A patient is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this patient's bedside?

Choice A rationale

While providing reassurance is part of psychosocial care, it is not the physiological priority when an artificial airway has been removed. Assessment of respiratory status is important, but the nurse must first ensure that the patient has a patent airway and adequate oxygen delivery to prevent hypoxia and hypercapnia. Delaying life-saving ventilation to offer verbal comfort or perform a long assessment can lead to rapid desaturation in critically ill patients.

Choice B rationale

This is the first action because unplanned extubation requires immediate rescue ventilation. The nurse should use a manual resuscitation bag with 100 percent oxygen to maintain oxygenation and provide positive pressure if necessary. This stabilizes the patient’s gas exchange while preparations for reintubation are made. Securing the airway and preventing hypoxemia is the most critical step in an emergency involving a compromised artificial airway to protect vital organ function and cerebral perfusion.

Choice C rationale

Calling the health care provider is necessary for reintubation, but it is not the first action. The nurse must first manually ventilate the patient to ensure safety before leaving the bedside or focusing on communication. Assessment for the need to reintubate happens simultaneously with or after the patient is stabilized with supplemental oxygen. The immediate physical requirement is the delivery of oxygen to the lungs through the least invasive or most available means.

Choice D rationale

Sedation is contraindicated in a patient who has just lost their airway because it can suppress the remaining respiratory drive and worsen hypoxia. Placing the patient on their left side does not resolve the lack of an artificial airway or the need for high-flow oxygen. This action would waste valuable seconds that should be spent on manual ventilation. Patient safety depends on active airway management rather than pharmacological intervention or simple repositioning during an extubation crisis.

Choice A rationale

Ativan is a benzodiazepine used primarily for sedation or to treat anxiety and seizures. It has no direct effect on reducing central venous pressure or managing fluid volume overload. A central venous pressure of 15 mmHg is elevated, as the normal range is typically 2 to 8 mmHg. Administering a sedative would not address the physiological issue of excess preload or right-sided heart congestion indicated by the high pressure reading in this patient.

Choice B rationale

Albumin is a colloid used to expand intravascular volume by pulling fluid from the interstitial space into the vessels. Administering albumin would increase the central venous pressure further, which is dangerous in a patient who already shows signs of volume excess with a reading of 15 mmHg. This would worsen the strain on the heart and potentially lead to pulmonary edema. Normal range for central venous pressure is 2 to 8 mmHg.

Choice C rationale

Furosemide is a potent loop diuretic that increases the excretion of sodium and water by the kidneys. It is the appropriate treatment for a central venous pressure of 15 mmHg, which indicates fluid volume overload or right heart failure since the normal range is 2 to 8 mmHg. By inducing diuresis, furosemide reduces the total circulating blood volume and lowers the preload, thereby decreasing the central venous pressure and relieving the workload on the heart.

Choice D rationale

Digoxin is an inotropic agent used to increase the force of myocardial contraction and slow the heart rate in conditions like atrial fibrillation. While it can help with heart failure, it is not the first-line medication for an acute elevation in central venous pressure caused by volume overload. Diuresis is a more direct and faster way to lower the pressure reading of 15 mmHg back toward the normal range of 2 to 8 mmHg.