Mechanical Ventilation - FINAL

When assessing an intubated and mechanically ventilated newborn in the NICU the RT hears course wet crackles on expiration and documents an increased peak inspiratory pressure while performing a scheduled ventilator check. The RT determines that suctioning is needed. What is the appropriate range of suction that the RT should use for this patient? -20 to -60 mmHg -60 to -100 mmHg -80 to -100 mmHg -100 to -120 mmHg

-60 to -100 mmHg

The normal airway resistance range is which of the following? 0.6-2.4 cm H2O/L/sec 16-24 cm H2O/L/sec 26-34 cm H2O/L/sec 70-100 cm H2O/L/sec

0.6-2.4 cm H2O/L/sec

If the heart rate is 80 beats per minute, how long is one beat? 0.75 second 0.9 second 1 second 1.3 second

0.75 second

A patient receiving mechanical ventilation should not be transported under which of the following conditions? 1. Patient is hemodynamically unstable 2. It is not possible to monitor cardiac function 3. Patient is nasally intubated 4. Patient has multiple IV lines

1 & 2

The ETT cuff pressure is usually checked 1. once a shift. 2. immediately following intubation. 3. prior to extubation. 4. every 4 hours.

1 & 2

When should the FiO2 be measured using an oxygen analyzer? 1. At least every 24 hours 2. Continuously with infants 3. During suctioning procedures 4. When static P-V loops are determined

1 & 2

Following the administration of a bronchodilator through the ventilator circuit of an intubated patient, which of the following suggest an improvement in lung mechanics? 1. Increase in tidal volumes while in PC-CMV mode 2. Increased PIP 3. Increase in peak flow rates 4. Increase in auto-PEEP levels

1 & 3

Which of the following abnormal conditions is/are known to decrease cardiac output? 1. Hypothermia 2. Hypervolemia 3. Congestive heart failure 4. Hyperthermia

1 & 3

Which of the following is recommended when administering aerosols to mechanically ventilated patients with a small-volume nebulizer? 1. If using VC-CMV closely monitor the inhaled and exhaled tidal volumes. 2. Keep the HME in-line during the aerosol treatment. 3. Use the ventilator nebulizer system when appropriate. 4. Bypass the humidifier during the aerosol treatment.

1 & 3

A 45-year-old woman arrives in the emergency department after ingesting an unknown quantity of pain medication and alcohol. Her friend found her unconscious in her apartment. She is currently unresponsive to verbal stimuli. Vital signs reveal: pulse 56 beats/min; respiratory rate 10 breaths/min and shallow; and BP 90/50 mm Hg. Her ABG on room air reveals: pH 7.21; PaCO2 64 mm Hg; PaO2 52 mm Hg, HCO3- 24 mEq/L. The appropriate treatment for this patient includes which of the following? 1. Naloxone hydrochloride (Narcan) 2. Nasal cannula 4 L/min 3. Nonrebreather mask 4. Intubation and ventilatory support

1 & 4

Which of the following statements is true concerning the insertion of a radial arterial line? 1. The catheter tip must face upstream. 2. The catheter tip must face downstream. 3. The transducer must be higher than the catheter tip. 4. The transducer must be level with the catheter tip.

1 & 4

For a given minute ventilation, partial pressure of end-tidal carbon dioxide (PetCO2) is a function of which of the following? 1. Metabolic rate 2. Cardiac output 3. Alveolar dead space 4. Physiologic shunt

1,2 & 3

Which of the following conditions will adversely affect pulse oximeter readings? 1. Hypovolemia 2. Methemoglobinemia 3. Anemia 4. Hyerbilirubinemia

1,2 & 3

Evidence and signs of a possible VAP in mechanically ventilated patients includes which of the following? 1. Yellow sputum 2. Fever 3. Elevated WBC 4. Consolidation on CXR

1,2,3 & 4

The use and reference of ventilator graphics allow for which of the following? 1. Monitoring of ventilator function 2. Provides insight in to a patient's mechanics of breathing 3. Evaluates patient response to mechanical ventilation 4. Adjusting ventilator settings according to changes in lung conditions

1,2,3 & 4

Which of the following data should be recorded when making transcutaneous measurements? 1. Date and time of the measurement 2. Clinical appearance of the patient 3. Site of electrode placement on the patient 4. Type of oxygen delivery device and the FiO2

1,2,3 & 4

Which of the following is considered a cause of physical discomfort to the patient? 1. Restraints 2. Inadequate ventilation 3. Inability to talk 4. Inability to maintain oral hygiene

1,2,3 & 4

Which of the following is/are circumstances when it is appropriate to use PSV? 1. As a weaning method 2. To overcome the WOB through the ETT and the patient vent circuit 3. For patients using the IMV mode 4. For long-term patient support

1,2,3 & 4

Which of the following is/are problems that can occur when administering a SVN through the ventilator circuit for an intubated patient? 1. Expiratory measurements on the ventilator will display higher flows and volumes 2. The high volumes may cause activation of "high volume" alarms on the ventilator 3. The added flow creates increased volume and increased pressure 4. Inline SVN can become contaminated with bacteria and increase the risk of nosocomial infections

1,2,3 & 4

Which of the following is/are required for invasive ventilation? 1. Artificial airway 2. Positive pressure ventilation 3. Mechanical ventilator 4. Availability of suction

1,2,3 & 4

Which of the following should be monitored before, during and after endotracheal suctioning? 1. Cough effort 2. SpO2 3. Sputum 4. Heart rate

1,2,3 & 4

What is the range for setting flow triggering? 1-10 L/min 10-15 L/min 12-16 L/min 20-30 L/min

1-10 L/min

Calculate the expiratory time (TE) when the ventilator frequency is set to 25 breaths/min and the inspiratory time (TI) is 0.75 second. 0.75 second 1.16 second 1.65 second 2.4 seconds

1.65 second

Once an ETT is properly placed and secured, the patient's anatomic dead space is reduced by 1/8. 1/4. 1/2. 3/4.

1/2.

