WorksheetsARDS / Mechanical Ventilation
Total questions: 20
Worksheet time: 40mins
You are an RN in the ICU and hear a high pressure alarm coming from an intubated patient. The monitor shows increased PIP, PaO2 75, & PaCO2 49. Upon assessment, the patient is displaying decreased breath sounds & unequal chest excursion. What priority intervention should occur next?
Call a code & stay with the patient
Call the physician & prepare for chest tube insertion
Perform manual ventilation with an ambu bag
Turn down vent settings & call the physician
Disconnect the patient from the vent
What equipment is needed for intubation? (9)
(a)
A patient that was previously on an assist/control (A/C) vent mode has now been switched to SIMV. The patient is alert, has an O2 sat that has risen to 70%, a RR of 31 with normal breath sounds, & has a normal sinus rhythm. What order does the nurse anticipate the MD will make next?
Switch the patient to A/C mode
Decrease the ventilation rate for more spontaneous breaths
Order a new set of ABGs
Have the RT attach the patient to a CPAP adjunct to the vent
Which of the following patients would be the best candidate for PEEP?
Heart failure patient with decreased lung compliance
An ARDS patient at 70% FiO2
A covid patient with an EF of 24%
An ARF patient that needs more hemodynamic stability
List the 5 components of the VAP bundle.
(a)
A patient with a history of COPD is receiving oxygen via nasal cannula at 6 L/min. ABG results are as follows: pH 7.28, PaCO2 60 mm Hg, PaO2 51 mm Hg, HCO3 18 mEq/L. Which priority intervention is indicated?
Place the patient on a simple mask at 40% FiO2
Intubate & place on mechanical ventilation
Place the patient on BiPAP
Place the patient on a non-rebreather mask
A client with acute respiratory distress syndrome (ARDS) is on a ventilator. The client’s peak inspiratory pressures and spontaneous respiratory rate are increasing, and the PO2 is not improving. Using SBAR, the nurse calls the physician with the recommendation for:
Initiation IV sedation
Starting a high-protein diet
Providing pain medication
Increasing the ventilator rate
List 5 parameters that would indicate the patient may be ready for weaning.
(a)
Which of the following modes of ventilation may be used to help strengthen the client's respiratory muscles?
Synchronized intermittent mechanical ventilation (SIMV)
Pressure support ventilation (PSV)
High frequency oscillation ventilation (HFOV)
Assist / Control ventilation (A/C)
Name 4 risk factors that put the patient at risk for ventilator-associated pneumonia.
(a)
When planning care for a patient on a mechanical ventilator, the nurse understands that the application of positive end-expiratory pressure (PEEP) to the ventilator settings has which therapeutic effect?
Increased inflation of the lungs
Prevention of barotrauma to the lung tissue
Prevention of alveolar collapse during expiration
Increased fraction of inspired oxygen concentration (FIO2) administration
List at least 3 additional interventions to the VAP bundle to help prevent VAP.
(a)
To detect ventilator-related hemodynamic complications in a client receiving mechanical ventilation set with a high tidal volume and a high PEEP, the nurse assesses the client for…
Vitals q 4 hours with urine output
A decreased respiratory rate and tachycardia
Low blood pressure and low urine output
Bibasilar crackles and low O2 sat
The nurse receives orders to administer vecuronium, a neuromuscular agent, to an ARDS patient that has just recently been intubated. What does the nurse understand is true concerning this medication? Select all that apply.
A sedative must be given immediately after the administration of a neuromuscular agent
This medication will improve patient-ventilator synchronization & decrease hypoxemia
Eye care will be needed with this medication
The patient can only be disconnected from the vent while on this medication while the RT is present
Pain should be anticipated after administration
A patient in respiratory failure is on a ventilator. The mode is Assist control (A/C) with a rate of 10, tidal volume of 600 mL, & FiO2 40%. ABG results are as follows: pH 7.30, PaCO2 51, HCO3 26, PaO2 90. The nurse would expect the physician to make which adjustment to the ventilator settings?
Add positive end-expiratory pressure
Add pressure support
Increase the respiratory rate
Change the mode to SIMV
The nurse has placed the intubated client with acute respiratory distress syndrome (ARDS) in prone position for 30 minutes. Which of the following would require the nurse to discontinue prone positioning and return the client to the supine position? Select all that apply.
The family is coming in to visit
The client has increased secretions requiring frequent suctioning
The SpO2 and PO2 have decreased
The client is tachycardia with drop in blood pressure
The face has increased skin breakdown and edema
The nurse is going through the last of her weaning parameter assessments for an intubated patient. Upon the RT slowly deflating the ET cuff, passing air can be heard. What is the nurse’s next priority action?
This indicates an air leak, the nurse should then give solumedrol IVP
This indicates an edematous airway, which is a normal finding & weaning can be started
This indicates an air leak, which the nurse understand as a positive sign to continue the weaning process
This indicates the patient is at risk for airway collapse & the cuff needs to be re-inflated immediately
What is the priority nursing diagnosis for a patient with ARDS?
(a)
The nurse hears the low pressure alarm coming from the patient’s mechanical ventilator. What should the nurse assess to find the cause of the alarm? Select all that apply.
Assess for disconnection of the ET tube
Auscultate for passing of air at the tracheal cuff
Assess for kinks or water in tubing
Assess for secretion build up
Assess if patient has recently coughed
A patient with ARDS is intubated and placed on mechanical ventilation. The ventilator settings include PEEP of 15 cm of H2O. The nurse realizes some of the reasons PEEP is useful in the treatment of ARDS includes... (Select all that apply)
Improves the client's cardiac output
Allows more time for gas exchange to occur
Decreases the intrathoracic pressure
It lengthens the end of expiration to keep alveoli open longer
Usually improves hypoxia
