120 Final Exam

Which of the following values indicates hypertension?

> 140/90

What is the normal setting for sensitivity (inspiration trigger pressure) when in the assist/control mode?

-0.5 to -2 cm H2O

Which of the following is most likely to cause somnolence? Lox PaCo2

False

A patient has a PaO2 of 53 mmHg on a 60 FIO2, What is the lowest FIO2 that would be needed to achieve a PaO2 of at least 62 mmHg?

0 70

Calculate the VD/VT for a patient with the following values: PaO2 = 87 torr PaCO2 = 65 torr pH = 7.37 SaO2 = 95% PECO2 =53 torr PB = 751 torr

18%

A ventilator is set at a mandatory rate of 15/min with an inspiratory time of 1 sec- What is the I:E ratio?

1:3

Given a f of 12 br/min and a 1 second inspiratory time, what is the I/E ratio?

1:4

If the patient is on a patient-triggered mode, in which inspiration is initiated by patient effort, the clinician should check the pressure or flow needed to trigger the ventilation- It should take no more than -1 or -2 cm H2O to trigger the ventilator. If the ventilator is flow triggered, the sensitivity may be a change of of flow.

2 to 3 L/min

The frequency of a patient-ventilator check depends on the policy of the institution and generally occurs every around the clock.

2 to 4 hours

In general, the type of lung pathology which, in combination with hypoxemia refractory to elevated O2%, is appropriate for CPAP/PEEP therapy would be:

A condition which is homogenous and which causes a decrease in CLT.

A decrease in oxyhemoglobin may be indicated by?

Cyanosis

An increase in airway resistance during pressure ventilation will result in which of the following?

Inspiration will end prior to flow tapering to zero.

A 75-year-old man with a long history of COPD is brought to the emergency department with shortness of breath. He has a persistent, productive cough with green purulent sputum, cyanosis of the lips and extremities, and is uncooperative. His arterial blood gas values on 2 L/min by nasal cannula are: pH = 7.25; PaCO2 = 90 mm Hg; PaO2 = 38 mm Hg; SaO2 = 59%; HCO3- = 38 mEq/L. The most appropriate action at this time is which of the following?

Invasive mechanical ventilation

Pressure support?

Is a mode of ventilation in which the breathing circuit is pressurized to a pre-determined level for the duration of inspiration

All of the following are true regarding auto-PEEP EXCEPT?

It can be measured directly from the ventilator, by reading the auto-PEEP gauge.

In cases of chronic hypercarbia, the PaCO2 should not be decreased more quickly than 5-10 torr/hour because?

It could lead to severe cardiac arrhythmias

You might use SIMV mode because?

It results in less muscle atrophy than A/C

Through daily weighings and I/O analysis, it has been determined that a ventilator patient is excessively retaining fluid, Furosemide (Lasix) is ordered, What electrolyte should also be ordered?

K+

An invasively ventilated patient with ARDS is on PC-CMV, PIP = 30 cm H2O, PEEP = 12 cm H2O, FIO2 = 1.0. The patient's returned VT is 320 mL. The ABG results on these settings are: pH 7.3, PaCO2 53 mm Hg, PaO2 62 mm Hg. The patient is placed in the prone position, and after 1 hour, ABG results show: pH 7.38, PaCO2 46 mm Hg, PaO2 83 mm Hg. The respiratory therapist should do which of the following?

Keep the patient in the prone position and decrease the FIO2

Which respiratory pattern is associated with diabetic ketoacidosis?

Kussmaul's

The most common cause of post-extubation stridor is?

Laryngeal edema.

Please choose all the would cause a low pressure alarm

Leak in the circuit, Ruptured ETT cuff/balloon, patient compliance is improving

During mechanical ventilation of a patient with CHF, the PaO2 = 38 mm Hg and the FIO2 = 0.6. If the desired PaO2 is 60 mm Hg, the FIO2 needs to be changed to which of the following?

Left lung down laterally

Compared to an adult set-up, a desired difference in circuit tubing for an infant or pediatric ventilator would be?

Less compliance only.

After a ventilator patient near you in the ICU turns his head, you hear a significant air leak at his mouth coming from around the ET tube cuff. Which of the following alarms would you now expect to be activated?

Low Pressure

Which alarm would sound if a port on the patient wye connector were left uncovered?

Low exhaled volume alarm

Which alarm would sound if the circuit disconnects from the patient's ET tube?

Low pressure alarm

The point on a static pressure-volume curve (SPV) where the alveoli begin to open is referred to as which of the following?

Lower inflection point on the inflation limb

When severe, uncontrollable increased intracranial pressure is present, patients may be mechanically hyperventilated to reduce intracranial pressure by?

Lowering PaCO2 to 25 to 30 mm Hg

When severe, uncontrollable increased intracranial pressure is present, patients may be mechanically hyperventilated to reduce intracranial pressure by:

Lowering PaCO2 to 25 to 30 mm Hg.

You reveiw the vent flowsheet for a patient who is receiving mechanical ventilation. The ventilator settings have not changed. The plateau and peak pressures are as follows: Time, Plateau Pressure, Peak Pressure- (8 PM 30 cm H2O 35 cm H2O), (11 PM 44 cm H2O 50 cm H2O)

Lung compliance is decreasing

The "sigmoid" shape of the static pressure-volume lung recruitment maneuver indicates which of the following?

Lung units open at different times with different pressures.

Which of the following is the most reliable parameter for providing indication of an impending need for mechanical ventilatory support in a patient with Guillain-Barré?

MIP (NIF)

Which filter most directly protects a ventilator patient's lungs?

Mainstream inspiratory line filter

The compressed volume will increase with decreases in patient lung compliance, if ventilator parameters are constant and the greater the peak delivery pressure, the greater the compressed volume loss

True

The highest pressure observed during inspiration, which is recorded on the flow sheet as Ppeak, may also be termed?

PIP

Changes in which of the following measurements would be most helpful to evaluate the effects of CPAP on tissue oxygenation?

PO2

You are IMV weaning a patient from mechanical ventilation- Because of a desire to minimize glottal/laryngeal damage, initial intubation was done with the smallest acceptable ET tube. During peak inspiratory effort a high WOB is evident by soft thoracic tissue retractions. Vent settings are: SIMV, VT 550 mL, FIO2 0.40, f 6, PEEP 4. Which of the following might combat this patient's high WOB?

PSV

Which of the following is the best readily measurable index of adequate ventilation?

PaCO2

PEEP therapy is indicated for patients with which of the following?

PaO2 of 100 mm Hg while receiving an FIO2 of 80%

You come on your shift and upon making your first ventilator check find that the patient is on A/C when he was ordered to be on IMV-The patient has been on the ventilator for four shifts and has been assisting the ventilator on occasion- You should?

Page the physician yourself, explain the situation and determine whether he wants to go with A/C or IMV

Paralytics such as vecuronium are commonly used in mechanically ventilated patients when which of the following occurs?

Patient-ventilator dyssynchrony cannot be corrected

The high pressure alarm should be set at least 10 cm H2O above which of the following during volume-controlled ventilation?

Peak airway pressure

For mechanical ventilators, "cycling" refers to what.

Physically causes inspiration to end.

Positive end-expiratory pressure is most appropriately used with which of the following conditions?

Post-trauma acute respiratory distress syndrome

The arterial-venous content difference represents?

the tissue uptake (usage) of oxygen

A patient is receiving VC-SIMV with +10 cm H2O PEEP through a Siemens-Servo-i ventilatoR, With each resting spontaneous inspiration the pressure drops to +2 cm H2O, According to this situation?

there is no need to make any changes; the conditions are normal.

