NEURO FINAL EXAM URDEN
1. Which of the following arterial blood gas values would indicate a need for oxygen therapy?
a.
PaO2 of 80 mm Hg
c.
HCO3- of
... [Show More] 24 mEq
b.
PaCO2 of 35 mm Hg
d.
SaO2 of 87%
ANS: D
The amount of oxygen administered depends on the pathophysiologic mechanisms affecting the patient's oxygenation status. In most cases, the amount required should provide an arterial partial pressure of oxygen (PaO2) of greater than 60 mm Hg or an arterial hemoglobin saturation (SaO2) of greater than 90% during both rest and exercise.
2. Which of the following oxygen administration devices can deliver oxygen concentrations of 90%?
a.
Nonrebreathing mask
c.
Partial rebreathing mask
b.
Nasal cannula
d.
Simple mask
ANS: A
With an FiO2 of 55% to 70%, a nonrebreathing mask with a tight seal over the face can deliver 90% to 100% oxygen. It is used in emergencies and short-term therapy requiring moderate to high FiO2.
3. The most accurate and reliable control of FiO2 can be achieved through the use of a(n)
a.
simple mask.
c.
air-entrainment mask.
b.
nonrebreathing circuit (closed).
ANS: B
The most reliable and accurate means of delivering a prescribed concentration of oxygen is through the use of a nonrebreathing circuit (closed).
4. Use of oxygen therapy in the patient who is hypercapnic may result in
a.
oxygen toxicity.
c.
carbon dioxide retention.
b.
absorption atelectasis.
d.
pneumothorax.
ANS: C
Deoxygenated hemoglobin carries more CO2 compared with oxygenated hemoglobin. Administration of oxygen increases the proportion of oxygenated hemoglobin, which causes increased release of CO2 at the lung level. Because of the risk of CO2 accumulation, all patients who are chronically hypercapnic require careful low-flow oxygen administration.
5. The correct procedure for selecting an oropharyngeal airway is to:
a.
measure from the tip of the nose to the ear lobe.
b.
measure from the mouth to the ear lobe.
c.
measure from the tip of the nose to the middle of the trachea.
d.
measure the airway from the corner of the patient's mouth to the angle of the jaw.
ANS: D
An oropharyngeal airway's proper size is selected by holding the airway against the side of the patient's face and ensuring that it extends from the corner of the mouth to the angle of the jaw. If the airway is improperly sized, it will occlude the airway. Nasopharyngeal airways are measured by holding the tube against the side of the patient's face and ensuring that it extends from the tip of the nose to the ear lobe.
6. The finding of normal breath sounds on the right side of the chest and absent breath sounds on the left side of the chest in a newly intubated patient is probably caused by a
a.
right mainstem intubation.
c.
right hemothorax.
b.
left pneumothorax.
d.
gastric intubation.
ANS: A
The finding of normal breath sounds on the right side of the chest and absent breath sounds on the left side of the chest in a newly intubated patient is probably caused by a right mainstem intubation
7. Long-term ventilator management over 21 days is best handled through use of a(n)
a.
oropharyngeal airway.
c.
tracheostomy tube.
b.
esophageal obturator airway.
d.
endotracheal intubation.
ANS: C
Although no ideal time to perform the procedure has been identified, it is commonly accepted that if a patient has been intubated or is anticipated to be intubated for longer than 7 to 10 days, a tracheostomy should be performed.
8. Which of the following statements is correct concerning endotracheal tube cuff management?
a.
The cuff should be deflated every hour to minimize pressure on the trachea.
b.
A small leak should be heard on inspiration if the cuff has been inflated using the minimal leak technique.
c.
Cuff pressures should be kept between 40 to 50 mm Hg to ensure an adequate seal.
d.
Cuff pressure monitoring should be done once every 24 hours.
ANS: B
The minimal leak technique consists of injecting air into the cuff until no leak is heard and then withdrawing the air until a small leak is heard on inspiration. Problems with this technique include difficulty maintaining positive end-expiratory pressure and aspiration around the cuff.
