A patient, admitted with respiratory failure, is intubated and placed on the ventilator with the following settings: Continuous mandatory volume (CMV) rate of 12 breaths per minute. TV 500 mL. Fi02 50% and PEEP 5 cm H20. The following arterial blood gases are obtained: pH 7.30. PaCO2 50 mmHg HCO3 23 mEq/L. PaO2 82 mmHg. Which of the following ventilator changes would the nurse recommend in the SBAR to the physician?

An increase in the CMV rate

Change to SIMV MODE

A decrease in The PaO2

A decrease in the CMV rate

Answer and Explanation

The Correct Answer is B

A. An increase in the CMV rate:
Increasing the continuous mandatory volume (CMV) rate would provide more mandatory breaths, which may not address the patient's respiratory acidosis. It could potentially worsen the situation by causing respiratory alkalosis.

B. Change to SIMV (Synchronized Intermittent Mandatory Ventilation) MODE
The patient's arterial blood gas results indicate respiratory acidosis with an elevated PaCO2 (50 mmHg) and a low pH (7.30). The nurse would recommend changing to SIMV mode to allow for spontaneous breaths in addition to the set mandatory breaths. This change helps the patient to have more control over their respiratory efforts and may assist in lowering the PaCO2.

C. A decrease in the PaO2:
Decreasing the partial pressure of oxygen (PaO2) is not an appropriate response, especially when the patient is already on mechanical ventilation and has a moderate PaO2 level. The primary concern is the elevated PaCO2 and respiratory acidosis.

D. A decrease in the CMV rate:

Decreasing the CMV rate would reduce the number of mandatory breaths, potentially allowing the patient to hypoventilate further and retain more carbon dioxide. This is not the appropriate intervention for a patient with respiratory acidosis.

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Correct Answer is A

Explanation

A. The patient may need suctioning:
A high-pressure alarm indicates increased resistance to airflow, which could be caused by secretions or mucus in the airways. Suctioning is the appropriate intervention to clear the airways of excess secretions, reducing airway resistance and preventing the high-pressure alarm.

B. The patient extubated himself:
If the patient extubates himself (removes the endotracheal tube), this may result in a low-pressure alarm, not a high-pressure alarm. The low-pressure alarm is triggered when there is a loss of pressure within the ventilator circuit due to disconnection or extubation.

C. The ventilator tubing may be disconnected:
If the ventilator tubing is disconnected, it is more likely to trigger a low-pressure alarm, indicating a loss of pressure in the ventilator circuit. This is not the primary cause of increased resistance seen with a high-pressure alarm.

D. The cuff at the end of the endotracheal tube is deflated:
A deflated cuff can lead to air leakage around the endotracheal tube but is not the primary cause of increased airway resistance seen with a high-pressure alarm. It may cause a low-pressure alarm if cuff pressure is monitored.

A. Fluctuation of the fluid level within the water seal chamber B. Equal amounts of fluid drainage in each collection chamber C. Continuous bubbling within the water seal chamber D. Absence of fluid in the drainage tubing

Correct Answer is A

Explanation

A. Fluctuation of the fluid level within the water seal chamber
Fluctuation of the fluid level within the water seal chamber indicates that the chest tube is functioning properly. This fluctuation is a normal finding and reflects the movement of air in and out of the pleural space during the respiratory cycle. As the patient inhales, the fluid level drops, and as they exhale, it rises.

B. Equal amounts of fluid drainage in each collection chamber:
Equal amounts of drainage may suggest a problem with the drainage system or that the chest tube is not effectively draining air or fluid from the pleural space.

C. Continuous bubbling within the water seal chamber:
Continuous bubbling in the water seal chamber may indicate an air leak, which is not a normal finding. It should be investigated further.

D. Absence of fluid in the drainage tubing:
The absence of fluid in the drainage tubing may suggest that the chest tube is not effectively draining fluid from the pleural space or that there is a blockage in the system. It requires assessment and intervention.

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Naxlex Comprehensive Predictor Exams

A patient is on the ventilator and a high-pressure alarm sounds. The nurse should assess for which of these possible causes for the alarm?

Correct Answer is A

Explanation

The nurse is caring for a postoperative client who has a chest tube connected to suction and a water seal drainage system. Which of the following indicates to the nurse that the chest tube is functioning properly?

Correct Answer is A

Explanation

A nurse is planning care for a client who has acute respiratory distress syndrome (ARDS). Which of the following interventions should the nurse include in the plan?

A nurse is caring for four clients who are postoperative from surgery 24 hr ago. At 1200 the nurse assesses the clients. Which of the clients is the nurse’s priority?

A nurse checks with assistive personnel on the unit throughout the shift to determine if they are completing tasks. The nurse is demonstrating which of the following rights of delegation?

A nurse is reviewing the medical records of four clients who have an acid-base imbalance. The nurse should recognize that a clients is at risk for metabolic acidosis?

A nurse is teaching a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication has following actions?

A nurse has received morning report on the following four clients. Which of the following clients should the nurse assess first?

A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose?

A nurse is caring for a client who has acute respiratory distress syndrome (ARDS), and requires mechanical ventilation. The client receives a prescription for pancuronium. The nurse recognizes that this medication is for which of the following purposes?