NRNP 6566 Week 7 Knowledge Check (Collection) version 1, 2 and 3 all Answered (Grade A+)
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NRNP 6566 (NRNP6566)
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Walden University
(NRNP 6566 Week 7 Knowledge Check, NRNP 6566 Week 7 Knowledge Check)
NRNP 6566 Week 7 Knowledge Check (Version 1)
Question: A patient with respiratory failure has hemodynamic monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 10 cm H2O. Which informatio...
nrnp 6566 week 7 knowledge check collection version 1
2 and 3 all answered grade a
question a patient with respiratory failure has hemodynamic monitoring and is receiving mechanical ventilation
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NRNP 6566 (NRNP6566)
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Question 1
A patient with respiratory failure has hemodynamic monitoring and is receiving
mechanical ventilation with peak end-expiratory pressure (PEEP) of 10 cm H2O. Which
information indicates that a change in the ventilator settings may be required?
a. The arterial line shows a blood pressure of 90/46.
b. The pulmonary artery pressure (PAP) is decreased.
c. The cardiac monitor shows a heart rate of 58 beats/min.
d. The pulmonary artery wedge pressure (PAWP) is increased.
Correct
Answer: The hypotension indicates that the high intrathoracic pressure caused by the
PEEP may be de-creasing venous return and cardiac output (CO). Decreasing
the PEEP should decrease the intrathoracic pressure and improving venous
return and cardiac output.
Question 2
The APRN is monitoring a newly intubated patient. He appears to be very anxious and
“fighting” the ventilator. What would be the most appropriate action?
Correct
Answer: Remove the patient from the ventilator and bag him with 100% FIO2. If the
patient improves, then the problem is with the ventilator. Respiratory
professional should check the ventilator function.
If the patient does not improve, the problem is with the patient. If death
appears imminent, airway obstruction pneumothorax, and dislodged
endotracheal tube must be considered as the cause. If death is not imminent,
close examination of the patient and chest X-ray should be completed. The
need for additional sedation should be considered as well.
Question 3
A 59 year old man was admitted to the ICU for a COPD exacerbation. He was intubated
earlier in the day. Initially after being intubated his static pressure was 23 cm H2o and
peak pressure 47 cm H20. The APRN is notified that currently his peak pressure has risen
to 62 cm H20 and the static pressure is 42 cm H20. His heart rate has increased from 88
to 112beats / minute and his blood pressure has decreased from 112/88 to 92/ 72. He has
decreased breath sounds on the left side.
Where do you think the problem lies with this particular patient?
Correct
Answer: This patient has had increases in both the peak and static pressures
suggestion this patient has a new “compliance” problem. A patient with COPD
who develops unilateral decreased breath sounds, tachycardia, and
hypotension while on mechanical ventilation should be suspected that he has
developed a tension pneumothorax.
This study source was downloaded by 100000839287192 from CourseHero.com on 03-08-2022 09:20:33 GMT -06:00
, Question 4
0.5 out of 1 points
A 34 year ole email who weights 96 kg (211 lbs.) and is 165 cm (5 ft. 6 inches) tall has
chest trauma due to a motorcycle accident. The patient has just been intubated, sedated
and paralyzed with morphine sulfate and pancuronium bromide. What initial ventilator
settings are appropriate for this patient?
Correct
Answer: Assist control mode (A/C) is utilized after intubation. Tidal volume is based on
the patients ideal body weight (not actual body weight). Ideal body weight for
this patient is 63 kg. Tidal volume is set at 8-10 ml/kg or 500-600 ml in this
patient. FIO2 should initially be 100% with an initial PEEP of 5 and respiratory
rate of 12 - 14. ABG should be obtained after intubation and appropriate
adjustments made.
Question 5
A 40 year-old. 6-foot tall man has been inpatient on the step down unit for the past 2
days. He was admitted for fever and cough with production of yellow sputum. His
admission blood pressure was 128/72 and initial chest x-ray showed a left lower lobe
infiltrate. His ABG on room air showed: pH 7.31, PCO2 30, PO2 78, HCO3 17. He was
started on antibiotics and progress notes from he past two days indicate improvement in
his condition.
The APRN is called by the nurse because of worsening of the patients condition.
