Review Comprehensive Questions

Respiratory Management and Mechanical Ventilation > Adult Health

Exam Review

Comprehensive Questions

Share This Link

Share on social media

Facebook

Messager

WhatsApp

Share URL
Copy

We are excited to announce the release of a NEW VERSION OF THE SYSTEM! To benefit from the latest features, improvements, and component updates, please switch to the new system as soon as possible.

Visit Latest Version

Total Questions : 17

Showing 17 questions, Sign in for more

Question 1:

While suctioning the ET tube of a spontaneously breathing patient, the nurse notes that the patient develops bradycardia with premature ventricular contractions. What should the nurse do first?

A. Stop the suctioning and assess the patient for spontaneous respirations. B. Attempt to resuction the patient with reduced suction pressure and pass time. C. Stop the suctioning and ventilate the patient with slow, small-volume breaths using a bag-valve-mask (BVM) device. D. Stop suctioning and ventilate the patient with a BVM device with 100% oxygen until the heart rate returns to baseline.

Answer and Explanation

Choice A:

Stop the suctioning and assess the patient for spontaneous respirations: Although assessment is important, the priority is to restore oxygenation immediately rather than simply observe the patient.

Choice B:

Attempt to resuction the patient with reduced suction pressure and pass time: Resuctioning at this point would worsen hypoxia and bradycardia. Suctioning should be resumed only after stabilization and reoxygenation.

Choice C:

Stop the suctioning and ventilate the patient with slow, small-volume breaths using a BVM device: Ventilating with small-volume breaths does not ensure adequate reoxygenation. The patient needs 100% oxygen to rapidly reverse the hypoxic state.

Choice D:

Stop suctioning and ventilate the patient with a BVM device with 100% oxygen until the heart rate returns to baseline: This response directly addresses the cause of the bradycardia and PVCs—hypoxia and vagal stimulation. Providing 100% oxygen restores oxygen saturation, reverses vagal-induced bradycardia, and prevents further dysrhythmias. Reoxygenation before and after suctioning is essential for patient safety.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 2:

What precautions should the nurse take during mouth care and repositioning of an oral ET tube to prevent and detect tube dislodgement? Select all that apply

A. Confirm bilateral breath sounds after care. B. Use suction pressures less than 120 mm Hg. C. Use water swabs to prevent mucosal drying. D. Use humidified inspired gas to help thin secretions. E. One staff member holds the tube and one performs care. F. Move secretions into larger airways with turning every 2 hours.

Answer and Explanation

Choice A:

Confirm bilateral breath sounds after care: Checking for equal and bilateral breath sounds immediately after repositioning or oral care ensures that the ET tube has not shifted or migrated into one bronchus. Unequal or absent breath sounds can indicate tube displacement, requiring prompt repositioning.

Choice B:

Use suction pressures less than 120 mm Hg: While this is an important airway suctioning precaution, it does not specifically prevent or detect tube dislodgement during oral care.

Choice C:

Use water swabs to prevent mucosal drying: This measure maintains oral hygiene, not ET tube placement stability.

Choice D:

Use humidified inspired gas to help thin secretions: Humidification prevents secretion thickening but does not protect against tube dislodgement.

Choice E:

One staff member holds the tube and one performs care: This is a critical safety measure. Having one nurse stabilize the ET tube while another provides oral care or repositioning prevents accidental extubation or tube movement. It maintains correct tube depth and placement throughout the procedure.

Choice F:

Move secretions into larger airways with turning every 2 hours: Turning promotes lung expansion and secretion movement but is unrelated to detecting tube displacement during oral care.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 3:

A patient with an oral ET tube has a nursing diagnosis of risk for aspiration related to presence of artificial airway. What are appropriate nursing interventions for this patient? Select all that apply

A. Assess gag reflex. B. Ensure that the cuff is properly inflated. C. Suction the patient’s mouth frequently. D. Keep the ventilator tubing cleared of condensed water. E. Raise the head of the bed 30 to 45 degrees unless the patient is unstable.

Answer and Explanation

Choice A:

Assess gag reflex: The gag reflex is not a reliable indicator of aspiration risk in an intubated patient, as the ET tube bypasses the normal swallowing mechanism. Assessing it is unnecessary and may cause discomfort or coughing.

Choice B:

Ensure that the cuff is properly inflated: A well-inflated ET tube cuff seals the trachea, preventing secretions from the upper airway or gastric contents from leaking into the lungs. Cuff pressure should be maintained within the recommended range (20–25 cm H₂O) to balance airway protection with tracheal safety.

Choice C:

Suction the patient’s mouth frequently: Regular oropharyngeal suctioning helps remove accumulated secretions that could leak past the cuff or be aspirated when the patient is repositioned or the cuff deflates slightly.

Choice D:

Keep the ventilator tubing cleared of condensed water: While important for infection control and ventilator function, draining condensate from the tubing does not directly prevent aspiration.

Choice E:

Raise the head of the bed 30 to 45 degrees unless the patient is unstable: This semi-Fowler’s position minimizes the risk of aspiration by using gravity to keep gastric and oropharyngeal contents away from the airway. It’s a standard component of ventilator-associated pneumonia (VAP) prevention bundles.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 4:

Although the oxygen saturation is above 92%, an orally intubated, mechanically ventilated patient is restless and very anxious. What intervention should be used first to decrease the risk of accidental extubation?

A. Obtain an order and apply soft wrist restraints. B. Remind the patient that he needs the tube inserted to breathe. C. Administer sedatives and have a caregiver stay with the patient. D. Move the patient to an area close to the nurses’ station for closer observation.

Answer and Explanation

Choice A:

Obtain an order and apply soft wrist restraints: Restraints should be a last resort after sedation and close monitoring fail. Applying restraints first does not address anxiety, may increase agitation, and carries ethical considerations.

Choice B:

Remind the patient that he needs the tube inserted to breathe: Verbal reassurance alone is insufficient for a patient who is physiologically and psychologically distressed and may not fully comprehend due to sedation or confusion.

Choice C:

Administer sedatives and have a caregiver stay with the patient: Sedation decreases anxiety and restlessness, reducing the likelihood of self-extubation or tube displacement. A caregiver or nurse provides constant supervision, ensuring rapid intervention if the patient attempts to pull at the tube. This approach addresses the root cause of agitation while maintaining patient safety.

Choice D:

Move the patient to an area close to the nurses’ station for closer observation: While closer observation may help, it does not reduce agitation or prevent self-extubation by itself; sedation and continuous presence are more effective first-line interventions.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 5:

Which mode of ventilation is used with critically ill patients and allows the patient to self-regulate the rate and depth of spontaneous respirations but may also deliver a preset volume and frequency of breaths?

A. Assist-control ventilation (ACV) B. Pressure support ventilation (PSV) C. Pressure-controlled inverse ratio ventilation (PC-IRV) D. Synchronized intermittent mandatory ventilation (SIMV)

Answer and Explanation

Choice A:

Assist-control ventilation (ACV): Delivers a full ventilator-assisted breath for every patient-initiated or timed breath, minimizing spontaneous effort. The patient has less control over rate and depth.

Choice B:

Pressure support ventilation (PSV): Only provides pressure assistance for patient-initiated breaths. There are no mandatory breaths; it cannot deliver preset volume or frequency.

Choice C:

Pressure-controlled inverse ratio ventilation (PC-IRV): Used in severe ARDS to improve oxygenation by prolonging inspiratory time. It is a fully controlled mode, not allowing spontaneous regulation of rate and depth.

Choice D:

Synchronized intermittent mandatory ventilation (SIMV): In SIMV, the ventilator delivers a set number of mandatory breaths at a preset volume or pressure, synchronized with the patient’s spontaneous efforts. Between mandatory breaths, the patient can breathe spontaneously, controlling rate and tidal volume, which promotes respiratory muscle use and supports gradual weaning.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 6:

A patient in acute respiratory failure is receiving ACV with a positive end-expiratory pressure (PEEP) of 10 cm H₂O. What sign alerts the nurse to undesirable effects of increased airway and thoracic pressure?

A. Decreased blood pressure B. Decreased PaO₂ C. Increased crackles D. Decreased spontaneous respirations

Answer and Explanation

Choice A:

Decreased blood pressure: Elevated intrathoracic pressure from high PEEP reduces venous return to the heart, lowering cardiac output and causing hypotension. This is an important early indicator of PEEP-induced hemodynamic compromise that requires prompt assessment and adjustment of ventilator settings.

Choice B:

Decreased PaO₂: PEEP is designed to improve oxygenation; a decrease in PaO₂ usually indicates a problem with lung compliance, secretions, or oxygen delivery, not direct hemodynamic compromise from PEEP.

Choice C:

Increased crackles: Crackles suggest pulmonary edema or fluid overload, which is not an immediate or reliable indicator of high PEEP effects.

Choice D:

Decreased spontaneous respirations: In ACV, the ventilator delivers full breaths; spontaneous respirations are minimal or absent and do not indicate PEEP-related hemodynamic compromise.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 7:

What should the nurse recognize as a factor commonly responsible for sodium and fluid retention in the patient on mechanical ventilation?

