Exam 3 NSG 229 Application Day

A nurse is caring for a patient requiring Positive Pressure Ventilation (PPV). The client is fighting the ventilator. Which intervention by the nurse is MOST appropriate?

• Place the client in prone position

• Notify respiratory therapy & anticipate a ventilator setting change

• Prepare to administer aminophylline

• Assess the patient for cause of ventilator asynchrony

Answer explanation

You should always assess your patient and gather data to determine next course of action. Page 561 Analgesia and sedation

A nurse hears the low-pressure limit alarm on a client requiring mechanical ventilation. Which action should the nurse take?

• Silence the alarm and restart the ventilator

• Increase the tidal volume being delivered to the client

• Check the ventilator tubing for disconnections

• Allow patient to stop coughing and auscultate lung sounds

Answer explanation

Table 28.13 Understand the causes of high pressure and low pressure alarms and how to troubleshoot each.

Which of the following statement accurately describes positive-end-expiratory-pressure?

• Used to prevent lung damage for a client being mechanically ventilated

• The maximal pressure the ventilator can generate to deliver the tidal volume

• Prevents alveolar collapse and restores previously collapsed alevoli

• Provides pressure during spontaneous inspiration

Answer explanation

Positive end-expiratory pressure (PEEP) is a ventilator setting in which positive pressure is applied to the airway during exhalation. During exhalation, airway pressure normally drops to near 0. Exhalation occurs passively. With PEEP, exhalation remains passive, but pressure falls to the preset PEEP level, often set between 5 to 10 cm H2O. PEEP increases FRC and often improves oxygenation by restoring the lung volume that normally remains at the end of passive exhalation. The mechanisms by which PEEP increases FRC and oxygenation include splinting open of previously collapsed alveoli (increasing the opportunity for O2 and CO2 to diffuse across the alveolar capillary membrane) and preventing alveolar collapse throughout the respiratory cycle.

Which of the following statements regarding chest tube drainage systems are true? Select All That Apply.

• A small amount of subcutaneous emphysema at the insertion stie is normal immediately following tube insertion

• The drainage system should remain on the bedside table to avoid overturning

• Bubbling in the water-seal changer is expected

• The amount of suction is always controlled by the wall suction settings

• Tidaling will gradually stop when the lung re-expands

Answer explanation

Table 28.6 Understand the normal findings associated with chest tube insertion, how to delegate tasks to UAP with chest tube care, the different chambers, normal findings within those chambers, and expectations for chest tube removal.

A patient with a chest tube has had an accidental disconnection. Which of the following action is considered priority?

• Clamp the drainage tube

• Place the distal end of tube in sterile water

• Replace the drainage system

• Lay patient flat and assist them onto their left side

Answer explanation

Maintaining water seal and pressure are priority with disconnections. Make sure to review safety and management of chest tube.

The classic sign of flail chest is __________

Answer explanation

Understand the meaning of paradoxical chest movement along with how to properly identify and care for flail chest

A patient is being seen in the emergency department for a penetrating chest wound. Which of the following actions is contraindicated?

• Stabilize the foreign object

• If tolerated, place patient in semi-fowlers position to assist with breathing

• Remove the foreign object and place an occlusive dressing over wound

• Assess for life-threatening injuries

Answer explanation

Understand the difference between blunt and penetrating trauma and proper steps of care. Table 30.17

What size syringe should the nurse use when administering medications via central venous access devices?

Answer explanation

Only 10mL syringes should be used with any central venous access device due to amount of pressure being placed on the line. Refer to ATI skill module for questions related to CVC.

Which information will the nurse include in the teaching plan for a patient newly diagnosed with asthma?

• Ipratropium is a 1st line medication for use in long-term treatment

• How to complete a peak flow & use results to guide treatment

• Inhale slowly and deeply when using a dry powder inhaler (DPI)

• Hold your breath for 5 seconds after using bronchodilator inhaler

Answer explanation

•Peak flows are used to determine green, yellow, or red status and will guide best actions.

It is important to understand how to perform peak flows, proper instruction on use of MDI and DPI, and understanding the difference between the two.

The nurse is completing an admission history on a patient with asthma how has new onset wheezing and shortness of breath. Which information may indicate a need for changes to therapy?

• The patient has chronic inflammatory bowel disease

• The patient has a history of pneumonia 6 months ago

• The patient takes propranolol for hypertension

• The patient takes acetaminophen for headaches

Answer explanation

Beta blockers can cause bronchospasm in patients with asthma.