The initial action by the nurse after placement of an endotracheal tube in any patient should be:

tape the tube securely in place

perform endotracheal suctioning

request a CXR

auscultate breath sounds

Answer and Explanation

The Correct Answer is D

Rationale:
A. Tape the tube securely in place is incorrect as the first action. While securing the endotracheal tube is important to prevent displacement, it should follow verification of correct placement, not precede it. Taping an incorrectly positioned tube could worsen hypoxia or cause trauma.

B. Perform endotracheal suctioning is incorrect as an initial action. Suctioning is only necessary if there is evidence of airway obstruction or secretions. Suctioning before confirming tube placement could cause trauma or worsen oxygenation.

C. Request a CXR is incorrect as the first action. A chest X-ray is used to confirm tube placement but is not immediately available in most emergency situations. Immediate bedside verification is critical before imaging.

D. Auscultate breath sounds is correct. The first priority after endotracheal tube placement is to verify correct tube placement by assessing for bilateral breath sounds, symmetrical chest rise, and, if available, end-tidal CO2. Proper placement ensures that the patient is being ventilated effectively. Immediate verification prevents hypoxia, gastric insufflation, and other complications.

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Correct Answer is B

Explanation

Rationale:

A. Nitroglycerine is primarily a venodilator that reduces systemic preload and myocardial oxygen demand. It has minimal effect on pulmonary vascular resistance (PVR) and is not used to treat pulmonary hypertension.

B. Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor that causes vasodilation of pulmonary arteries, thereby decreasing pulmonary vascular resistance. It is commonly used in the management of pulmonary arterial hypertension to improve pulmonary blood flow and reduce right ventricular afterload.

C. Digoxin is a cardiac glycoside that increases myocardial contractility and can slow heart rate in atrial fibrillation. It does not directly affect pulmonary vascular resistance, though it may improve cardiac output in right heart failure.

D. Dopamine is a catecholamine that primarily acts as an inotrope and vasopressor. At low doses, it increases renal perfusion, and at higher doses, it increases systemic vascular resistance, but it does not reliably decrease pulmonary vascular resistance and can sometimes increase it.

E. Furosemide (Lasix) is a loop diuretic that reduces fluid volume and preload, but it does not directly dilate pulmonary vessels or reduce pulmonary vascular resistance.

A. clamp the chest tube to avoid further blood loss. B. monitor the chest tube drainage every 15 minutes for 1 hour. C. contact the physician to report possible hemorrhage. D. administer protamine to reverse the bleeding.

Correct Answer is C

Explanation

Rationale:

A. Clamping a chest tube after lung surgery is contraindicated because it can cause tension pneumothorax or accumulation of blood in the pleural space, worsening respiratory compromise.

B. While close monitoring is important, simply observing does not address the potential life-threatening complication. The amount of blood lost in a short period is concerning and requires immediate reporting and intervention.

C. Loss of 350 ml of blood in the first hour post-op is above expected post-surgical drainage and indicates possible hemorrhage. This is a priority finding because continued bleeding can lead to hypovolemic shock. Prompt communication with the physician is essential to initiate interventions such as fluid resuscitation, blood transfusion, or return to surgery if necessary.

D. Protamine is used to reverse heparin anticoagulation. There is no indication that the patient received heparin, and administering it without cause could be harmful. The priority is to report the hemorrhage and allow the physician to determine appropriate interventions.

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The initial action by the nurse after placement of an endotracheal tube in any patient should be:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following drugs decrease pulmonary vascular resistance?

Correct Answer is B

Explanation

Following lung resection surgery, the patient loses 350 ml of blood in the chest drainage system during the first hour post-op. The priority action for the nurse is to:

Correct Answer is C

Explanation

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