A. Increased release of ADH B. Increased release of atrial natriuretic factor C. Increased insensible water loss via the airway D. Decreased renal perfusion with release of renin

Answer and Explanation

Choice A:

Increased release of ADH: Positive pressure ventilation decreases left atrial filling and cardiac output, triggering ADH secretion from the posterior pituitary. ADH increases water reabsorption in the kidneys, leading to fluid retention, mild hyponatremia, and potential edema, which are commonly observed in ventilated patients.

Choice B:

Increased release of atrial natriuretic factor: This hormone promotes sodium and water excretion, not retention. It is usually decreased in patients with positive pressure ventilation due to altered atrial stretch.

Choice C:

Increased insensible water loss via the airway: While mechanical ventilation can increase water loss from humidified gases, this results in fluid loss, not sodium and fluid retention.

Choice D:

Decreased renal perfusion with release of renin: Although renal hypoperfusion can trigger RAAS activation, ADH release is a more direct and consistent mechanism responsible for ventilation-related fluid retention.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 8:

A nurse is caring for a client who is experiencing respiratory distress. Which of the following are early clinical manifestations of hypoxemia? Select all that apply

A. Confusion B. Pale skin C. Bradycardia D. Hypotension E. Elevated blood pressure

Answer and Explanation

Choice A:

Confusion: The brain is highly sensitive to low oxygen levels. Early hypoxemia often presents with altered mental status, anxiety, or confusion before more obvious physical signs develop.

Choice B:

Pale skin: Peripheral vasoconstriction occurs to preserve blood flow to vital organs, leading to pallor as an early visible sign of decreased tissue oxygenation.

Choice C:

Bradycardia: Bradycardia is a late sign of hypoxemia, often occurring only after prolonged oxygen deprivation or severe hypoxia.

Choice D:

Hypotension: Hypotension is also a late manifestation, reflecting circulatory collapse after compensatory mechanisms fail.

Choice E:

Elevated blood pressure: The body initially compensates for hypoxemia by increasing sympathetic activity, causing tachycardia and elevated blood pressure to maintain tissue perfusion.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 9:

A nurse is orienting a newly licensed nurse on performing routine assessment of a client who is receiving mechanical ventilation via an endotracheal tube. Which of the following should the nurse include in the teaching?

A. Apply a vest restraint if self-extubation is attempted. B. Monitor ventilator settings every 8 hours. C. Document tube placement in centimeters at the angle of the jaw. D. Assess breath sounds every 1 to 2 hours.

Answer and Explanation

Choice A:

Apply a vest restraint if self-extubation is attempted: Restraints are used only as a last resort and not as part of routine assessment. Priority interventions should focus on sedation, monitoring, and safety precautions.

Choice B:

Monitor ventilator settings every 8 hours: Ventilator settings should be monitored continuously or at least every 1–2 hours, not only every 8 hours, to detect sudden changes in ventilation or patient-ventilator synchrony.

Choice C:

Document tube placement in centimeters at the angle of the jaw: ETT placement is typically documented at the lip or teeth, not the jaw, and should be checked frequently rather than once during orientation.

Choice D:

Assess breath sounds every 1 to 2 hours: Frequent auscultation helps detect unequal or absent breath sounds, which may indicate ETT displacement, mucus plugging, or lung collapse. This assessment is critical for ensuring adequate oxygenation and ventilation and should be part of routine care for all mechanically ventilated patients.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 10:

The purpose of adding PEEP to positive pressure ventilation is to:

A. Increase functional residual capacity and improve oxygenation. B. Increase FiO₂ in an attempt to wean the patient and avoid O₂ toxicity. C. Determine if the patient is in synchrony with the ventilator or needs to be paralyzed. D. Determine if the patient is able to be weaned and avoid the risk of pneumomediastinum.

Answer and Explanation

Choice A:

Increase functional residual capacity and improve oxygenation: PEEP maintains alveolar patency, preventing atelectasis and improving gas exchange. By increasing FRC, more alveoli participate in oxygenation, which enhances PaO₂ and overall tissue oxygen delivery.

Choice B:

Increase FiO₂ in an attempt to wean the patient and avoid O₂ toxicity: FiO₂ is the fraction of inspired oxygen delivered, not affected by PEEP. PEEP improves oxygenation mechanically without altering FiO₂.

Choice C:

Determine if the patient is in synchrony with the ventilator or needs to be paralyzed: Ventilator synchrony is assessed through patient comfort, respiratory effort, and waveforms, not PEEP.

