CPAP and BIPAP modes can be used:

all of these answers.

in conjunction with steroids and bronchodilators.

to delay intubation.

as weaning protocol.

Answer and Explanation

The Correct Answer is A

Rationale:

A. CPAP (Continuous Positive Airway Pressure) and BiPAP (Bilevel Positive Airway Pressure) are forms of noninvasive positive pressure ventilation (NIPPV). They are versatile tools in respiratory care and can be used for multiple purposes, including supporting oxygenation, reducing the work of breathing, and preventing intubation when appropriate.

B. Patients with conditions such as acute exacerbations of asthma or COPD often benefit from a combination of NIPPV and pharmacologic therapy. Steroids reduce airway inflammation, bronchodilators open the airways, and CPAP or BiPAP improves alveolar ventilation.

C. NIPPV can provide temporary respiratory support in patients with respiratory distress or failure, potentially avoiding or delaying the need for invasive mechanical ventilation. This is particularly useful in patients with exacerbations of chronic respiratory diseases or pulmonary edema.

D. CPAP or BiPAP can be used as part of a weaning strategy from invasive mechanical ventilation. They provide partial ventilatory support while allowing the patient to resume spontaneous breathing, facilitating a smoother transition and reducing complications associated with prolonged intubation.

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Correct Answer is E

Explanation

Rationale:

A. Increasing the ventilator rate would enhance ventilation (removal of CO2), but this patient already has a normal PaCO2. There is no evidence of respiratory acidosis or hypercapnia, so adjusting the rate would not improve the hypoxemia.

B. Lowering the rate would further reduce CO2 removal, which is unnecessary because CO2 levels are normal. This adjustment would not improve oxygenation.

C. PEEP (positive end-expiratory pressure) helps keep alveoli open during expiration, improving oxygenation. Reducing PEEP could worsen alveolar collapse and further decrease PaO2.

D. Increase tidal volume is not the first intervention. The patient’s tidal volume of 550 mL for a 75 kg patient is about 7.3 mL/kg, which is within the recommended range (6–8 mL/kg ideal body weight) for lung-protective ventilation. Increasing tidal volume could increase the risk of barotrauma or volutrauma without effectively improving oxygenation as the main problem is hypoxemia, not ventilation.

E. Fraction of inspired oxygen (FIO2) directly increases the amount of oxygen delivered to the alveoli and subsequently to the bloodstream. With a PaO2 of 49 mmHg, the patient is severely hypoxemic and at risk for tissue hypoxia, organ dysfunction, and cardiac compromise. Increasing FIO2 is the most immediate and appropriate intervention to improve oxygenation while continuing to monitor the patient. Once oxygenation stabilizes, other adjustments, such as increasing PEEP or optimizing positioning, may be considered if needed.

A. Disconnect the chest tube from the drainage system during transport. B. Clamp the chest tube prior to transferring the client to a wheelchair. C. Empty the collection chamber prior to transport. D. Keep the drainage system below the level of the client's chest at all times.

Correct Answer is D

Explanation

Rationale:

A. Disconnect the chest tube from the drainage system during transport is incorrect because the chest tube must remain connected to the closed drainage system at all times. Disconnecting it would allow air to enter the pleural space, potentially causing a pneumothorax or tension pneumothorax. Maintaining a closed system is essential to preserve negative intrapleural pressure and prevent respiratory compromise.

B. Clamp the chest tube prior to transferring the client to a wheelchair is incorrect because routine clamping of a chest tube is contraindicated. Clamping can trap air in the pleural space and lead to a tension pneumothorax, which is life-threatening. Chest tubes are only clamped briefly for specific provider-ordered procedures, such as changing the drainage system or assessing for air leaks—not for transport.

C. Empty the collection chamber prior to transport is incorrect because emptying the drainage system is not routinely required before transport and may disrupt the sterile, closed system. Additionally, breaking the system increases infection risk and compromises accurate measurement of output. The drainage system is typically replaced—not emptied—when full, per facility protocol.

D. Keep the drainage system below the level of the client's chest at all times is correct. The drainage system must remain below chest level to prevent backflow of drainage or air into the pleural space. Gravity facilitates proper drainage, and elevating the system above chest level could allow fluid to reflux into the pleural cavity, increasing the risk of complications such as recurrent pneumothorax or infection.

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CPAP and BIPAP modes can be used:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is E

Explanation

A nurse is caring for a client who has a chest tube connected to a closed drainage system and needs to be transported to the x-ray department. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

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