A client in severe pulmonary edema is being intubated by the resident. What action by the nurse will assist in the confirmation of the endotracheal tube placement in the proper position?

Observe for mist in the endotracheal tube

Call for a chest x-ray

Attach a pulse oximeter and document O2 saturation

Check the pH of secretions

Answer and Explanation

The Correct Answer is B

Choice A reason: Observing mist in the endotracheal tube suggests air movement but is not a reliable indicator of correct placement. Mist can occur with esophageal intubation or partial airway placement. Definitive confirmation requires imaging, as mist does not distinguish between tracheal and esophageal placement, risking ventilation errors.

Choice B reason: A chest x-ray is the gold standard for confirming endotracheal tube placement. It visualizes the tube’s position relative to the carina, ensuring it is in the trachea and not the esophagus or a main bronchus. This is critical in pulmonary edema to ensure effective ventilation and oxygenation.

Choice C reason: Attaching a pulse oximeter monitors oxygen saturation but does not confirm endotracheal tube placement. Improved saturation may occur with incorrect placement (e.g., esophageal), and low saturation does not specify tube position. Imaging is required for definitive confirmation, making pulse oximetry a supportive, not primary, measure.

Choice D reason: Checking the pH of secretions is not a standard method for confirming endotracheal tube placement. Secretions’ pH varies and does not indicate whether the tube is in the trachea or esophagus. Chest x-ray provides anatomical confirmation, essential for ensuring proper ventilation in critical conditions like pulmonary edema.

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Correct Answer is C

Explanation

Choice A reason: Hemodialysis rapidly removes fluid and solutes, which can cause significant hemodynamic shifts, including hypotension, in unstable patients. It involves high blood flow rates and ultrafiltration, stressing the cardiovascular system. For a hemodynamically unstable patient with acute renal failure, hemodialysis is less suitable due to its potential to exacerbate hypotension and circulatory collapse.

Choice B reason: Peritoneal dialysis uses the peritoneal membrane for slow fluid and solute exchange, which is gentler on hemodynamics. However, it is less efficient for rapid correction of hypervolemia and hyperkalemia in acute renal failure. It also carries risks of peritonitis and is impractical in critically ill patients with abdominal trauma or instability.

Choice C reason: Continuous venovenous hemodialysis (CVVHD) is ideal for hemodynamically unstable patients. It provides slow, continuous fluid and solute removal, minimizing cardiovascular stress. CVVHD effectively manages hypervolemia and hyperkalemia in acute renal failure by maintaining steady-state clearance, reducing the risk of hypotension compared to intermittent hemodialysis, making it the best choice.

Choice D reason: Plasmapheresis removes plasma components, not fluid or electrolytes like potassium, and is used for conditions like autoimmune disorders, not acute renal failure. It does not address hypervolemia or hyperkalemia and can cause hemodynamic instability due to rapid plasma exchange, making it inappropriate for this patient’s needs.

A. Pulmonary embolism B. Acute myocardial infarction C. Pericarditis D. Aortic dissection

Correct Answer is B

Explanation

Choice A reason: Pulmonary embolism causes chest pain and diaphoresis but typically presents with tachycardia, dyspnea, and normal or non-specific ECG changes, not ST-segment elevation. The latter is specific to myocardial ischemia, making pulmonary embolism less likely. Embolism affects pulmonary circulation, not coronary arteries, which are implicated in the described ECG findings.

Choice B reason: Acute myocardial infarction presents with chest pain, diaphoresis, and ST-segment elevation on ECG, indicating acute coronary artery occlusion leading to myocardial ischemia. This is a life-threatening emergency requiring immediate intervention like percutaneous coronary intervention. The symptoms and ECG findings align with myocardial infarction, making it the most likely diagnosis.

Choice C reason: Pericarditis causes chest pain, often pleuritic, and may cause diaphoresis, but ECG typically shows diffuse ST-segment elevation, not localized as in myocardial infarction. Pericarditis is less likely to cause acute, severe ischemic symptoms. The specific ST elevation and symptoms point to coronary occlusion, not pericardial inflammation.

Choice D reason: Aortic dissection causes severe, tearing chest pain and may cause diaphoresis, but ECG is usually normal or shows non-specific changes, not ST-segment elevation. Dissection affects the aorta, not coronary arteries, making it less likely. The ECG findings and symptoms strongly suggest myocardial infarction over aortic dissection.

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A client in severe pulmonary edema is being intubated by the resident. What action by the nurse will assist in the confirmation of the endotracheal tube placement in the proper position?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A client in the emergency department presents with chest pain, diaphoresis, and ST-segment elevation on ECG. Which condition should the nurse suspect?

Correct Answer is B

Explanation

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