A patient is receiving pressure-controlled, volume variable mechanical ventilation. What is a disadvantage of this type of mechanical ventilation?
It is associated with a risk of lung injury.
The distending pressure of the lungs is limited.
✓
Inspiration is terminated when a certain pressure is achieved.
Minute ventilation volume is not guaranteed.
Correct Answer
The distending pressure of the lungs is limited.
The disadvantage of pressure-controlled, volume variable mechanical ventilation is that the minute ventilation volume is not guaranteed and requires more attentive monitoring to prevent hypoventilation or hyperventilation. The advantage of this mode is that it limits the distending pressure of the lungs because inspiration is terminated when a certain pressure is achieved. The disadvantage of volume-controlled, pressure variable ventilation is the risk of lung injury when high pressures are required to deliver the set tidal volume in patients with low lung compliance.
Question 2
Which intracranial pressure monitoring device allows for drainage and sampling of cerebrospinal fluid?
Subdural catheter
Intraparenchymal probe
Subarachnoid screw
Ventriculostomy catheter
✓
Correct Answer
Ventriculostomy catheter
The ventriculostomy catheter is the only device that allows for drainage and sampling of cerebrospinal fluid.
Question 3
Which patient is most likely to experience primary airway compromise?
A patient with an inhalation injury
✓
A patient with a cerebral aneurysm
A patient with a stroke
A patient with a traumatic brain injury
Correct Answer
A patient with an inhalation injury
The edema caused by an inhalation injury places the patient at risk for a partial or complete primary airway obstruction. A patient with a stroke, traumatic brain injury, or cerebral aneurysm may be at risk for the inability to protect or maintain a patent airway secondary to altered neurologic function.
Question 4
For a patient receiving a neuromuscular blocker, which mode of mechanical ventilation is indicated?
Synchronized intermittent mandatory ventilation
Continuous positive airway pressure
Controlled mandatory ventilation
✓
Pressure control ventilation
Correct Answer
Controlled mandatory ventilation
Controlled mandatory ventilation is used for patients who have received a neutomuscular blocker. Synchronized intermittent mandatory ventilation allows the patient to breathe at his or her own rate and tidal volume in addition to the ventilator's preset rate and tidal volume. Continuous positive airway pressure allows the patient to breathe at his or her own pace while providing constant positive pressure to the airway. Pressure control ventilation lets the patient breathe spontaneously although the preset inspiratory time remains constant.
Question 5
Which patient needs a long expiratory time to be set for mechanical ventilation?
A patient with pneumonia
A patient with chronic obstructive pulmonary disease
✓
A patient with a pneumothorax
A patient with a pulmonary contusion
Correct Answer
A patient with chronic obstructive pulmonary disease
A patient with an obstructive airway disease, such as asthma or chronic obstructive pulmonary disease, needs a longer expiratory time, such as an inspiratory/expiratory ratio of 1:4 or longer, to prevent air trapping and lung overdistention. This setting is not necessary for a patient with a pulmonary contusion, a pneumothorax, or pneumonia.
Question 6
In a patient with abdominal hypertension, what causes inadequate ventilation?
Shunting
Partial airway obstruction
Anatomical causes
✓
Muscular abnormalities
Correct Answer
Anatomical causes
In a patient with abdominal hypertension, inadequate ventilation results from anatomic causes that impair ventilation. Shunting occurs when the alveoli are perfused but not ventilated in disorders such as acute lung injury and pulmonary hemorrhage. Muscular abnormalities occur in disorders such as myasthenia gravis and myopathies. Partial airway obstruction can occur in disorders such as laryngeal edema and foreign object aspiration.
Question 7
A patient with sepsis has a blood pressure of 80 mm Hg despite receiving fluid resuscitation and high-dose vasopressors. Which therapy is the priority to improve this patient's blood pressure?
Oxygen
Hydrocortisone
✓
Antibiotic therapy
Endotracheal intubation
Correct Answer
Hydrocortisone
A patient who does not respond to fluid resuscitation or high-dose vasopressors may have relative adrenal insufficiency. Adrenal insufficiency reduces the cortisol level, which can decrease the vasopressive response to catecholamines. As a result, peripheral vascular resistance drops and hypotension ensues. Hydrocortisone helps replace cortisol. Antibiotics and oxygen are used to treat sepsis but do not improve the patients response to fluid resuscitation and vasopressors. Endotracheal intubation may be necessary to provide adequate oxygenation; however, it does not improve the patients response to fluid resuscitation and vasopressor.