On your arrival to the room, vitals signs are. BP. 86/60 P 118 RR 38 oxygen saturation on
a non-rebreather mask is 78% (this am it was 97% on 2L per NC). The patient is laboring
to breath with accessory muscle use. He is less responsive, diaphoretic, and is speaking
in short sentences. Repeat chest x-ray shows bilateral diffuse lung opacities. ABG on the
non-rebreather mask show: pH 7.18, PCO2 47, PO2 56, HCO3 13.
The decision to intubate the patient is made. What initial ventilator settings would you
order?
Correct
Answer: Ventilator settings include the mode of mechanical ventilation, tidal volume,
respiratory rate, the inspired oxygen concentration (FiO2), and the level of
positive end expiratory pressure (PEEP).
Assist control mode is usually initiated after intubation however there is
varying data on the use of different modes without clear evidenced based
guidelines on this. FiO2 is usually started at 100% and weaned down based on
patient response.
Tidal volumes are calculated based on the patient’s ideal body weight (not
their actual weight). Ideal body weight is calculated by utilizing the patients
height To calculate the ideal body weight in kilograms, you can use the
following formulas:
Men: [(height in inches – 60) X 2.2] + 50
Women: [(height in inches – 60) X 2.2] + 45
Once you have calculated the ideal body weight, the tidal volume is calculated
at 6-8 cc/ kg
This study source was downloaded by 100000839287192 from CourseHero.com on 03-08-2022 09:20:33 GMT -06:00
, The patient in this case is 6-foot tall (72 inches). Using the formula above, his
ideal body weight is about 76kg. A tidal volume of 600 cc would be 8 ml/kg
The respiratory rate should be determined based on an assessment of the
patient’s minute ventilation requirements. For example, a patient with a
normal bicarbonate of 24 who was intubated for a procedure may only need 6-
8 liters/minute of ventilation whereas a patient in severe sepsis with a
bicarbonate of 10 may require upwards of 20-25 liters/minute of ventilation to
maintain an adequate acid-base status. Once you derive an estimate of the
minute ventilation (VE ) needs of the patient, you can use your previously
determined tidal volume and simple division to calculate an appropriate
respiratory rate (RR = VE/tidal volume)
The initial PEEP is usually set at 5 cm H2O. The PEEP is typically not decreased
below 5 cm H2O but can be increased as necessary (up to 15 to 20 cm H20) to
support oxygenation in patients with severe hypoxemia
Question 6
A 59 year old man was admitted to the ICU for a COPD exacerbation. He was intubated
earlier in the day. Initially after being intubated his static pressure was 23 cm H2o and
peak pressure 47 cm H20. The APRN is notified that currently his peak pressure has risen
to 62 cm H20 and the static pressure is 42 cm H20. His heart rate has increased from 88
to 112beats / minute and his blood pressure has decreased from 112/88 to 92/ 72. He has
decreased breath sounds on the left side.
What management steps should you institute at this point?
Correct
Answer: A chest X-ray should be obtained to look for evidence of a pneumothorax, new
pleural effusion, developing ARDS. Examine the patient for any abdominal
distention. If the patient becomes hemodynamically unstable and there is high
index of suspicion for a tension pneumothorax, a large bore needle should be
placed into the second intercostal space along the mid-clavicular line to
decompress the pneumothorax. Chest tube placement would be indicated
after initial needle placement for decompression.
Question 7
Four hours after mechanical ventilation is initiated for a patient with chronic obstructive
pulmo-nary disease (COPD), the patient's arterial blood gas (ABG) results include a pH of
7.50, PaO2 of 80 mm Hg, PaCO2 of 29 mm Hg, and HCO3- of 23 mEq/. What change in
ventilator settings would be indicated?
Correct
Answer: The patient's PaCO2 and pH indicate respiratory alkalosis. In mechanically
ventilated patients who have respiratory alkalosis, the tidal volume and/or
respiratory rate may need to be de-creased. Inadequate sedation and pain
control may contribute to respiratory alkalosis in patients breathing over the
set ventilator rate.
The PaO2 is appropriate for a patient with COPD,
Question 8
This study source was downloaded by 100000839287192 from CourseHero.com on 03-08-2022 09:20:33 GMT -06:00
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