A mechanically ventilated patient is going to be placed on pressure support ventilation following an acceptable spontaneous weaning trial. The patient is a 5'9" male who weighs 185 lb. During volume-controlled continuous mandatory ventilation (VC-CMV) his average peak inspiratory pressure (PIP) was about 26 cm H2O and the plateau pressure (PPlateau) was 16 cm H2O. What initial pressure support level should be set? 5 cm H2O 10 cm H2O 15 cm H2O 20 cm H2O

10 cm H2O

How much patient effort is needed to trigger a ventilator breath when there is 8 cm H2O of unintended positive end-expiratory pressure (auto-PEEP) and a pressure trigger setting of 2 cm H2O? 2 cm H2O 6 cm H2O 8 cm H2O 10 cm H2O

10 cm H2O

Following successful cardiac resuscitation, a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (FIO2) settings? 50% 60% 80% 100%

100%

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? 8/min 11/min 14/min 18/min

11/min

Calculate the systemic vascular resistance (SVR) given the following measurements obtained during a hemodynamic study: pulmonary artery pressure (PAP) = 40/22 mm Hg, pulmonary artery occlusion pressure (PAOP) = 12 mm Hg, blood pressure (BP) = 156/80 mm Hg, central venous pressure (CVP) = 19 mm Hg, cardiac output (C.O.) = 4.8 L/min, and heart rate (HR) = 68 beats/min. 170 dyne × sec × cm-5; 2.125 Wood units 283 dyne × sec × cm-5; 3.53 Wood units 362 dyne × sec × cm-5; 4.53 Wood units 1439 dyne × sec × cm-5; 18.0 Wood units

1439 dyne × sec × cm-5; 18.0 Wood units

How long after beginning mechanical ventilation on a patient should an initial arterial blood gas sample be drawn? 5-10 minutes 10-15 minutes 15-20 minutes 20-25 minutes

15-20 minutes

Which of the following is the range for the time a pulmonary artery catheter should be inflated? 5-10 seconds 15-30 seconds 30-60 seconds 60-120 seconds

15-30 seconds

Calculate the inspiratory to expiratory (I:E) ratio when the inspiratory time is 0.5 second and the respiratory rate is 30 breaths/min. 1:3 1:4 4:1 3:1

1:3

After deep suctioning a patient and removing a moderate amount of thick yellow secretions the RT should identify 1. An increase in PIP 2. A decreased in Raw 3. An improvement in SpO2 4. An improvement in breath sounds

2,3 & 4

What findings on the ventilator would indicate that auto-PEEP is occurring? 1. Patient's blood pressure is dropping 2. Patient is showing signs of increased WOB 3. Ventilator graphics show a failure of the expiratory flow to return to 0 or the set PEEP pressure before the next breath is delivered 4. Patient is using accessory muscles of inspiration

2,3 & 4

A patient with a mitral valve stenosis is most likely to have which of the following pulmonary artery occlusion (wedge) pressure (PAOP) values? 4 mm Hg 6 mm Hg 12 mm Hg 20 mm Hg

20 mm Hg

A 36-year-old man with ARDS is ventilated with a Vt of 400ml. The patient's IBW is 176 lb (80kg). The HME has a volume of 50 ml. What is an approximate alveolar volume for one breath of this patient? 350 ml 260 ml 320 ml 190 ml

260 ml

Calculate the pulmonary vascular resistance (PVR) given the following measurements obtained during a hemodynamic study: pulmonary artery pressure (PAP) = 40/22 mm Hg, pulmonary artery occlusion pressure (PAOP) = 12 mm Hg, blood pressure (BP) = 156/80 mm Hg, central venous pressure (CVP) = 19 mm Hg, cardiac output (C.O.) = 4.8 L/min, and heart rate (HR) = 68 beats/min. 150 dyne × sec × cm-5; 1.875 Wood units 267 dyne × sec × cm-5; 3.34 Wood units 317 dyne × sec × cm-5; 3.96 Wood units 1496 dyne × sec × cm-5; 18.7 Wood units

267 dyne × sec × cm-5; 3.34 Wood units

A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity? 10 mg H2O/L at 35-37° C 20 mg H2O/L at 31-35° C 30 mg H2O/L at 31-35° C 47 mg H2O/L at 35-37° C

30 mg H2O/L at 31-35° C

Following initiation of volume-controlled continuous mandatory ventilation (VC-CMV) ventilation, the patient's average peak inspiratory pressure (PIP) is 23 cm H2O. The high pressure limit alarm should be set at which of the following? 28 cm H2O 33 cm H2O 38 cm H2O 43 cm H2O

33 cm H2O

A 32-year-old female arrives to the ER in respiratory distress and is able to appropriately answer questions. She states that she has a history of asthma and that her symptoms have been getting progressively worse the last 2 days even with the use of her nebulizer machine and taking her DuoNeb treatments every 4 hours. She states that she has never been a smoker, is 5'5" tall and weighs 160 pounds. Her ABGs on a 6 LPM cannula upon arrival were: pH 7.27; PaCO2 68mmHg; PaO2 62mmHg; HCO3- 24mEq/L and SaO2 90%. The ER doctor orders NIV with pressures of 10/5cmH2O and 100% FiO2. He also asks that the RT bring a ventilator into the room in case she fails the NIV trial. If she should fail the NIV trial, what would you determine to be the best tidal volume for this patient? 300 ml 375 ml 475 ml 500 ml

375 ml

Calculate the static compliance given the following clinical data: tidal volume 600 mL, peak inspiratory pressure (PIP) 40 cm H2O, plateau pressure (Pplateau) 30 cm H2O, positive end-expiratory pressure (PEEP) 15 cm H2O, and tubing compliance (CT) 2 mL/cm H2O. 14.5 mL/cm H2O 38 mL/cm H2O 55 mL/cm H2O 58 mL/cm H2O

38 mL/cm H2O

In the clinical setting, the P(a-et)CO2 is normally: -2 to -5 mmHg 1 to 3 mmHg 4 to 6 mmHg 10-15 mmHg

4 to 6 mmHg

Calculate the cardiac output (CO) using the following information: heart rate = 88 beats/min, BP 128/82 mmHg; and stroke volume = 60 ml. 3.6 L/min 4.1 L/min 5.3 L/min 6.4 L/min

5.3 L/min

The ventilator volume is set at 575 mL. The low exhaled tidal volume (VT) alarm should be set at which of the following? 150 mL 350 mL 400 mL 500 mL

500 mL

The average tidal volume range in an individual with no pulmonary problems is which of the following? 4-6 mL/kg IBW 6-8 mL/kg IBW 8-10 mL/kg IBW 12-15 mL/kg IBW

6-8 mL/kg IBW

A 47-year-old, 5'6", 112 lb female patient, is still under the effects of anesthesia following a hysterectomy. Her body temperature is 37° C. She has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following? 5.1 L/min 6.1 L/min 11.2 L/min 13.5 L/min

6.1 L/min

The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which of the following ranges? 40-55 mm Hg 50-60 mm Hg 60-100 mm Hg 100-120 mm Hg

60-100 mm Hg

Calculate the airway resistance given the following clinical data: flow rate 60 L/min, PIP 28 cm H2O, Pplateau 21 cm H2O, and PEEP 8 cm H2O. 7 cm H2O/L/sec 13 cm H2O/L/sec 20 cm H2O/L/sec 28 cm H2O/L/sec

7 cm H2O/L/sec

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? 4.3 L/min 4.8 L/min 6.6 L/min 7.1 L/min

