Alteration in Ventilation

1. RASS scoring: Unarousable; no response to voice or physical stimulation.

• Answer: - 5

2. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34
mmol/L. What acid-base disorder is shown?
● Respiratory Alkalosis, Uncompensated
● Respiratory Acidosis, Partially Compensated
● Metabolic Alkalosis, Uncompensated
● Metabolic Alkalosis, Partially Compensated

Rationale: The elevated pH and HCO3 levels suggest metabolic alkalosis. The uncompensated
status is indicated by the normal PaCO2.

3. Patient breathes spontaneously while ventilator maintains constant airway pressure, used in weaning.
● CPAP
● SIMV
● AC
● PSV

Rationale: CPAP is commonly used in weaning scenarios to provide support for spontaneous
breathing efforts while keeping the airways open.

SIMV (Synchronized Intermittent Mandatory Ventilation): In SIMV, the ventilator delivers a set
number of breaths, and the patient can breathe spontaneously between those mandatory
breaths.

AC (Assist Control): In AC mode, the ventilator delivers a preset tidal volume at a set rate, but the
patient can trigger additional breaths.

PSV (Pressure Support Ventilation): PSV assists spontaneous breaths by providing a preset level
of pressure support during inspiration.

4. Nurse Johnny called his patient Mr. Papa and noted an eye opening without eye contact. What is his
patient's RASS score?
● -1
● -2
● -3
● -4

5. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3
25 mmol/L. What does this mean?
● Respiratory Alkalosis, Uncompensated
● Respiratory Acidosis, Partially Compensated
● Metabolic Alkalosis, Uncompensated
● Metabolic Alkalosis, Partially Compensated

Rationale: The elevated pH and low PaCO2 suggest respiratory alkalosis. The uncompensated status
is indicated by the normal HCO3.

6. Weaning Trial Criteria, except:

● SBP > 90 with pressors
● The initial indication for intubation is resolving
● The patient can take spontaneous breaths over the vent with RR < 20
● pO2 > 60

Rationale: Weaning trial criteria typically include factors that assess the patient's readiness to be
liberated from mechanical ventilation. However, having a specific pO2 value greater than 60 mm Hg
is not a standard weaning criterion.
Other options:

7. Indications for intubation:

● decline in mental status
● airway protection
 ● pCO2 of 4.8 kPa
● pH 7.35

Rationale:

A decline in mental status is a common indication for intubation, as it may suggest a compromised
ability to protect the airway or ventilate adequately.

Intubation is often performed to protect the airway in situations where there is a risk of aspiration or
inability to maintain a patent airway.

8. In measuring patient's Capillary Wedge Pressure, you have to inflate the ballon at the tip of the
catheter with:
● air
● saline solution
● sterile water
● betadine solution

Rationale: Inflating the balloon with saline allows the catheter to wedge into a small pulmonary
vessel, blocking the blood flow temporarily. This allows for the measurement of pressures in the left
side of the heart, helping assess left ventricular function and filling pressures.

Inflating the balloon with air, sterile water, or betadine solution would not be appropriate as they can
cause complications or inaccurate pressure readings.

9. Ventilator delivers a minimum set number of breaths, and patient initiated breaths trigger fully-assisted
vent breaths.
● Synchronized Intermittent Mandatory Ventilation/ SIMV
● Assist control /AC MODE
● Continuous positive airway pressure/ CPAP
● Pressure Support Ventilation/ PSV/Spontaneous Mode

Rationale: In Synchronized Intermittent Mandatory Ventilation (SIMV), the ventilator delivers a

minimum set number of breaths per minute, and patient-initiated breaths trigger fully-assisted
ventilator breaths. It allows the patient to breathe spontaneously between the mandatory ventilator
breaths.

10. Determined by airway resistance and compliance:

● Peak inspiratory pressure
● Plateau pressure
● PEEP
● FiO2

Rationale: Peak Inspiratory Pressure (PIP) is determined by a combination of airway resistance and
lung compliance. It represents the highest pressure reached during inspiration and reflects the effort
required to overcome both airway resistance and the elastic properties of the lungs.

11. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse
should include which action in the plan of care?
● Measuring and documenting the drainage in the collection chamber
● Keeping the collection chamber at chest level
● Stripping the chest tube every hour
● Maintaining continuous bubbling in the water-seal chamber

Rationale: Keeping the collection chamber at chest level ensures proper functioning of the closed
water-seal drainage system. This positioning allows for accurate measurement of the drainage and
prevents backflow or improper drainage due to changes in the water-seal dynamics.

12. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen
saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?
● Nasal prongs
● Simple mask
● Face tent
● Non-rebreather mask
 Rationale: In a situation where a patient has abrupt difficulty breathing and a low arterial oxygen
saturation, a non-rebreather mask is often the most appropriate choice to rapidly increase the oxygen
concentration delivered to the patient.

13. High Pressure Alarms, except:

● Secretions/ needs to be suctioned
● Kinked tubing/ malposition of ETT
● Bronchospasm
● Tubing disconnect from ventilator
● Extubation

Rationale: High-pressure alarms are designed to detect issues within the ventilator system or the
patient's airway. Extubation, which involves the removal of the endotracheal tube (ETT), would not
trigger a high-pressure alarm. Instead, it would likely trigger a low-pressure or disconnect alarm.

14. RASS scoring: Frequent non-purposeful movement, fights ventilator.

Answer: +2 Agitated

15. The four things needed to avoid respiratory failure are adequate oxygen, clear airways, clear, alveoli,
and good circulation. Which medical intervention is used for a client with blocked alveoli and an arterial
blood gas (ABG) reading of PaO2 52 mmHg? Select all that apply.
● Absolutely, it's the Ventilator!
● Of course, not nasal cannula.
● Definitely not anticoagulants.
● Needless to say it's really the ventilator...
● Clearly, not masks!

Rationale: Ventilator support may be necessary to provide mechanical assistance in breathing,

especially if there is evidence of blocked alveoli and impaired oxygenation.

If there are blocked alveoli and the ABG reading indicates inadequate oxygenation (PaO2 of 52
mmHg), the use of a higher-concentration oxygen delivery method, such as a non-rebreather mask or
mechanical ventilation, may be more appropriate than nasal cannula.

16. Pressure at end of inspiration when flow has ceased, dependent on compliance.
● Plateau pressure
● PEEP
● Inspiratory flow rate
● Inspiratory time

Rationale: Plateau pressure is the pressure measured at the end of inspiration during an inspiratory
pause, when flow has ceased. It provides information about the pressure within the alveoli and is
dependent on lung compliance.

17. A mode of ventilation that adjusts the amount of pressure used to keep the large airways open
(typically 5-15mmHg), which helps to decrease the work of breathing (1 Point)
● Pressure Support Ventilation
● Continuous mechanical ventilation (CMV)
● CPAP
● SIMV

Rationale: Pressure Support Ventilation (PSV) is a mode of ventilation that assists spontaneous
breaths by delivering a preset level of pressure during inspiration. This pressure helps keep the large
airways open, reducing the work of breathing for the patient.

18. Arterial line indications:

● Continuous monitoring of blood pressure, for patients with hemodynamic instability
● For reliable titration of supportive medications such apressors/inotropes/antihypertensive
infusions.
● For frequent arterial blood sampling.
● None of the above.

Rationale: Arterial lines are commonly used for continuous blood pressure monitoring, especially in
patients with hemodynamic instability who require close monitoring of their blood pressure.
For reliable titration of supportive medications such as pressors/inotropes/antihypertensive infusions.
 Rationale: Arterial lines provide a direct and real-time measurement of blood pressure, allowing
healthcare providers to titrate medications more accurately in critically ill patients.
For frequent arterial blood sampling.

Rationale: Arterial lines are also used for obtaining frequent arterial blood samples, which is important
for assessing oxygenation, acid-base balance, and other parameters in critically ill patients.

