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 C

Explanation

A. Glucagon:
Glucagon is not used as an antidote for heparin overdose. It is typically used to treat severe hypoglycemia.

B. Vitamin K:
Vitamin K is the antidote for warfarin, another anticoagulant, but it is not effective for reversing the effects of heparin.

C. Protamine
Protamine is the specific antidote for heparin. It acts by binding to heparin, neutralizing its anticoagulant effects. It is important to note that the administration of protamine should be done carefully, and the dosage must be based on the amount of heparin the patient has received.

D. Calcium:
Calcium is not an antidote for heparin. It is more relevant in cases of calcium channel blocker toxicity or hypocalcemia.

A. The AP’s rapport with clients B. The AP’s ability to complete the task without assistance C. The AP has the knowledge and sail to perform the task D. The AP’s ability to prioritize

Correct Answer is C

Explanation

A. The AP’s rapport with clients:
While a positive rapport with clients is valuable, it is not a direct factor in determining whether an AP is suitable for a specific task based on the five rights of delegation.

B. The AP’s ability to complete the task without assistance:
The ability to complete a task without assistance is relevant but does not guarantee that the AP has the necessary knowledge and skill for the task. The focus should be on competence rather than independence.

C. The AP has the knowledge and skill to perform the task
When considering the five rights of delegation, one of the crucial factors is ensuring that the assistive personnel (AP) has the knowledge and skill necessary to perform the delegated task safely and effectively. Delegated tasks should align with the AP's competence and training to maintain the safety and well-being of the client.

D. The AP’s ability to prioritize:
Prioritization skills are important for healthcare providers, but the focus of delegation, as per the five rights, is on the AP's competence to perform the specific task.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is C

Explanation

When planning delegation of tasks to assistive personnel (AP), a nurse considers the five rights of delegation. Which of the following should the nurse consider when using one of the five rights of delegation?

Correct Answer is C

Explanation

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 is caring for a client who has a chest tube. Which of the following actions should the nurse take?

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?

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?

A student is caring for a patient with positive end-expiratory pressure (PEEP) at 5 cm H20. The student asks “What is the purpose of PEEP?” which of the following is an appropriate response by the nurse?

A client smoking in his bathroom has dropped a cigarette butt into a wastepaper basket, which begins to smolder. Which of the following actions is the nurse’s priority?

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?