7.1 L/min

A patient-ventilator system check reveals the following information: peak inspiratory pressure (PIP) 27 cm H2O, positive end-expiratory pressure (PEEP) 5 cm H2O, plateau pressure (Pplateau) 14 cm H2O, inspiratory time (TI) 0.75 second, and set frequency 20/minute. Calculate the mean airway pressure. 6.75 cm H2O 7.75 cm H2O 11.75 cm H2O 12.37 cm H2O

7.75 cm H2O

The most appropriate tidal volume setting for a 6'3" male ventilator patient with normal lungs is which of the following? 300 mL 400 mL 700 mL 900 mL

700 mL

Which of the following is the minimum ventilator rate that is considered full ventilatory support? 4 breaths/min 6 breaths/min 8 breaths/min 10 breaths/min

8 breaths/min

A patient receiving 60% oxygen from an air entrainment mask has a partial pressure of oxygen (PaO2) of 45 mm Hg. The patient is being intubated and the ventilator set up. What is the appropriate fractional inspired oxygen (FIO2) to achieve a PaO2 of 60 mm Hg? 65% 75% 80% 95%

80%

A pulse oximeter is generally considered accurate for oxygen saturations greater than which of the following? 65% 70% 75% 80%

80%

Calculate the average tidal volume for a patient who has a minute ventilation of 10 L/min with a respiratory rate (RR) of 12 breaths/min. 120 mL 833 mL 1000 mL 1200 mL

833 mL

What percentage of fractional inspired oxygen (FIO2) setting should be set on the ventilator when the patient currently has a partial pressure of oxygen (PaO2) of 53 mm Hg while receiving 50% oxygen and the desired PaO2 is 90 mm Hg? 65% 75% 85% 95%

85%

A 26-year-old, 6'6", 250 lb male patient, is still under the effects of anesthesia following knee surgery. His body temperature is 37° C. He has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following? 8.9 L/min 9.7 L/min 11.4 L/min 13.6 L/min

9.7 L/min

In which of the following patient situations would you try NIV? A patient with a BP of 65/35, HR of 150 beats/min, and RR of 34 breaths/min. A near drowning patient who has copious amounts of white, frothy secretions. A patient with COPD and RLL pneumonia with respiratory acidosis and increased WOB. A 5-year-old child who aspirated a piece of chicken and is having difficulty breathing.

A patient with COPD and RLL pneumonia with respiratory acidosis and increased WOB.

A 46-year-old male presents to the emergency department with a chief complaint of shortness of breath. Physical assessment reveals: pulse 102 beats/min, blood pressure 138/80 mm Hg, respiratory rate 25 breaths/min with accessory muscle use, and breath sounds are decreased with bilateral inspiratory and expiratory wheezing with a prolonged expiratory phase. The peak expiratory flow rate is 100 L/min. The immediate action by the respiratory therapist should include which of the following? Intubate and mechanically ventilate. Administer oxygen via nonrebreather mask. Administer continuous beta-2 agonist bronchodilator therapy. Initiate noninvasive positive pressure ventilation.

Administer continuous beta-2 agonist bronchodilator therapy.

A physician and a respiratory therapist are performing a bedside bronchoscopy on an invasively ventilated patient. Fentanyl and midazolam were used for conscious sedation. After the bronchoscopy, the patient is not arousable. Which of the following should be done at this time? Draw a sample for arterial blood gas determinations. Increase the patient's respiratory rate. Administer naloxone (Narcan). Administer atropine.

Administer naloxone (Narcan).

The respiratory therapist has just stopped postural drainage for a 24-year-old patient with cystic fibrosis because of shortness of breath and slight cyanosis in the "head-down" position. The respiratory therapist should recommend which of the following adjustments to therapy? Continue postural drainage and monitor patient with capnography. Use a transcutaneous partial pressure of oxygen (PtcO2) monitor to assess the extent of hypoxemia. Use only upright or flat postural drainage positions and draw an arterial blood gas (ABG). Administer oxygen via nasal cannula and monitor with pulse oximetry.

Administer oxygen via nasal cannula and monitor with pulse oximetry.

The underlying physiological process leading to pure hypercapnic respiratory failure is which of the following? Ventilation/perfusion mismatch Intrapulmonary shunting Diffusion impairment Alveolar hypoventilation

Alveolar hypoventilation

A breath that is patient triggered, pressure targeted, and time cycled is which of the following? Mandatory breath Assisted breath Spontaneous breath NIV breath

Assisted breath

Hypercapnic respiratory failure due to increased work of breathing will be caused by which of the following? Drug overdose Myasthenia gravis Asthma exacerbation Pulmonary embolism

Asthma exacerbation

Before a ventilator is used, an operational verification check is performed. A simple variation of this procedure is also performed under which of the following circumstances? Before an ABG is obtained When the physician's order specifies a change in ventilator settings Before a patient is reconnected to a ventilator after the ventilator circuit has been changed Before the patient's hemodynamics status is monitored

Before a patient is reconnected to a ventilator after the ventilator circuit has been changed

When using an SVN or pMDI with NPPV, where in the NPPV circuit should the device be placed to obtain the greatest aerosol deposition? Before the leak port Anywhere in the circuit Between the NPPV and the humidifier Between the leak port and the face mask

Between the leak port and the face mask

The mode of pressure ventilation that is patient- or time-triggered and flow-cycled is which of the following? Volume support (VS) Pressure support ventilation (PSV) Pressure-controlled continuous mandatory ventilation (PC-CMV) Bilevel positive airway pressure (bilevel PAP)

Bilevel positive airway pressure (bilevel PAP)

Slow flow rates will cause which of the following to occur? Poor gas exchange Increase peak pressures Shorten expiratory time Decrease mean airway pressure

Shorten expiratory time

A patient arrives in the emergency department via ambulance following rescue from a house fire. The instrument that would be most appropriate to assist the respiratory therapist in assessing this patient's oxygenation status is which of the following? Pulse oximeter Calorimeter Capnograph CO-oximeter

CO-oximeter

An indistinct phase 3 on a patient's capnogram is most often associated with airway obstruction and _____________________________. Rebreathing exhaled gas Anemia Cheyne-Stokes breathing COPD

COPD

Which of the following measurements can be used to estimate right ventricular preload? Cardiac output Central venous pressure Pulmonary artery pressure Pulmonary artery occlusion pressure

Central venous pressure

Which of the following is the hemodynamic measurement that is indicative of a patient with right heart failure? Pulmonary artery occlusion pressure (PAOP) = 12 mm Hg Central venous pressure (CVP) = 16 mm Hg Pulmonary artery pressure (PAP) = 35/15 mm Hg Mean arterial pressure (MAP) = 80 mm Hg

Central venous pressure (CVP) = 16 mm Hg

Patients that require the assistance of mechanical ventilation for more than a 2 week time period include which of the following? Postoperative procedure Uncomplicated drug overdose Cerebral vascular accident/stroke Mild-moderate COPD exacerbation

Cerebral vascular accident/stroke

Which of the following can be used to estimate the contractility of the ventricles? Systemic vascular resistance Pulmonary vascular resistance Right and left ventricular end-diastolic pressure Ejection fraction

Ejection fraction

A 215-lb, 6-foot 4-inch tall man has a size 7.0 oral ETT in place. Cuff pressure is 39 cmH20. The set Vt is 600 ml, and the delivered Vt is 500 ml. The patient is likely to need mechanical ventilation for at least a week. What would you recommend? Increase the set Vt Reduce the ETT cuff pressure to 30 cmH2O Change the ETT to a size 8.0 Make no changes at this time

Change the ETT to a size 8.0

A RT encounters a patient whose pulse oximetry reading is 73% and is showing a good pulsatile heart beat. The most appropriate action is which of the following? Contact the patient's physician for further instruction. Change the sensor and move it to a different location Accept the value and record it in the patient's medical chart. Confirm the value with arterial blood CO-oximeter analysis.

Confirm the value with arterial blood CO-oximeter analysis.

A patient has recently been diagnosed with obstructive sleep apnea. The most appropriate treatment includes which of the following? Pressure support ventilation (PSV) Continuous positive airway pressure (CPAP) Noninvasive positive pressure ventilation (NIV) Pressure-controlled continuous mandatory ventilation (PC-CMV)

Continuous positive airway pressure (CPAP)

The limit variable set on a mechanical ventilator will do which of the following? End expiration Begin inspiration Control the maximum value allowed Control the minimum value allowed

Control the maximum value allowed

Setting flow rates high will cause which of the following to occur? Improve gas exchange Lengthen inspiratory time Increase air trapping Increase peak pressures

Increase peak pressures

Of the following breath descriptions, which one is considered spontaneous? Flow triggered, pressure limited, flow cycled Time triggered, volume limited, volume cycled Pressure triggered, pressure limited, time cycled Patient triggered, patient cycled, baseline pressure +5 cm H2O

Patient triggered, patient cycled, baseline pressure +5 cm H2O

Which one of the following changes would you need to make in order to correct an ABG result with respiratory alkalosis? Increase the Vt Increase the FiO2 Decrease RR Decrease PEEP

Decrease RR

An 18-year-old, 5'6", 125 lb female patient was admitted to the hospital 2 days ago for spinal meningitis. She developed sepsis and suffered hypercapnic respiratory failure. The patient was intubated and placed on volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequency (f) 12 breaths/min, tidal volume (VT) 600 mL, positive end-expiratory pressure (PEEP) 5 cm H2O, fractional inspired oxygen (FIO2) 0.40. Twenty-four hours later, the patient's oxygen requirements have dramatically increased and her lung compliance has dramatically dropped, while her chest X-ray showed development of bilateral fluffy infiltrates. The most appropriate actions to take include which of the following? Keep Vt the same, increase f to 25 breaths/min, increase PEEP to 12 cm H2O. Decrease Vt to 250 mL, increase f to 15 breaths/min, increase PEEP to 15 cm H2O. Increase Vt to 550 mL, decrease f to 8 breaths/min, increase PEEP to 10 cm H2O. Decrease Vt to 400 mL, decrease f to 8 breaths/min, decrease PEEP to 3 cm H2O.

Decrease Vt to 250 mL, increase f to 15 breaths/min, increase PEEP to 15 cm H2O.

A reduction in lung compliance during pressure ventilation will cause which of the following? Volume curve will end under the zero line. Inspiration will end prior to flow tapering to zero. Pressure curve will become concave on inspiration. Delivered tidal volume will decrease.

Delivered tidal volume will decrease.

With which flow waveform pattern will the mean airway pressure be the highest? Sine Square Ascending ramp Descending ramp

Descending ramp

The concept of "patient-centered mechanical ventilation" includes which of the following? Determining patient comfort level Maintaining a PaO2 greater than 60 mmHg Maintaining a plateau pressure less than 40 cmH2O Determining nutritional needs

Determining patient comfort level

The most important factor to affect the degree of resistance in the airways is which of the following? Flow rate of the gas Viscosity of the gas Length of the airways Diameter of the airways

Diameter of the airways

A 49-year-old female patient intubated with a size 7.0 mm inner diameter (ID) endotracheal tube is being mechanically ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode. During patient rounds, both the low-pressure and low-volume alarms are sounding persistently on the ventilator. Upon observation of the patient the respiratory therapist confirms that the ETT is properly secured, but hears audible sounds during inspiration. The cause of this condition is which of the following? Incorrect ETT size Circuit disconnection Circuit leak ETT cuff leak

ETT cuff leak

The partial pressure of end-tidal carbon dioxide is read at what point on the capnogram? During phase 1 End of phase 2 End of phase 3 End of phase 4

End of phase 3

The respiratory therapist in the intensive care unit (ICU) responds to a patient's room because the ventilator is alarming. The most appropriate immediate action is which of the following? Replace the ventilator immediately. Silence the alarms and call for help. Ensure the patient is being ventilated. Troubleshoot the alarm settings.

Ensure the patient is being ventilated.

How often should the fractional inspired oxygen (FIO2) of an adult be measured and documented? Twice daily Continuously Every patient-ventilator system check Every other patient-ventilator system check

Every patient-ventilator system check

If the lungs are very compliant, then they very stiff and require higher pressures to inflate.

False

The patient trigger that requires the least amount of work of breathing for the patient is which of the following? Time Flow Pressure Volume

Flow

Respiratory failure due to inadequate ventilation is known as which of the following? Hypoxemic Hypercapnic Compensated Chronic

Hypercapnic

Which one of the following conditions is NOT responsible for increasing metabolism and CO2 production? Fever Sepsis Muscle tremors Hypothyroidism

Hypothyroidism

During mechanical ventilation, a patient with a closed head injury develops the Cushing response. This may be immediately managed by using which of the following? Pressure-controlled continuous mandatory ventilation (PC-CMV) with positive end- expiratory pressure (PEEP) Sedation and paralysis Permissive hypercapnia Iatrogenic hyperventilation

Iatrogenic hyperventilation

A male patient (76-kg IBW) with no history of pulmonary disease is brought to the emergency department for treatment of a drug overdose. He is intubated and placed on mechanical ventilation with VC-CMV, f = 12/min, VT = 450 mL. The resulting arterial blood gas values are: pH 7.32, PaCO2 53 mm Hg, and HCO3- 25 mEq/L. The most appropriate action to correct the acid-base disturbance is which of the following? Increase Vt to 595 mL. Increase VT to 760 mL. Increase frequency to 16/min. Decrease frequency to 10/min.

