Chapter 18; Troubleshooting and Problem Solving

Chapter 18; Troubleshooting and Problem Solving

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. When an alarm is activated on a ventilator, the respiratory therapist’s first priority is to ______________.

a.	assess the patient’s level of consciousness.
b.	ensure adequate ventilation and oxygenation.
c.	assess lung compliance and airway resistance.
d.	ensure that bilateral and equal breath sounds are present.

 

 

ANS:   B

Patient safety is the foremost obligation of the respiratory therapist. Whenever an alarm activates on a ventilator, the respirator therapist first should make sure the patient is adequately ventilated and oxygenated. To do this, the respiratory therapist can assess the patient’s level of consciousness, use of accessory muscles, and chest wall movements; determine whether bilateral breath sounds are present; and evaluate the heart rate and SpO₂.

 

DIF:    1                      REF:    pg. 354

 

2. Removing a patient from a ventilator to ventilate manually can lead to which of the following?
3. Barotrauma
4. Lung derecruitment
5. Increased airway resistance
6. Ventilator-acquired pneumonia

a.	1, 2, and 3
b.	1, 2, and 4
c.	2, 3 and 4
d.	3 and 4

 

 

ANS:   B

Removing a patient from the ventilator for manual ventilation can inadvertently cause barotrauma by using excessive pressure during ventilation (>40 cm H₂O). Disconnecting a patient who is being ventilated with a high level of PEEP (15 to 25 cm H₂O) can cause derecruitment of the lung. Disconnection of the ventilator can cause contamination of the patient’s airway, increasing the patient’s risk of developing ventilator-associated pneumonia.

 

DIF:    1                      REF:    pg. 355

 

3. A 68-year-old woman was admitted to the ICU with pneumonia and was intubated when she developed progressive hypoxemia. She has been on the ventilator for 5 days and has been tolerating this therapy well. The patient has suddenly become severely agitated and appears to be fighting the ventilator. The ventilator’s high pressure alarm is sounding continuously. The respiratory therapist disconnects the patient from the ventilator and begins manual ventilation with 100% oxygen and PEEP. The resuscitator bag is difficult to squeeze, breath sounds are present on the left with no adventitious sounds and absent on the right side, and percussion reveals hyperresonance over the right side. The most appropriate action to address this situation is which of the following?

a.	Pull the endotracheal tube back until bilateral breath sounds are heard.
b.	Administer a bronchodilator and suction the endotracheal tube.
c.	Extubate the patient and reintubate with a larger endotracheal tube.
d.	Insert a 14-gauge needle in the second intercostal space, midclavicular line, right side.

 

 

ANS:   D

If the endotracheal tube had slipped into the right mainstem bronchus, breath sounds would be heard on the right side and not on the left. The absence of breath sounds on the right side indicates that the endotracheal tube has not slipped into the right mainstem bronchus. No adventitious breath sounds are heard over the left lung, the patient has no history of bronchospasm, and no wheezing is heard—this essentially eliminates bronchospasm as the problem. The patient had been tolerating mechanical ventilation well for 5 days; therefore, the ET tube is not too small. The presence of auto PEEP would cause hyperresonance to percussion bilaterally. The patient apparently has a pneumothorax on the right side, as evidenced by the absence of breath sounds and hyperresonance to percussion on that side.

 

DIF:    3                      REF:    pg. 355-357

 

4. The respiratory therapist is called to the bedside of a patient mechanically ventilated in the VC-CMV mode because the low pressure, low exhaled tidal volume, and low exhaled minute volume alarms all have activated. This situation could be caused by which of the following?

a.	Patient biting the endotracheal tube.
b.	Rupture of the endotracheal tube cuff.
c.	Slipping of the endotracheal tube into the right mainstem.
d.	Plugging of the airways by airway secretions and mucus.

 

 

ANS:   B

With rupture of the ET tube cuff, volume escapes the system rather than being delivered to the patient. This activates the low pressure alarm and eventually leads to activation of the low tidal volume and low minute volume alarms. All the other options would activate the high pressure alarm.

 

DIF:    2                      REF:    pgs. 356-357; Box 18-7

 

5. The initial step in the management of patient-ventilator asynchrony is which of the following?

a.	Lower the high pressure alarm setting.
b.	Check the endotracheal tube cuff pressure.
c.	Ventilate the patient with a manual resuscitator bag.
d.	Check the low and high pressure alarm settings.

 

 

ANS:   C

If the patient is in severe distress, the first step is to disconnect the patient from the ventilator and carefully ventilate the patient using a manual resuscitation bag.

 

DIF:    1                      REF:    pg. 356