TMC Mechanical Ventilation Practice questions

A 60-year-old male patient is receiving ventilatory support in the SIMV mode. A blood gas sample was collected and analysis shows a PaCO2 of 60 mmHg. Which of the following would you recommend? A. Increase the frequency B. Increase the FiO2 C. Increase the mechanical deadspace in the ventilator circuit D. Decrease the tidal volume

A

A 63-year-old female patient is intubated and receiving mechanical ventilation in the pressure controlled A/C mode. If the patient's compliance were to decrease, which of the following would you expect to occur? A. Her delivered volume will decrease B. Her peak pressure will increase C. Her inspiratory time will increase D. Her PEEP level will decrease

A

An adult patient with a tracheostomy in place is receiving ventilatory support in the volume-control SIMV mode with a set rate of 10/min. Upon assessment, the patient has started to use their accessory muscles during spontaneous breaths. Which of the following would you recommend? A. Increase the level of pressure support B. Decrease the SIMV rate to 8/min C. Switch to the patient to pressure-control SIMV D. Switch the patient to a pressure-limited mode

A

The physician has chosen to use the SIMV mode of ventilation over the Assist/Control mode. Which of the following is an advantage of the SIMV mode? A. SIMV maintains respiratory muscle strength B. SIMV prevents hyperventilation C. SIMV increases pleural pressures D. SIMV increases the need for sedation

A

While assessing a mechanically ventilated patient after a neurosurgical procedure, the patient has an intracranial pressure of 20 mmHg but is otherwise stable. The latest ABG results are as follows: pH 7.31 PaCO2 48 mmHg HCO3 24 mEq/L PaO2 88 mmHg SpO2 95% Based on this information, which of the following would you recommend? A. Increase the minute ventilation B. Add 10 cm H2O PEEP C. Decrease the tidal volume D. Maintain the current settings

A

While selecting the initial ventilatory settings for a newly intubated patient, which of the following is most important? A. The type of device that is being used B. The quality and amount of nursing supervision C. The patient's size and clinical condition D. The amount of spontaneous ventilatory effort

A C!

A 68-year-old female patient in the ICU is receiving mechanical ventilation but appears to be breathing asynchronously with the ventilator. Which of the following medications would you recommend? A. Fluoxetine (Prozac) B. Lorazepam (Ativan) C. Dextroamphetamine (Dexedrine) D. Cisatracurium (Nimbex)

B

A 68-year-old male patient with COPD is receiving volume control SIMV with the following settings: Tidal volume 480 mL Rate 12/min Pressure support 10 cm H2O PEEP 5 cm H2O During a spontaneous breathing trial via T-tube, the patient's breathing rate increased drastically which required that he be placed back on the ventilator. Which of the following would you recommend during the next breathing trial? A. Increase the sedation dosage B. CPAP with pressure support via ET tube C. CPAP without pressure support via ET tube D. Extubate and provide BiPAP via full face mask

B

A 71-year-old female patient is intubated and receiving positive-pressure ventilation. In order to prevent barotrauma, you should strive to keep the plateau pressure below which of the following thresholds? A. 20 cm H2O B. 30 cm H2O C. 40 cm H2O D. 50 cm H2O

B

A patient in the ICU is receiving positive pressure ventilatory support but appears to be breathing asynchronously with the machine-delivered breaths. Which of the following medications would you recommend? A. Fluoxetine (Prozac) B. Midazolam (Versed) C. Dextroamphetamine (Dexedrine) D. Cisatracurium (Nimbex)

B

An adult patient is receiving mechanical ventilation with a PEEP setting of 10 cmH2O. The physician has requested that you increase the setting to 14 cmH2O. After making the adjustment, there is a rapid drop in the patient's blood pressure and a significant increase in heart rate. Which of the following actions should you take? A. Increase the FiO2 by 10% B. Lower the PEEP back to 10 cmH2O C. Administer sodium bicarb D. Obtain a stat EKG

B

The physician has requested a mode of ventilation in which you can maintain a precise I:E ratio. Which of the following modes would you select? A. Synchronous Intermittent Mandatory Ventilation B. Control Mode Ventilation C. Assist-Control Ventilation D. Pressure Support Ventilation

B

The physician has requested the dynamic compliance measurement for an adult patient who is receiving mechanical ventilation. This value can be obtained by dividing the patient's tidal volume by which of the following: A. (Pplat - PEEP) B. (PIP - PEEP) C. (PIP - Paw) D. (Paw - Pplat)

B

Which of the following tidal volume settings for mechanical ventilation would be most appropriate for a 5'2" female patient with normal lungs? A. 200 mL B. 400 mL C. 600 mL D. 700 mL