Choice D:

Determine if the patient is able to be weaned and avoid the risk of pneumomediastinum: PEEP is not a weaning tool. Excessive PEEP can increase the risk of barotrauma, including pneumomediastinum, rather than prevent it.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 11:

The nursing management of a patient with an artificial airway includes:

A. Maintaining ET tube cuff pressure at 30 cm H₂O. B. Routine suctioning of the tube at least every 2 hours. C. Observing for cardiac dysrhythmias during suctioning. D. Preventing tube dislodgment by limiting mouth care to lubrication of the lips.

Answer and Explanation

Choice A:

Maintaining ET tube cuff pressure at 30 cm H₂O: Recommended cuff pressure is generally 20–25 cm H₂O to prevent tracheal injury while ensuring a seal; 30 cm H₂O is too high and increases the risk of tracheal necrosis.

Choice B:

Routine suctioning of the tube at least every 2 hours: Suctioning should be performed as needed based on secretions, breath sounds, and patient tolerance, not routinely on a fixed schedule, to reduce mucosal trauma and hypoxemia.

Choice C:

Observing for cardiac dysrhythmias during suctioning: Suctioning an ET or tracheostomy tube can cause vagal stimulation, hypoxemia, or irritation of the myocardium, leading to bradycardia, PVCs, or other dysrhythmias. Continuous cardiac monitoring and pulse oximetry during suctioning allows for prompt recognition and intervention if complications occur.

Choice D:

Preventing tube dislodgment by limiting mouth care to lubrication of the lips: Proper oral hygiene and tube stabilization are necessary to prevent infection and accidental extubation. Limiting care to lip lubrication does not adequately protect the airway.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 12:

The nurse monitors the patient with positive pressure mechanical ventilation for:

A. Paralytic ileus because pressure on the abdominal contents affects bowel motility. B. Diuresis and sodium depletion because of increased release of atrial natriuretic peptide. C. Signs of cardiovascular insufficiency because pressure in the chest impedes venous return. D. Respiratory acidosis in a patient with COPD because of alveolar hyperventilation and increased PaO₂ levels.

Answer and Explanation

Choice A:

Paralytic ileus because pressure on the abdominal contents affects bowel motility: While critically ill patients may develop ileus, it is not directly caused by positive pressure ventilation.

Choice B:

Diuresis and sodium depletion because of increased release of atrial natriuretic peptide: Positive pressure ventilation actually stimulates ADH release, leading to fluid retention, not sodium depletion.

Choice C:

Signs of cardiovascular insufficiency because pressure in the chest impedes venous return: Positive pressure ventilation increases intrathoracic pressure, which decreases venous return to the right atrium, leading to reduced stroke volume and cardiac output. Monitoring blood pressure, heart rate, urine output, and perfusion is essential to detect cardiovascular compromise early.

Choice D:

Respiratory acidosis in a patient with COPD because of alveolar hyperventilation and increased PaO₂ levels: Respiratory acidosis occurs with hypoventilation, not hyperventilation. Alveolar hyperventilation lowers PaCO₂ and increases PaO₂, which does not cause acidosis.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 13:

A patient on mechanical ventilation suddenly triggers a high-pressure alarm. Which of the following should the nurse assess first?

A. The patient’s airway for secretions or kinking B. The ventilator’s tubing connections C. The humidifier water level D. The patient’s urine output in the past hour

Answer and Explanation

Choice A:

The patient’s airway for secretions or kinking: Obstruction in the airway is the most common cause of a high-pressure alarm. Rapid assessment and intervention, such as suctioning or repositioning the ET tube, can restore ventilation and prevent hypoxia. Immediate patient assessment is priority over equipment checks.

Choice B:

The ventilator’s tubing connections: Loose or disconnected tubing usually triggers a low-pressure alarm, not high-pressure. While checking equipment is important, it is secondary to assessing the patient.

Choice C:

The humidifier water level: Low or high water in the humidifier may affect humidification but is unlikely to trigger a high-pressure alarm.

Choice D:

The patient’s urine output in the past hour: Urine output is unrelated to ventilator pressure alarms and is not an immediate concern in this context.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 14:

The nurse is caring for a patient who is being weaned from mechanical ventilation. Which finding indicates that the patient is not yet ready for extubation?

A. Vital capacity of 12 mL/kg and strong cough reflex B. Respiratory rate of 36 breaths/min and shallow respirations C. Oxygen saturation consistently above 94% on FiO₂ 0.4 D. Negative inspiratory force (NIF) of −30 cm H₂O

Answer and Explanation

Choice A:

Vital capacity of 12 mL/kg and strong cough reflex: Adequate vital capacity and a strong cough indicate the patient has sufficient lung expansion and airway clearance ability, supporting readiness for extubation.