Increase Vt to 595 mL.

While listening with a stethoscope over the trachea during VC-CMV, the RT hears a slight leak at the end of inspiration on an orally intubated patient. What change should the therapist make? Increase cuff pressure until no sound is heard Check cuff pressure and delivered volume Check cuff volume Recommend changing the artificial airway

Increase cuff pressure until no sound is heard

During the course of several patient-ventilator system checks a respiratory therapist notices that the patient's peak inspiratory pressure (PIP) is rising, while the plateau pressure (Pplateau) has remained the same. This most likely indicates which of the following? Decrease in dynamic compliance Increase in airway resistance Decrease in static compliance Increase in elastic recoil of alveolar walls

Increase in airway resistance

During volume control ventilation a patient's airway resistance increases. This change will cause which of the following to occur? Increase in delivered volume Increase in peak airway pressure Decrease in plateau pressure Decrease in peak airway pressure

Increase in peak airway pressure

A patient has a body temperature of 40° C. How should the initial minute ventilation setting be adjusted? Increase it by 15%. Decrease it by 18%. Decrease it by 25%. Increase it by 30%.

Increase it by 30%.

A patient is intubated due to an acute exacerbation of chronic obstructive pulmonary disease (COPD). The patient is now breathing with pressure support ventilation 5 cm H2O and continuous positive airway pressure (CPAP) 5 cm H2O. The patient is unable to flow trigger every inspiration. Unintended positive end-expiratory pressure (auto-PEEP) is measured at 10 cm H2O. The most appropriate action to take is which of the following? Decrease the CPAP to 3 cm H2O. Increase the CPAP to 8 cm H2O. Increase pressure support to 10 cm H2O. Change the flow trigger setting to 1 L/min.

Increase the CPAP to 8 cm H2O.

An 85-kg (IBW) male patient is being ventilated with VC-CMV with the following settings: RR = 12 breaths/min Vt = 450ml FiO2 = 50% PEEP = 5 The patient's ABG results are: pH 7.32 PaCO2 55 mmHg PaO2 84 mmHg HCO3- 25 mEq/L Which of the following changes should be made to the ventilator settings to reduce the patient's PaCO2 to 40 mmHg? Increase the Vt to 600ml Decrease the Vt to 400ml Increase the PEEP to 8cm H20 Decrease the RR to 10 breaths/min

Increase the Vt to 600ml

A patient with pneumonia and underlying COPD is being mechanically ventilated in the VC-CMV mode with VT 650 mL. The resulting PaCO2 is 62 mm Hg. What change should be made to the VT to obtain a desired PaCO2 of 50 mm Hg for this patient? Decrease the Vt to 400 mL Increase the Vt to 800 mL Increase the Vt to 1000 mL Increase the Vt to 1200ml

Increase the Vt to 800 mL

A patient requiring mechanical ventilation has an 8mm ETT in place. The patient requires frequent suctioning and has a small amount of thin white-colored sputum with each suction attempt. A 10-French catheter is being used with a suction pressure of -120. The RRT should recommend which of the following? Increase the suction pressure to -150 A set suction frequency of every 2 hours Instill saline with every suctioning procedure Increase the size of the suction catheter to a 12-French catheter

Increase the size of the suction catheter to a 12-French catheter

Which of the following situations will cause an increase in the single-breath carbon dioxide (SBCO2) curve? Decreased metabolic rate and decreased ventilation Decreased metabolic rate and increased ventilation Increased metabolic rate and increased ventilation Increased metabolic rate and decreased ventilation

Increased metabolic rate and decreased ventilation

A patient who has a decrease in lung compliance due to acute respiratory distress syndrome during volume-limited ventilation will cause which of the following? Decreased flow delivery Decreased peak pressure Increased volume delivery Increased peak pressure

Increased peak pressure

Methods to minimize air trapping in mechanically ventilated patients include which of the following? Using a longer inspiratory time (TI) Switching to pressure support ventilation (PSV) Increasing inspiratory flow Administering a mucolytic agent

Increasing inspiratory flow

Which maneuver will maintain air in the lungs at the end of inspiration, before the exhalation valve opens? Pressure limit Inspiratory hold Expiratory hold Expiratory resistance

Inspiratory hold

A patient, who is nasally intubated, due to facial surgery, has been successful on her spontaneous breathing trial. She currently has moderate hypoxemia, despite a fractional inspired oxygen (FIO2) of 40% and positive end-expiratory pressure (PEEP) of 5 cm H2O while on volume-controlled continuous mandatory ventilation (VC-CMV). The most appropriate ventilator mode for this patient is which of the following? Airway pressure release ventilation (APRV) Continuous positive airway pressure (CPAP) Pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP) Intermittent mandatory ventilation (IMV) with pressure support ventilation (PSV) and positive end-expiratory pressure (PEEP)

Intermittent mandatory ventilation (IMV) with pressure support ventilation (PSV) and positive end-expiratory pressure (PEEP)

During the insertion of a pulmonary artery catheter, the balloon needs to be inflated with air when it enters which of the following? Right atrium Right ventricle Pulmonary artery Intrathoracic vessel

Intrathoracic vessel

What effect does positive-pressure ventilation have on fluid balance? It increases urinary output. It increases renal perfusion. It decreases the plasma antidiuretic hormone (ADH). It decreases cardiac output.

It decreases cardiac output.

Following intubation and placement on volume-controlled continuous mandatory ventilation (VC-CMV), a patient's average peak inspiratory pressure (PIP) is 26 cm H2O following suctioning. The appropriate settings for the low- and high-pressure alarms are which of the following? Low pressure = 6 cm H2O, high pressure = 46 cm H2O Low pressure = 15 cm H2O, high pressure = 41 cm H2O Low pressure = 20 cm H2O, high pressure = 36 cm H2O Low pressure = 24 cm H2O, high pressure = 31 cm H2O

Low pressure = 20 cm H2O, high pressure = 36 cm H2O

What type of breath occurs when the ventilator controls the timing, tidal volume, or inspiratory pressure? Mandatory Controlled Assisted Spontaneous

Mandatory

A high pressure ventilator alarm is sounding and you are unsure if ventilation is occurring. What action should you take first? Hit the alarm silent button. Increase the oxygen concentration to 100%. Increase the peak pressure alarm. Manually ventilate the patient.

Manually ventilate the patient.