19. Ventilator supports patient initiated breaths with a set inspiratory pressure.
● Continuous positive airway pressure/ CPAP
● Pressure Support Ventilation/ PSV/Spontaneous Mode
● Synchronized Intermittent Mandatory Ventilation/ SIMV
● Assist control /AC MODE

Rationale: Pressure Support Ventilation (PSV) is a mode of mechanical ventilation that supports
patient-initiated breaths with a set inspiratory pressure. It allows the patient to breathe spontaneously,
and the ventilator assists by delivering a preset level of pressure during each breath.

20. Amount of pressure at the end of the expiration that helps keep alveoli open for O2/CO2 exchange
(typically 5-20mmHg):
● Inspiratory time
● Plateau pressure
● Inspiratory flow rate
● PEEP

Rationale: Positive End-Expiratory Pressure (PEEP) is the amount of pressure maintained at the end
of expiration. It helps prevent alveolar collapse, improve oxygenation, and facilitate gas exchange
(O2/CO2). The typical range for PEEP is 5-20 mmHg.

21. In obtaining arterial blood specimen in the A-line, after disinfecting the port:(1 Point)
● Aspirate 5 mL of arterial blood from heparinized syringe.
● Flush with 10 mL NSS.
● Aspirate 5-10 mL of blood then discard.
● Perform zeroing.

Rationale: When obtaining an arterial blood specimen from an arterial line (A-line), the correct
practice is to aspirate 5-10 mL of blood and discard it before obtaining the actual sample. This
ensures that the blood in the tubing is fresh and representative of the patient's current arterial blood
gases.

22. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed
on mechanical ventilation. The physician orders pulse oximetry to monitor the client’s arterial oxygen
saturation (SaO2) noninvasively. Which of the following may alter patient's pulse oximetry values?
● BP of 80/60 mmHg
● Febrile at 38 degree Celsius
● Heart rate of 99 bpm
● Patient is tachypneic

Rationale: Changes in heart rate can affect pulse oximetry readings. A higher heart rate may result in
shorter cardiac cycles, potentially affecting the accuracy of the pulse oximeter in detecting and
calculating oxygen saturation.

23. A clear yellow fluid was obtained from a Thoracentesis, you document it as:
● normal finding
● exudative
● serosanguineous
● sanguineous

Rationale: Clear yellow fluid from Thoracentesis is often a normal finding, indicating a non-
pathological pleural effusion.

24. Ventilator delivers a minimum number of supported breaths synchronized with patient's efforts.
● Pressure Support Ventilation/ PSV/ Spontaneous Mode
● Assist control /AC MODE
 ● Continuous positive airway pressure/ CPAP
● Synchronized Intermittent Mandatory Venti / SIMV

Rationale: SIMV (Synchronized Intermittent Mandatory Ventilation) is a mode of mechanical

ventilation where the ventilator delivers a minimum number of mandatory breaths, and the patient can
take additional spontaneous breaths that are synchronized with the ventilator's support.

25. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when
caring for a client with a tracheostomy is:
● keeping his airway patent
● helping him communicate
● preventing him from developing an infection
● encouraging him to perform
● activities of daily living

Rationale: The first priority when caring for a client with a tracheostomy is to ensure that the airway
remains patent and clear of any obstructions. This involves maintaining an open airway to allow for
proper breathing and ventilation.

26. Normal pulmonary capillary wedge pressure:

● 10-15 mmHg
● 4 to 12 mmHg
● 5-10 mmHg
● 4 to 8 mmHg

27. Before weaning a male client from a ventilator, which assessment parameter is most important for the
nurse to review?
● Electrocardiogram (ECG) results
● Baseline arterial blood gas (ABG) levels
● Prior outcomes of weaning
● 24-hour cumulative intake and
output

Rationale: Before weaning a client from a ventilator, reviewing baseline arterial blood gas (ABG)
levels is crucial. ABG levels provide information about the patient's oxygenation and ventilation
status, helping the nurse assess the adequacy of gas exchange and respiratory function.