Choice B:

Respiratory rate of 36 breaths/min and shallow respirations: A rapid, shallow breathing pattern reflects increased work of breathing and fatigue. This is a sign of poor ventilatory reserve, indicating the patient may fail extubation if removed from the ventilator prematurely.

Choice C:

Oxygen saturation consistently above 94% on FiO₂ 0.4: Adequate oxygenation on moderate FiO₂ suggests the patient can maintain sufficient gas exchange without high ventilatory support.

Choice D:

Negative inspiratory force (NIF) of −30 cm H₂O: NIF values more negative than −20 cm H₂O indicate adequate respiratory muscle strength for spontaneous breathing.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 15:

A patient receiving assist-control ventilation develops respiratory alkalosis on the latest arterial blood gas (ABG) results. What adjustment should the nurse anticipate the provider will make?

A. Decrease the ventilator rate B. Increase the FiO₂ level C. Increase the tidal volume D. Add positive end-expiratory pressure (PEEP)

Answer and Explanation

Choice A:

Decrease the ventilator rate: Lowering the respiratory rate reduces minute ventilation, allowing PaCO₂ to rise and correcting respiratory alkalosis. This adjustment directly targets the cause of excessive alveolar ventilation.

Choice B:

Increase the FiO₂ level: FiO₂ affects oxygenation, not CO₂ elimination. Increasing FiO₂ does not correct alkalosis caused by hyperventilation.

Choice C:

Increase the tidal volume: Increasing tidal volume would further increase CO₂ elimination, worsening respiratory alkalosis rather than correcting it.

Choice D:

Add positive end-expiratory pressure (PEEP): PEEP improves oxygenation and alveolar recruitment, but it does not correct PaCO₂ or respiratory alkalosis.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 16:

During endotracheal intubation, the nurse’s priority action to confirm correct tube placement immediately after insertion is to:

A. Obtain a chest X-ray B. Assess bilateral breath sounds and observe for symmetrical chest rise C. Check the patient’s oxygen saturation after 10 minutes D. Inflate the cuff and secure the tube

Answer and Explanation

Choice A:

Obtain a chest X-ray: A chest X-ray is the gold standard for confirming tube depth but is not immediate. Initial verification must be done at the bedside before ventilating.

Choice B:

Assess bilateral breath sounds and observe for symmetrical chest rise: Auscultation of both lungs and observation of chest movement immediately confirm tracheal placement. Absence of breath sounds on one side may indicate mainstem bronchus intubation, and absent breath sounds bilaterally suggests esophageal placement, both of which require immediate correction.

Choice C:

Check the patient’s oxygen saturation after 10 minutes: Waiting 10 minutes delays recognition of malposition, risking hypoxia. Immediate assessment is required.

Choice D:

Inflate the cuff and secure the tube: While necessary for stabilizing the airway, cuff inflation alone does not confirm correct tracheal placement.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 17:

The nurse is caring for a patient with an endotracheal tube. Which of the following findings requires immediate intervention?

A. Cuff pressure of 20 cm H₂O B. Absence of condensation in the ventilator tubing C. Small amount of oral secretions present D. Oxygen saturation of 95% on 40% FiO₂

Answer and Explanation

Choice A:

Cuff pressure of 20 cm H₂O: This is within the recommended safe range (20–25 cm H₂O) to prevent air leaks while minimizing tracheal injury.

Choice B:

Absence of condensation in the ventilator tubing: Condensation is a normal indicator of humidified gas flow during mechanical ventilation. A sudden absence may signal tube obstruction, disconnection, or ventilator malfunction, which can lead to rapid hypoxia. Immediate assessment and correction are necessary.

Choice C:

Small amount of oral secretions present: This is expected in patients with an ET tube and is managed with routine suctioning.

Choice D:

Oxygen saturation of 95% on 40% FiO₂: This indicates adequate oxygenation and does not require immediate action.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Sign Up or Login to view all the 17 Questions on this Exam

Join over 100,000+ nursing students using Naxlex’s science-backend flashcards, practice tests and expert solutions to improve their grades and reach their goals.

Exam Review

Comprehensive Questions Share this Share This Link Share on social media Facebook Messager WhatsApp Share URL Copy Close

Total Questions : 17

Sign Up or Login to view all the 17 Questions on this Exam

Comprehensive Questions

Share This Link

Share on social media

Facebook

Messager

WhatsApp

Share URL
Copy