A nurse is caring for a client who is using a ventilator when the low-pressure ventilator alarm sounds. Which of the following actions should the nurse take?
Suction secretions from the endotracheal tube.
Check the ventilator tubing connections.
Administer intravenous sedation and analgesia.
Reassure the client and instruct them not to bite on the tube.
The Correct Answer is B
Choice A Reason:
Suctioning secretions from the endotracheal tube is a common intervention for high-pressure alarms, which indicate an obstruction in the airway. However, a low-pressure alarm typically signals a disconnection or leak in the ventilator system, not an obstruction.
Choice B Reason:
Checking the ventilator tubing connections is the appropriate response to a low-pressure alarm. This alarm usually indicates a disconnection or leak in the ventilator circuit, which can compromise the delivery of adequate ventilation to the patient. Ensuring all connections are secure is the first step in troubleshooting this issue.
Choice C Reason:
Administering intravenous sedation and analgesia is not directly related to addressing a low-pressure ventilator alarm. While sedation may be necessary for patient comfort and to prevent agitation, it does not resolve the underlying issue of a disconnection or leak in the ventilator system.
Choice D Reason:
Reassuring the client and instructing them not to bite on the tube is more relevant to high-pressure alarms, where patient actions such as biting the tube can cause increased airway resistance. It does not address the cause of a low-pressure alarm, which is typically due to a disconnection or leak.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason
Diazepam IV is the correct choice for managing repeated tonic-clonic seizures, especially in the context of status epilepticus. Diazepam is a benzodiazepine that acts quickly to stop seizures by enhancing the effect of the neurotransmitter GABA. It is commonly used in emergency settings due to its rapid onset of action when administered intravenously.
Choice B Reason
Lorazepam PO is not the best choice in this scenario. While lorazepam is also a benzodiazepine effective in stopping seizures, the oral route is not suitable for immediate control of seizures. Intravenous administration is preferred for rapid action.
Choice C Reason
Diltiazem IV is incorrect. Diltiazem is a calcium channel blocker used primarily for managing hypertension and certain types of arrhythmias. It is not indicated for the treatment of seizures.
Choice D Reason
Clonazepam PO is not appropriate for immediate seizure control. Although clonazepam is a benzodiazepine used for seizure management, the oral route is not effective for rapid seizure termination. Intravenous administration of a benzodiazepine like diazepam or lorazepam is preferred.
Correct Answer is ["B","E"]
Explanation
Choice A Reason:
Initiating an insulin drip is not a standard intervention for all clients with acute pancreatitis. This intervention is typically reserved for clients who develop hyperglycemia or diabetes as a complication of pancreatitis. Acute pancreatitis can affect the pancreas’ ability to produce insulin, but not all clients will require an insulin drip.
Choice B Reason:
Monitoring blood glucose levels is crucial for clients with acute pancreatitis because the pancreas plays a key role in regulating blood sugar. Inflammation or damage to the pancreas can lead to fluctuations in blood glucose levels, making regular monitoring essential to manage potential hyperglycemia or hypoglycemia.
Choice C Reason:
Continuing a regular diet as tolerated is not appropriate for clients with acute pancreatitis. These clients are typically kept NPO (nothing by mouth) to rest the pancreas and reduce the secretion of pancreatic enzymes, which can exacerbate inflammation and pain.
Choice D Reason:
Maintaining NPO status until the client is pain-free is a standard intervention for acute pancreatitis. This approach helps to rest the pancreas and prevent the release of digestive enzymes that can further inflame the pancreas. Once the client is pain-free and inflammation has subsided, a gradual reintroduction of oral intake can be considered.
Choice E Reason:
Managing acute pain is a critical aspect of care for clients with acute pancreatitis. Pain management can include medications such as opioids, as well as non-pharmacological interventions like positioning and relaxation techniques. Effective pain management improves the client’s comfort and can help reduce stress on the pancreas.
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
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.