A 28-year-old male has arrived in the emergency department following a motor vehicle accident. He has a Glasgow Coma Score of 14. Chest X-ray reveals five ribs broken anteriorly in two areas each. Physical assessment reveals paradoxical movement of the chest. Breath sounds are diminished and the trachea is midline. Arterial blood gas on nonrebreather mask is: pH 7.53, partial pressure of carbon dioxide (PaCO2) is 25 mm Hg, partial pressure of oxygen (PaO2) is 59 mm Hg, arterial oxygen saturation (SaO2) 93%, bicarbonate (HCO3-) 23 mEq/L. The respiratory therapist should recommend which of the following for this patient? Intubation with CPAP and pressure support Mask continuous positive airway pressure (CPAP) with supplemental oxygen Noninvasive positive pressure ventilation (NIV) with supplemental oxygen Intubation with volume-controlled continuous mandatory ventilation (VC-CMV) with positive end-expiratory pressure (PEEP)

Mask continuous positive airway pressure (CPAP) with supplemental oxygen

Which of the following actions in indicated when there is disparity between SpO2, SaO2, and the clinical presentation of a patient? Moving the probe to an alternative site to check for SpO2 Replacing the pulse oximeter probe Measuring arterial oxygen saturation by CO-oximetry Disregarding the SaO2

Measuring arterial oxygen saturation by CO-oximetry

A 28-year-old man with botulism poisoning is beginning to develop progressive paralysis. The respiratory therapist has been monitoring the patient's MIP and VC every 2 hours. The most recent results show that the patient continues to deteriorate: MIP = -20 cm H2O, VC = 12 mL/kg. Which of the following could be appropriately recommended? Gastric lavage Oxygen therapy Medication to reverse the paralysis Mechanical ventilatory support

Mechanical ventilatory support

Diabetes, alcoholism, starvation, and diarrhea are all conditions that are known to cause which of the following? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Metabolic acidosis

A 72-year-old male patient (height 6'2", weight 95 kg) with a history of congestive heart failure (CHF) presents to the emergency department complaining of shortness of breath and inability to lie down to sleep. Physical assessment reveals a very anxious patient with a pulse of 140, respirations 32, and labored with diaphoresis. Breath sounds are decreased with bibasilar coarse crackles. The patient has a productive cough of pink frothy secretions. The patient is placed on a nonrebreather mask and the resulting arterial blood gases (ABG) show: pH 7.25, partial pressure of carbon dioxide (PaCO2) 55 mm Hg, partial pressure of oxygen (PaO2) 54 mm Hg, oxygen saturation (SaO2) 86%, bicarbonate (HCO3-) 24 mEq/L. The most appropriate immediate action to take includes which of the following? Face mask continuous positive airway pressure (CPAP) 10 cm H2O on 100% FiO2. Intubate, volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequency (f) 20, tidal volume (VT) 810 mL, positive end-expiratory pressure (PEEP) 8 cm H2O, FiO2 100% Intubate, volume-controlled intermittent mandatory ventilation (VC-IMV), f 6, VT 425 mL, PEEP 10 cm H2O, FiO2 80% Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP), inspiratory positive airway pressure (IPAP) 15 cm H2O, expiratory positive airway pressure (EPAP) 5 cm H2O, FiO 100%

Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP), inspiratory positive airway pressure (IPAP) 15 cm H2O, expiratory positive airway pressure (EPAP) 5 cm H2O, FiO 100%

Which of the following ventilatory pressures is used to monitor the success of a weaning trial? PIP Plateau PEEP Occlusion

Occlusion

A patient has a PTA of 5 cmH20. Three hours later a high-pressure alarm activates. The patients PTA is now 15 cmH20. What is the most likely cause of this change? Pneumothorax Deflated ETT cuff Water in the circuit Secretions in the airway

Secretions in the airway

An assisted breath in the pressure controlled continuous mandatory ventilation (PC-CMV) mode can be described by which of the following? Patient triggered, pressure limited, time cycled Time triggered, pressure limited, time cycled Patient triggered, volume limited, volume cycled Time triggered, pressure limited, pressure cycled

Patient triggered, pressure limited, time cycled

The respiratory therapist preparing to obtain an ABG from the right radial artery and performs an Allen test. The result of the Allen test is 20 seconds. The respiratory therapist should do which of the following? Insert the cannula into the right radial artery. Recommend a surgical cut down at the right radial site. Repeat the Allen test on the right hand. Perform an Allen test on the left hand.

Perform an Allen test on the left hand.

During the application of positive end-expiratory pressure (PEEP), the monitoring of which pressure will alert the respiratory therapist specifically to alveolar overdistention? Mean airway pressure Transairway pressure (PTA) Plateau pressure (Pplateau) Peak inspiratory pressure (PIP)

Plateau pressure (Pplateau)

When changing the control variable from volume control (VC) to pressure control (PC), the initial inspiratory pressure should be set based on which of the following methods? Body surface area multiplied by 4 Plateau pressure measurement taken during VC ventilation Maximum peak inspiratory pressure during VC ventilation Maximum peak inspiratory pressure minus plateau pressure during VC ventilation

Plateau pressure measurement taken during VC ventilation

A 31-year-old woman is admitted to the emergency department following a motor vehicle accident. The paramedics brought her into the ER in respiratory distress. She was intubated in the field and started on mechanical ventilation as soon as she arrived. Breath sounds were clear on the left and absent on the right. Percussion revealed resonance on the left and hyperresonance on the right. The patient's trachea was shifted to the left. The most likely cause of this patient's clinical presentation is which of the following? Acute respiratory distress syndrome (ARDS) Pulmonary edema Pleural effusion Pneumothorax

Pneumothorax

Which of the following describes the filling pressure of the ventricle at the end of ventricular diastole? Preload Afterload Ejection fraction Dicrotic notch

Preload

The most reliable method for ruling out esophageal intubation is which of the following? Presence of CO2 in the patient's exhaled gas. Presence of condensation in the ETT Presence of bilateral breath sounds. Increased resistance to squeezing the manual resuscitation bag.

Presence of CO2 in the patient's exhaled gas.

