ELECTIVE 102

MODULE 3 ACTIVITIES

Lesson 1
Acute/critically ill patients with Mechanical Ventilation –Assessment of a critically ill client/s
with Mechanical Ventilation

TEST YOUR NURSING KNOWLEDGE

MULTIPLE CHOICE: Analyse the situation before you answer. Select and
write only the letter of choice and give the rationale to your answer.

1. When auscultating a client’s lungs, you hear crackles. These are caused by:
a. Consolidation
b. A foreign body obstructing the trachea
c. Collapsed or fluid-filled alveoli snapping open
d. Secretions blocking the bronchial airways
Rationale:  secretions are caused by either an exudate or a transudate. Exudate is due
to lung infection eg, pneumonia while transudate such as congestive heart failure.

2. The nurse knows that when a client has a tracheostomy tube with a high-volume, low
pressure cuff, it is used primarily to prevent:
a. Tracheal secretion
b. Mucosal necrosis
c. Lung infection
d. Leakage of air
Rationale: Cuffed tubes allow positive pressure ventilation and prevent aspiration. If the cuff
is not necessary for those reasons, it should not be used because it irritates the trachea and
provokes and trap secretions, even when deflated

3. A client is placed on a ventilator. Because hyperventilation can occur when mechanical

ventilation is used, the nurse should monitor the client for signs of:
a. Respiratory alkalosis
b. Metabolic acidosis
c. Hypercapnia
d. Hypoxia
Rationale: Hyperventilation, sustained abnormal increase in breathing. During
hyperventilation the rate of removal of carbon dioxide from the blood is increased. As the
partial pressure of carbon dioxide in the blood decreases, respiratory alkalosis,
characterized by decreased acidity or increased alkalinity of the blood, ensues.

4. Which ABG analysis results would you expect to find in a client with acute respiratory
failure?
 a. pH 7.30, PaO2 85, PaCO2 48
b. pH 7.50, PaO2 60, PaCO2 45
c. pH 7.40, PaO2 82, PaCO2 45
d. pH 7.25, PaO2 48, PaCO2 55
Rationale: Persons with COPD are typically separated into one of two catagories:
“pink puffers” (normal PaCO2, PaO2 > 60 mmHg) or “blue bloaters” (PaCO2 > 45
mmHg, PaO2 < 60 mmHg). Pink puffers have severe emphysema, and characteristically
are thin and free of signs of right heart failure.

5. Which option isn’t a method of weaning a client from mechanical ventilation?

a. Controlled mandatory ventilation
b. Spontaneous breathing trials with T-piece
c. Pressure support ventilation
d. Intermittent mandatory ventilation
Rationale: In patients with repeatedly unsuccessful weaning trials, a gradual
withdrawal from mechanical ventilation can be attempted while factors responsible
for the ventilatory dependence are corrected. The most common methods of
discontinuing mechanical ventilation are SIMV, pressure-support ventilation (PSV) and
T-tube.

Lesson 2
Acute/critically ill patients with Mechanical Ventilation –Management of a critically ill
client/s with Mechanical Ventilation

TEST YOUR NURSING KNOWLEDGE

MULTIPLE CHOICE: Analyse the situation before you answer. Select and
write only the letter of choice and give the rationale to your answer.
1. A client respiratory status necessitates endotracheal intubation and positive pressure
ventilation. The most immediate nursing intervention for this client at this time would be
to:
a. Maintain sterility of the ventilation system that the client is using
b. Assess the client’s response to the mechanical ventilation
c. Facilitate the client’s response to the mechanical ventilation
d. Prepare the client for emergency surgery
Rationale: Mechanical ventilation increases intrathoracic pressure, which could affect
blood pressure and cardiac output.
2. A client is on a ventilator. One of the nurses asks what should be done when condensation
resulting from humidity collects in the ventilator tubing. The best response to this
question would be to:
a. “Record the amount of fluid removed from the tubing.”
b. “Decrease the amount of humidity.”
c. “Empty the fluid from the tubing.”
d. “Notify the respiratory therapist.”
Rationale: incomplete alveolar emptying, ventilation-perfusion mismatch or a leak ...
appear necessary due to the neutralization of surfactant by edema fluid.

