Correct Answer: A

Rationale: The correct answer is A: Difficulty communicating. When a patient undergoes endotracheal intubation and mechanical ventilation, they are unable to speak normally. This leads to frustration and anxiety due to the inability to communicate effectively with healthcare providers and loved ones. The lack of communication can also impact their emotional well-being. Choices B, C, and D are less likely as the most common recollection because patients might not remember feeling uncomfortable, experiencing pain, or having sleep disruption during sedation and ventilation. Additionally, the inability to communicate is a primary concern for patients in this situation.

Correct Answer: C

Rationale: The correct answer is C: Change to assist/control ventilation at a rate of 4 breaths/min. When the patient's spontaneous respirations decrease to match the ventilator rate, it indicates that the patient is not actively participating in breathing. Changing to assist/control ventilation allows the patient to trigger breaths when they desire, ensuring a more synchronized and comfortable breathing pattern. A: Adding PEEP may help improve oxygenation but is not directly related to the issue of decreased spontaneous respirations. B: Adding pressure support provides additional support during inspiration but does not address the underlying issue of decreased spontaneous respirations. D: Increasing the SIMV respiratory rate would not address the patient's decreased spontaneous respirations and could potentially lead to overventilation.

Correct Answer: B

Rationale: The correct answer is B: Disconnection from the ventilator. This is the correct choice because a high inspiratory pressure alarm can indicate a disconnection, leading to inadequate ventilation and increased pressure in the circuit. This can be a life-threatening situation that requires immediate attention. Explanation of why other choices are incorrect: A: Coughing or attempting to talk - While coughing or talking may affect the patient's ability to ventilate properly, it is not directly related to the high inspiratory pressure alarm. C: Kinks in the ventilator tubing - Kinks in the tubing may cause increased resistance to airflow, but they are more likely to trigger a low pressure alarm rather than a high inspiratory pressure alarm. D: Need for suctioning - Suctioning may be necessary for airway clearance, but it is not directly related to the high inspiratory pressure alarm.

Correct Answer: B

Rationale: The correct answer is B: The RN uses a closed-suction technique to suction the patient. This is the safe action because closed-suction technique minimizes the risk of ventilator-associated infections by maintaining a closed system during suctioning, reducing the exposure to pathogens. Closed-suction systems also help maintain lung compliance and oxygenation levels during the suctioning process. Rationale: Option A is incorrect because suctioning every 1 to 2 hours may be too frequent and can lead to hypoxia and mucosal damage. Option C is incorrect as taping the connection between the ventilator tubing and ET can interfere with the proper functioning of the ventilator and increase the risk of disconnection. Option D is incorrect because changing ventilator circuit tubing routinely every 48 hours is not evidence-based practice and can increase the risk of contamination and unnecessary costs.

Correct Answer: A

Rationale: Step-by-step rationale: 1. The American Association of Critical-Care Nurses (AACN) publishes the American Journal of Critical Care (AJCC). 2. The AJCC is a peer-reviewed journal that covers critical care nursing practice, research, and education. 3. The content in AJCC aligns with AACN's mission and standards for critical care nursing. 4. Hence, AJCC is an official journal of AACN. Summary of other choices: - B: Critical Care Clinics of North America - Not an official journal of AACN. - C: Critical Care Nurse - Not an official journal of AACN. - D: Critical Care Nursing Quarterly - Not an official journal of AACN.