At the extreme apex in the upright lung, which of the following is true regarding blood flow?

there is virtually no blood flow

You are called to get a shunt measurement on Mr. Fubar Now, who has been diagnosed with ARDS. You calculate a shunt of 68% on an FIO2 of 100%, A/C, f 32, VT 500, PIP 50 cm H2O and PEEP 10 cm H2O. How would you interpret this result?

this result is associated with high mortality.

Volume, inspiratory time and flow are not constant for a ventilator which is?

Pressure-controlled

Assessing the outcome of PEEP at levels set above 15-20 cm H2O is best done using which of the following?

Pulmonary artery occlusion pressure

Mr. Joe Pokenoe has an order for VC-CMV with a set VT of 700 ml- When charting the set inspiratory pressure for Mr Pokenoe's ventilator check, you should?

Record the PIP

The greatest hazard of PEEP therapy is?

Reduced cardiac output.

Negative-pressure ventilators cause air to enter the lungs by increasing ______________ pressure.

transpulmonary

What does the difference between the peak system pressure and plateau (static) pressure represent?

The airway resistance of the patient's lungs and the breathing circuit

blood flow most abundant in the lungs at the bases?

True

Which of the following is a normal VD/VT for a normal, spontaneously breathing patient?

0.2-0.4

Which of the following V/Q ratios indicates shunting?

0.5

Which of the following is a clinically significant problem VD/VT for a ventilator patient?

0.6-0.8

What's VT if TI 1.5 sec and constant flow 750 mL/sec?

1.125 L

Which of the following V/Q ratios indicates dead space?

1.2

When setting the flow rate on the patient initially, you should aim for an I/E ratio of?

1/3

Audible and visual alarms are activated if PIP exceeds a limit- This limit is usually set at about above the PIP reading?

10 cm H2O

A patient with acute cardiogenic pulmonary edema is to be placed on CPAP. What should the initial setting be?

10-12 cm H2O

For a patient with a CDYN of 50 mL/cmH2O to receive an actual 1000 mL from a volume ventilator, what would the vent's VT have to be set at to compensate for CTUBING- Asssume a CTUBING of 3 mL/cmH2O, a perfect circuit (no leaks), and negligible RAW?

1060 mL

A patient with CHF is being mechanically ventilated. The patient's current PaCO2 = 28 mm Hg, and the ventilator set rate is 16 per minute. The desired PaCO2 for this patient is 40 mm Hg. To what should the set rate be changed?

11/min

An apneic patient is on VC-A/CMV with f = 10 br/min and VT = 550 mL/br, ABGs show that the patient's PaCO2 is 64 mmHg, What should f be in order to achieve a target PaCO2 of 46 mmHg?

14 br/min

An apneic patient is on VC-A/CMV with f = 10 br/min and VT = 550 mL/br. ABGs show that the patient's PaCO2 is 64 mmHg. What should f be in order to achieve a target PaCO2 of 46 mmHg?

14b/min

How long after PEEP is increased should all ventilatory and available hemodynamic parameters be measured and calculated?

15 MINUTES

Low-pressure alarms, used to detect patient disconnections and leaks in the system, are usually set at about?

15 cm H2O below PIP

Routine monitoring of the mechanically ventilated patient includes the artificial airways- About once every 8 to 12 hours, the endotracheal or tracheostomy cuff pressure should be checked to guarantee that intracuff pressures do not exceed?

15 to 20 mm Hg & 20-25mmHg (per lecture)

Calculate the oxygen content for the following data: pH 7.32, PaCO2 62, PaO2 50, HCO3- 30, SaO2 84%, all other values normal.

17.03vol %

A patient undergoing controlled volume ventilation at a rate of 14 bpm has a tidal volume of 1100 ml and a peak flow of 40 LPM, Dynamic pressure is 51 cm H2O and static pressure is 39 cm H2O (Tubing compliance is 2 ml/cm H2O) The RAW is cm H2O/L/sec?

18

Calculate the VD/VT for a patient with the following values-PaO2 = 87 torr PaCO2 = 65 torr pH = 7.37SaO2 = 95% PECO2 =53 torr PB = 751 torr.

18%

A patient is being mechanically ventilated with a Susie volume cycled ventilator at a VT of 600 mL, f = 12 bpm and flow = 70 lpm. The PIP is consistently between 30-32 cm H2O pressure, Which of the following would be the proper low pressure and volume alarm settings (cmH20,ml)?

20 400

Which of the following sets of values suggests a patient who is experiencing VE to PaCO2 disparity (i.e., CO2 production is at the cellular level)?

20 lpm 40 torr

To reduce the risk of tracheal damage associated with overinflated tube cuffs, cuff pressures should not exceed what range of pressures?

20-25 mm Hg

What is this patient's static compliance if f 8 br/min, VT 0.9 L/br, flow 40 L/min, PIP 35 cm H2O, PPLATEAU 30 cm H2O, PEEP 0 ?

30 mL/cm H2O

Given a Vt 750ml, PPlat 28 cmh20 and flow of 55lpm. what is the patients elastance?

37.3 cmh20/l

To deliver a 900 cc tidal volume in one second to a patient on a mechanical ventilator, 43 cm H2O is needed, The patient's static pressure is 33 cm H2O, The FIO2 is 50% and the PEEP is 10 cm H2O, Calculate the effective static compliance?

39 cc/cm H2O

Patients with chronic hypoventilation disorders typically need a minimum of _________ hours of NIV to experience improved quality of life.

4-6

The average tidal volume range in an individual with no pulmonary problems is which of the following?

5-8 mL/kg IBW

ou wish to deliver a 950 cc VT to a patient in 1.2 sec. How would you adjust the peak flow setting on the ventilator to accomplish this?

50 Lpm

You wish to deliver a 950 cc VT to a patient in 1.2 sec. How would you adjust the peak flow setting on the ventilator to accomplish this?

50 lpm

Non-invasive ventilation (such as BiPAP™), would be most appropriate to use with which of the following patients?

55 y.o. emphysema patient URI and acute distress

During mechanical ventilation of a patient with COPD, the PaO2 = 58 mm Hg and the FIO2 = 0.5. If the desired PaO2 is 65 mm Hg, the FIO2 needs to be changed to which of the following?

56

47 y.o. motor vehicle accident (MVA) victim is in your ICU. It is now 48 hours after the accident. The patient is breathing spontaneously without ventilatory support on a 0.85 FIO2 through an oral endotracheal tube. ABGs show: pH=7.48 PaCO2=33 HCO3-=22mEq/L PaO2=51 SaO2=82%. According to the data you would suggest

6 cm H2O CPAP and an 0.85 FIO2.

This patient's minute ventilation is equal to approximately pH7.41 PaCO238 PaO298 HCO323 SaO298% , Ventilator settings are VT 850mL f 8 FIO2 0.35 I/E=1/6.5 PEEP=0 ?

6.800 L/min.

A PB 840 ST is being used to deliver VC-A/CMV to an adult patient- The following parameters are noted VT = 600 mL/br, f = 16 br/min, O2 = 60%, PEEP = 6 cm H2O, and peak flowrate = 60 L/min -During machine tidal volumes the PIP is 36 cm H2O and the PPLAT is 16 cm H2O -What is this patient's static compliance?

60 mL/cm H2O

A PB 840 ST is being used to deliver VC-A/CMV to an adult patient. The following parameters are noted: VT = 600 mL/br, f = 16 br/min, O2 = 60%, PEEP = 6 cm H2O, and peak flowrate = 60 L/min. During machine tidal volumes the PIP is 36 cm H2O and the PPLAT is 16 cm H2O. What is this patient's static compliance?

60 mL/cm H2O

During mechanical ventilation of a patient with COPD, the PaCO2 = 58 mm Hg and the minute ventilation = 5.5 L/min. The desired PaCO2 for this patient is 45 mm Hg. To what should the minute ventilation be changed?

7.1 L/min

A patient is receiving volume-controlled ventilation. Which of the following arterial blood gas results most clearly indicate minute ventilation should be increased? pH (torr) PaCO2 (torr )PaO2 (torr)

7.28 51 55

A volume ventilator is pumping out 700 mL with each inspiration, The patient-circuit system has a CSTATIC of 10 mL/cm H2O, RAW is negligible, What will PPLAT be?

70 cm H2O

Thirty minutes after intubation and initiation of mechanical ventilation, a patient's PaO2 = 55 mm Hg and the FIO2 = 0.5. To what should the FIO2 be set to obtain a PaO2 of 80 mm Hg?

75

A time cycled ventilator is set to a f of 10 br/min and a 1:2 I:E ratio- On the control panel, a square wave flow pattern and flowrate of 24 L/min have been selected- What is this patient's VT?

800 mL

During mechanical ventilation of a patient with CHF, the PaO2 = 38 mm Hg and the FIO2 = 0.6. If the desired PaO2 is 60 mm Hg, the FIO2 needs to be changed to which of the following?

95

Your patient's MIP level is dropping over the course of your shift, At which of the following MIP levels would you first consider mechanical ventilation?

; -18 cm H2O

Your patient's MIP level is dropping over the course of your shift. At which of the following MIP levels would you first consider mechanical ventilation?

< -18 cm H2O

Acceptable PIP pressure for ventilated pt.'s is....

< 35 cmH2O

Audible and visual alarms alert the clinician that PIP has fallen below a desired limit, which is usually 5 to 10 cm H2O below PIP- This indicates that the pressure has fallen significantly, probably because of?

A leak in the patient-ventilator interface

Audible and visual alarms alert the clinician that PIP has fallen below a desired limit, which is usually 5 to 10 cm H2O below PIP. This indicates that the pressure has fallen significantly, probably because of:

A leak in the patient-ventilator interface.

All of the following are true of the tests for brain death EXCEPT?

A negative Babinski reflex (inward flexion of all toes) signals brain death

You have a patient apparently ready for a trial of ventilator discontinuance who has been maintaining a SPO2 in the low 90s on an FIO2 of 0.40- To attempt to ensure continued adequate oxygenation when you turn the rate off, you would?

A the FIO2 to 0.50.

A patient is receiving volume-controlled ventilation. Which of the following arterial blood gas results most clearly indicate minute ventilation should be increased? pH (torr) PaCO2 (torr) PaO2 (torr) A. 7.28 51 55 B. 7.36 61 62 C. 7.51 35 85 D. 7.55 22 89

A. 7.28 51 55

Which of the following are true statements about hemodynamic measurements? I. The CVP line is placed at the level of the RA, usually in the SVC or IVC; normal value:0-5 torr. II. PCWP (pulmonary capillary wedge pressure ) is equivalent to the LVEDP (left ventricular end diastolic pressure); normal value is 8-12 torr. III. An PAP with normal PCWP generally indicates a pulmonary disorder (i.e., a pulmonary embolism). IV. The PAP line is placed at the level of the RA, usually in the SVC or IVC; normal value:0-5 torr. V. CVP is equivalent to the LVEDP (left ventricular end diastolic pressure); normal value is 8-12 torr. A. I, II, III B. II, IV, V C. I, III, V D. III, IV, V E. All of the above

A. I, II, III

In which of the following disorders is compliance decreased?

ARDS

Which of the following patients may benefit from PEEP?

ARDS

The level of applied PEEP should be set at what point on the pressure-volume curve?

Above the upper inflection point of the deflation curve.

The interpretation of pH7.41 PaCO2 38 PaO2 98 HCO3 23 SaO298% blood gas acid-base values is?

Acceptable (normal).

A near drowning victim has been brought into your ICU, The patient is significantly hypothermic, In managing this patient's ventilator you aim to?

Achieve slow central rewarming

A patient with central sleep apnea uses a nasal mask with NIV at night. The patient complains of nasal congestion. What action should the respiratory therapist take?

Add a heated humidifier.

To use CPAP successfully, a patient must have which of the following?

Adequate spontaneous ventilation

You have a patient with suspected cerebral edema causing increased ICPs,You recommend managing him by?

Adjusting VE and FIO2 to maintain a low PaCO2 and high PaO2

Which one of the following is the LEAST necessary condition to consider when initiating a program of ventilator discontinuance?

An ability to cough adequately.

The primary goal of NIV in the acute care setting is to do which of the following?

Avoid invasive ventilation.

You have a patient with a closed head injury suffered in a pedestrian/tree accident (the tree was intoxicated). Presently the patient is receiving controlled mechanical ventilation via a volume-cycled ventilator and has blood gas values of: pH=7.31 PaCO2=38 PaO2=155 HCO3-=20 SaO2=99% Ventilator settings are: VT=700mL/br f =12 br/min FIO2=0.40 I:E=1:4 PEEP=0 Other clinical data includes: body weight=67 kg, age 29, patient is pharmacologically paralyzed, barometric pressure=763 mmHg, body temperature=37.5˚C, room temperature=29˚C, relative humidity=60%, the wind is coming out of the SW at 35 knots. Your patient is on a volume-cycled PB-7200 ventilator set for constant flow. The physician calls and orders the tidal volume to be decreased from 1000 mL to 0.85 L. Which of the following will most likely occur? I. Increased inspiratory time II. Increased PaCO2 III. Decreased PIP IV. Decreased cardiac output V. Increased PaO2 A. I, II B. II, III C. I, II, III D. I, IV, V E. III, IV, V

B. II, III

Which of the following values indicates hypertension?

BP higher than 140/90.

Entering the ICU you detect an audible ventilator alarm coming from the bed #7 area. As you are going through the unit toward the ventilator the patient's nurse informs you (and you can see) that the "Ventilator Inoperative" indicator is lit. When you first arrive at bed #7 you should:

Begin bagging the patient.

When PEEP is applied the first monitored parameter is?

Blood Pressure

A 25-year-old male comes into your ER shortly after having ridden his motorcycle into a tree,He has already been intubated by the EMTs,The ER doctor tells you to put the patient on the ventilator STAT?

Bring a ventilator to the ER, assess the patient, pick vent settings with the doctor, do a quick leak check, put the vent on the patient and check it

When evaluating pressure-volume curves, conditions in which only the PIP is elevated, shifting only the dynamic curve, include?

Bronchospasm

A 38 y.o., white was admitted to your E.R. suffering severe hemorrhage after an MVA. The patient appeared shocky and hypotensive on admission, which has since been corrected. She has been mechanically ventilated for 2 days. ABGs show: pH=7.32 PaCO2=47 mmHg PaO2=44 mmHg. Present vent settings are: VT=800mL f=11 FIO2=0.75, PEEP=8 cm H2O. Based on this information the PaO2 should be improved by:

C PEEP

You have a patient with a closed head injury suffered in a pedestrian/tree accident (the tree was intoxicated). Presently the patient is receiving controlled mechanical ventilation via a volume-cycled ventilator and has blood gas values of: pH=7.31 PaCO2=38 PaO2=155 HCO3-=20 SaO2=99% Ventilator settings are: VT=700mL/br f =12 br/min FIO2=0.40 I:E=1:4 PEEP=0 Other clinical data includes: body weight=67 kg, age 29, patient is pharmacologically paralyzed, barometric pressure=763 mmHg, body temperature=37.5˚C, room temperature=29˚C, relative humidity=60%, the wind is coming out of the SW at 35 knots The patient's PAO2 is

C. 239 mmHg.

You have a patient with a closed head injury suffered in a pedestrian/tree accident (the tree was intoxicated). Presently the patient is receiving controlled mechanical ventilation via a volume-cycled ventilator and has blood gas values of: pH=7.31 PaCO2=38 PaO2=155 HCO3-=20 SaO2=99% Ventilator settings are: VT=700mL/br f =12 br/min FIO2=0.40 I:E=1:4 PEEP=0 Other clinical data includes: body weight=67 kg, age 29, patient is pharmacologically paralyzed, barometric pressure=763 mmHg, body temperature=37.5˚C, room temperature=29˚C, relative humidity=60%, the wind is coming out of the SW at 35 knots. This patient's minute alveolar ventilation is equal to approximately:

C. 6.636 L/min.

In determining need for a mechanical ventilator to assist patient oxygenation, the major factors to consider are: I. PaCO2 II. PaO2 III. The patient's work of breathing IV. The patient's ventilatory reserves V. The amount of VD-MECH attached to the ventilator A. I, II, III B. I, IV, V C. II, III, IV D. II, IV, V E. III, IV, V

C. II, III, IV

NIV is considered the standard of care for the treatment of which of the following?

COPD exacerbation

The ABG results for a patient in pulmonary edema due to left ventricular myocardial infarction show- pH=7 42 PaCO2=38 PaO2=48 HCO3-=26mEq/L, The patient is breathing spontaneously with a f = 12 and VT = 800mL and is on a 75 FIO2, Which of the following therapies would be most appropriate for this patient?

CPAP

The arterial blood gas results for a patient in pulmonary edema due to left ventricular myocardial infarction show: pH=7.42 PaCO2=38 PaO2=48 HCO3-=26mEq/L. The patient is breathing spontaneously with a f=12 and VT=800mL and is on a 0.75 FIO2. Which of the following therapies would be most appropriate for this patient?

CPAP

A 47 yo motor vehicle accident (MVA) victim is in your ICU, It is now 48 hours after the accident, The patient is breathing spontaneously through an oral endotracheal tube and is on a 85 FIO2, ABGs show- pH=7 48 PaCO2=33 HCO3-=22mEq/L PaO2=51 SaO2=82% According to the data you would suggesT?

CPAP of 6 cm H2O and keep at 85 the FIO2.

In which ventilator mode should a patient receiving a sustained inflation technique be placed?

CPAP/spontaneous

Which of the following are true regarding use of chest X-rays (CXR) in mechanically ventilated patients?

CXRs are usually done daily to review artificial airway placement

Oxygen consumption (usage) can be expressed as:

Ca-vO2

Reduction of preload and afterload is important in the management of which of the following?

Cardiogenic pulmonary edema

Your ventilator patient has an order for PEEP of 12 cm H2O-You study the ventilator's pressure curve and see that during machine breaths the pressure rises to 35 cm H2O before dropping to a baseline of 12 cm H2O at end exhalation-You also observe that during spontaneous inpiration the pressure dips down to 9 cm H2O before rising during exhalation to 15 cm H2O and settling back at 12 cm H2O-When you read the digital diplay it says "PIP = 35 cm H2O, PPlat = 32 cm H2O, PEEP = 12 cm H2O, MAP = 20 cm H2O"-Based on this, you would?

Chart that the PEEP level is 12 cm H2O

The presence of high PaCO2 with elevated HCO3- and pH in the normal range is defined as?

Chronic ventilatory failure

Permissive hypercapnia is needed to protect a patient with ARDS from atelectrauma, Which of the following paralytic medications is appropriate to facilitate this?

Cisatracurium

Which of the following is employed in transcutaneous O2 analysis?

Clark electrode

A patient has acute pulmonary edema from left-sided heart failure and acute hypoxemic respiratory failure that has not responded to conventional pharmacologic and oxygen therapy. As the next line of therapy, the respiratory therapist should recommend which of the following?

Continuous positive airway pressure

With a patient set in the A/C mode, the sensitivity properly set, and the rate control set at 12 BPM, it is true that: I. The ventilator will respond to the patient's decrease in airway pressure only 12 times a minute II. The ventilator will automatically deliver a breath every 12 seconds III. The rate of 12 is set as a back-up rate to ensure a minimum minute ventilation should the patient make no inspiratory effort IV. The patient may receive more than 12 mechanical positive pressure breaths in one minute A. I B. I, II C. I, II, III D. III, IV

D. III, IV

Calculate the percent shunt for a patient on 100% FIO2 and the following values: PaO2 = 87 torr PaCO2 = 45 torr pH = 7.37 PvO2 = 36 torr SvO2 = 73% PB = 751 torr SaO2 = 95% Hgb = 14 gm

D?

.A patient is being ventilated with a PEEP of 10 cm H2O and an FIO2 of 0.4. The arterial blood gas results show that the patient remains hypoxemic, and the respiratory therapist increases the PEEP to 18 cm H2O, maintaining the FIO2 at 0.4. The patient's static compliance changes from 28 to 22 mL/cm H2O just after this change. The respiratory therapist should do which of the following?

Decrease PEEP to 15 cm H2O and measure static compliance.

A patient who weighs 85 kg (187 lb) is receiving volume-controlled mechanical ventilation after open heart surgery. After 2 hours, ventilator settings are: Mode: SIMV FIO2 40% Mandatory rate 10 bpm Total rate 10 bpm VT 500 ml PEEP 4 cm H2O After 30 minutes, arterial blood gas results are as follows: pH 7.51 PaCO2 30 torr PaO2 93 torr HCO3- 23 mEq/L SaO2 98% Which of the following should the respiratory therapist do?

Decrease the mandatory rate to 6/min.

A 59-year-old man who weighs 77 kg (169 lb) is receiving volume-controlled ventilation after abdominal surgery. Ventilator settings and arterial blood gas analysis results are below: FIO2 40% Mandatory rate 14 bpm Total rate 14 bpm VT 650 ml pH 7.47 PaCO2 31 torr PaO2 117 torr HCO3- 22 mEq/L The respiratory therapist should:

Decrease the minute ventilation.

You are asked to evaluate a distressed patient who is on a Servo U in the CMV mode with no PEEP- The respiratory rate is 44 bpm, there is a high rate alarm, the I:E ratio alert is flashing, and you notice that when the patient is temporarily disconnected, the "assist" light in the Patient Data section flashes repeatedly- What is the most important therapeutic modification you can make at this time?

Decrease the ventilator sensitivity

For a patient receiving an elevated FIO2 and PEEP therapy who is now showing significant improvement in oxygenation status, you should first:

Decrease whichever parameter may be at a more hazardous level.

Which of the following will increase the V/Q ratio?

Decreased venous return to the heart

An increasing PIP may indicate which of the following?

Decreasing lung compliance

A reduction in compliance during pressure ventilation will cause which of the following?

Delivered tidal volume will decrease.

A patient who is being mechanically ventilated with a volume ventilator suddenly becomes cyanotic and unresponsive,There is no return to the spirometer,You should IMMEDIATELY?

Disconnect the patient from the ventilator and ventilate with a hand resuscitator

Possible causes of low pressure alarms during the operation of the PB-980 ventilator would include?

Disconnection of tubing from the ventilator.

The majority of adult ventilator patients:

Do not require a process of slow removal of ventilatory support.

You have a patient on a BeBop ventilator in CPAP mode- Presently the patient is on CPAP = 28 cm H2O and FIO2 is at 35%. ABGs on the patient show: pH = 7.38, PaCO2 = 32, HCO3- = 22 mEq/L, PaO2 = 148 mmHg, and SaO2 = 99%. Given this data, the next vent change would be to?

E CPAP

Forms of pulmonary volutrauma would include: I. Hyperventilation II. Pneumonia III. Pneumothorax IV. Subcutaneous emphysema V. ¯ WBC A. I, II B. I, II, IV C. II, III, IV D. II, IV, V E. III, IV

E. III, IV

Choose all of the following that may result in a high pressure alarm

ETT kink/bite, Pneumothorax, ETT tp close to the carina, Bronchospasm

Which of the following is a pathologic cause for dead space effect?

Emphysema

Mr. Joe Nomonomoe has an order for PC-CMV with a set inspiratory pressure of 30 cm H2O, set rate of 20 bpm and TI of 1.1 sec- When charting the set TI for Mr Nomonomoe's ventilator check, you should?

Ensure that the ordered, set and actual TI are reconciled before recording

A ventilator may malfunction during use- When this occurs, the clinician must first?

Ensure that the patient is being ventilated

A COPD patient with pneumonia has the following ABG results pH 7.43 PaCO2 51 HCO3 39 PaO2 46. Your interpretation is Chronic respiratory alkalosis.

False

Which of the following is true regarding the factors that impact on temperature in the ventilator patient?

Fever is the most common sign of post-op complications

A patient is receiving 18 cm H2O CPAP via a PB-980 ventilator- Sensitivity is set to 2 cm H2O- With each spontaneous breath the pressure drops to -6 cm H2O- In this situation?

Flow triggering should be initiated.

How might a patient's blood pressure and cardiac output be maintained in the face of a decreased venous return?

Fluid therapy

PPV increases GI vascular resistance, decreases GI venous outflow, and may contribute to gastric mucosal ischemia-This last change is one of the factors leading to increased incidence of ____, which are frequently seen in critically ill patients.

Gastrointestinal bleeding and gastric ulcers

Mr. Puffer is on SIMV with a set rate of 6 and a set VT of 600, and you count a spontaneous rate of 18 with a VT of 350- Which of the following is true of his VE?

His spontaneous VE is 6.3 lpm

Which of the following ventilator controls have a direct effect on the I/E ratio I-Tidal volume II-Flow rate III-PEEP IV-FIO2?

I, II

Possible causes of high pressure alarms during the operation of the Puritan-Bennett 980 ventilator would include, I- Airway secretions II- Patient coughing III- Kinking of an endotracheal tube IV- Calibrating the manometer so it reads higher than actual V- Disconnection of the expiratory tubing from the spirometer water trap?

I, II, III

When using the PB-840 ventilator, the pressure limit alarm begins to sound within ten minutes of your ventilator check, when it has not been sounding for the previous six hours of your shift, Which of the following have definitely occurred -I-Pressure cycling has occurred II- The set VT has not been delivered III-The inspiratory phase is ended IV-The pressure limit is set too low ?

I, II, III

During the first vent checks of your shift you discover that one patient's humidifier is malfunctioning and is delivering gases at 25˚ C to the patient connector instead of an expect-ed 35°C. Problems this can cause include I- Increased tendency towards secretion retention,II-Inspissation of secretions, III-Inadequate condensation in the expiratory limb of the ventilator circuit, IV-Inaccuracy, according to Boyle's law, of the rotating vane expiratory pneumotach, V-Increased patient energy expenditure?

I, II, V

Which situations might result in an increase in the peak inspiratory pressure reading I-Adding 10 cm H2O PEEP II-Reducing the FIO2 III-A spontaneous pneumothorax developed by the patient IV-Adjusting the sensitivity control ?

I, III

Which situations might result in an increase in the peak inspiratory pressure reading? I. Adding 10 cm H2O PEEP II. Reducing the FIO2 III. A spontaneous pneumothorax developed by the patient IV. Adjusting the sensitivity control

I, III

Which of the following are selectable "modes" of ventilation? I. A/CMV II. BRB III. DMV IV. ECMO V. SIMV

I, V

Diseases which would most likely require mechanical ventilatory assistance to improve oxygenation are I-ARDS II-Carbon monoxide poisoning III-Early stage pulmonary edema IV- A major pulmonary embolus V - Pneumonia?

I,IV

A patient on a Servo-I with an SIMV of 10 becomes disconnected. An audible low pressure alarm fails to activate. The ventilator will:I. Automatically activate an internal low pressure alarmII. Continue to cycle at 10 BPMIII. Activate the visual high pressure alarm on the control panelIV. Stop cycling due to absence of a pressure gradient

II

In determining need for a mechanical ventilator to assist patient oxygenation, the major factors to consider are I-PaCO2 II-PaO2 III-The patient's work of breathing IV-The patient's ventilatory reserves V-The amount of VD-MECH attached to the ventilator?

II,III,IV

Which of the following are true statements about compressed volume? I. the compressed volume is the additional volume from the circuit that is delivered to the patient II. the greater the peak delivery pressure, the greater the minute alveolar ventilation III. the compressed volume will increase with decreases in patient lung compliance, if ventilator parameters are constant IV. to determine the compressed volume, the alveolar minute ventilation must be known V. the greater the peak delivery pressure, the greater the compressed volume loss

III, V

Which of the following are true statements about compressed volume?I. the compressed volume is the additional volume from the circuit that is delivered to the patientII. the greater the peak delivery pressure, the greater the minute alveolar ventilationIII. the compressed volume will increase with decreases in patient lung compliance, if ventilator parameters are constantIV. to determine the compressed volume, the alveolar minute ventilation must be knownV. the greater the peak delivery pressure, the greater the compressed volume loss

III, V

Forms of pulmonary volutrauma would include I-Hyperventilation II-Pneumonia III-Pneumothorax IV-Subcutaneous emphysema V-WBC?

III,IV

A 24 YO 70 kg student was admitted to your ER after bleeding severely for several hours from a pencil fight wound, The patient appeared shocky and hypotensive (BP 73/40) on admission, He is now being mechanically ventilated and has been for 2 days, ABGs show- pH = 7 4 PaCO2 = 41 mmHg PaO2 = 48 mmHg, Present vent settings are- VT = 700mL f = 8 FIO2 = 70 PEEP = 6 cmH2O BP is currently stable without requiring pressors, Based on this information the PaO2 should be improved by?

INCREASE PEEP

Which of the following NIV settings produces the greatest tidal volume, with all other variables being equal (i.e., airway resistance and lung compliance)?

IPAP = 18 cm H2O; EPAP = 4 cm H2O

Which of the following is true?

In volume-cycled ventilation the VT is set and the PIP is variable

Which of the following is true?

In volume-cycled ventilation the VT is set and the PIP is variable.

On a volume controlled ventilator, an increase in RAW will?

Increase peak airway pressure.

A 75-year-old, 5-foot, 7-inch female patient with an exacerbation of COPD is placed on the following NIV settings: IPAP = 8 cm H2O, EPAP = 4 cm H2O, rate = 12 breaths/min, FIO2 = 0.3. The resulting VT is 255 mL. An arterial blood gas sample is drawn 1 hour later, and the results are: pH = 7.33, PaCO2 = 70 mm Hg, PaO2 = 58 mm Hg, HCO3- = 35 mEq/L. What action should the respiratory therapist take at this time?

Increase the IPAP to 10 cm H2O.

A 68-year-old, 5-foot, 10-inch male patient with acute-on-chronic respiratory failure due to COPD has been placed on NIV with these settings: IPAP = 8 cm H2O, EPAP = 4 cm H2O, FIO2 = 0.28. The patient's measured exhaled volume is 350 mL with a spontaneous respiratory rate of 24 breaths/min. The resulting arterial blood gas values are: pH = 7.27, PaCO2 = 77 mm Hg, PaO2 = 64 mm Hg, SaO2 = 88%, HCO3- = 36 mEq/L. What action should the respiratory therapist take at this time?

Increase the IPAP to 12 cm H2O.

A patient is receiving mechanical ventilation. The following data are available: Mode: Assist/control FIO2 90% Mandatory rate 10 bpm VT 800 ml PEEP 5 cm H2O After 30 minutes, arterial blood gas results are as follows:: pH 7.43 PaCO2 41 torr PaO2 52 torr HCO3- 26 mEq/L Which of the following should the respiratory therapist do?

Increase the PEEP to 10 cm H2O.

A patient on VC-A/CMV was apneic and receiving 8 br/min with at VT of 700 mL/br and a square wave flowrate of 30 L/min. The PIP is 32 cm H2O. Now the patient is actively breathing. The rate is now 28 bpm, and the I:E ratio light is flashing. You should now:

Increase the peak flow setting to 50 L/min.

The following data are obtained for a patient who is receiving volume-controlled ventilation with a VT of 1.0 L: Peak AW Pressure= (@10AM) 38 cm H2O, (@12PM) 45 cm H2O Static Pressure= (@10AM) 34 cm H2O, (@12PM) 34 cm H2O This information indicates:

Increased airway resistance.

Positive pressure ventilation can cause fluid retention by?

Increasing ADH levels

Capnograph uses which of the following technology?

Infrared absorption meter

A 68-year-old woman was admitted to the ICU with pneumonia and was intubated when she developed progressive hypoxemia. She has been on the ventilator for 5 days and has been tolerating this therapy well. The patient has suddenly become severely agitated and appears to be fighting the ventilator. The ventilator's high pressure alarm is sounding continuously. The respiratory therapist disconnects the patient from the ventilator and begins manual ventilation with 100% oxygen and PEEP. The resuscitator bag is difficult to squeeze, breath sounds are present on the left with no adventitious sounds and absent on the right side, and percussion reveals hyperresonance over the right side. The most appropriate action to address this situation is which of the following?

Insert a 14-gauge needle in the second intercostal space, midclavicular line, right side.

A patient with acute cardiogenic pulmonary edema (ACPE), as evidenced by pink, frothy secretions, arrives in the emergency department (ED) by ambulance with a nonrebreather mask (NRM) at 15 L/min. An arterial blood gas sample is drawn in the ED while the patient is on the NRM; the values are: pH = 7.50, PaCO2 = 28 mm Hg; PaO2 = 43 mm Hg; SaO2 = 84%; HCO3- = 24 mEq/L. After evaluating the situation, the respiratory therapist should suggest which of the following therapies?

Mask CPAP with supplemental oxygen

Positive end expiratory pressure:

May decrease cardiac output.

Which of the following ventilator circuit components can provide an excellent home and source of transportation for undeserving microbes (i.e., most likely to infect patient)?

Medication nebulizer

The respiratory therapist enters the room of an intubated and mechanically ventilated patient to find the low pressure, low exhaled volume, and low VE alarms active. The ventilator circuit is connected to the patient's endotracheal tube. This situation could be caused by which of the following?

Migration of the ET tube into the upper airway.

A patient with a flail chest is on a volume controlled ventilator- Which of the following is a goal of mechanical ventilation for this patient?

Minimize fracture motion to allow healing

Increased pulse, cardiac output, cyanosis, dilation of coronary vasculature and constriction of peripheral and pulmonary vasculature are collectively signs of

Moderate hypoxia

Control mode ventilation should, wherever possible, be achieved by?

Neuromuscular paralysis with no sedation

A 62-year-old male patient with COPD is being seen in the pulmonary clinic for dyspnea at rest and daytime hypersomnolence. The patient has been hospitalized three times in the past year for COPD exacerbations and once for pneumonia. He currently uses 2 L/min oxygen from a concentrator all the time. The patient reports that he is able to sleep only about 2 hours each night and that he has a headache every morning. Which of the following should be recommended to the physician?

Nocturnal NIV

A patient who was diagnosed 1 year ago with amyotrophic lateral sclerosis is being seen in his primary care physician's office. The patient is complaining of fatigue and inability to concentrate at work. The patient's FVC is 45% of predicted, the PaCO2 is 47 mm Hg, and the MIP is 54 cm H2O. Which of the following should be considered for this patient?

Nocturnal NIV

The absolute "best" PEEP is achieved when you have increased to maximum the patient's?

O2 transported to the tissues (i.e. CaO2 x cardiac output)

Immediately after connecting a patient to a mechanical ventilator the major concern would be to?

Observe the patient's chest for ventilatory movement

Immediately after connecting a patient to a mechanical ventilator the major concern would be to:

Observe the patient's chest for ventilatory movement.

You have a patient with a closed head injury suffered in a pedestrian/tree accident (the tree was intoxicated). Presently the patient is receiving controlled mechanical ventilation via a volume-cycled ventilator and has blood gas values of: pH=7.31 PaCO2=38 PaO2=155 HCO3-=20 SaO2=99% Ventilator settings are: VT=700mL/br f =12 br/min FIO2=0.40 I:E=1:4 PEEP=0 Other clinical data includes: body weight=67 kg, age 29, patient is pharmacologically paralyzed, barometric pressure=763 mmHg, body temperature=37.5˚C, room temperature=29˚C, relative humidity=60%, the wind is coming out of the SW at 35 knots. The oxygenation status is one of:

Overcorrected hypoxemia.

Changes in which one of the following measurements (ie., not used in combination with other values) is most helpful in evaluating the effects of CPAP on tissue oxygenation?

P O2

An adult patient is receiving mechanical ventilation- Which of the following should be recommended to improve oxygenation and recruit collapsed alveoli?

PEEP

It has been known for nearly half a century that pressurized breathing can induce reductions in renal function and urine output- These effects include?

Renal responses to hemodynamic changes resulting from high intrathoracic pressures

After you complete your ventilator check, you auscultate and discover coarse expiratory rhonchi bilaterally- You then suction large volume of thick sputum- You should?

Repeat the ventilator check because all of the pressures you charted are invalid.

If a patient develops moderate airway obstruction after endotracheal extubation, appropriate actions might include?

Requesting an order for a racemic epinephrine aerosol treatment.

The respiratory therapist is called to the bedside of a patient mechanically ventilated in the VC-CMV mode because the low pressure, low exhaled tidal volume, and low exhaled minute volume alarms all have activated. Which of the following could be the cause of this situation?

Rupture of the endotracheal tube cuff

You have a patient who has been trying to wean on PSV for days and can only tolerate 30 minutes. The doctor asked what mode would you suggest to help decrease WOB but also allow the patient to exercise his respiratory muscles?

SIMV + PSV

A home care patient using NIV complains that when she puts on the NIV mask at night and turns on the machine, "at first the gas feels like it is punching her in the face." The patient is noncompliant with the NIV because of this. What action should the respiratory therapist take?

Set the ramp and delay time.

The resident calls you to repeat an ABG on Mr. Tote Lee Spazz, because she believes the results must be invalid. The ABG results on RA were pH = 7.52, PaCO2 = 28 torr and PaO2 = 108 torr. You tell the doctor:

She's incorrect; the PaO2 can be greater than 100 torr on RA if the patient is hyperventilating.

The resident calls you to repeat an ABG on Mr. Tote Lee Spazz, because she believes the results must be invalid. The ABG results on RA were pH = 7.52, PaCO2 = 28 torr and PaO2 = 108 torr. You tell the doctor?

She's incorrect; the PaO2 can be greater than 100 torr on RA if the patient is hyperventilating.

If a rip develops in the balloon or diaphragm of an exhalation valve of a ventilator operating in VC-CMV mode, the machine will?

Show a decreased peak inspiratory pressure.

Lack of adequate for long periods_ + Stress = ICU Psychosis

Sleep

Lack of adequate for long periods_ + Stress = ICU Psychosis.

Sleep

When checking the ventilator's set tidal volume, you should reconcile/check all of the following EXCEPT?

Spontaneous VT

A female patient who is 5'7" tall and weighs 68 kg is being mechanically ventilated with volume-controlled continuous mandatory ventilation (VC-CMV), set rate 12, patient trigger rate 25 breaths/min, tidal volume (VT) 500 mL, set flow rate 60 L/min, fractional inspired oxygen (FIO2) 40%, positive end-expiratory pressure (PEEP) 5 cm H2O. The patient is currently in distress using accessory muscles of inspiration. The respiratory therapist performs a patient-ventilator system check. The flow-time waveform shows a failure of the expiratory flow to return to zero before the next breath is triggered. The most appropriate action for the respiratory therapist to take includes which of the following?

Switch to volume-controlled intermittent mandatory ventilation (VC-IMV).

The technique of ventilation that allows a patient to breathe with variable spontaneous VT and RR and also receive intermittent positive-pressure ventilated breaths is known as?

Synchronized intermittent mandatory ventilation (SIMV).

PEEP/CPAP affects which of the following lung capacities?

TLC minus IC

CPAP/PEEP increases PaO2 primarily by Increasing alveolar recruitment (re-expansion of collapsed alveoli)and Increasing FRC (improving compliance)?

TRUE

Which of the following is true regarding FIO2 measurement during ventilator checks?

The Servo is one of the few modern ventilators to have a built-in oxygen analyzer.

You are called to investigate a problem in the ICU, An apneic patient is on VC ventilation with a VT of 650 mL, The low exhaled V alarm is set at 450 mL and, according to nursing staff, has been going off for the last 15 minutes, The patient's vital signs are normal, coloration and breath sounds are good, and no other alarms are sounding, Using a recently calibrated Boehringer respirometer you find the VT distal to the exhalation valve is 650 mL, The most probable explanation for the sounding of the alarm is that?

The expiratory pneumotach (i.e., ventilator's internal spirometer) is malfunctioning.

Which of the following is the reason CPAP may be therapeutic for OSA (obstructive sleep apnea)?

The positive end-expiratory pressure supports the pharyngeal diameter.

Your pt. is on a non-rebreather with an arterial oxygen level of 55 torr. You can ascertain that

The pt. is refractory to Oxygen therapy

When checking the ventilator rate, which of the following is true?

The set rate and the total rate should each be counted for at least 30 seconds

All of the following are true of the measurement of peak and plateau pressures EXCEPT?

The static pressure is also called the PIP

An intubated patient should not be extubated if?

There are copious, tenacious pulmonary secretions present and the patient is comatose.

The deleterious effects of PEEP on the cardiovascular system are least likely to be pronounced in which of the following patients?

Those with decreased pulmonary compliance

The most common inspiratory trigger for assisted breaths on a Vela would be?

Time

What is the trigger of a machine initiated ventilator breath?

Time

Anemic hypoxia can be caused by carbon monoxide poisoning?

True

If a patients Fio2 was at 70% and their peep was only at 5 cmH20, we should consider increasing the peep?

True

If the sensitivity is too sensitive and the vent is auto cycling the high F alarm was set appropriate, this would trigger the alarm?

True

If the sensitivity is too sensitive and the vent is auto cycling the high F alarm would be set off?

True

Normal anatomical deadspace is... 1ml/lb

True

The following are all true statements about hemodynamic measurements -The CVP line is placed at the level of the RA, usually in the SVC or IVC; normal value:0-5 torr.-PCWP (pulmonary capillary wedge pressur) is equivalent to the LVEDP (left ventricular end diastolic pressure); normal value is 8-12 torr and An A PAP with normal PCWP generally indicates a pulmonary disorder (a pulmonary embolism).

True

To decrease a PaCO2 of 50mmhg to 40 mmHg, we would need to increase minute ventilation either by adjusting the f or the Vt?

True

Which of the following is true regarding the factors that impact on temperature in the ventilator patient? Fever is the most common sign of post-op complications.

True

A COPD patient with a history of compensated respiratory acidosis and hypoxemia requiring home O2 has been admitted to your ICU with an acute pneumonia and is now on a mechanical ventilator, In managing this patient's ventilator you would?

Try to maintain the patient's PaCO2 higher than 40 mmHg and PaO2 lower than 90 mmHg

You have a patient with a closed head injury suffered in a pedestrian/tree accident (the tree was intoxicated). Presently the patient is receiving controlled mechanical ventilation via a volume-cycled ventilator and has blood gas values of: pH=7.31 PaCO2=38 PaO2=155 HCO3-=20 SaO2=99% The interpretation of the above blood gas acid-base values is:

Uncompensated metabolic acidosis.

An absolute contraindication to PEEP is which of the following?

Untreated tension pneumothorax

Regardless of the procedure used to establish an appropriate PEEP level, ventilating pressures should not be allowed to exceed which of the following?

Upper inflation point on the inspiratory limb (UIPi)

Which calculation is used to determine the initial set VT for a ventilator patient?

Using the formula 7-8 cc/kg of ideal body weight

While ventilating a pediatric patient it is noted that the patient's PaCO2 level is too high, To bring the patient's PaCO2 level down you could remove the 50 mL tube connecting the patient "Y" connector to the endotracheal tube and attach the "Y" connector directly onto the endotracheal tube adapter, This technique would work because it will increase the patient's?

VA

You enter an ICU and see a patient on a PB 980 ventilator- You note the baseline pressure is 0 cm H2O, the ventilator f is set at 8 br/min but the total f display shows 17 br/min- Machine VT is set for 800 mL-The VT exhaled display is reading between 780 and 820 mL for every breath- What ventilation mode is being used for this patient?

VC-A/CMV

You obtain information about the patient in order to pick ventilator settings. He weighs 165 lbs. and his ABGs were pH 7.32, PaO2 54, and PaCO2 56 on 100% FIO2 (he is being manually ventilated with a bag). He has chest contusions and several broken ribs.For other settings, you recommend:

VT 550 ml; FIO2 100%

Which of the following parameter values indicate the need for ventilator assistance in an 55 kg female?

VT of 130 cc

Which of the following is used to calculate the static compliance at the bedside of a patient who is being mechanically ventilated without PEEP?

VT ÷ plateau pressure

Pressure, inspiratory time and flow are not constant for a ventilator which is?

Volume-controlled

A ventilator that terminates inspiration when a pre-set volume is reached is labeled?

Volume-cycled

Mr. Joe Schmoe has an order for PC-CMV with a set inspiratory pressure of 30 cm H2O, and PEEP of 0 cm H2O-When charting the set inspiratory pressure for MrSchmoe's ventilator check, you should check the PCV actual pressure -What is the best way to do this?

Watch the pressure curve during a machine breath; the pressure should rise to 30 cm H2O and hold until inspiration ends

Mr. Joe Schmoe has an order for PC-CMV with a set inspiratory pressure of 30 cm H2O, and PEEP of 0 cm H2O. When charting the set inspiratory pressure for Mr. Schmoe's ventilator check, you should check the PCV actual pressure. What is the best way to do this?

Watch the pressure curve during a machine breath; the pressure should rise to 30 cm H2O and hold until inspiration ends.

Mr. Joe Blow has an order for PSV =10, When charting the PSV for Mr Blow's ventilator check, you should check the PSV actual pressure- What is the best way to do this?

Watch the pressure curve during a spontaneous breath; the pressure should rise to 10 cm H2O and hold until inspiration ends

Mr. Joe Blow has an order for PSV =10. When charting the PSV for Mr. Blow's ventilator check, you should check the PSV actual pressure. What is the best way to do this?

Watch the pressure curve during a spontaneous breath; the pressure should rise to 10 cm H2O and hold until inspiration ends.

In general, the type of lung pathology which, in combination with hypoxemia refractory to elevated O2%, is appropriate for CPAP/PEEP therapy would be?

a condition which is homogenous(i.e., bilateral and diffuse throughout both lungs)and which causes a decrease in CLT.

Which of the following are signs of abnormal neurological response?

a. Negative gag and grasp reflexes b. Decerebrate posturing to painful stimuli c. Positive Babinski reflex (dorsoflexion of great toe and fanning of others) d. All of the above Feedback The correct answer is: All of the above

Regarding the calculation of compliance.

a. There is a correlation of 91% between decreases in compliance and decreases in PaO2 b. All of the above. c. When measuring plateau pressure, you occlude the exhalation valve, so there is no airflow d. Dynamic compliance is not reflective of pure elastic changes of the lung because there is airflow e. To measure static compliance, you divide the delivered tidal volume by plateau pressure minus PEEP All of the above

Which of the following could lead to a PvO2 below the normal of 40 torr?

a. all of the above b. decreased tissue perfusion c. decreased arterial O2 content d. decreased CO (cardiac output) e. increased metabolic rate All of the above

Despite the risk, it is still important to use PEEP, because it can prevent alveolar collapse during exhalation and reopening, even when a low VT is used. It now is theorized that it is important to use the pressure-volume loop to set PEEP _____________________.

above the upper inflection point detected during deflation of the lung

A patient is being ventilated with a Susie 248 ventilator,and the high pressure limit is sounding with each breath-Likely causes would include I-Bronchospasm II-Secretions III-Tension pneumothorax IV-Patient "fighting" the ventilator V-A kink in the ET tube?

all of the above

Which clinical condition(s) would indicate the need for instituting mechanical ventilation I- Apnea II- Acute ventilatory failure III- Unstable cardiovascular system IV- Impending ventilatory failure?

all of the above

You are continuously ventilating a patient in volume control mode, The PIP has increased regularly over the last several hours, Which of the following may be causing the increasing PIPs?

all of the above(partial airway obstruction, lung elastance, atelectasis, lung compliance)

During a patient case study, increasing increments of PEEP showed no significant effects until 15 cm H2O was used, at which time the PaO2 improved markedly. This represents the point at which _______________.

alveolar recruitment probably occurred

Your E.R. patient has extremely pink mucous membranes and soot inside the nostrils and mouth, and you know he was rescued from a burning house. HbCO analysis reveals elevated levels of CO in the blood. Which kind of hypoxia is generally associated with this condition?

anemic hypoxia

"Loose atelectasis," or compression atelectasis, is most often associated with _____________.

anesthesia

o avoid aspiration, it would be most appropriate to extubate (the actual pulling of the tube out)?

beginning just after the start of an exhalation.

Which of the following occur in moderate hypoxia?

coronary vasodilation

A physician has calculated that a minute alveolar ventilation of 4.8 L/min is desirable for one of his ventilator patients, The patient weighs 68 kg, his present CMV rate is set at 14 breaths/minute and the tidal volume is 550 mL, In order to achieve the desired minute alveolar ventilation you would?

dec f to 12 br/min

Which of the following are ways in which CO2 is carried in the plasma?

dissolved as PaCO2

You are called to see Mr. I. M. Outovit, a patient the resident fears may be retaining excessive CO2. While you are drawing an ABG to confirm this, which of the following are you most likely to see if the doctor is correct?

drowsiness

The statement movement of gas molecules across permeable membranes is the definition for which term below?

external respiration

For a patient triggering numerous assisted breaths on a Hamilton Veolar ventilator set to volume control, constant flow, and assist/control mode, which may routinely vary?

f

Match the values:

f/Vt ( RSBI) → < 100, Ve → < 10 L/min, VC (vital capacity) → > 15ml/kg, MIP → > -20 cm H20, f (frequency) → < 25 bpm, VD/Vt → < 0.6, PaO2/FIO2 (P/F ratio) → > 200, PaCO2 → < 50 mmHg, PaO2` → > 60 mmHg

The variable that ends pressure support breaths from a pressure-supported breath is

flow

After extubation of an oral endotracheal tube your patient immediately develops marked audible inspiratory stridor, severe suprasternal and intercostal retractions, cyanosis about the lips, tachycardia and begins to lose some of his former mental alertness, The best therapy for this situation would be to?

have the patient quickly reintubated.

The statement inadequate quantities of O2 in the blood is the definition for which term below?

hypoxemia

A patient is placed on a mechanical ventilator. It is observed that he has a V/Q ratio increase as a consequence. What might be a reason for this phenomenon?

impeded venous return caused by positive pressure ventilation.

A patient is placed on a mechanical ventilator.It is observed that he has a V/Q ratio increase as a consequence. What might be a reason for this phenomenon?

impeded venous return caused by positive pressure ventilation.

The ABG results for a patient who is being mechanically ventilated by a volume controlled ventilator are consistent with respiratory acidosis-The corrective action would be?

increase the tidal volume

Which of the following is usually used to perform exhaled carbon dioxide analysis?

infrared absorption meter (capnograph).

What happens ot intra-alveolar pressure spontaneous inspiration ( at mid-inhalation)?

it become subatmospheric

Which of the following is true of oxygen carrying capacity?

it is equal to the cardiac output times the O2 content

Which of the following is true of anatomical dead space?

it is that part of the total ventilation that does not come in contact with the alveolar epithelium (i.e., the gas found in the conducting airways).

Which of the following is true regarding O2 delivery?

its normal value is 1000ml/min. and its equation is CaO2 x CO = DO2

A 61-year-old female was admitted last night with shortness of breath. She currently is alert and oriented but very anxious. Her latest arterial blood gas values, on a nasal cannula at 3 L/min, show: pH = 7.39; PaCO2 = 41 mm Hg; PaO2 = 40 mm Hg; SaO2 = 74%; HCO3- = 24 mEq/L. Breath sounds are decreased throughout with fine late crackles on inspiration. The current chest X-ray shows an enlarged heart with bilateral vascular congestion. The most appropriate therapy for this patient is _________.

mask CPAP

Positive end expiratory pressure?

may decrease cardiac output.

A 55-year-old patient is in moderate respiratory distress while receiving oxygen by a non-rebreathing mask. Arterial blood gas results are: pH = 7.46 PaO2 = 54 torr BE 0 mEq/L PaCO2 = 33 torr HCO3- 23 mEq/L Which of the following conditions should you suspect?

mild hyperventilation with refractory hypoxemia

Indications for mechanical ventilation include which of the following?

pH 7.21............................. PaCO2 64 mmHg

Indications for mechanical ventilation include which of the following?

pH 721 PaCO2 64 mmHg

Positive end-expiratory pressure is most appropriately used with which of the following conditions?

post-trauma acute respiratory distress syndrome

Which of the following is a pathologic cause for alveolar dead space?

pulmonary embolus

One of the physiological goals of NIV in acute respiratory failure is to improve gas exchange by ______________.

resting the respiratory muscles

To determine whether hypoxemia is circulatory or respiratory in nature?

shunt will appear increased if there is a pulmonary problem

Considering ALL patients who may receive mechanical ventilation, what is the most frequent technique used to successfully discontinue mechanical ventilation from a patient?

sink or swim

Which of the following is employed in pulse oximetry?

spectrophotometric analysis

Which clinical finding represents the earliest sign of hypoxia?

tachycardia

*The RN calls you to see her ventilator patient, Ms. Shun Tid Flo, who has been diagnosed with ARDS after surviving an explosion in a fireworks factory. The RN and intern are concerned about the patient's oxygenation. You make a few FIO2 changes and get a few ABGs to get the following data:Results at 1:30 AM:Results at 2:10 AM:FIO2 = 40%FIO2 = 70%PaO2 = 57 torrPaO2 = 60 torrBased on these results, you tell the RN and MD

the patient's hypoxemia is refractory

The RN calls you to see her ventilator patient, Ms. Shun Tid Flo, who has been diagnosed with ARDS after surviving an explosion in a fireworks factory. The RN and intern are concerned about the patient's oxygenation. You make a few FIO2 changes and get a few ABGs to get the following data: Results at 1:30 AM: Results at 2:10 AM: FIO2 = 40% FIO2 = 70% PaO2 = 57 torr PaO2 = 60 torr Based on these results, you tell the RN and MD:

the patient's hypoxemia is refractory

Which of the following would provide the largest alveolar ventilation for a 68-kg (150- lb) patient?

vt 600 rr20