NRNP 6566 / NRNP6566 Advanced Care of Adults in Acute Settings I Week 7 Knowledge Check | Questions and Verified Answers | Latest 2020 / 2021

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NRNP 6566 / NRNP6566 Advanced Care of Adults in Acute Settings I Week 7 Knowledge Check | Questions and Verified Answers | Latest 2020 / 2021 • Question 1 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 2 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 3 The APRN is notified that an intubated patients endotracheal tube (ET) was marked at 21 cm and is not at the 24 cm line. The patient appears anxious and restless. What action should the APRN take? Correct Answer: Advancement of the ET could cause the tube to be displaced into the right mainstream bron-chus. Initial assessment would be to see if there are unilateral breath sounds. A stat portable chest X-ray could be ordered to assess the location. If the patient’s oxygenation is low, he could be bagged with 100% FIO2 until the X-ray results are available. If indicated, the tube should be repositioned immediately. Any change in position of the endotracheal tube should be assessed with a stat portable chest X-ray. • Question 4 [Show More]

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