9. Nursing interventions to limit the complications of suctioning include
a.
inserting the suction catheter no more than 5 inches.
b.
premedicating the patient with atropine.
c.
hyperoxygenating the patient with 100% oxygen.
d.
increasing the suction to 150 mm Hg.
ANS: C
Hypoxemia can be minimized by giving the patient three hyperoxygenation breaths (breaths at 100% FiO2) with the ventilator before the procedure and again after each pass of the suction catheter.
10. Which of the following levels would be classified as a low-flow system of oxygen administration?
a.
O2 via nasal cannula at 4 L/min
b.
O2 via nasal catheter at a FiO2 range of 60% to 75%
c.
O2 via transtracheal catheter at 10 L/min
d.
O2 via simple mask at 12 L/min.
ANS: A
A low-flow oxygen delivery system provides supplemental oxygen directly into the patient's airway at a flow of 8 L/min or less. Because this flow is insufficient to meet the patient's inspiratory volume requirements, it results in a variable FiO2 as the supplemental oxygen is mixed with room air. Nasal catheter FiO2 range is 22% to 45%. Oxygen flow through a transtracheal catheter is 0.25 to 4 L/min. A simple mask is a reservoir delivery system.
11. The ventilator variable that causes inspiration is called the
a.
cycle.
c.
flow.
b.
trigger.
d.
pressure.
ANS: B
The phase variable that initiates the change from exhalation to inspiration is called the trigger. Breaths may be pressure triggered or flow triggered based on the sensitivity setting of the ventilator and the patient's inspiratory effort or time triggered based on the rate setting of the ventilator.
12. The assist-control mode of ventilation functions in which of the following manners?
a.
It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts.
b.
It delivers gas at a preset volume, allowing the patient to breathe spontaneously at his or her own volume.
c.
It applies positive pressure during both ventilator breaths and spontaneous breaths.
d.
It delivers gas at preset rate and tidal volume regardless of the patient's inspiratory efforts.
ANS: A
Whereas a breath that is initiated by the patient is known as a patient-triggered or patient-assisted breath, a breath that is initiated by the ventilator is known as a machine-triggered or machine-controlled breath. A time-triggered breath is a machine-controlled breath that is initiated by the ventilator after a preset length of time has elapsed. It is controlled by the rate setting on the ventilator (e.g., a rate of 10 breaths/min yields 1 breath every 6 seconds). Flow-triggered and pressure-triggered breaths are patient-assisted breaths that are initiated by decreased flow or pressure, respectively, within the breathing circuit.
13. Preset positive pressure used to augment the patient's inspiratory effort is known as
a.
positive end-expiratory pressure (PEEP).
b.
continuous positive airway pressure (CPAP).
c.
pressure control ventilation (PCV).
d.
pressure support ventilation (PSV).
ANS: D
Preset positive pressure used to augment the patient's inspiratory efforts is known as pressure support ventilation. With continuous positive airway pressure, positive pressure is applied during spontaneous breaths; the patient controls rate, inspiratory flow, and tidal volume. Positive end-expiratory pressure is positive pressure applied at the end of expiration of ventilator breaths.
14. Which of the following statements best describes the effects of positive-pressure ventilation on cardiac output?
a.
Positive-pressure ventilation increases intrathoracic pressure, which increases venous return and cardiac output.
b.
Positive-pressure ventilation decreases venous return, which increases preload and cardiac output.
c.
Positive-pressure ventilation increases venous return, which decreases preload and cardiac output.
d.
Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return and cardiac output.
ANS: D
Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return to the right side of the heart. Impaired venous return decreases preload, which results in a decrease in cardiac output.
15. Nursing management of the patient receiving a neuromuscular blocking agent should include
a.
withholding all sedation and narcotics.
b.
protecting the patient from the environment.
c.
keeping the patient supine.
d.
speaking to the patient only when necessary.
ANS: B
Patient safety is a major concern for the patient receiving a neuromuscular blocking agent because these patients are unable to protect themselves from the environment. Special precautions should be taken to protect the patient at all times. [Show Less]