The respiratory therapist enters the room of a patient being mechanically ventilated with volume ventilation. The high pressure alarm is sounding and the measured exhaled tidal volume is significantly lower than what is set. The variable that is ending inspiration is which of the following? Time Flow Pressure Volume

Pressure

An increase in airway resistance during volume-controlled ventilation will have which of the following effects? Volume increase Pressure increase Flow decrease Rate decrease

Pressure increase

Full ventilatory support is provided by which of the following modes? Pressure support ventilation (PSV) with continuous positive airway pressure (CPAP) Volume support ventilation (VSV) with continuous positive airway pressure (CPAP) Volume-controlled intermittent mandatory ventilation (VC-IMV) rate 6 with pressure support (PS) Pressure-controlled intermittent mandatory ventilation (PC-IMV) rate 12 with pressure support (PS)

Pressure-controlled intermittent mandatory ventilation (PC-IMV) rate 12 with pressure support (PS)

The mode of ventilation that provides pressure-limited, time-cycled breaths that use a set tidal volume as a feedback control is which of the following? Pressure support ventilation (PSV) Pressure-regulated volume control (PRVC) Pressure-controlled continuous mandatory ventilation (PC-CMV) Bilevel positive airway pressure (Bilevel PAP)

Pressure-regulated volume control (PRVC)

The ventilator mode that delivers pressure breaths that are patient or time triggered, volume targeted, time cycled, and where the pressure is automatically adjusted to maintain delivery of the targeted volume is which of the following? Volume support ventilation (VSV) Pressure augmentation (Paug) Mandatory minute ventilation (MVV) Pressure-regulated volume control (PRVC)

Pressure-regulated volume control (PRVC)

An increase in intrinsic work of breathing due to a decrease in static compliance is caused by which of the following pulmonary diseases? Emphysema Bronchospasm Pulmonary fibrosis Airway inflammation

Pulmonary fibrosis

Advancing a pulmonary artery catheter into a smaller artery may cause which of the following complications? Pneumothorax Air embolism Pulmonary infarction Ventricular fibrillation

Pulmonary infarction

The type of flow curve produced by volume ventilation with constant flow is which of the following? Sinusoidal Rectangular Descending ramp Exponential decay

Rectangular

The flow waveform pattern that provides the shortest inspiratory time (TI) of all the available flow patterns with an equivalent peak flow rate setting is which of the following? Sine Rectangular/square Ascending ramp Descending ramp

Rectangular/square

The respiratory therapist is monitoring the cuff pressure of a tracheostomy tube inserted in a patient who is receiving mechanical ventilation. The cuff pressure is measured at 41 cm H2O. The respiratory therapist should immediately do which of the following? Inject more air through the pilot balloon. Release some of the air from the cuff. Insert a new tracheostomy tube. Do nothing; everything is acceptable.

Release some of the air from the cuff.

While attempting to draw blood from an indwelling arterial catheter, the respiratory therapist notices a dampened waveform and has difficulty withdrawing blood for sampling. What should the respiratory therapist's immediate action be? Flush the catheter. Reposition the catheter. Remove the catheter. Recalibrate the transducer.

Remove the catheter.

When alveolar ventilation is not adequate which of the following conditions is the result? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Respiratory acidosis

Anxiety, head trauma, meningitis and parenchymal lung disease are known to cause which of the following? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Respiratory alkalosis

Acute hypercapnic respiratory failure may be caused by which of the following? Respiratory muscle fatigue Decreased fractional inspired oxygen (FIO2) Pulmonary shunt Perfusion/diffusion impairment

Respiratory muscle fatigue

A physical examination of the chest is performed on a mechanically ventilated patient. Breath sounds and percussion are normal except for over the right middle lobe, where late end inspiratory crackles are heard. This area is dull to percussion. A CXR reveals infiltrates in the right middle lobe. Based on these findings alone, which of the following is most likely the problem? Pneumothorax in the right hemithorax Congestive heart failure Right middle lobe pneumonia Asthma affecting the right side only

Right middle lobe pneumonia

Calculate the stroke volume (SV) using the following information: cardiac output = 4.5 L/min, heart rate = 110 beats/min, and body surface area = 1.3 m2. SV = 41 mL SV = 45 mL SV = 46 mL SV = 49.5 mL

SV = 41 mL

During a closed suctioning procedure, the patient's heart rate changes from 95 to 58 beats/min. The respiratory therapist should take what immediate action? Continue the procedure until secretions are removed. Stop the procedure and use the ventilator to hyperoxygenate the patient with 100% oxygen. Stop the procedure and switch to the open suctioning method. Obtain an order to discontinue suctioning because the patient cannot tolerate the procedure

Stop the procedure and use the ventilator to hyperoxygenate the patient with 100% oxygen.

A patient with acute respiratory distress syndrome (ARDS) has developed a pneumothorax from elevating peak and plateau pressures. The patient is currently being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode with a set rate of 12 breaths/min. However, the patient is triggering the ventilator at a rate of 25 breaths/min. The arterial blood gas reveals ventilator-induced hyperventilation with corrected hypoxemia. The most appropriate recommendation to manage this patient on the ventilator is which of the following? Sedate the patient. Decrease the set ventilator rate. Switch the mode to pressure-controlled intermittent mandatory ventilation (PC-IMV). Switch the mode to pressure-controlled continuous mandatory ventilation (PC-CMV).

Switch the mode to pressure-controlled intermittent mandatory ventilation (PC-IMV).

An ICU patient is on PC-CMV and has widely fluctuating changes in Raw because of secretions and bronchospasm. The low tidal volume alarm is activated every few hours; the set pressure is 18 cmH2O. The physician is concerned about consistency in ventilation. What would you recommend? Increase the set pressure Sedate the patient Switch to VC-IMV Switch to PSV

Switch to VC-IMV

What is associated with an increased work of breathing in mechanically ventilated patients? Switching from controlled mechanical ventilation to assisted ventilation Decreased spontaneous breathing frequency Using a larger ETT Bronchodilation

Switching from controlled mechanical ventilation to assisted ventilation

Which of the following is an indication of left ventricular afterload? Ejection fraction Systemic vascular resistance Pulmonary vascular resistance Left ventricular end-diastolic pressure

Systemic vascular resistance

Calculate the expiratory time given the following information and determine the I:E ratio: RR = 16 breaths/min Inspiratory time = 0.8 second TE = 2.75 seconds; I:E = 1:3.4 TE = 3 seconds; I:E = 1:3.75 TE = 2.5 seconds; I:E = 1:3.1 TE = 2.95 seconds; I:E = 1:3.6

TE = 2.95 seconds; I:E = 1:3.6

Which of the following statements is true pertaining to the Hi-Lo Evac ETT? The tube has a suction port at the level of the ETT cuff The continuous suction pressure needs to be set at -30 mmHg The device can reduce the incidence of nosocomial infections All patients should have this type of ETT in place

The device can reduce the incidence of nosocomial infections

Which of the following is considered a contraindication when transporting a mechanically ventilated patient? The patient can be ventilated by a resuscitation bag The patient can be ventilated by a portable ventilator The patient's cardiopulmonary status cannot be monitored The patient's hemodynamic status is stable

The patient's cardiopulmonary status cannot be monitored

Closed-circuit suction catheters may be more appropriate than using open-circuit suctioning because of which of the following? They are less expensive. There is no risk of the catheter migrating into the ETT. They reduce the risk of infection. The catheter adds no additional weight to the ventilator circuit.

They reduce the risk of infection.