3. A client with a pulmonary embolus is intubated and placed on mechanical ventilation.

When suctioning the endotracheal tube, the nurse should:
a. Suction two or three times in quick succession to remove the secretions
b. Use short, jabbing movements of the catheter to loosen secretions
c. Hyperoxygenate with 100% oxygen before and after suctioning
d. Apply suction while inserting the catheter
Rationale:
4. A client who is admitted with emphysema has a PCO2 of 60. The nurse, noting this is
excessively high, calls the physician to obtain an order for:
a. Intermittent positive pressure breathing (IPPB)
b. Mechanical ventilation
c. Bronchodilators
d. Mucolytics
Rationale:  Mechanical ventilation has several effects on lung mechanics. ... Any disease
that destroys lung parenchyma like emphysema will increase compliance.

5. The nurse knows that when a client has a tracheostomy tube with a high-volume, low
pressure cuff, it is used primarily to prevent:
a. Tracheal secretion
b. Mucosal necrosis
c. Lung infection
d. Leakage of air
Rationale: Cuffed tubes allow positive pressure ventilation and prevent aspiration. If the
cuff is not necessary for those reasons, it should not be used because it irritates the
trachea and provokes and trap secretions, even when deflated

Lesson 3
Acute/critically ill patients with Mechanical Ventilation –Complications

TEST YOUR NURSING KNOWLEDGE

IDENTIFICATION
1. 3 indications for mechanical ventilation.
The main indications are:
(1) airway protection for a patient with a decreased level of consciousness (eg, head trauma,
stroke, drug overdose, anesthesia).
(2) hypercapnic respiratory failure due to airway, chest wall, or respiratory muscle diseases,
(3) hypoxemic respiratory failure, or (4) circulatory failure

2. 2 reasons why clients receiving a neuromuscular blocking agent requires close

monitoring while on a mechanical ventilation.
I. It is important to optimize neuromuscular blockade for each individual patient and
II. to avoid complications of therapy.

3. 2 nursing interventions in response to low-pressure ventilator alarm.

I. Check the tube connections.
II. Replace leaking tubes by manually ventilating the patient.

4. 3 nursing interventions in response to high-pressure ventilator alarm.

I. Assess your patient.
II. Auscultate lung fields for secretions. This should be done at least every 2 hours or
more.
III. Suction secretions as needed. Oxygenate patient manually before suctioning.

Lesson 4
Use of Critical Thinking in Caring for Clients with Cardiovascular and Respiratory disorders

TEST YOUR NURSING KNOWLEDGE

MULTIPLE CHOICE: Analyse the situation before you answer. Select and
write only the letter of choice and give the rationale to your answer.

1. Oxygen by nasal cannula is prescribed for a client in the coronary care unit. The nurse
plans to use safety precautions in the room because oxygen:
a. Converts to an alternate form of matter
b. Has unstable properties
c. Supports combustion
d. Is flammable
 Rationale: Oxygen supports the chemical processes that occur during fire. When fuel
burns, it reacts with oxygen from the surrounding air, releasing heat and
generating combustion products (gases, smoke, embers, etc.). This process is known as
oxidation

2. The nurse is aware that the gradual occlusion of the internal or common carotid arteries,
manifested by transient ischemic attacks, may occur because of:
a. Developmental defects of the arterial wall
b. Emboli associated with atrial fibrillation
c. Atherosclerosis of the vascular system
d. Acquired valvular heart disease
Rationale: The underlying cause of a TIA often is a buildup of cholesterol-containing fatty
deposits called plaques (atherosclerosis) in an artery or one of its branches that supplies
oxygen and nutrients to your brain. Plaques can decrease the blood flow through an artery
or lead to the development of a clot.