Question 8
The nurse is caring for a patient after pulmonary artery catheter insertion. Which complication may occur if the catheter migrates?
Premature ventricular contractions
✓
Pulmonary hypertension
Vasospasm
Cardiac tamponade
Correct Answer
Premature ventricular contractions
Premature ventricular contractions frequently occur when the pulmonary artery catheter migrates to the right ventricle. Vasospasm is a complication of arterial line placement. Cardiac tamponade and pulmonary hypertension may cause elevation of the right arterial pressure but are not complications of pulmonary artery catheter insertion.
Question 9
Which complication is associated with a radial artery line placement?
Vasospasm
✓
Dysrhythmias
Knotting
Pneumothorax
Correct Answer
Vasospasm
Complications of arterial lines are not common but may include vasospasm, ischemic tissue necrosis, infection, thrombus formation, embolism, hematoma, and pseudoaneurysm formation. Knotting and dysrhythmias are complications of pulmonary artery catheters. Pneumothorax is a complication of central venous pressure monitoring related to line placement.
Question 10
A nurse is being oriented to the emergency department. Which statement by the nurse demonstrates a correct understanding of the dicrotic notch on an arterial waveform?
A dicrotic notch establishes the zero reference point on the central venous pressure reading.
A dicrotic notch separates the systolic and diastolic phases on the arterial waveform.
✓
A dicrotic notch represents the inotropic upstroke.
A dicrotic notch represents the perfusion pressure.
Correct Answer
A dicrotic notch separates the systolic and diastolic phases on the arterial waveform.
The arterial waveform is pulsatile and depicts the systolic and diastolic phases of the cardiac cycle. The dicrotic notch on this waveform separates the systolic and diastolic phases because it represents aortic valve closure, which occurs just before diastole. Creation of the arterial pressure wave and blood flow acceleration correlate with the inotropic upstroke (initial anacrotic rise). The phlebostatic axis is the zero reference point for central venous pressure readings. The mean arterial pressure (MAP) represents the perfusion pressure.
Question 11
What causes stacking breaths in a patient on mechanical ventilation?
Barotrauma
Oxygen toxicity
Infection
Auto-positive end-expiratory pressure
✓
Correct Answer
Auto-positive end-expiratory pressure
Auto-positive end-expiratory pressure (auto-PEEP or intrinsic PEEP) occurs when a ventilator breath is not completely exhaled before the next delivered inspiratory breath (stacking breaths). It commonly affects patients with asthma or chronic obstructive pulmonary disease who require longer exhalation times. Barotrauma is lung tissue damage caused by high airway pressures and alveolar rupture. Infection, such as ventilator-associated pneumonia, is a nosocomial pneumonia that develops after 48 hours of intubation. Oxygen toxicity is caused by a fraction of inspired oxygen (FiO2) that exceeds 0.5 for a long time. It may produce oxygen-free radicals that damage the pulmonary epithelium, inactivate the surfactant, and cause intra-alveolar edema, interstitial thickening, and pulmonary fibrosis.
Question 12
Which mode of mechanical ventilation lets the patient breathe at his or her own tidal volume?
Synchronized intermittent mandatory ventilation
✓
Continuous positive airway pressure
Assist control
Pressure control ventilation
Correct Answer
Synchronized intermittent mandatory ventilation
Synchronized intermittent mandatory ventilation lets the patient breathe at his or her own rate and tidal volume in addition to the ventilator's preset rate and tidal volume. Pressure control ventilation lets the patient breathe spontaneously although the preset inspiratory time remains constant. Assist control is used for apneic patients who require a greater tidal volume than they can generate on their own. Continuous positive airway pressure lets the patient breathe at his or her own pace while providing constant positive pressure to the airway.
Question 13
In a patient admitted with sepsis, the nurse should expect which laboratory finding?
Elevated serum lactate level
✓
Elevated platelet
Decreased bilirubin level
Hypoglycemia
Correct Answer
Elevated serum lactate level
In a patient with sepsis, expected laboratory findings include elevated serum lactate level, hyperglycemia, elevated bilirubin level, and decreased platelets.
Question 14
A hypotensive patient with urosepsis is not responding to fluid volume resuscitation. Which vasopressor should the nurse expect the physician to prescribe for this patient?
Vasopressin
Phenylephrine
Epinephrine
Norepinephrine
✓
Correct Answer
Norepinephrine
Norepinephrine is the first-line agent. Dopamine, vasopressin, or epinephrine may be added as needed to raise MAP to the target or to decrease norepinephrine dosage.
Question 15
Which statement best defines bacteremia?
