A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate?

Preparing to assist with intubating the patient

Setting up oxygen at 5 L/minute by nasal cannula

Performing deep suctioning

Setting up a nebulizer to administer corticosteroids

Answer and Explanation

The Correct Answer is A

Rationale:

A. Preparing to assist with intubating the patient is correct. ARDS is characterized by severe hypoxemia that is often refractory to supplemental oxygen. Patients frequently require early airway management with endotracheal intubation and mechanical ventilation to maintain adequate oxygenation and prevent respiratory failure. Prompt anticipation of intubation is critical in preventing rapid deterioration.

B. Setting up oxygen at 5 L/minute by nasal cannula is incorrect because ARDS patients typically do not achieve adequate oxygenation with low-flow oxygen. They require higher oxygen delivery methods, often non-rebreather masks initially or mechanical ventilation.

C. Performing deep suctioning is incorrect as a first intervention. Suctioning may be needed to clear secretions, but it does not address the primary problem of hypoxemia in ARDS.

D. Setting up a nebulizer to administer corticosteroids is incorrect because corticosteroids are not the first-line intervention for acute ARDS and are not delivered via nebulizer in this scenario. Immediate focus is on airway and oxygenation support.

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Correct Answer is C

Explanation

Rationale:
A. Assist/control ventilation is incorrect because in this mode, the ventilator delivers a set tidal volume or pressure for every breath, either initiated by the patient or by the machine. The patient does not breathe spontaneously in between ventilator breaths independently; each initiated breath triggers the ventilator.

B. Controlled ventilation is incorrect because the ventilator delivers all breaths at a set rate and tidal volume, regardless of patient effort. There is no allowance for spontaneous breathing.

C. Synchronized intermittent mandatory ventilation (SIMV) is correct. SIMV delivers a preset number of mechanical breaths per minute while allowing the patient to take additional spontaneous breaths at their own tidal volume. This mode supports oxygenation and ventilation while promoting muscle activity and patient-initiated breathing, which is helpful for weaning from the ventilator.

D. Positive end-expiratory pressure (PEEP) is incorrect because PEEP is not a ventilation mode; it is a ventilator setting used to maintain positive pressure in the lungs at the end of expiration to improve oxygenation and alveolar recruitment. It does not control breath delivery.

A. The system is functioning normally. B. The patient has a pneumothorax. C. The system has an air leak. D. The chest tube is obstructed.

Correct Answer is C

Explanation

Rationale:
A. The system is functioning normally is incorrect because normal function of a water-seal chamber includes tidaling with respiration (the water level rises and falls with breathing) and intermittent bubbling, usually only during suction. Constant bubbling in the water-seal chamber indicates a problem, not normal function.

B. The patient has a pneumothorax is incorrect because while a pneumothorax may have caused the chest tube placement, the presence of constant bubbling in the water-seal chamber specifically indicates an air leak in the system, not necessarily a new or persistent pneumothorax.

C. The system has an air leak is correct. Constant bubbling in the water-seal chamber indicates that air is escaping somewhere in the system, either from the patient’s pleural space (ongoing pneumothorax) or from a loose connection, crack, or defect in the tubing or drainage system. The nurse should inspect all connections, tubing, and insertion site to locate and correct the leak.

D. The chest tube is obstructed is incorrect because obstruction typically prevents fluid or air from moving through the system, which may result in no tidaling or reduced drainage, not constant bubbling.

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A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate?

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Naxlex Comprehensive Predictor Exams

A patient's status worsens and he needs mechanical ventilation. The pulmonologist wants him to receive 10 breaths/min minute from the ventilator but wants to encourage him to breathe spontaneously in between the mechanical breaths at his own tidal volume. This mode of ventilation is called:

Correct Answer is C

Explanation

While assessing the patient, the nurse observes constant bubbling in the water-seal chamber of the patient's closed chest-drainage system. What should the nurse conclude?

Correct Answer is C

Explanation

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