B

An adult patient who is receiving mechanical ventilation has a peak airway pressure of 60 cmH2O and a plateau pressure of 45 cmH2O. The ventilator flow rate is set at 60 L/min. What is the patient's airway resistance? A. 5 cm H2O/L/sec B. 15 cm H2O/L/sec C. 30 cm H2O/L/sec D. 60 cm H2O/L/sec

B (Pip-plateau) / flow

A 176 lb male patient is intubated and receiving volume control A/C ventilation with the following settings: FiO2 of 40%, Rate of 12/min, and Tidal Volume of 550 mL. An ABG was analyzed and the following results were obtained: ABG Results and Ventilator Settings pH 7.39 PaCO2 37 mmHg HCO3- 23 mEq/L PaO2 107 mmHg Spontaneous Tidal Volume 180 mL Spontaneous Rate 37/min Vital Capacity 550 mL MIP/NIF -12 cm H2O Which of the following would you recommend? A. Place the patient on a 40% T-piece and monitor closely B. Switch the patient to SIMV at a rate of 5/minute C. Place the patient on CPAP and monitor closely D. Maintain the current ventilator settings and re-evaluate later

B? D!

A 60-year-old female patient is receiving assist-control mechanical ventilation. Which of the following is the most common problem associated with this ventilatory mode? A. Hypoventilation B. Hyperventilation C. The need for neuromuscular paralysis D. Increased work of breathing

B? D?

A 43-year-old male patient was admitted to the emergency department with a suspected drug overdose. The patient is receiving oxygen via nonrebreather but is unconscious and isn't making any respiratory efforts to breathe. The patient's body weight is 57 kg and his ABG results are as follows: pH 7.28 PaCO2 74 torr HCO3 20 mEq/L PaO2 315 torr Which of the following would you recommend? A. Apply BiPAP with: IPAP 20 cm H2O, EPAP 5 cm H2O, FiO2 30% B. Intubate and apply: SIMV, tidal volume 600 mL, rate 6/min, FiO2 40% C. Intubate and apply: A/C ventilation, tidal volume 450 mL, rate 12/min, FiO2 50% D. Apply CPAP at 10 cm H2O and an FiO2 of 100%

C

A 51-year-old female patient with a history of asthma is receiving mechanical ventilation in the assist-control mode. Upon assessment, you note that she is struggling to initiate inspiration. Which of the following settings would you check first in order to resolve of this problem? A. Tidal volume B. Pressure limit C. Sensitivity D. PEEP

C

A 64-year-old male patient is intubated and receiving ventilatory support in the volume-controlled SIMV mode. The physician anticipates that the patient will be on the ventilator for another 3-5 days. Which of the following would you recommend? A. Switch to the patient to NPPV B. Switch from an ET tube to a tracheostomy C. Maintain the endotracheal tube in place D. Switch to a pressure-controlled mode

C

A 66-year-old female patient is receiving ventilatory support in the SIMV mode with an FiO2 of 40% and a PEEP of 10 cmH2O. Over the past hour, her SpO2 has decreased from 94% to 81%. Which of the following would you recommend FIRST? A. Change to VC, A/C B. Increase the PEEP C. Increase the FiO2 D. Increase the flow

C

A 70-year-old male patient with COPD is receiving ventilatory support in a volume-controlled mode. Upon assessment, the high pressure alarm suddenly begins to sound. Which of the following would recommend? A. Increase the flow setting B. Increase the pressure limit setting C. Suction the airway D. Remove air from the endotracheal tube cuff

C

A stable adult patient who is receiving mechanical ventilation displays the following results: pH 7.49 PaCO2 29 mm Hg HCO3 24 mEq/L BE +1 PaO2 87 mm Hg SaO2 96% Which of the following would you recommend? A. Add 10 cm H2O PEEP B. Increase the minute ventilation C. Decrease the tidal volume D. Maintain the current setting

C

During the assessment of an adult patient who is receiving mechanical ventilation, you suddenly notice the simultaneous sounding of both the high pressure and low volume alarms. What is the most likely cause of this finding? A. There is a disconnection in the ventilator circuit B. There is a leak in the ET tube cuff C. There is a mucous plug in the ET tube D. The patient has developed pneumonia

C

During the ventilator check of an adult patient who weighs 77 kg, you note the following settings: -Exhaled tidal volume 550 mL -PIP 35 cm H2O -High pressure limit 65 cm H2O -Low pressure alarm 25 cm H2O -Low tidal volume alarm 500 mL Which of the following changes should be made at this time? A. Increase the set tidal volume to 700 mL B. Increase the low tidal volume alarm to 600 mL C. Decrease the high pressure limit to 45-50 cmH2O D. Decrease the low pressure alarm to 10 cmH2O