Bacteremia is the presence or presumed presence of an infection as well as single or multiple organ dysfunction, hypoperfusion, or hypotension.
Bacteremia is the systemic inflammatory response specifically attributed to an infection or a presumed infection.
Bacteremia is the inflammatory response by a host to invasion by a microorganism.
Bacteremia is the presence of bacteria in the bloodstream.
✓
Correct Answer
Bacteremia is the presence of bacteria in the bloodstream.
Bacteremia is the presence of bacteria in the bloodstream. Infection is the inflammatory response by a host to invasion by a microorganism. Sepsis is the systemic inflammatory response specifically attributed to an infection or a presumed infection. Severe sepsis is the presence or presumed presence of an infection as well as single or multiple organ dysfunction, hypoperfusion, or hypotension.
Question 16
A patient receiving mechanical ventilation has a leak from the endotracheal tube cuff. Which ventilator alarm alerts the nurse to this problem?
Low oxygen pressure
Apnea
Low airway pressure
✓
High airway pressure
Correct Answer
Low airway pressure
The low airway pressure alarm may be triggered by a cuff leak, a ventilator disconnect, inadvertent extubation, or a leak in the ventilator system. The apnea alarm is triggered by insufficient spontaneous breathing by the patient in the continuous positive airway pressure or pressure support mode. The low oxygen pressure alarm is triggered when the oxygen tank is empty, the cylinder valve is closed, or the unit is not connected to the wall terminal. The high airway pressure alarm is triggered when the endotracheal tube has an obstruction or kink, has been bitten, or when compliance or resistance is increased.
Question 17
Which measurement indicates hypoperfusion in a patient with sepsis?
An elevated temperature measurement
An elevated serum lactate level
✓
An abnormal blood pressure reading
A central venous pressure of 10 mm Hg
Correct Answer
An elevated serum lactate level
An elevated serum lactate level is a useful indicator of hypoperfusion and can occur with normal blood pressure. The nurse should not wait for hypotension before initiating fluid resuscitation if the patient has signs of hypoperfusion. The goal of therapy is to achieve a central venous pressure of 8 to 12 mm Hg. A patient with sepsis can have a temperature of less than 96.8 F (36 C) or more than 100.4 F (38 C).
Question 18
When caring for a patient on mechanical ventilation, the nurse should expect which ventilator setting to increase the patient's functional residual capacity?
Positive inspiratory pressure
Sensitivity
Inspiratory/expiratory ratio
Positive end-expiratory pressure
✓
Correct Answer
Positive end-expiratory pressure
Positive end-expiratory pressure exerts pressure (above atmospheric level) in the patient's airway to prevent alveolar collapse by increasing functional residual capacity. The inspiratory/expiratory ratio controls the ratio of the breathing cycle, which normally is 1:2 or 1:3. The sensitivity is set to recognize the patient's spontaneous respiratory effort. The positive inspiratory pressure alerts the nurse to decreased lung compliance or conditions that do not allow full exhalation.
Question 19
Which statement accurately describes the mean arterial pressure in relation to the brain?
The mean arterial pressure is the driving force of blood supply to the brain.
✓
The mean arterial pressure is the resistance force within the brain.
The mean arterial pressure is a measure of the relationship between the contents of the brain.
The mean arterial pressure is a measure of the compensatory adjustment of brain components.
Correct Answer
The mean arterial pressure is the driving force of blood supply to the brain.
The bodys autoregulatory system maintains a constant cerebral blood flow within a range of mean arterial pressure from 50 to 150 mm Hg. The mean arterial pressure is the driving force of blood supply to the brain and is met with resistance from the intracranial pressure. Intracranial pressure is a measurement of the relationship between the contents of the brain, which include cerebrospinal fluid (10%), blood (10%), and brain tissue (80%). The Monro-Kellie doctrine hypothesizes that when the volume of one brain component increases, a corresponding and compensatory decrease occurs in one of the other brain components.
Question 20
Which ventilator setting can inactivate the surfactant in a patient's lungs?
