Chapter 28 Skills in Clinical Nursing 8th Edition by Audrey J. Berman- Shirlee Snyder

Chapter 28 Skills in Clinical Nursing 8th Edition by Audrey J. Berman- Shirlee Snyder

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE.  Choose the one alternative that best completes the statement or answers the question.

• The nurse working with a student nurse is providing care for a client requiring mechanical 1) The student nurse asks the meaning of assist control. The nurse’s best response would

be:

1. “Assist control is a means of delivering ventilation that delivers a preset volume and/or pressure each time the client begins an “
2. “Assist control allows the client to breathe independently, but supplies a breath if the client does not begin an inhalation in a specified period of “
3. “Assist control is used when weaning a client from the ventilator because the client must exercise the muscles of respirations in order to get a full “
4. D) “Assist control is often used when a client is receiving a paralytic “

Answer: A

Explanation: A)       Assist control allows the client to begin inspiration, but the ventilator provides a preset pressure or volume to boost the client’s tidal volume. If the ventilator is set to provide a breath only when the client doesn’t breathe, it is not assist control but Synchronized Intermittent Mandatory Ventilation (SIMV). Because the ventilator provides the breath begun by the client, it does not improve muscle function. Assist control would not be used for the client receiving a paralytic agent because

he would be unable to initiate a breathe.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

1. Assist control allows the client to begin inspiration, but the ventilator provides a preset pressure or volume to boost the client’s tidal If the ventilator is set to provide a breath only when the client doesn’t breathe, it is not assist control but Synchronized Intermittent Mandatory Ventilation (SIMV). Because the ventilator provides the breath begun by the client, it does not improve muscle function. Assist control would not be used for the client receiving a paralytic agent because

he would be unable to initiate a breathe.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

1. Assist control allows the client to begin inspiration, but the ventilator provides a preset pressure or volume to boost the client’s tidal If the ventilator is set to provide a breath only when the client doesn’t breathe, it is not assist control but Synchronized Intermittent Mandatory Ventilation (SIMV). Because the ventilator provides the breath begun by the client, it does not improve muscle function. Assist control would not be used for the client receiving a paralytic agent because

he would be unable to initiate a breathe.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

 

1. Assist control allows the client to begin inspiration, but the ventilator provides a preset pressure or volume to boost the client’s tidal If the ventilator is set to provide a breath only when the client doesn’t breathe, it is not assist control but Synchronized Intermittent Mandatory Ventilation (SIMV). Because the ventilator provides the breath begun by the client, it does not improve muscle function. Assist control would not be used for the client receiving a paralytic agent because he would be unable to initiate a breathe.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Objective: Learning Outcome 28-1: Define the key terms associated with the skills of caring for clients with

mechanical ventilation.

• The nurse is caring for a client with What order would the nurse anticipate to correct 2) this problem?

1. A) Increase oxygen B) Increase flow rate.
2. C) Increase tidal D) Set PEEP at 6 cm H2O.

Answer: D

Explanation: A) PEEP is often used to prevent further atelectasis because it maintains open alveoli between breaths. Increasing tidal volume would not prevent airway collapse after expiration. Increasing oxygen concentration or oxygen flow rate would not impact atelectasis.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Planning

1. PEEP is often used to prevent further atelectasis because it maintains open alveoli between Increasing tidal volume would not prevent airway collapse after expiration. Increasing oxygen concentration or oxygen flow rate would not impact atelectasis.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Planning

1. PEEP is often used to prevent further atelectasis because it maintains open alveoli between Increasing tidal volume would not prevent airway collapse after expiration. Increasing oxygen concentration or oxygen flow rate would not impact atelectasis.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Planning

1. PEEP is often used to prevent further atelectasis because it maintains open alveoli between Increasing tidal volume would not prevent airway collapse after expiration. Increasing oxygen concentration or oxygen flow rate would not impact atelectasis.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Planning

Objective: Learning Outcome 28-1: Define the key terms associated with the skills of caring for clients with mechanical ventilation.

 

• When caring for the client requiring mechanical ventilation, the nurse would anticipate providing 3) all of the following care except:
  1. Confirm airway placement by auscultating the lungs and checking the length marking of the tube at the

1. Assure that tube cuff inflation is no greater than 15 cm H20, and that there is no audible air

leak.

1. Assure ventilator tubing is secured and does not pull on the client’s
2. Verify correct ventilator

Answer: B

Explanation: A)      Tube cuff inflation is normally set at 20-25 cm H2O. The other care is correct. Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

1. B) Tube cuff inflation is normally set at 20-25 cm H2O. The other care is correct.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

1. Tube cuff inflation is normally set at 20-25 cm The other care is correct. Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

1. Tube cuff inflation is normally set at 20-25 cm The other care is correct. Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

Objective: Learning Outcome 28-2: Identify nursing interventions for meeting the needs of the client with

mechanical ventilation.

• The nurse working in the intensive care unit is assigned a client requiring mechanical 4) When responding to the ventilator alarm, the nurse sees a high-pressure alarm. What is the nurse’s priority action?

1. A) Silence the
   1. Remove the client from the ventilator, and use a bag-valve device to oxygenate the client until the respiratory therapist can be
2. Empty the collected water from the ventilator
3. Assess the

Answer: D

Explanation: A)      The nurse should treat the client and not the alarm, so the first action would be to assess the client quickly. In most instances, depending on facility policy, if a client requires mechanical ventilation, he is placed on cardiorespiratory monitors with continuous oxygen saturation monitoring. The nurse would assess heart rate and oxygen saturation, and examine the client for any signs of distress. If the client is comfortable, and assessment findings are within normal limits, the cause of the alarm could be water collecting in the tubing (which should be emptied). However, if the client is in distress, it might be necessary to remove the client from the ventilator and to bag the client until the cause of the problem can be located

and corrected.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

 

1. The nurse should treat the client and not the alarm, so the first action would be to assess the client In most instances, depending on facility policy, if a client requires mechanical ventilation, he is placed on cardiorespiratory monitors with continuous oxygen saturation monitoring. The nurse would assess heart rate and oxygen saturation, and examine the client for any signs of distress. If the client is comfortable, and assessment findings are within normal limits, the cause of the

alarm could be water collecting in the tubing (which should be emptied).

However, if the client is in distress, it might be necessary to remove the client from the ventilator and to bag the client until the cause of the problem can be located

and corrected.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

1. The nurse should treat the client and not the alarm, so the first action would be to assess the client In most instances, depending on facility policy, if a client requires mechanical ventilation, he is placed on cardiorespiratory monitors with continuous oxygen saturation monitoring. The nurse would assess heart rate and oxygen saturation, and examine the client for any signs of distress. If the client is comfortable, and assessment findings are within normal limits, the cause of the

alarm could be water collecting in the tubing (which should be emptied).

However, if the client is in distress, it might be necessary to remove the client from the ventilator and to bag the client until the cause of the problem can be located

and corrected.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

1. The nurse should treat the client and not the alarm, so the first action would be to assess the client In most instances, depending on facility policy, if a client requires mechanical ventilation, he is placed on cardiorespiratory monitors with continuous oxygen saturation monitoring. The nurse would assess heart rate and oxygen saturation, and examine the client for any signs of distress. If the client is comfortable, and assessment findings are within normal limits, the cause of the

alarm could be water collecting in the tubing (which should be emptied).

However, if the client is in distress, it might be necessary to remove the client from the ventilator and to bag the client until the cause of the problem can be located

and corrected.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Objective: Learning Outcome 28-2: Identify nursing interventions for meeting the needs of the client with

mechanical ventilation.