What might be the advantages of NMB in a ventilated patient? (Select all that apply)
Prevent bucking the ventilator
Increase peak airway pressures
Increased oxygen demand
Increased oxygen delivery
Improve chest wall compliance
Correct Answer : A,D,E
A. One of the main indications for NMB in mechanically ventilated patients is to improve patient-ventilator synchrony. Some patients may fight the ventilator, causing “bucking” or asynchronous breaths, which can increase work of breathing, elevate airway pressures, and compromise gas exchange. NMB temporarily paralyzes skeletal muscles, eliminating involuntary movements and allowing the ventilator to deliver precise tidal volumes with minimal resistance. This can improve oxygenation and reduce the risk of ventilator-induced lung injury (VILI).
B. NMB does not increase peak airway pressures; in fact, it often reduces them. By relaxing the chest wall and diaphragm, NMB allows more uniform lung expansion, decreasing the pressure needed to deliver the set tidal volume. Higher peak airway pressures are typically harmful and may contribute to barotrauma or volutrauma.
C. NMB reduces oxygen consumption by paralyzing skeletal muscles and preventing excessive work of breathing. Normally, active respiratory muscles and accessory muscles consume significant oxygen, especially in patients with severe respiratory distress. NMB decreases metabolic demand, conserving oxygen for vital organs and improving systemic oxygen delivery.
D. By improving ventilator synchrony, reducing oxygen consumption, and allowing for more efficient alveolar ventilation, NMB can enhance oxygenation and tissue oxygen delivery. This is particularly important in patients with acute respiratory distress syndrome (ARDS) or severe hypoxemia, where optimizing oxygen delivery is critical to prevent organ dysfunction.
E. NMB relaxes all skeletal muscles, including the intercostal and accessory respiratory muscles, resulting in better chest wall compliance. This facilitates even distribution of tidal volumes, reduces localized overdistension, improves alveolar recruitment, and decreases the risk of ventilator-induced lung injury. Improved compliance allows the ventilator to work more effectively, providing adequate ventilation at lower pressures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. In a COPD exacerbation, the primary concern is respiratory compromise. Monitoring respiratory rate, depth, pattern, and use of accessory muscles provides immediate information about the patient’s ventilatory status and oxygenation. Early recognition of worsening respiratory distress allows for prompt interventions such as supplemental oxygen, bronchodilators, or noninvasive ventilation.
B. While tachycardia may occur due to hypoxemia or stress, it is a secondary indicator and less directly reflective of acute respiratory status. Heart rate alone does not provide sufficient information about ventilation or gas exchange.
C. Fever may indicate infection, which can trigger or worsen an exacerbation, but it is not the most immediate indicator of respiratory compromise. Delaying attention to respiratory distress in favor of temperature assessment can lead to deterioration.
D. Blood pressure monitoring is important for overall hemodynamic status, but it does not directly assess the severity of a COPD exacerbation. It is a secondary consideration compared with respiratory assessment.
Correct Answer is D
Explanation
A. Atrial flutter typically presents with regular atrial activity, often at a rate of 250–350 beats per minute, producing sawtooth “flutter” waves on the ECG. The ventricular response can be regular or irregular, but the defining feature is the visible flutter waves, which are not present in this patient.
B. Rapid ventricular response occurs when the ventricular rate exceeds 100–150 beats per minute. In this patient, the ventricular rate is 90 bpm, which is within normal limits, making rapid response unlikely. Additionally, flutter waves are absent.
C. Atrial tachycardia is a regular rhythm originating from an ectopic atrial focus, usually with distinct P waves preceding each QRS. This patient’s rhythm is extremely irregular and lacks discernible P waves, so atrial tachycardia is not consistent with the findings.
D. Atrial fibrillation is characterized by completely irregular rhythm, absent P waves, and fibrillatory waves that are too fine to discern. The ventricular rate is variable and can be slow, normal, or rapid. This patient is hemodynamically stable, and the ventricular rate of 90 bpm is consistent with controlled atrial fibrillation.
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