Your patient has just had an ABG drawn by the respiratory therapist when you walk into the room and see the patient gasping for air with the SpO2 decreasing.

The patient reports feeling short of breath and having chest pain.

You suspect the patient has an air embolism from the syringe going into the radial artery.

What is your PRIORITY intervention?

Have the patient ambulate to help pass the gas.

Place the patient in Trendelenburg position on their left side.

Place the patient into reverse Trendelenburg position.

Place the patient in McRoberts position.

Answer and Explanation

The Correct Answer is B

Choice B rationale

Placing the patient in Trendelenburg position on their left side is the priority intervention for a suspected air embolism. This position traps the air in the apex of the right ventricle, preventing it from entering the pulmonary circulation and causing a pulmonary embolism, which can be fatal. The left lateral position further aids in keeping the air bubble within the right ventricle.

Choice A rationale

Ambulation would be contraindicated as it could facilitate the movement of the air embolism through the circulatory system, potentially leading to a more severe and widespread impact, including cerebral or pulmonary embolism. The goal is to isolate and prevent the air from progressing, not to mobilize it.

Choice C rationale

Reverse Trendelenburg position elevates the head of the bed, which would cause the air embolism to travel towards the brain, increasing the risk of a cerebral air embolism, a life-threatening complication. This position is actively harmful in the context of an air embolism.

Choice D rationale

McRoberts maneuver is used in obstetrics to aid in shoulder dystocia during childbirth by hyperflexing the mother's thighs toward her abdomen. This maneuver has no physiological relevance or benefit in the management of an air embolism and would not prevent or mitigate its effects.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is ["A","B","D","E"]

Explanation

Choice A rationale

Daily sedation and weaning protocols, often termed "sedation vacations," reduce the duration of mechanical ventilation by allowing for spontaneous breathing trials. Decreased ventilation duration minimizes the risk of VAP by reducing exposure to invasive tubes and promoting earlier extubation and mobility.

Choice B rationale

Oral care with Chlorhexidine (CHG) significantly reduces the bacterial load in the oropharynx. This decreases the aspiration of pathogenic microorganisms into the lungs, which is a primary pathway for the development of ventilator-associated pneumonia (VAP), thereby disrupting biofilm formation.

Choice C rationale

Suctioning on a frequent schedule can actually increase the risk of VAP by introducing bacteria into the lower respiratory tract. Suctioning should only be performed as needed based on patient assessment, such as visible secretions or adventitious breath sounds, to minimize contamination.

Choice D rationale

Elevating the head of the bed (HOB) to 30 degrees or more helps prevent aspiration of oropharyngeal secretions and gastric contents into the lungs. This reduces the risk of VAP by minimizing the entry of bacteria from the upper airway and gastrointestinal tract into the sterile lower respiratory tract.

Choice E rationale

Hand hygiene is paramount in preventing healthcare-associated infections, including VAP. Proper handwashing or alcohol-based hand rub use before and after patient contact, and especially before manipulating the ventilator circuit, reduces the transmission of pathogens to the patient.

A. Position patient sitting on the edge of the bed, leaning on a pillow that is on top of the bedside table. B. Place the patient in prone position and open the back of their gown. C. Have the patient lying supine with arms folded across their chest. D. No particular positioning is required.

Correct Answer is A

Explanation

Choice A rationale

Positioning the patient sitting on the edge of the bed, leaning on a pillow on the bedside table, is the optimal position for a thoracentesis. This position maximizes the intercostal spaces, allowing for easier access to the pleural cavity while keeping the diaphragm in a lowered position. This widens the spaces between the ribs, facilitating needle insertion and minimizing the risk of injury to surrounding structures like the lungs or diaphragm.

Choice B rationale

Placing the patient in a prone position is contraindicated for a thoracentesis. This position would make accessing the posterior pleural space extremely difficult and unsafe, increasing the risk of accidental organ puncture. It offers no anatomical advantage for the procedure and significantly impedes proper visualization and access to the typical insertion site.

Choice C rationale

Lying supine with arms folded across the chest is not an appropriate position for a thoracentesis. This position would flatten the intercostal spaces, making needle insertion more challenging and increasing the risk of lung puncture. It does not provide optimal access to the pleural cavity for fluid drainage and limits respiratory excursion.

Choice D rationale

Stating no particular positioning is required for a thoracentesis is incorrect and potentially dangerous. Proper positioning is critical for patient safety and procedural success, as it optimizes access to the pleural space, minimizes risks, and enhances patient comfort during the procedure. Incorrect positioning can lead to complications.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Appropriate interventions for a patient intubated on continuous sedation to prevent Ventilator-Associated Pneumonia (VAP) are what?

Correct Answer is ["A","B","D","E"]

Explanation

Your patient comes into the Emergency Room with a chief complaint of dyspnea which is worse upon inspiration. The patient is diagnosed with a pleural effusion, and the medical doctor wants to do a Thoracentesis. How should you position the patient?

Correct Answer is A

Explanation

Which of the following are appropriate while suctioning a patient with an artificial airway on mechanical ventilation?

A nurse is providing discharge teaching to a client who has COPD and a new prescription for Albuterol. Which of the following statements by the client indicates an understanding of the teaching?

Your patient developed acute respiratory distress and was just emergently intubated. Because of normal human anatomy, you understand that the most common misplacement of tube position is likely to be: