans can pose significant risks to sanitation workers, the environment, and public health.
B. Proper disposal of soiled linens contaminated with radioactive materials is essential to prevent radiation exposure to others. Soiled linens should be handled and disposed of according to institutional protocols for managing radioactive waste.
C. Maintaining a safe distance from the client is an important radiation safety precaution. However, this alone may not be sufficient to ensure adequate protection, depending on the specific circumstances of the treatment and the level of radiation emitted by the sources.
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