C

A 52 kg female patient is receiving volume control A/C mechanical ventilation with a tidal volume of 400 mL, a set rate of 10/min, and an FiO2 of 35%. Her blood gas results are as follows: pH 7.31 PaCO2 49 torr HCO3 24 mEq/L BE -2 mEq/L PaO2 84 torr SpO2 95% Based on the given information, which of the following changes is appropriate at this time? A. Increase the FiO2 B. Increase the tidal volume C. Increase the set rate D. Maintain the current settings

C?

An alert 59-year-old male patient is orally intubated with an endotracheal tube. During a weaning trial, the patient was switched to CPAP mode with an FiO2 of 40%. Within the first 5 minutes, the patient's respiratory rate has increased from 22 to 31 breaths/min with increased usage of accessory muscles while breathing. Which of the following would you recommend? A. Return the patient to full ventilatory support B. Increase the FiO2 to 50% C. Apply 5-10 cm H2O of pressure support D. Extubate the patient and reassess

C? A..

A 58-year-old female is receiving volume control A/C ventilation at a rate of 12/min with a tidal volume of 450 mL. The FiO2 is set at 40% and her ABG results are as follows: pH 7.35 PaCO2 44 torr HCO3 22 mEq/L BE 0 PaO2 91 torr SaO2 97% Based on this information, you should recommend which of the following? A. Decrease the minute ventilation B. Discontinue mechanical ventilation C. Administer IV bicarbonate D. Maintain the current settings

D

A 63-year-old male patient with a tracheostomy is being mechanically ventilated in the ICU. Upon assessment, you noticed that as the patient coughs, blood and secretions were blown back into the circuit. What action should you take at this time? A. Flush the blood out of the circuit with normal saline B. Sedate the patient to prevent more coughing C. Nebulize a local anesthetic to reduce surgical pain D. Replace the circuit with a new one

D

A 70-year-old male patient is intubated and receiving mechanical ventilation in the volume controlled A/C mode. After performing endotracheal suctioning, which of the following would indicate the effective clearance of retained secretions? A. An increased tidal volume B. A decreased inspiratory time C. A decreased plateau pressure D. A decreased peak pressure

D

A 74 kg male patient is intubated and receiving volume control A/C ventilation with the following settings: FiO2 of 50% set rate of 15 tidal volume of 550 mL. The patient's total respiratory rate is 29 breaths/min. His ABG results are as follows: pH 7.53 PaCO2 27 torr HCO3 23 mEq/L BE -2 PaO2 82 torr SaO2 97% Which of the following would you recommend? A. Increase the FiO2 B. Increase the ventilator rate C. Increase the tidal volume D. Add mechanical deadspace

D

During the assessment of a 64-year-old patient who is receiving volume-controlled ventilation, you note that the peak airway pressure has decreased from 36 to 19 cmH2O. There have been no changes to the ventilator settings. Which of the following would you recommend? A. Increase the volume setting until the pressure equals 36 cmH2O B. Increase the flow setting until the pressure equals 36 cmH2O C. Check for increased secretions and suction if needed D. Check the circuit for system leaks

D

The physician has ordered mechanical ventilation in the pressure control A/C mode for a 55 kg postoperative male patient. Which of the following initial settings would you choose? A. PIP = 25 cm H2O; Rate = 30/min; Inspiratory time = 1 second B. PIP = 32 cm H2O; Rate = 12/min; Inspiratory time = 2 seconds C. PIP = 40 cm H2O; Rate = 20/min; Inspiratory time = 1 second D. PIP = 25 cm H2O; Rate = 12/min; Inspiratory time = 1 second

D

A 69-year-old male patient is undergoing a spontaneous breathing trial for weaning from mechanical ventilation. Which of the following changes in the patient's status would be acceptable? A. A decrease in SpO2 from 91% to 81% B. An increased usage of the scalene muscles during breathing C. An increase in heart rate from 97 to 115/min D. A decrease in the systolic blood pressure from 115 to 76 mmHg

D C! Hasnt gone over 20

A 60-year-old female patient who in orally intubated is going through a spontaneous breathing trial. Which of the following would indicate the need to stop the trial and return the patient back to full ventilatory support? A. An increase in heart rate from 96 to 114/min B. An increase in respiratory rate from 17 to 27/min C. An increase in arterial PCO2 from 44 to 52 torr D. A decrease in SpO2 from 92% to 83%

Eithe A or B D!