3. A laborer is brought to the emergency department by co-workers and is admitted

with a possible myocardial infarction. The client is experiencing severe chest pain. He is
diaphoretic, and his pulse rate is 110 beats per minute. The nurse should immediately:
a. Administer the ordered nitroglycerin until the pain subsides
b. Notify the physician and administer the ordered morphine
c. Take the blood pressure and an electrocardiogram
d. Increase the oxygen flow
Rationale: The rationale behind oxygen therapy is to increase oxygen delivery to the
ischemic myocardium and thereby limit infarct size and subsequent complications.

4. A client who has had a myocardial infarction develops cardiogenic shock despite
treatment in the emergency department. When assessing this client the nurse would
expect to find:
a. Decreased urinary output
b. Warm moist skin
c. Restlessness
d. Tachycardia
Rationale: Low blood pressure and rapid heart rate (tachycardia) are the key signs of
shock. Symptoms of all types of shock include: Rapid, shallow breathing. Cold, clammy skin.

5. During a routine physical examination, an abdominal aortic aneurysm is diagnosed. The

client is immediately admitted to the hospital, and surgery is scheduled for the next
morning. When performing the admission assessment the nurse should expect:
a. Cyanosis with other symptoms of shock
b. A palpable pulsating abdominal mass
c. A pattern of visible peristaltic waves
d. Severe radiating abdominal pain
 Rationale: Clinical palpation of a pulsating abdominal mass alerts the clinician to the
presence of a possible abdominal aortic aneurysm (AAA). Generally an arterial aneurysm is
defined as a localized arterial dilatation ≥50 % greater than the normal diameter.

6. A client is admitted to the intensive care unit with pulmonary edema. When performing
the admission assessment, the nurse should expect:
a. Crackles at the base of each lung
b. A pulse that is weak and rapid
c. Radiating anterior chest pain
d. A decreased blood pressure
Rationale: Crackles (rales) are caused by excessive fluid (secretions) in the airways. It
is caused by either an exudate or a transudate. Exudate is due to lung infection e.g
pneumonia while transudate such as congestive heart failure.

7. The nurse in the ICU is monitoring a client who has had an aortic valve replacement. The
nurse is aware that a slow pulse rate during the early postoperative period following
open heart surgery can indicate:
a. Heart failure
b. Heart block
c. Hypoxia
d. Shock
Rationale: Stroke is one of the most devastating complications after coronary artery
bypass graft (CABG) surgery, entailing permanent disability, a 3–6 fold increased risk of
mortality, an incremental hospital resource consumption and a longer length of hospital
stay

8. An important nursing interventions that ensures adequate ventilator exchange after

surgery would be to:
a. Remove the airway only when the client is fully conscious
b. Assess the hypoventilation by auscultating the lungs
c. Position the client laterally with the neck extended
d. Maintain humidified oxygen via nasal cannula
Rationale: To avoid obstruction of airway so that drainage of secretions and oxygen and
carbon dioxide exchange can occur.

9. On the way to the x-ray examination a client with a chest tube becomes confused and
pulls the chest tube out. The nurse’s immediate action should be to:
a. Cover the opening with the cleanest material available
b. Obtain sterile gauze to cover the opening
c. Hold the insertion site open with a Kelly clamp
d. Place the client in the supine position
 Rationale: Sterile gauze pads are a must-have for every first-aid kit due to their incredible
absorption capabilities, plus they are chemical free. Generally used for minor scrapes,
cuts and burns, sterile gauze pads are good for allowing just enough room for the wound
to breathe without leaving too much space for air exposure – which can prompt wound
infection.

10. To promote continued improvement in a client’s respiratory status after a chest tube is
removed, the nurse should:
a. Encourage bed rest with active and passive range-of-motion exercises
b. Remind the client to turn from side to side at least every 2 hours
c. Encourage frequent coughing and deep breathing
d. Continue observing for dyspnea and crepitus
Rationale: Physical activity increases blood flow to the skin, which can keep bed sores
from developing. This exercise can help maintain range of motion and increase blood.