An inspiratory/expiratory ratio of 1:2
Minute ventilations at 5 L per minute
A fraction of inspired oxygen (FiO2) that exceeds 0.5 for a prolonged time
✓
A sensitivity set at 2 cm of water
Correct Answer
A fraction of inspired oxygen (FiO2) that exceeds 0.5 for a prolonged time
A fraction of inspired oxygen that exceeds 0.5 for a prolonged time can inactivate the lungs surfactant. The patient can develop oxygen toxicity, which produces oxygen-free radicals that damage the pulmonary epithelium. This action inactivates the surfactant, leading to intra-alveolar edema, interstitial thickening, and pulmonary fibrosis. The ideal minute ventilation is 5 to 10 L per minute, which should not damage or inactivate the surfactant. The sensitivity recognizes the patients spontaneous respiratory effort and is usually set at -1 to -2 cm of water. A setting that is too high increases the patients effort to initiate a breath but should not affect the surfactant. The normal inspiratory/expiratory ratio is 1:2 or 1:3 and should not affect the surfactant. run 2 Test results for the lesson: Taken on 2/25/2026 12:11:55 AM ET Your score was: 20.00% The minimum passing score as set by your training administrator is: 80% To return to your lesson plan, click Exit from the menu above. To access certificates available for completion of this lesson click the button below: Test Results Summary
Question 21
The nurse is calculating the patient's cerebral perfusion pressure. The cerebral perfusion pressure should minimally be maintained at which target level?
80 to 100 mm Hg
Less than 50 mm Hg
60 to 70 mm Hg
✓
More than 100 mm Hg
Correct Answer
60 to 70 mm Hg
The cerebral perfusion pressure equals the mean arterial pressure minus the intracranial pressure. The cerebral perfusion pressure should be maintained at 60 to 70 mm Hg at least. Normally, the average cerebral perfusion pressure is 80 to 100 mm Hg. If the pressure falls below 50 mm Hg, cerebral hypoperfusion and ischemia occur.
Question 22
A patient in the emergency department is started on permissive hypercapnia. The physician orders arterial blood gas analysis on this patient. Which arterial blood gas finding should you expect?
pH of 7.25
✓
pH of 7.15
pH of 7.45
pH of 7.35
Correct Answer
pH of 7.25
With permissive hypercapnia, the arterial carbon dioxide level is allowed to gradually rise, and the pH is allowed to drop to 7.2 to 7.25. Permissive hypercapnia is a lung-protective strategy that decreases alveolar ventilation to prevent lung injury due to high volumes and high pressures. It involves the use of low tidal volumes (4 to 6 mL/kg ideal body weight) and pressure-limited ventilation.
Question 23
A patient with a traumatic brain injury from a motor vehicle crash arrives at the emergency department. Which findings suggest the need for placement of an intracranial pressure monitoring device?
A Glasgow Coma Scale score of 10 and abnormal posturing
Under age 40 and a normal computed tomography scan
Abnormal flexion and a systolic blood pressure of 80 mm Hg
✓
A systolic blood pressure that exceeds 90 mm Hg and a Glasgow Coma Scale score of 7
Correct Answer
Abnormal flexion and a systolic blood pressure of 80 mm Hg
Evidence-based traumatic brain injury guidelines call for the placement of an intracranial pressure monitoring device for patients with severe traumatic brain injury and a Glasgow Coma Scale score of less than 8 with an abnormal computed tomography scan or patients with a normal computed tomography scan and two or more high-risk indicators, such as abnormal motor posturing, over age 40, or a systolic blood pressure of less than 90 mm Hg.
Question 24
When assessing a patient on mechanical ventilation, you discover absent breath sounds on one side and tracheal deviation. Which complication of mechanical ventilation should you suspect?
Tension pneumothorax
✓
Oxygen toxicity
Auto-positive end-expiratory pressure
Pneumonia
Correct Answer
Tension pneumothorax
Tension pneumothorax, which causes unilateral absent breath sounds and tracheal deviation, is an example of barotrauma. Infection, such as ventilator-associated pneumonia, is manifested by fever, purulent secretions, and adventitious breath sounds. Oxygen toxicity results from a fraction of inspired oxygen that exceeds 0.5 for a long time and is manifested by intra-alveolar edema, interstitial thickening, and pulmonary fibrosis. Auto-positive end-expiratory pressure causes an increasing peak inspiratory pressure and an increasing baseline in the respiratory waveform.
Question 25
In a patient with sepsis, the nurse should expect which laboratory test result to be decreased?
Creatinine level
Lactate level
Platelet count
✓
Bilirubin level
Correct Answer
Platelet count
Thrombocytopenia, or a platelet count of less than 100,000/mm3, is expected in a patient with sepsis. The creatinine, bilirubin, and lactate levels are elevated in sepsis.
Question 26
A patient on mechanical ventilation is experiencing fluctuations in his arterial pH level. Which ventilator setting is likely to cause these fluctuations?
