Certified Registered Nurse Anesthetist (CRNA) Practice Exam

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In an intubated patient, hypoxemia, bronchospasm, atelectasis and coughing are all signs of what?

  1. Left mainstream intubation

  2. Right mainstream intubation

  3. Improper ventilation management

  4. Severe hypoxia

The correct answer is: Right mainstream intubation

In the context of an intubated patient, the presence of hypoxemia, bronchospasm, atelectasis, and coughing indicates a potential issue with the position of the endotracheal tube. Specifically, the scenario describes signs consistent with mainstream intubation, where the endotracheal tube enters the right mainstem bronchus. When the tube is inadvertently positioned in the right mainstem, it can lead to inadequate ventilation of the left lung. This situation may manifest as hypoxemia due to the decreased ability to oxygenate blood, bronchospasm due to irritation of the bronchi, atelectasis in the non-ventilated left lung, and increased coughing reflex as the body's response to impaired ventilation. Recognizing these signs helps healthcare providers identify the need for immediate assessment and correction of the tube placement to ensure proper ventilation and oxygenation.