CHAMBERLAIN COLLEGE OF NURSING: COMPLEX CRITICAL NURSING 341 TEST 1. 100% correct

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Ch 9 1. A patient has coronary artery bypass graft surgery and is transported to the surgical intensive care unit at noon. He is placed on mechanical ventilation. Interpret his initial arterial bloo... d gas levels: pH 7.31 PaCO2 48 mm Hg Bicarbonate 22 mEq/L PaO2 115 mm Hg O2 saturation 99% a. Normal arterial blood gas levels with a high oxygen level b. Partly compensated respiratory acidosis, normal oxygen c. Uncompensated metabolic acidosis with high oxygen levels d. Uncompensated respiratory acidosis; hyperoxygenated The high PaO2 level reflects hyperoxygenation; the PaCO2 and pH levels show respiratory acidosis. The respiratory acidosis is uncompensated as indicated by a pH of 7.31 (acidosis) and a normal bicarbonate level. No metabolic compensation has occurred. DIF: Cognitive Level: Analysis REF: pp. 178-179 | Box 9-2 | Box 9-3 OBJ: Describe methods for assessing the respiratory system, including physical assessment, interpretation of arterial blood gases, and noninvasive techniques. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 2. The physician orders the following mechanical ventilation settings for a patient who weighs 75 kg. The patient’s spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO2: 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H2O a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis Assist/control ventilation may result in respiratory alkalosis, especially when the patient is breathing at a high rate. Each time the patient initiates a spontaneous breath—in this case 22 times per minute—the ventilator will deliver 600 mL of volume. DIF: Cognitive Level: Analysis REF: p. 197 OBJ: Relate complications associated with mechanical ventilation. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 3. A patient’s ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from .60 to .70, and the positive end-expiratory pressure is increased from 10 to 15 cm H2O. Shortly after these adjustments, the nurse notes that the patient’s blood pressure drops from 120/76 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in blood pressure? a. Decrease in cardiac output b. Hypovolemia c. Increase in venous return d. Oxygen toxicity Positive end-expiratory pressure increases intrathoracic pressure and may result in decreased venous return. Cardiac output decreases as a result, and is reflected in the lower blood pressure. It is essential to assess the patient to identify optimal positive end-expiratory pressure—the highest amount that can be applied without compromising cardiac output. Although hypovolemia can result in a decrease in blood pressure, there is no indication that this patient has hypovolemia. As noted, higher levels of positive end-expiratory pressure may cause a decrease, not an increase, in venous return. Oxygen toxicity can occur in this case secondary to the high levels of oxygen needed to maintain gas exchange; however, oxygen toxicity is manifested in damage to the alveoli. DIF: Cognitive Level: Analysis REF: p. 196 OBJ: Relate complications associated with mechanical ventilation. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 4. The nurse is caring for a patient with an endotracheal tube. The nurse understands that endotracheal suctioning is needed to facilitate removal of secretions and that the procedure: a. decreases intracranial pressure. b. depresses the cough reflex. c. is done as indicated by patient assessment. d. is more effective if preceded by saline instillation to loosen secretions. Suctioning is performed as indicated by patient’s assessment. Suctioning is associated with increases in intracranial pressure; therefore, it is important to hyperoxygenate the patient prior to suctioning to reduce this complication. Suctioning can stimulate the cough reflex rather than depress this reflex. Saline instillation is associated with negative physiological outcomes and is not recommended as part of the suctioning procedure; it does not loosen secretions, which is a common misperception. DIF: Cognitive Level: Comprehension REF: p. 193 | Box 9-7 | Nursing Care Plan OBJ: Discuss methods for maintaining an open airway. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 5. A 65-year-old patient is admitted to the progressive care unit with a diagnosis of community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease and diabetes. A set of arterial blood gases obtained on admission without supplemental oxygen shows pH 7.35; PaCO2 55 mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. These blood gases reflect: a. hypoxemia and compensated metabolic alkalosis. b. hypoxemia and compensated respiratory acidosis. c. normal oxygenation and partly compensated metabolic alkalosis. d. normal oxygenation and uncompensated respiratory acidosis. The PaO2 of 65 mm Hg is lower than normal range (80-100 mm Hg), indicating hypoxemia. The high PaCO2 indicates respiratory acidosis. The elevated bicarbonate indicates metabolic alkalosis. Because the pH is normal, the underlying acid-base alteration is compensated. Given the patient’s history of chronic pulmonary disease and a pH that is at the lower end of normal range, it can be determined that this patient is hypoxemic with fully compensated respiratory acidosis. DIF: Cognitive Level: Analysis REF: pp. 181-182 | Box 9-2 | Box 9-3 OBJ: Describe methods for assessing the respiratory system, including physical assessment, interpretation of arterial blood gases, and noninvasive techniques. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 6. A patient’s status worsens and needs mechanical ventilation. The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously in between the mechanical breaths at his own tidal volume. This mode of ventilation is called: a. assist/control ventilation b. controlled ventilation c. intermittent mandatory ventilation d. positive end-expiratory pressure The intermittent mandatory ventilation mode allows the patient to breathe spontaneously between breaths. The patient will receive a preset tidal volume at a preset rate. Any additional breaths that he initiates will be at his spontaneous tidal volume, which will likely be lower than the ventilator breaths. In assist/control ventilation, spontaneous effort results in a preset tidal volume delivered by the ventilator. Spontaneous effort during controlled ventilation results in patient/ventilator dyssynchrony. Positive end-expiratory pressure (PEEP) is application of positive pressure to breaths delivered by the ventilator. PEEP is an adjunct to both intermittent mandatory and assist/control ventilation. DIF: Cognitive Level: Application REF: p. 198 OBJ: Describe types and modes of mechanical ventilation. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 7. A patient’s endotracheal tube is not secured tightly. The respiratory care practitioner assists the nurse in taping the tube. After the tube is retaped, the nurse auscultates the patient’s lungs and notes that the breath sounds over the left lung fields are absent. The nurse suspects that: a. the endotracheal tube is in the right mainstem bronchus. b. the patient has a left pneumothorax. c. the patient has aspirated secretions during the procedure. d. the stethoscope earpiece is clogged with wax. The endotracheal tube can become dislodged during repositioning and is likely in the right mainstem bronchus. It is important to reassess breath sounds after the retaping procedure. A pneumothorax would also result in diminished or absent breath sounds; however, it is not associated with repositioning the endotracheal tube. Aspiration may occur during the procedure but would be manifested in changes in chest x-ray, hypoxemia, etc. The stethoscope is not a factor. DIF: Cognitive Level: Analysis REF: p. 193 | Box 9-7 | Nursing Care Plan OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 8. A mode of pressure-targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through the endotracheal tube is: a. continuous positive airway pressure. b. positive end-expiratory pressure. c. pressure support ventilation. d. T-piece adapter. Pressure support (PS) is a mode of ventilation in which the patient’s spontaneous respiratory activity is augmented by the delivery of a preset amount of inspiratory positive pressure. Positive end-expiratory pressure provides positive pressure at end expiration during mechanical breaths, and continuous positive airway pressure provides positive pressure during spontaneous breaths. The T-piece adapter is used to provide oxygen with spontaneous, unassisted breaths. DIF: Cognitive Level: Comprehension REF: pp. 199-200 OBJ: Describe types and modes of mechanical ventilation. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 9. Neuromuscular blocking agents are used in the management of some ventilated patients. Their primary mode of action is: a. analgesia. b. anticonvulsant. c. paralysis. d. sedation. Neuromuscular blocking agents cause respiratory muscle paralysis. They do not have sedative, analgesic, or anticonvulsant effects. DIF: Cognitive Level: Comprehension REF: pp. 212-213 OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 10. One of the early signs of the effect of hypoxemia on the nervous system is: a. cyanosis. b. restlessness. c. tachycardia. d. tachypnea. Decreased oxygenation to the nervous system may result in restlessness and agitation—early signs of hypoxemia. Cyanosis is a late sign. Tachycardia and tachypnea may occur, but CNS changes tend to occur earlier. DIF: Cognitive Level: Comprehension REF: p. 179 | Box 9-1 OBJ: Review the anatomy and physiology of the respiratory system. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 11. The amount of effort needed to maintain a given level of ventilation is termed: a. compliance. b. resistance. c. tidal volume. d. work of breathing. Work of breathing is the amount of effort needed to maintain a given level of ventilation. Compliance is a measure of the distensibility, or stretchability, of the lung and chest wall. Resistance refers to the opposition to the flow of gases in the airways. Tidal volume is the volume of air in a typical breath. DIF: Cognitive Level: Comprehension REF: p. 173 OBJ: Review the anatomy and physiology of the respiratory system. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 12. Which of the following devices is best suited to deliver 65% oxygen to a patient who is spontaneously breathing? a. Face mask with non-rebreathing reservoir b. Low-flow nasal cannula c. Simple face mask d. Venturi mask Face masks with reservoirs (partial rebreathing and non-rebreathing reservoir masks) provide oxygen concentration of 60% or higher. The addition of the reservoir increases the amount of oxygen available to the patient during inspiration and allows for the delivery of concentrations of 35% to 60% (partial rebreather) or 60% to 80% (non-rebreather) depending on the flowmeter setting, the fit of the mask, and the patient’s respiratory pattern. The high-flow nasal cannula, not the traditional low-flow models, can provide higher flows. The simple face mask can deliver flows up to 60%. The Venturi mask allows better regulation of oxygen concentration and generally does not deliver more than 60% oxygen. DIF: Cognitive Level: Comprehension REF: pp. 183-184 OBJ: Compare commonly used oxygen delivery devices. TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 13. A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives a dose of morphine sulfate, and his respirations decrease to 4 breaths/min. Which acid-base disturbance will likely occur? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis The morphine caused respiratory depression. As a result, the frequency and depth of respiration is compromised, which can lead to respiratory acidosis. DIF: Cognitive Level: Application REF: p. 198 | Box 9-2 OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 14. A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives a dose of morphine sulfate, and his respirations decrease to 4 breaths/min. What adjustments may need to be made to the patient’s ventilator settings? a. Add positive end-expiratory pressure (PEEP). b. Add pressure support. c. Change to assist/control ventilation at a rate of 4 breaths/min. d. Increase the synchronized intermittent mandatory ventilation respiratory rate. The morphine caused respiratory depression. As a result, the frequency and depth of respiration is compromised, which can lead to respiratory acidosis. The respiratory rate on the mechanical ventilator needs to be increased. The patient also may need to have naloxone administered to reverse the effects of the morphine. PEEP is added to improve oxygenation; it does not increase the rate or depth of respirations. Pressure support will not be effective in increasing the rate of spontaneous respiration. Changing to assist/control ventilation is an option; however, the rate needs to be set higher than 4 breaths/min. DIF: Cognitive Level: Analysis REF: pp. 204-207, 212 | Box 9-2 OBJ: Relate complications associated with mechanical ventilation. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 15. Current guidelines recommend the oral route for endotracheal intubation. The rationale for this recommendation is that nasotracheal intubation is associated with a greater risk for: a. basilar skull fracture. b. cervical hyperextension. c. impaired ability to “mouth” words. d. sinusitis and infection. Nasotracheal intubation is associated with an increased risk for sinusitis, which may contribute to ventilator-associated infection. Nasal intubation is contraindicated in patients with basilar skull fracture. The procedure is sometimes performed in patients with cervical spine injury; the procedure can be done without hyperextending the neck. Patients with nasotracheal tubes are generally more comfortable and have a greater ability to “mouth words.” DIF: Cognitive Level: Comprehension REF: p. 187 | Box 9-6 OBJ: Discuss methods for maintaining an open airway. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 16. Oxygen saturation (SaO2) represents: a. alveolar oxygen tension. b. oxygen that is chemically combined with hemoglobin. c. oxygen that is physically dissolved in plasma. d. total oxygen consumption. Oxygen saturation value reflects the saturation of the hemoglobin. DIF: Cognitive Level: Knowledge REF: p. 178 OBJ: Review the anatomy and physiology of the respiratory system. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 17. Pulse oximetry measures: a. arterial blood gases. b. hemoglobin values. c. oxygen consumption. d. oxygen saturation. Pulse oximetry measures oxygen saturation in the peripheral tissues. It does not measure arterial blood gases, but it does estimate the PaO2 that is obtained via a blood gas analysis. It does not measure hemoglobin levels or oxygen consumption. DIF: Cognitive Level: Comprehension REF: p. 182 OBJ: Describe methods for assessing the respiratory system, including physical assessment, interpretation of arterial blood gases, and noninvasive techniques. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 18. A PaCO2 of 48 mm Hg is associated with: a. hyperventilation. b. hypoventilation. c. increased absorption of O2. d. increased excretion of HCO3. PaCO2 rises in patients with hypoventilation. Hyperventilation results in a decrease in PaCO2.PaCO2 does not affect oxygen absorption. Increased excretion of bicarbonate would result in metabolic acidosis. DIF: Cognitive Level: Application REF: p. 180 OBJ: Review the anatomy and physiology of the respiratory system. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 19. The nurse notes that the patient’s arterial blood gas levels indicate hypoxemia. The patient is not intubated and has a respiratory rate of 22 breaths/min. The nurse’s first intervention to relieve hypoxemia is to: a. call the physician for an emergency intubation procedure. b. obtain an order for bilevel positive airway pressure (BiPAP). c. notify the provider of values and obtain order for oxygen. d. suction secretions from the oropharynx. Oxygen is administered to treat or prevent hypoxemia. Oxygen should be considered a first-line treatment in cases of hypoxemia. Emergency intubation is not warranted at this time. BiPAP may be considered if administration of supplemental oxygen does not correct the hypoxemia. There is no indication that the patient requires suctioning. DIF: Cognitive Level: Analysis REF: p. 183 OBJ: Describe methods for assessing the respiratory system, including physical assessment, interpretation of arterial blood gases, and noninvasive techniques. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 20. A patient presents to the emergency department demonstrating agitation and complaining of numbness and tingling in his fingers. His arterial blood gas levels reveal the following: pH 7.51, PaCO2 25, HCO3 25. The nurse interprets these blood gas values as: a. compensated metabolic alkalosis. b. normal values. c. uncompensated respiratory acidosis. d. uncompensated respiratory alkalosis. The low PaCO2 and high pH values show respiratory alkalosis. The bicarbonate level is normal. DIF: Cognitive Level: Analysis REF: pp. 181-182 | Table 9-3 OBJ: Describe methods for assessing the respiratory system, including physical assessment, interpretation of arterial blood gases, and noninvasive techniques. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 21. Positive end-expiratory pressure (PEEP) is a mode of ventilatory assistance that produces the following condition: a. Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume. b. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient’s ability to generate negative pressure. c. The patient must have a respiratory drive, or no breaths will be delivered. d. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O. PEEP is the addition of positive pressure into the airways during expiration. PEEP is measured in centimeters of water. DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: Describe types and modes of mechanical ventilation. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 22. The nurse is caring for a patient who is mechanically ventilated. As part of the nursing care, the nurse understands that: a. communication with intubated patients is often difficult. b. controlled ventilation is the preferred mode for most patients. c. patients with chronic obstructive pulmonary disease wean easily from mechanical ventilation. d. wrist restraints are applied to all patients to avoid self-extubation. Communication difficulties are common because of the artificial airway. Restraints must be determined individually. Patients with chronic obstructive pulmonary disease often have difficulty weaning. Synchronized intermittent mandatory ventilation and assist/control ventilation are the commonly used modes. DIF: Cognitive Level: Application REF: p. 212 | Nursing Care Plan OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 23. A patient is having difficulty weaning from mechanical ventilation. The nurse assesses the patient for a potential cause of this difficult weaning, which includes: a. cardiac output of 6 L/min. b. hemoglobin of 8 g/dL. c. negative sputum culture and sensitivity. d. white blood cell count of 8000. The low hemoglobin level will decrease oxygen-carrying capacity and may make weaning difficult. A cardiac output of 6 L/min is normal. A negative sputum culture indicates absence of lower respiratory infection, which should promote rather than hinder weaning. A white blood cell count of 8000 is normal and indicates absence of infection, which should promote rather than hinder weaning. DIF: Cognitive Level: Analysis REF: pp. 213-215 OBJ: Explain methods for weaning patients from mechanical ventilation. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 24. A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery with the following arterial blood gas (ABG) levels. What is the nurse’s interpretation of these values? pH 7.4 PaCO2 40 mm Hg Bicarbonate 24 mEq/L PaO2 95 mm Hg O2 saturation 97% Respirations 20 breaths per minute a. Compensated metabolic acidosis b. Metabolic alkalosis c. Normal ABG values d. Respiratory acidosis These are normal values. All parameters are within normal limits. DIF: Cognitive Level: Analysis REF: p. 181 | Table 9-3 OBJ: Describe methods for assessing the respiratory system, including physical assessment, interpretation of arterial blood gases, and noninvasive techniques. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 25. A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital signs and normal arterial blood gases (ABGs), and is placed on a T-piece for ventilatory weaning. During the nurse’s 7 PM (1900) assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretions. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. How does the nurse interpret the following blood gas levels? pH 7.28 PaCO2 46 mm Hg Bicarbonate 22 mEq/L PaO2 58 mm Hg O2 saturation 88% a. Hypoxemia and compensated respiratory alkalosis b. Hypoxemia and uncompensated respiratory acidosis c. Normal arterial blood gas levels d. Normal oxygen level and partially compensated metabolic acidosis These levels show respiratory acidosis. The bicarbonate is normal; therefore, no compensation has occurred. This patient is also hypoxemic. DIF: Cognitive Level: Analysis REF: p. 181 | Table 9-3 OBJ: Describe methods for assessing the respiratory system, including physical assessment, interpretation of arterial blood gases, and noninvasive techniques. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 26. A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital signs and normal arterial blood gases (ABGs) and is placed on a T-piece for ventilatory weaning. During the nurse’s 7 PM (1900) assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretions. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. In communicating with the physician, which statement indicates the nurse understands what is likely occurring with the patient? a. “May we have an order for cardiac enzymes? This patient is exhibiting signs of a myocardial infarction.” b. “My assessment indicates potential fluid overload.” c. “The patient is having frequent PVCs that are compromising the cardiac output.” d. “The patient is having a hypertensive crisis; what medications would you like to order?” The crackles, high pulmonary artery pressure, and pink, frothy sputum indicate fluid volume overload. There are not any cues to suggest a myocardial infarction. The PVCs may be related to the surgery or hypoxemia; however, the blood pressure indicates adequate perfusion. The blood pressure is high secondary to fluid overload; treatment of the fluid overload will result in a decrease in blood pressure. DIF: Cognitive Level: Analysis REF: pp. 177-178 OBJ: Describe methods for assessing the respiratory system, including physical assessment, interpretation of arterial blood gases, and noninvasive techniques. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 27. The nurse is caring for a mechanically ventilated patient and notes the high pressure alarm sounding. The nurse cannot quickly identify the cause of the alarm and notes the patient’s oxygen saturation is decreasing and heart rate and respiratory rate are increasing. The nurse’s priority action is to: a. ask the respiratory therapist to get a new ventilator. b. call the rapid response team to assess the patient. c. continue to find the cause of the alarm and fix it. d. manually ventilate the patient while calling for a respiratory therapist. The nurse must quickly assess the patient and determine possible causes of the alarm. If the cause is not assessed within seconds, the nurse must manually ventilate the patient and secure assistance in troubleshooting the problem. The patient must be treated while the causes are being assessed by the nurse and respiratory therapist. Continuing to assess for the cause without manually ventilating the patient can result in patient compromise. The respiratory therapist, not the rapid response team, will assess and remedy the problem. A new ventilator may be needed, but that would be determined after the respiratory therapist has assessed the situation. DIF: Cognitive Level: Analysis REF: pp. 203-204 OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment 28. The nurse is caring for a patient whose ventilator settings include 15 cm H2O of positive end-expiratory pressure (PEEP). The nurse understands that although beneficial, PEEP may result in: a. fluid overload secondary to decreased venous return. b. high cardiac index secondary to more efficient ventricular function. c. hypoxemia secondary to prolonged positive pressure at expiration. d. low cardiac output secondary to increased intrathoracic pressure Positive end-expiratory pressure, especially at higher levels, can result in a decreased cardiac output and index secondary to increased intrathoracic pressure, which impedes venous return. Fluid overload is not an expected finding. The cardiac index would likely decrease, not increase, along with cardiac output. PEEP is used to treat hypoxemia; it does not cause it. DIF: Cognitive Level: Analysis REF: p. 196 OBJ: Relate complications associated with mechanical ventilation. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 29. When assessing the patient for hypoxemia, the nurse recognizes that an early sign of the effect of hypoxemia on the cardiovascular system is: a. heart block. b. restlessness. c. tachycardia. d. tachypnea. Tachycardia can occur as a compensatory mechanism to increase cardiac output and oxygenation. Dysrhythmias may occur; however, they are not an early sign and tend to be premature ventricular contractions. Restlessness is an early neurological sign, whereas tachypnea is an early respiratory sign. DIF: Cognitive Level: Comprehension REF: p. 179 | Box 9-1 OBJ: Review the anatomy and physiology of the respiratory system. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 30. The nurse is caring for a mechanically ventilated patient. The physicians are considering performing a tracheostomy because the patient is having difficulty weaning from mechanical ventilation. Related to tracheostomy, the nurse understands which of the following? a. Patient outcomes are better if the tracheostomy is done within a week of intubation. b. Percutaneous tracheostomy can be done safely at the bedside by the respiratory therapist. c. Procedures performed in the operating room are associated with fewer complications. d. The greatest risk after a percutaneous tracheostomy is accidental decannulation. Optimal timing of tracheostomy is not yet known. Percutaneous procedures done at the bedside are not associated with any higher risks than those done in the operating room. Trained physicians safely perform percutaneous tracheostomies at the bedside. The greatest risk for percutaneous tracheostomy is accidental decannulation because the trachea is not surgically attached. DIF: Cognitive Level: Analysis REF: pp. 190-191 OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment 31. The nurse is assessing the exhaled tidal volume (EVT) in a mechanically ventilated patient. The rationale for this assessment is to: a. assess for tension pneumothorax. b. assess the level of positive end-expiratory pressure. c. compare the tidal volume delivered with the tidal volume prescribed. d. determine the patient’s work of breathing. The EVT is assessed to determine if the patient is receiving the tidal volume that is prescribed. Volume may be lost because of leaks in the ventilator circuit, around the endotracheal tube cuff, or around a chest tube. The assessment will not detect a pneumothorax and does not assess positive end-expiratory pressure or work of breathing. DIF: Cognitive Level: Comprehension REF: p. 197 OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity MULTIPLE RESPONSE 1. The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following? (Select all that apply.) a. Coughing or attempting to talk b. Disconnection from the ventilator c. Kinks in the ventilator tubing d. Need for suctioning , C, D Coughing, kinks, and mucus in the airway can cause the inspiratory pressure to increase; ventilator disconnects result in low-volume alarms. A disconnection from the ventilator would result in a low exhaled volume alarm, not a high-pressure alarm. DIF: Cognitive Level: Analysis REF: pp. 203-204 | Table 9-4 OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 2. Select all of the factors that may predispose the patient to respiratory acidosis. a. Anxiety and fear b. Central nervous system depression c. Diabetic ketoacidosis d. Nasogastric suctioning e. Overdose of sedatives , E Central nervous system depression and drug overdose may result in hypoventilation and cause respiratory acidosis. Anxiety is a cause of hyperventilation and respiratory alkalosis. Diabetic ketoacidosis is a cause of metabolic acidosis. Nasogastric suctioning is a cause of metabolic alkalosis. DIF: Cognitive Level: Comprehension REF: p. 180 | Box 9-2 OBJ: Review the anatomy and physiology of the respiratory system. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 3. The nurse is assisting with endotracheal intubation and understands correct placement of the endotracheal tube in the trachea would be identified by which of the following? (Select all that apply.) a. Auscultation of air over the epigastrium b. Equal bilateral breath sounds upon auscultation c. Position above the carina verified by chest x-ray d. Positive detection of carbon dioxide (CO2) through CO2 detector devices , C, D The position of the tube is assessed after intubation through auscultation of breath sounds, carbon dioxide testing, and chest x-ray. Auscultation of air over the epigastrium indicates placement in the esophagus rather than the trachea. DIF: Cognitive Level: Analysis REF: p. 190 OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Safe and Effective Care Environment COMPLETION 1. The nurse is caring for a mechanically ventilated patient and is charting outside the patient’s room when the ventilator alarm sounds. What is the priority order for the nurse to complete these actions: _______________, _______________, _______________, _______________? (Put a comma and space between each answer choice.) A. Check quickly for possible causes of the alarm that can be fixed. B. After troubleshooting, connect back to mechanical ventilator and reassess patient. C. Go to patient’s bedside. D. Manually ventilate the patient while getting respiratory therapist. ANS: C, A, D, B The nurse must quickly assess the patient and determine possible causes of the alarm. If the cause is not assessed within seconds, the nurse must manually ventilate the patient and secure assistance in troubleshooting the problem. Once the problem has been corrected, the patient must be reassessed. DIF: Cognitive Level: Analysis REF: pp. 203-204 OBJ: Formulate a plan of care for the mechanically ventilated patient. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment 2. The nurse is assisting with endotracheal intubation of the patient and recognizes that the procedure will be done in what order: _______________, _______________, _______________, _______________, _______________? (Put a comma and space between each answer choice.) A. Assess balloon on endotracheal tube for symmetry and leaks. B. Assess lung fields for bilateral expansion. C. Inflate balloon of endotracheal tube. D. Insert endotracheal tube with laryngoscope and blade. E. Suction oropharynx. ANS: A, E, D, C, B Intubation is done systematically by the physician, therapist, or anesthetist. Equipment is gathered and assessed (e.g., balloon/cuff on endotracheal tube). The patient is hyperoxygenated and secretions are suctioned from the oropharynx to visualize the vocal cords. The tube is inserted, and the balloon is inflated once the tube is in place. The position of the tube is assessed after intubation through auscultation of breath sounds, carbon dioxide testing, and chest x-ray. Ch 10 1. The nurse chooses which method and concentration of oxygen administration until intubation is established in a patient who has sustained a cardiopulmonary arrest? a. Bag-valve-mask at FiO2 of 100% b. Bag-valve-mask at FiO2 of 50% c. Mouth-to-mask ventilation with supplemental oxygen d. Non-rebreather mask at FiO2 of 100% Oxygen can be delivered via mouth to mask or with a bag-valve device connected to a mask or endotracheal tube. During resuscitation efforts, 100% oxygen is administered. DIF: Cognitive Level: Application REF: p. 238 | Table 10-4 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 2. Laypersons should use which device to treat lethal ventricular dysrhythmias that occur outside a hospital setting? a. Automatic external defibrillator b. Carbon dioxide detector c. Pocket mask d. Transcutaneous pacemaker Because of the ease of use and efficacy in treating lethal ventricular dysrhythmias, automatic external defibrillators are recommended to be placed in a variety of public settings where they may be used by laypersons. DIF: Cognitive Level: Comprehension REF: p. 232 OBJ: Identify equipment used during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 3. When doing manual ventilations during a code, the nurse would administer ventilations following which guideline? a. Approximately 8 to 10 breaths per minute b. During the fifth chest compression c. Every 3 seconds or 20 times per minute d. While compressions are stopped Manual ventilations are delivered one breath every 6 to 8 seconds or