Pressure-controlled ventilation
Rate
✓
Tidal volume
Fraction of inspired oxygen (FiO2)
Correct Answer
Rate
An increased rate equals an increased pH, whereas a decreased rate equals a decreased pH and increased partial pressure of carbon dioxide (PaCO2). A tidal volume that is set too high places the patient at risk for barotrauma. Pressure-controlled ventilation affects lung compliance. Fraction of inspired oxygen affects the arterial oxygen pressure (PaO2).
Question 27
A patient on mechanical ventilation is being boarded in the emergency department until a bed is available in the intensive care unit. This patient is most likely to receive which common mode of mechanical ventilation?
Negative pressure
Pressure-controlled, volume variable
Pressure-controlled
Volume-controlled, pressure variable
✓
Correct Answer
Volume-controlled, pressure variable
The most common mode of mechanical ventilation is volume-controlled, pressure variable. The tidal volume is preset and delivered during the inspiratory phase of the ventilator cycle. The pressure needed to deliver the set tidal volume varies. With this mode, the patient receives guaranteed minute ventilation volumes. Negative pressure ventilation, such as an iron lung or cuirass, is rarely used in the emergency department. Pressure-controlled ventilators are less common than volume-controlled ventilators.
Question 28
In which disorder are the alveoli ventilated but not perfused?
Traumatic brain injury
Pulmonary contusion
Cardiogenic shock
✓
Atelectasis
Correct Answer
Cardiogenic shock
A patient with low cardiac output and subsequent cardiogenic shock experiences dead space ventilation because the alveoli are ventilated but not perfused. In patients with pulmonary contusion and atelectasis, the alveoli may be perfused, but not ventilated because the alveoli do not completely expand due to trauma or mucus plugs. Patients with a traumatic brain injury may be unable to maintain a patent airway; therefore, the alveoli may not be ventilated.
Question 29
When preparing for central venous catheter placement, the nurse should tell the patient that which site is the most likely one for insertion?
Superior vena cava
✓
Radial artery
Pulmonary artery
Brachial vein
Correct Answer
Superior vena cava
Catheters for central venous pressure monitoring are typically placed in the superior vena cava through the internal jugular, external jugular, or subclavian vein. Arterial lines are commonly placed in the radial artery because of its superficial location and ease of placement and maintenance. The pulmonary artery catheter can be inserted into the internal jugular, subclavian, femoral, brachial, or basilic vein through an introducer catheter.
Question 30
What is the function of the thermistor lumen of a pulmonary artery catheter?
It measures right atrial pressure.
It measures cardiac output.
✓
It measures pulmonary artery occlusion pressure (wedge pressure).
It measures pulmonary artery systolic pressure.
Correct Answer
It measures cardiac output.
The thermistor lumen of a pulmonary artery catheter measures cardiac output. The proximal port of the catheter measures right atrial pressure. The distal port measures the pulmonary artery systolic and diastolic pressures and pulmonary artery occlusion pressure (wedge pressure).
Question 31
For a mechanically ventilated patient, which nursing intervention decreases the risk of developing ventilator-associated pneumonia?
Routine saline lavage
Keeping the patient flat in bed
Use of the same suction catheter periodically
Regular oral care
✓
Correct Answer
Regular oral care
Ventilator-associated pneumonia is a serious and potentially life-threatening consequence of endotracheal intubation and mechanical ventilation. Prevention techniques include regular oral care, rigorous hand washing, avoidance of routine saline lavage, sterile suction technique, and elevation of the head of the bed 30 degrees.
Question 32
A patient in the emergency department is diagnosed with acute respiratory distress syndrome. Why does this patient need immediate endotracheal intubation?
Failure to maintain a patent airway
Alveolar shunting
✓
Anticipated airway failure
Dead space ventilation
Correct Answer
Alveolar shunting
A patient with acute respiratory distress syndrome needs immediate endotracheal intubation because of alveolar shunting, which occurs when the alveoli are perfused but not ventilated. Patients with disorders such as epiglottitis and bronchospasm may need endotracheal intubation to maintain a patent airway. Patients with neurologic disorders, such as brain anoxia and stroke, may be unable to maintain a patent airway. Dead space ventilation occurs when the alveoli are ventilated but not perfused as in disorders such as pulmonary embolus.
Question 33
Which disorder is most likely to cause a decreased central venous pressure?
Pulmonary hypertension
Cardiac tamponade
Mitral stenosis
Hypovolemia
✓
Correct Answer
Hypovolemia
Causes of decreased central venous pressure readings include hypovolemia, reduced intrathoracic pressure, sudden blood or fluid loss, or venodilation. Causes of increased central venous pressure readings include cardiac tamponade, pulmonary hypertension, and mitral stenosis.