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:

assist/control ventilation.

controlled ventilation.

synchronized intermittent mandatory ventilation.

positive end-expiratory pressure.

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is B

Explanation

Rationale:

A. If the endotracheal tube is mistakenly placed in the stomach, there would be no breath sounds bilaterally, absent chest rise, and possible abdominal distention. Normal breath sounds on the right rule out gastric intubation.

B. If the endotracheal tube is advanced too far, it can enter the right main bronchus, which is wider, shorter, and more vertical than the left. This results in ventilation of only the right lung, producing normal breath sounds on the right and decreased or absent breath sounds on the left. This is a common complication of intubation and requires immediate repositioning of the tube.

C. A pneumothorax on the right side would cause absent or decreased breath sounds on the right, not the left. This is inconsistent with the finding of decreased breath sounds on the left.

D. A pneumothorax on the left side could decrease breath sounds on the left; however, in the context of a newly intubated patient, the more likely cause of unilateral decreased breath sounds is malposition of the tube in the right mainstem bronchus, especially if this is an acute finding immediately after intubation.

A. Assure the patient that everything will be all right and that remaining calm is the best strategy. B. Ask a family member to interpret what the patient is trying to communicate. C. Ask the physician to wean the patient off the mechanical ventilator to allow the patient to speak freely. D. Express empathy and then encourage the patient to write, use a picture board, or spell words with an alphabet board.

Correct Answer is D

Explanation

Rationale:
A. Assure the patient that everything will be all right and that remaining calm is the best strategy is incorrect because while reassurance is supportive, it does not address the patient’s immediate communication needs, which are causing frustration.

B. Ask a family member to interpret what the patient is trying to communicate is incorrect because family members may not understand the patient’s intended message accurately, which can lead to miscommunication or frustration.

C. Ask the physician to wean the patient off the mechanical ventilator to allow the patient to speak freely is incorrect because weaning must be based on clinical readiness, not solely on communication needs. Premature weaning could compromise patient safety.

D. Express empathy and then encourage the patient to write, use a picture board, or spell words with an alphabet board is correct. These are alternative communication strategies for patients who are intubated or mechanically ventilated. By validating the patient’s feelings and providing tools for nonverbal communication, the nurse reduces frustration and supports patient autonomy and safety. This is considered best practice for facilitating communication in ventilated patients.

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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:

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Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is D

Explanation

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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: