Patient Assessment Chapter 14

In the intensive care unit (ICU), the airway resistance (Raw) of a mechanically ventilated patient can be estimated easily by using which of the following formulas? A. (Peak pressure - Static pressure)/Flow B. (Peak pressure - Static pressure)/2 C. (ET tube diameter - Static pressure)/Peak airway pressure D. (Flow - inspiratory time)/60

A. (Peak pressure - Static pressure)/Flow

Carbon dioxide production is increased by approximately what percentage per 1° C of body temperature in patients with fever? A. 10% B. 50% C. 25% D. 1%

A. 10%

Which of the following RSBI values would predict that the patient is least likely to be successfully weaned from mechanical ventilation? A. 100 B. 25 C. 75 D. 50

A. 100

Which of the following waveforms most accurately allows the clinician the recognition of auto-PEEP? A. Flow-time B. Pressure-time C. Pressure-volume D. Flow-volume

A. Flow-time

All of the following are likely to cause a decrease in a patient's tidal volume except: A. Metabolic acidosis B. The postoperative period after coronary artery bypass surgery C. Pulmonary edema D. Acute respiratory distress syndrome

A. Metabolic acidosis

A non-intubated patient should be monitored for lung volumes in the presence of the following clinical conditions except: A. Respiratory rate less than 30 breaths/min B. Receipt of noninvasive positive-pressure ventilation C. Central nervous system depression D. Deteriorating blood gases

A. Respiratory rate less than 30 breaths/min

Which of the following conditions explains why lung damage persists after recovery from a severe protracted episode of acute respiratory distress syndrome (ARDS)? A. Volutrauma B. Use of excessive amounts of PEEP during the episode C. Severity of the episode of ARDS D. Condition of the lungs before the onset of disease

A. Volutrauma

For weaning to be successful, the patient's spontaneous minute ventilation needs to be less than _____ L/min. A. 30 B. 10 C. 40 D. 20

B. 10

Which of the following values of VC is more consistent with impending respiratory failure? A. 30 mL/kg B. 10 mL/kg C. 70 mL/kg D. 50 mL/kg

B. 10 mL/kg

In adult patients, spontaneous tidal volumes should be at least what value if weaning is to be successful? A. 200 mL B. 300 mL C. 400 mL D. 500 mL

B. 300 mL

If auto-PEEP is present, it is most likely to be detected if the expiratory limb of the patient circuit is occluded at what point in the cycle? A. In maximal inhalation B. At the end of exhalation C. In the middle of inhalation D. At the middle of exhalation

B. At the end of exhalation

If intubated and mechanically ventilated patients are given shallow tidal volumes without sighs, which of the following is most likely to occur? A. Respiratory arrest B. Atelectasis C. Increase in secretion production D. Coughing

B. Atelectasis

All of the following are likely to increase the mean airway pressure (MAP) except an increase in: A. Flow rate B. Expiratory time C. Peak pressure D. PEEP levels

B. Expiratory time

The "stacking" of breaths, which often is seen in mechanically ventilated patients with severe airway obstruction, can be caused by: A. Ventilator malfunction B. Insufficient expiratory time C. A low-measured tidal volume D. A respiratory rate that is too low

B. Insufficient expiratory time

Which of the following is least likely to cause an increase in a patient's tidal volume? A. Metabolic acidosis B. Metabolic alkalosis C. Sepsis D. Severe neurologic injury

B. Metabolic alkalosis

The amount of force needed to overcome opposition to air flow in the lungs during mechanical ventilation is known as: A. Maximal airway resistance B. Peak pressure C. Airway pressure D. Positive end-expiratory pressure

B. Peak pressure

Which of the following is normally used when PEEP levels are titrated to determine optimal PEEP? A. Volume-time curve B. Pressure-volume curve C. Flow-time Curve D. Pressure-time curve

B. Pressure-volume curve

All of the following activities are included in respiratory monitoring except: A. Alarm setting B. Pulmonary consults C. Physical examination D. Measurements and calculations

B. Pulmonary consults

In healthy, spontaneously breathing patients, an occasional increase in tidal volume to three or four times the normal level, which normally occurs about six to ten times each hour, is the definition of a: A. Sneeze B. Sigh C. Cough D. Forced vital capacity

B. Sigh

In a sedated, mechanically ventilated patient, inspiratory tidal volumes are consistently larger than expiratory tidal volumes. If it is assumed that there is no leak in the circuit, which of the following provides the best explanation for this discrepancy? A. Different pressure profiles B. The compressibility factor of the ventilator circuit C. An increase in airway resistance that causes air trapping D. Ventilator malfunction

B. The compressibility factor of the ventilator circuit

Patients who are ventilated with excessively large tidal volumes are at risk of: A. Hyperventilation B. Volutrauma C. Emphysema D. Air trapping