In which situation should the heat moisture exchanger (HME) be replaced with a heated humidification system? With all tracheostomy tubes After 3 days of ventilation After 24 hours of ventilation Thick secretions not cleared by suctioning

Thick secretions not cleared by suctioning

If lung compliance decreases while a patient is receiving mechanical ventilation with pressure-controlled continuous mandatory ventilation (PC-CMV), which of the following would occur? Peak pressure increases. Peak pressure decreases. Tidal volume increases. Tidal volume decreases.

Tidal volume decreases.

Patients with acute severe asthma requiring mechanical ventilation are difficult to manage because of which of the following? Uneven alveolar hyperexpansion Decreased airway resistance Increased lung compliance Diaphragmatic paralysis

Uneven alveolar hyperexpansion

A 57-year-old, 5'3", 165 lb female patient arrives in the open heart unit following coronary artery bypass surgery. The patient has a history of diabetes and no history of pulmonary disease. The most appropriate initial volume-controlled continuous mandatory ventilation (VC-CMV) settings are which of the following? VT = 220 mL, rate = 25 breaths/min, PEEP = 10 cm H2O VT = 360 mL, rate = 15 breaths/min, PEEP = 5 cm H2O VT = 550 mL, rate = 12 breaths/min, PEEP = 12 cm H2O VT = 750 mL, rate = 10 breaths/min, PEEP = 8 cm H2O

VT = 360 mL, rate = 15 breaths/min, PEEP = 5 cm H2O

A 5'2" female patient with normal lungs has been intubated and requires mechanical ventilation with volume-controlled continuous mandatory ventilation (VC-CMV). The tidal volume (VT) and ventilator rate settings that should be recommended for this patient are which of the following? VT = 305 mL, rate = 20 breaths/min VT = 468 mL, rate = 12 breaths/min VT = 364 mL, rate = 14 breaths/min VT = 563 mL, rate = 10 breaths/min

VT = 364 mL, rate = 14 breaths/min

A 5'10" male patient with normal lungs has been intubated and requires mechanical ventilation with volume-controlled continuous mandatory ventilation (VC-CMV). The tidal volume and ventilator rate settings that should be recommended for this patient are which of the following? VT = 525 mL, rate = 14 breaths/min VT = 750 mL, rate = 12 breaths/min VT = 825 mL, rate = 10 breaths/min VT = 950 mL, rate = 8 breaths/min

VT = 525 mL, rate = 14 breaths/min

What is the most determining factor for preload? Contractility Venous return Ejection fraction Vascular resistance

Venous return

The first step in the assessment and documentation of patient-ventilator interaction following placement of a patient on a mechanical ventilator is which of the following? Verifying physician's orders. Verifying a passing operational verification procedure. Checking the integrity of the ventilator circuit and the humidifier system. Assessment of the patient's vital signs, breath sounds, and level of consciousness.

Verifying physician's orders.

A 28-year-old female was admitted last night for weakness and what appears to be ascending muscle paralysis. The patient is alert and oriented. Physical findings reveal: pulse 96 beats/min, regular; blood pressure 134/83 mm Hg; temperature 37° C; respiratory rate 24 breaths/min shallow with bilateral decrease in air entry; and no adventitious breath sounds. The patient's ABG results on room air are: pH 7.46; PaCO2 39 mm Hg; PaO2 80 mm Hg; Sat 97%; and HCO3- 26 mEq/L on room air. The most appropriate suggestion that the respiratory therapist should make for this patient includes which of the following? Vital capacity every 2 hours Continuous positive airway pressure Noninvasive positive pressure ventilation Peak expiratory flow rate

Vital capacity every 2 hours

An increase in airway resistance during pressure-targeted ventilation will have which of the following effects? Pressure increase Flow increase Volume decrease Rate decrease

Volume decrease

The ventilator mode where every breath is patient triggered, pressure targeted, and flow cycled with a volume target is which of the following? Volume support ventilation (VSV) Pressure-regulated volume control (PRVC) Airway pressure release ventilation (APRV) Pressure augmentation (Paug)

Volume support ventilation (VSV)

A male patient who is 5'10" and weighs 190 lb arrives at the hospital having suffered a closed head injury in a motor vehicle accident. The patient is unconscious and a computer tomogram (CT scan) of the head reveals an intracranial bleed. The patient receives an intracranial pressure (ICP) monitor following neurosurgery. Initial ventilator settings should include which of the following? Volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequency (f) 15 breaths/min, tidal volume (VT) 750 mL, positive end-expiratory pressure (PEEP) 5 cm H2O, FiO2 1.0 Pressure-controlled continuous mandatory ventilation (PC-CMV), f 15 breaths/min, peak inspiratory pressure (PIP) 35 cm H2O, PEEP 10 cm H2O, FiO2 1.0 Volume-controlled intermittent mandatory ventilation (VC-IMV), f 6 breaths/min, VT 300 mL, pressure support (PS) 10 cm H2O, PEEP 5 cm H2O, FiO2 0.50 Pressure-controlled intermittent mandatory ventilation (PC-IMV), f 12 breaths/min, PIP 20 cm H2O, PS 10 cm H2O, PEEP 5 cm H2O, FiO2 0.40

Volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequency (f) 15 breaths/min, tidal volume (VT) 750 mL, positive end-expiratory pressure (PEEP) 5 cm H2O, FiO2 1.0

A 45-year-old, 73-inch-tall, 200 lb male patient is admitted to the emergency department with an exacerbation of myasthenia gravis. He is receiving oxygen via 2 LPM nasal cannula with SpO2 of 98%. The respiratory therapist assesses the patient and finds the patient's maximum inspiratory pressure is -15 cm H2O and his vital capacity is 1200 mL. It is decided that the patient requires ventilatory support. The most appropriate ventilator settings for this patient are which of the following? Pressure support ventilation (PSV) 5 cm H2O, continuous positive airway pressure (CPAP) 10 cm H2O, FiO2 0.50 Pressure-controlled continuous mandatory ventilation (PC-CMV), f = 16 breaths/min, peak inspiratory pressure (PIP) = 35 cm H2O, positive end-expiratory pressure (PEEP) 3 cm H2O, FiO2 0.45 Noninvasive positive pressure ventilation—bilevel positive airway pressure (NPPV—BiPAP), f = 14 breaths/min, inspiratory positive airway pressure (IPAP) = 28 cm H2O, expiratory positive airway pressure (EPAP) = 5 cm H2O, FiO2 0.35 Volume-controlled intermittent mandatory ventilation (VC-IMV), f = 12 breaths/min, Vt = 650 mL, PSV 5 cm H2O, PEEP 5 cm H2O, FiO2 0.24

Volume-controlled intermittent mandatory ventilation (VC-IMV), f = 12 breaths/min, Vt = 650 mL, PSV 5 cm H2O, PEEP 5 cm H2O, FiO2 0.24