A client who has been mechanically ventilated for 5 days following ARDS is being evaluated for weaning readiness. The respiratory therapist reports the following parameters: Rapid shallow breathing index (RSBI) of 85, negative inspiratory force (NIF) of -28 cm H2O, spontaneous tidal volume of 6 mL/kg, and FiO2 requirement of 40% to maintain SpO2 >92%. Which parameter indicates the client may NOT be ready for weaning?

RSBI of 85 breaths/min/L

NIF of 28 cm H20

Spontaneous tidal volume of 6 mL/kg

FiO2 requirement of 40%

Answer and Explanation

The Correct Answer is D

A. The Rapid Shallow Breathing Index (RSBI) is calculated as the ratio of respiratory rate to tidal volume (in liters). An RSBI <105 is generally considered favorable for weaning. A value of 85 indicates the patient is breathing efficiently and may be ready to wean.

B. Negative inspiratory force measures inspiratory muscle strength. Values more negative than -20 to -30 cm H2O are considered adequate. A NIF of -28 cm H2O indicates sufficient inspiratory strength for spontaneous breathing.

C. A tidal volume ≥5 mL/kg is generally acceptable for weaning. A value of 6 mL/kg indicates adequate ventilation during spontaneous breathing trials.

D. A FiO2 >40% to maintain adequate oxygen saturation indicates ongoing oxygenation impairment, suggesting the client may not yet be ready for weaning. Successful weaning usually requires an FiO2 ≤40% and PEEP ≤5 cm H2O to maintain SpO2 ≥90–92%, ensuring the lungs can sustain oxygenation without excessive support.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is D

Explanation

A. Although it may seem intuitive to cool the bite site, ice is not recommendedin snakebite management. Cooling can damage local tissueand does not slow the systemic spread of venom. Applying ice can actually worsen tissue injury and delay healing.

B. Techniques such as suction or cutting the bite siteare outdated and ineffective. Studies show that attempting to extract venom orally does not remove enough venom to impact outcomesand increases the risk of infection or further tissue damage.

C. Tourniquets are contraindicatedbecause they can restrict blood flow, leading to tissue ischemia, necrosis, and permanent damage. Additionally, sudden release of a tourniquet may cause a surge of venom into the circulation, worsening systemic toxicity.

D. Immobilization helps slow lymphatic spread of venom, reducing systemic absorption. Keeping the limb at or slightly below heart levelprevents unnecessary venom circulation while avoiding excessive swelling that would occur if the limb were elevated above the heart. The patient should remain calm and limit movementto reduce venom distribution. Emergency medical services should be contacted immediately for assessment, antivenom administration if indicated, and monitoring of vital signs and systemic effects.

A. Verify the medication is infusing through a central venous catheter B. Place the client on continuous cardiac monitoring C. Assess baseline blood glucose level D. Document the clients current level of consciousness

Correct Answer is A

Explanation

A. Norepinephrine is a potent vasoconstrictor, and if it infiltrates peripheral tissue, it can cause severe tissue necrosis and extravasation injury. Administering it through a central venous catheteris the highest priority safety measurewhen initiating the infusion to prevent serious complications.

B. Continuous cardiac monitoring is importantbecause norepinephrine can cause tachycardia, arrhythmias, and increased myocardial oxygen demand, but the risk of tissue injury from peripheral administration is more immediately critical.

C. Assessing baseline blood glucose is not a priorityfor norepinephrine administration. Blood glucose monitoring may be relevant in critical care, but it does not directly prevent complications from norepinephrine infusion.

D. Documenting the client’s level of consciousness is important for ongoing assessment of perfusion and neurological status, but it is not the highest-priority actionat the time of initiating a vasopressor infusion.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

In addition to calling 911, what is the appropriate nursing response when a client calls the telehealth nurse to report being bitten on the arm by an unknown type of snake?

Correct Answer is D

Explanation

Correct Answer is A

Explanation

Which client will the emergency nurse triage as the priority?

A client with COPD who smokes 1 PPD presents for a routine appointment. Which client statement causes the nurse to suspect an increase in dyspnea?

Following management of a disaster, a patient care technician tells the nurse, "I keep seeing the faces of people that died when I close my eyes." What is the appropriate nursing response?

The nurse is caring for a client who was camping overnight. The client is vomiting and has severe pain in the left foot Blood pressure is 90/60, and the left lower leg is swollen and red. For which condition will the nurse assess as the priority?

The nurse is assessing a client who is in shock. Which of the following findings would indicate to the nurse that the client is entering an irreversible stage?

A client in acute respiratory failure is classified as having ventilatory failure. The nurse understands that which finding is a potential extrapulmonary cause of ventilatory failure?

The nurse is caring for a client with pulmonary embolism who is receiving enoxaparin. Which of the following actions should the nurse include in the plan of care?

The nurse is assessing a client who sustained a blunt chest injury. Which would indicate to the nurse that the client is exhibiting a flail chest?