B. Volutrauma

Weaning failure during a spontaneous breathing trial may be predicted when the spontaneous respiratory rate is greater than: A. 25 breaths/min B. 30 breaths/min C. 35 breaths/min D. 20 breaths/min

C. 35 breaths/min

In mechanically ventilated patients, the addition of positive end-expiratory pressure (PEEP) to normal tidal volumes is associated with the following effects except a(n): A. Decrease in intrapulmonary shunting B. Increase in functional residual capacity C. Increase in residual volume D. Increase in partial pressure of arterial oxygen

C. Increase in residual volume

Which of the following ventilator changes will have to be made if the problem of "breath stacking" is to be resolved? A. Increase in both respiratory rate and inspiratory flow B. Increase in respiratory rate C. Increase in inspiratory flow D. Increase in tidal volume

C. Increase in respiratory flow

Which of the following ventilator changes is most likely to increase the functional reserve capacity (FRC) and reduce the extent of acute lung injury? A. Increased FiO2 B. Decreased inspiratory time C. Increased PEEP D. Increased flow

C. Increased PEEP

Volutrauma is most likely to develop in: A. Small airways B. The larger airways C. Nondependent lung regions D. Dependent lung regions

C. Nondependent lung regions

Ventilatory measurements routinely monitored at the bedside include all of the following except: A. Lung volumes and flows B. Fractional gas concentrations C. Oxygen consumption and carbon dioxide production D. Airway pressures

C. Oxygen consumption and carbon dioxide production

The highest incidence of postoperative morbidity is associated with which of the following surgery sites? A. Transsternal B. Lower abdominal C. Thoracoabdominal D. Upper abdominal

C. Thoracoabdominal

Compliance is defined as: A. Volume change per unit of flow B. Elasticity C. Volume change per unit of pressure change D. Pressure change per unit of volume

C. Volume change per unit of pressure change

When a patient's mechanical ventilator has a graphic display screen, which of the following waveforms could be used to determine whether there is any leak in the system and the amount of the leak? A. Pressure-flow B. Pressure-time C. Volume-time D. Flow-time

C. Volume-time

Which of the following values for the ratio of respiratory frequency to tidal volume would predict that the patient will be successfully weaned off the ventilator? A. 100 B. 200 C. 150 D. 50

D. 50

All of the following changes can decrease "breath stacking" in a mechanically ventilated patient except: A. A decreased ventilator rate B. An increase inspiratory flow C. A decreased mechanical tidal volume D. A decreased expiratory time

D. A decreased expiratory time

It is important to monitor ventilatory parameters in addition to arterial blood gases because: A. Monitoring of ventilatory parameters does not require specialized equipment and can be done more quickly B. It is easier and more cost-effective to monitor ventilatory parameters C. Monitoring of ventilatory parameters can be done without a physician's order, whereas arterial blood gas monitoring requires a physician's order D. Changes in ventilatory parameters will occur before they are seen in arterial blood gas

D. Changes in ventilatory parameters will occur before they are seen in arterial blood gas

When carbon dioxide elimination is monitored, the highest levels are obtained at the: A. Middle of exhalation B. End of inhalation C. Middle of inhalation D. End of exhalation

D. End of exhalation

An important advantage of monitoring mechanical tidal volumes proximally is that: A. It decreases the respiratory work for the patient B. The measuring device is less susceptible to condensation C. It decreases circuit resistance and dead space D. It eliminates the compressible volume factor of tubing circuits

D. It eliminates the compressible volume factor of tubing circuits

Which of the following statements about the tidal volume is true? A. It has an inversely proportional relationship with minute ventilation B. It usually is 10 to 15 mL/kg of ideal body weight C. It usually is about 25% to 30% of total lung capacity D. It is made up of two components: alveolar volume and dead space volume

D. It is made up of two components: alveolar volume and dead space volume

The amount of force needed to maintain a mechanical tidal volume breath in the patient's lungs is known as _____ pressure. A. Positive end-expiratory B. Continuous positive airway C. Peak D. Static

D. Static

Acute respiratory distress syndrome (ARDS), pneumonia, and pulmonary edema are likely to cause a decrease in lung compliance. This is evidenced in a mechanically ventilated patient by an increase in: A. Expiratory time B. Dynamic pressure C. Inspiratory time D. Static pressure

D. Static pressure

The ratio of respiratory frequency to tidal volume that is used to predict the likelihood of success in weaning the patient from mechanical ventilation is also known as: A. A spontaneous breathing test B. The successful weaning test C. The spontaneous ventilation index D. The rapid-shallow breathing index

D. The rapid-shallow breathing index

It is important to monitor lung volumes in ICU patients because changes in lung volumes reflect all of the following changes except: A. Changes in gas exchange in the lung B. Changes in the patient's clinical status C. A response to therapy and any problems that may arise D. They influence the selection of antibiotic therapy in the ICU

D. They influence the selection of antibiotic therapy in the ICU