approximately 8 to 10 breaths per minute. DIF: Cognitive Level: Application REF: p. 227 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 4. The patient has been admitted to a critical care unit with a diagnosis of acute myocardial infarction. Suddenly his monitor alarms and the screen shows a flat line. What action should the nurse take first? a. Administer epinephrine by intravenous push. b. Begin chest compressions. c. Check patient for unresponsiveness. d. Defibrillate at 360 J. The first intervention is to assess unresponsiveness. DIF: Cognitive Level: Application REF: p. 226 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 5. During a code, the nurse would place paddles for anterior defibrillation in what locations? a. Second intercostal space, left sternal border and fourth intercostal space, left midclavicular line b. Second intercostal space, right sternal border and fourth intercostal space, left midaxillary line c. Second intercostal space, right sternal border and fifth intercostal space, left midclavicular line d. Fourth intercostal space, right sternal border and fifth intercostal space, left midclavicular line Anterior paddle placement is used most often for defibrillation. In the anterior method, one paddle or adhesive electrode pad is placed at the second intercostal space to the right of the sternum, and the other paddle or adhesive electrode pad is placed at the fifth intercostal space, midaxillary line, to the left of the sternum. DIF: Cognitive Level: Application REF: p. 231 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 6. During cardioversion, the nurse would synchronize the electrical charge to coincide with which wave of the ECG complex? a. P b. R c. S d. T During cardioversion, the electrical shock is synchronized to deliver shock on the R wave. This is to prevent the shock from being delivered during repolarization (T wave). Ventricular fibrillation may occur if the shock is delivered on the T wave. DIF: Cognitive Level: Comprehension REF: pp. 232-233 OBJ: Identify equipment used during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 7. The nurse knows that in advanced cardiac life support, the secondary survey includes steps A-B-C-D where “D” refers to: a. defibrillate. b. differential diagnosis. c. diltiazem intravenous push. d. do not resuscitate. The A-B-C-D (airway, breathing, circulation, differential diagnosis) in the Advanced Cardiac Life Support (ACLS) secondary survey involves the performance of more in-depth assessments and interventions. Differential diagnosis involves investigation into the cause of the arrest. If a reversible cause is identified, a specific therapy can be initiated. DIF: Cognitive Level: Application REF: p. 226 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 8. The patient is diagnosed with abrupt onset of supraventricular tachycardia (SVT). The nurse prepares which medication that has a short half-life and is recommended to treat symptomatic SVT? a. Adenosine b. Amiodarone c. Diltiazem d. Procainamide Adenosine is the initial drug of choice for the diagnosis and treatment of supraventricular dysrhythmias. Adenosine has an onset of action of 10 to 40 seconds and duration of 1 to 2 minutes; therefore, it is administered rapidly. DIF: Cognitive Level: Application REF: p. 239 | Table 10-4 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 9. The code team has just defibrillated a patient in ventricular fibrillation. Following CPR for 2 minutes, what is the next action to take? a. Administer amiodarone. b. Administer lidocaine. c. Assess rhythm and pulse. d. Prepare for transcutaneous pacing. Reassess the patient frequently. Check for return of pulse, spontaneous respirations, and blood pressure. DIF: Cognitive Level: Analysis REF: p. 229 OBJ: Compare roles of caregivers in rapid response teams and managing cardiopulmonary arrest situations. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 10. The patient’s monitor shows bradycardia (heart rate of 40 beats/min) and frequent premature ventricular contractions (PVCs) with a measured blood pressure of 85/50 mm Hg. The nurse anticipates the use of which drug? a. Atropine 0.5 to 1 mg intravenous push b. Dopamine drip—continuous infusion c. Lidocaine 1 mg/kg intravenous push d. Transcutaneous pacemaker This patient is having PVCs secondary to bradycardia. Atropine is a first-line drug for bradycardia. Administer atropine, 0.5 mg IV every 3 to 5 minutes to a total dose of 3 mg. Atropine is not indicated in second-degree atrioventricular (AV) block type II or third-degree AV block. DIF: Cognitive Level: Analysis REF: p. 238 | Table 10-4 OBJ: Identify medications used in code management, including use, action, side effects, and nursing implications. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 11. The monitor technician notifies the nurse “stat” that the patient has a rapid, chaotic rhythm that looks like ventricular tachycardia. What is the nurse’s first action? a. Call a code overhead. b. Check the patient immediately. c. Go to the nurse’s station and look at the rhythm strip. d. Take the crash cart to the room. The first intervention in this situation is to assess unresponsiveness by checking the patient. DIF: Cognitive Level: Analysis REF: Table 10-3 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 12. Which rhythm would be an emergency indication for the application of a transcutaneous pacemaker? a. Asystole b. Bradycardia (heart rate 40 beats/min) normotensive and alert c. Bradycardia (heart rate 50 beats/min) with hypotension and syncope d. Supraventricular tachycardia (heart rate 150 beats/min), hypotensive Transcutaneous (external noninvasive) cardiac pacing is used during emergencies to treat symptomatic bradycardia (hypotension, altered mental status, angina, pulmonary edema) that has not responded to atropine. This patient is symptomatic. DIF: Cognitive Level: Application REF: p. 234 OBJ: Discuss treatment of special problems that can occur during a code. TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 13. A 74-year-old patient is admitted to the coronary care unit with an inferior wall myocardial infarction and develops symptomatic bradycardia with premature ventricular contractions every third beat (trigeminy). The nurse knows to prepare to administer which drug? a. Amiodarone b. Atropine c. Lidocaine d. Magnesium Atropine is used to increase the heart rate by decreasing the vagal tone. It is indicated for patients with symptomatic bradycardia. DIF: Cognitive Level: Analysis REF: p. 236, 238 | Table 10-4 OBJ: Identify medications used in code management, including use, action, side effects, and nursing implications. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 14. A patient develops frequent ventricular ectopy. The nurse prepares to administer which drug? a. Adenosine b. Atropine c. Lidocaine d. Magnesium Lidocaine is an antidysrhythmic drug that suppresses ventricular ectopic activity. DIF: Cognitive Level: Analysis REF: p. 239 | Table 10-4 OBJ: Identify medications used in code management, including use, action, side effects, and nursing implications. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 15. It is determined that the patient needs a transcutaneous pacemaker until a transvenous pacemaker can be inserted. What is the most appropriate nursing intervention? a. Apply conductive gel to the skin. b. Provide adequate sedation and analgesia. c. Recheck leads to make sure that the rhythm is asystole. d. Set the milliamperes to 2 mA below the capture level. The alert patient who requires transcutaneous pacing may experience some discomfort. Because the skeletal muscles are stimulated, as well as the heart muscle, the patient may experience a tingling, twitching, or thumping feeling that ranges from mildly uncomfortable to intolerable. Sedation, analgesia, or both may be indicated. DIF: Cognitive Level: Analysis REF: p. 234 OBJ: Discuss treatment of special problems that can occur during a code. TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment 16. The nurse needs to evaluate arterial blood gases before the administration of which drug? a. Calcium chloride b. Magnesium sulfate c. Potassium d. Sodium bicarbonate Bicarbonate therapy should be guided by the bicarbonate concentration or calculated base deficit from arterial blood gas analysis or laboratory measurement. DIF: Cognitive Level: Analysis REF: p. 240 | Table 10-4 OBJ: Identify medications used in code management, including use, action, side effects, and nursing implications. TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 17. During a code situation, the nurse would prepare to use which preferred intravenous fluid? a. 5% Dextrose in 0.45 normal saline b. 5% Dextrose in water c. Dopamine infusion d. Normal saline Normal saline is the preferred intravenous fluid during resuscitation efforts because it expands intravascular volume better than infusions containing dextrose. DIF: Cognitive Level: Comprehension REF: p. 228 OBJ: Identify medications used in code management, including use, action, side effects, and nursing implications. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 18. A 90-year-old nursing home patient is admitted to the critical care unit with a severe case of pneumonia. No living will or designation of healthcare surrogate is noted on the chart. In the event this patient needs intubation and/or cardiopulmonary resuscitation, what should be the nurse’s action? a. Activate the code team, but initiate a “slow” code. b. Call the nursing home to determine the patient’s or family’s wishes. c. Code the patient for 5 minutes and then cease efforts. d. Initiate intubation and/or cardiopulmonary resuscitation efforts. In the absence of a written order from a physician to withhold resuscitative measures, resuscitation efforts must be initiated if indicated. DIF: Cognitive Level: Analysis REF: p. 220 OBJ: Identify psychosocial, legal, and ethical issues related to code management. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment 19. A patient is brought to the critical care unit after a motor vehicle crash. On admission, the patient is complaining of dyspnea and chest pain. Upon examination, the nurse notes a lack of breath sounds on the left side and a tracheal shift. What would be the most likely diagnosis? a. Pericardial tamponade b. Symptomatic bradycardia c. Tension pneumothorax d. Unstable tachycardia A tension pneumothorax occurs when air enters the pleural space but cannot escape. Pressure increases in the pleural space and causes the lung to collapse. Symptoms of a tension pneumothorax include dyspnea, chest pain, tachypnea, tachycardia, and jugular venous distention. DIF: Cognitive Level: Analysis REF: p. 228 OBJ: Discuss treatment of special problems that can occur during a code. TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment 20. The patient has pulseless electrical activity (PEA). The doctor decides that the cause of the PEA is pericardial tamponade. What is the most appropriate treatment for pericardial tamponade? a. Atropine b. Chest tube placement c. Pericardiocentesis d. Transcutaneous pacemaker Pericardiocentesis, or needle aspiration of pericardial fluid, is performed to alleviate the pressure around the heart. DIF: Cognitive Level: Comprehension REF: p. 229 OBJ: Discuss treatment of special problems that can occur during a code. TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment 21. What is the major reason for using a treatment to lower body temperature after cardiac arrest to promote better neurological recovery? a. Hypothermia decreases the metabolic rate by 7% for each decrease of 1° C. b. Lower body temperatures are beneficial in patients with low blood pressure. c. Temperatures of 40° C may reduce neurological impairment. d. The lower body temperature leads to decreased oxygen delivery. Hypothermia decreases the metabolic rate by 6% to 7% for every decrease of 1° C in temperature; decreased metabolic rate may protect neurological function. Induced hypothermia to a core body temperature of 32o C to 34o C for 12 to 24 hours may be beneficial in reducing neurological impairment after cardiac arrest. DIF: Cognitive Level: Analysis REF: p. 244 OBJ: Discuss treatment of special problems that can occur during a code. TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment 22. The patient has a transcutaneous pacemaker in place. Pacemaker spikes followed by QRS complexes are noted on the cardiac rhythm strip. To determine if the pacemaker is working, the nurse must do which of the following? a. Obtain a 12-lead electrocardiogram (ECG). b. Call for a pacemaker interrogation. c. Palpate the pulse. d. Run a 2-minute monitor strip for analysis. The electrical and mechanical effectiveness of pacing is assessed. The electrical activity is noted by a pacemaker “spike” that indicates that the pacemaker is initiating electrical activity. The spike is followed by a broad QRS complex. Mechanical activity is noted by palpating a pulse during electrical activity. DIF: Cognitive Level: Analysis REF: p. 234 OBJ: Discuss treatment of special problems that can occur during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment MULTIPLE RESPONSE 1. A patient has been successfully converted from ventricular tachycardia with a pulse to a sinus rhythm. Upon further assessment, it is noted that she is hypotensive. The appropriate treatment for her hypotension may include:(Select all that apply.) a. adenosine. b. dopamine infusion. c. magnesium. d. normal saline infusion. e. sodium bicarbonate. , D The patient may need fluid resuscitation; dopamine is indicated for hypotension once hypovolemia has been corrected. DIF: Cognitive Level: Application REF: p. 240 OBJ: Identify medications used in code management, including use, action, side effects, and nursing implications. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 2. A patient is admitted to the critical care unit with bradycardia at a heart rate of 39 beats/min and frequent premature ventricular contractions. Upon assessment, you note that she is lethargic and has complained of dizziness for the past 12 hours. Which of the following are acceptable treatments for symptomatic bradycardia? (Select all that apply.) a. Atropine b. Epinephrine c. Lidocaine d. Transcutaneous pacemaker , B, D Administer atropine, 0.5 mg IV every 3 to 5 minutes to a total dose of 3 mg for symptomatic bradycardia. Transcutaneous pacing is also indicated for symptomatic bradycardia unresponsive to atropine. Epinephrine is considered as well. Lidocaine is contraindicated in bradycardia because it can depress conduction, which would be detrimental with a heart rate of 39 beats/min. DIF: Cognitive Level: Analysis REF: p. 234, 238 | Table 10-4 OBJ: Identify medications used in code management, including use, action, side effects, and nursing implications. TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 3. Ventricular fibrillation should initially be treated by which of the following? (Select all that apply.) a. Administration of amiodarone, followed by defibrillation at 360 J b. Atropine 1 mg, followed by defibrillation at 200 J c. Defibrillation at 200 J with biphasic defibrillation d. Defibrillation at 360 J with monophasic defibrillation , D If a biphasic defibrillator is available, use the dose at which that defibrillator has been shown to be effective for terminating VF (typically 120 to 200 J). If the dose is not known, use 200 J. If a monophasic defibrillator is available, use an initial shock of 360 J and use 360 J for subsequent shocks. DIF: Cognitive Level: Comprehension REF: p. 228 OBJ: Discuss treatment of special problems that can occur during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 4. Which code drugs can be given safely through an endotracheal tube? (Select all that apply.) a. Adenosine b. Atropine c. Epinephrine d. Vasopressin , C, D Medications that can be administered through the endotracheal tube until IV access is established are atropine, epinephrine, lidocaine, and vasopressin. DIF: Cognitive Level: Comprehension REF: p. 228 | Table 10-4 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 5. Which of the following statements about defibrillation are correct? (Select all that apply.) a. Early defibrillation (if warranted) is recommended before other actions. b. It is not necessary to ensure that personnel are clear of the patient if hands-off defibrillation is used. c. It is not necessary to synchronize the defibrillation shocks. d. Paddles/patches can be placed anteriorly and posteriorly on the chest. , C, D Defibrillation is indicated as soon as possible because early defibrillation and CPR increase the chance of survival. Regardless of the method of defibrillation, all personnel must avoid contact with the patient or bed during the shock delivery. Shocks are delivered without synchronization. Anterior paddle placement is used most often; however, the alternative method is anteroposterior placement. DIF: Cognitive Level: Application REF: pp. 224-225 | 229 OBJ: Differentiate basic and advanced life-support measures used during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 6. Post-resuscitation goals include which of the following? (Select all that apply.) a. Control dysrhythmias b. Maintain airway c. Maintain blood pressure d. Wean off oxygen , B, C Post-resuscitation goals include optimizing tissue perfusion by airway, blood pressure maintenance, oxygenation, and control of dysrhythmias. DIF: Cognitive Level: Application REF: p. 242 OBJ: Describe care of patients after resuscitation. TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 7. Which of the following are documented as part of the cardiopulmonary arrest record? (Select all that apply.) a. Medication administration times b. Defibrillation times, joules, outcomes c. Rhythm strips of cardiac rhythm(s) noted d. Signatures of recorder and other personnel , B, C, D Documentation includes the time the code is called, the time CPR is started, any actions that are taken, and the patient’s response (e.g., presence or absence of a pulse, heart rate, blood pressure, cardiac rhythm). Intubation and defibrillation (and the energy used) must be documented, along with the patient’s response. The time and sites of IV initiations, types and amounts of fluids administered, and medications given to the patient must be accurately recorded. Rhythm strips are recorded to document events and response to treatment. Signatures of those involved in the code effort, including the recorder, are essential. DIF: Cognitive Level: Analysis REF: pp. 240-241 OBJ: Identify information to be documented during a code. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment 8. Benefits of having the family present during resuscitation include which of the following? (Select all that apply.) a. Facilitates the grief process b. Letting family sees that everything is being done c. Sustaining patient-family relationships d. Allows the staff easy access to ask for organ transplant e. Provides a sense of closure , B, C, E Families who have been present during a code describe the benefits as knowing that everything possible was being done for their loved one, feeling supportive and helpful to the patient and staff, sustaining patient-family relationships, providing a sense of closure on a life shared together, and facilitating the grief process. DIF: Cognitive Level: Analysis REF: pp. 243-244 OBJ: Identify psychosocial, legal, and ethical issues related to code management. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment 9. The nurse should call the rapid response EMS for which patients? (Select all that apply.) a. 53-year-old with pneumonia and severe respiratory distress b. 17-year-old with apnea following a head injury c. 24-year-old experiencing a severe asthmatic attack with stridor d. 73-year-old patient with bradycardia of 40 beats per minute e. 52-year-old patient with no palpable pulse , C, D Rapid response teams (RRTs) or medical emergency teams focus on addressing changes in a patient’s clinical condition before a cardiopulmonary arrest occurs. [Show More]

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