2414 Lab Exam 3

A 2-year-old child is ventilated with the Avea at 35% oxygen. The respiratory therapist presses the "increase O2 button" before suctioning. The resulting oxygen delivery will be: A. 100% for 2 minutes B. 35% for 2 minutes C. 55% for 2 minutes D. 100% for 1 minute

A. 100% for 2 minutes

A digital display of volume is in red on the Servo 300. This indicates which of the following? A. A measured value B. A set value C. An alarm condition D. An error in set-up

A. A measured value

A mode in which the operator sets P high, P low, T high and T low on the Drager EvitaXL is called: A. Airway pressure-release ventilation B. Pressure-regulated volume control ventilation C. Pressure-support ventilation D. Proportional assist ventilation

A. Airway pressure-release ventilation

The on/off power switch for the 840 is located on the: A. BDU B. GUI C. BPS D. compressor

A. BDU

Dual control modes

Allow the ventilator to control pressure or volume on a feedback loop by controlling either pressure or volume (not both at the same time).

Auto-trak sensitivity

Allows the V60 to automatically compensate for unintentional leaks by maintaining a stable baseline and adjusting trigger and cycle thresholds for optimum patient-to-ventilator synchrony.

Which of the following tests is not available with the SST on the PB 840? A. Leak test B. Tubing compliance test C. Oxygen sensor calibration D. Expiratory filter resistance

C. Oxygen sensor calibration

Ventilator adjustments with PEEP

If adding PEEP, reset high and low pressure limits, sensitivity (if not automatic), PEEP/CPAP alarm. In PCV, reset pressure settings in order to maintain the same Vt.

Dual control breath to breath

Operates in PSV or PCV, pressure limit increases or decreases to maintain a clinician set Vt.

How long is 100% O2 suction on the different vents?

PB 840 = 2 minutes Servo 300 = 20 breaths Servo i = 2 minutes Avea = 2 minutes (also on 79% or 20% O2) Drager = 3 minutes (also on 79% or 20% O2)

Which ventilators have inspiratory time as VT/IFR in VCV/PCV?

PB 840 and Avea

Ventilators offering square wave or decelerating in VCV

PB 840, Avea and Drager

The VCV limit is flow on which ventilators?

PB 840, Servo 300, Avea and Drager (autoflow)

In which ventilators do you set the Vt in VCV?

PB 840, Servo i, Avea and Drager

What is the trigger on all of the ventilators in PSV?

Patient

Who determines inspiratory time on all of the ventilators in PSV?

Patient

Trigger on all ventilators in VCV or PCV

Patient or time

Pressure support

Patient triggered to inspiration and normally cycled to exhalation when demand for flow is reduced to a terminal level. A form of pressure-limited assisted ventilation that decreases WOB, decreases frequency, increases Vt, decreases VO2 and increases patient comfort.

Which ventilators have air compressors?

The Avea. Optional on the PB 840 and Drager.

On which ventilator does the nebulizer change the VT or FiO2?

USN on the Servo i

Methods of applying PEEP

Under water column, water weighted diaphragm, exhalation valve systems (Venturi system, breathing valve, fixed orifice), Venturi PEEP, spring-loaded disk, magnetic PEEP device

Modes available on the Servo 300

VC, PC, VS, SIMV (VC with PS or PC with PS), PS/CPAP, PRVC, Automode, Standby, Ventinop

Modes available on the Servo i

VC, PC, VS, SIMV, PS, Spontaneous/CPAP, PRVC, BiVent, Nasal CPAP, Automode

Modes available on the Avea

Vol A/C, Vol SIMV, Press. A/C, Press. SIMV, PRVC A/C, PRVC SIMV, AAC, APRV/Biphasic, CPAP PSV, TCPL SIMV, TCPL A/C

What is the cycle in all of the ventilators in VCV?

Volume

Modes available on the Drager

Volume (CMV, CMV/Assist, SIMV, MMV, autoflow on or off), Pressure (PCV + BiPAP, PCV + Assist, CPAP/PS), autoflow, MMV, ATC, NIV, ILV, APRV

To set a descending flow waveform in volume A/C and volume SIMV on the Avea, the operator must: A. Go to the advanced settings window and press the peak flow control. B. Go to the mode selection screen and pick "waveform". C. Touch the waveform icon on the lower portion of the touch screen whenever volume-targeted ventilation is active. D. Do nothing, because the Avea only has a descending flow waveform.

A. Go to the advanced settings window and press the peak flow control.

Runaway can occur with PAV+ when which of the following conditions is present? I. The % support is set at a high value. II. The estimated E exceeds the actual value of E. III. The patient's effort exceeds the level of set support. IV. The high Vt limit is reached. A. I and II B. III C. I and IV D. II and IV

A. I and II

Using the expiratory hold function on the Drager EvitaXL allows for measurement of which of the following parameters? I. Negative inspiratory force (NIF) II. Occlusion pressure III. Intrinsic pressure IV. Slow vital capacity A. I and III B. II and IV C. II and III D. I, III, and IV

A. I and III

A patient is in the pressure-support mode on the Servo 300. The rate is set at 12 breaths/min. The patient's endotracheal tube cuff becomes deflated and a leak develops, preventing flow cycling. In this situation, what will end inspiratory flow? I. It will not end, but an apnea alarm will sound. II. It will end after 4 seconds (80% of TCT). III. It will switch to PRVC and the apnea alarm will sound. IV. It will end when the circuit pressure reaches the upper pressure limit. A. II only B. I and III only C. II and III only D. I, II, and IV only

A. II only

Which of the following controls sets the percent of peak inspiratory flow that cycles the Servo i out of inspiration during PS and VS? A. Inspiratory cycle-off B. Inspiratory rise time C. Peak flow control D. Trigger timeout

A. Inspiratory cycle-off

A blue reference loop appears continuously on the screen of the Drager EvitaXL while current loops (flow-volume) appear over the reference loop. The purpose of the reference loop is to allow: A. Observation of the flow-volume loop before and after a bronchodilator treatment. B. Quantification of the pressure from air trapped in the lungs. C. Verification that the patient is receiving a safe level of volume. D. Recalibration of the loop while the patient is still receiving ventilatory support.

A. Observation of the flow-volume loop before and after a bronchodilator treatment.

Which of the following modes guarantees volume delivery using pressure-targeted breaths and has a minimum set respiratory rate? A. Pressure-regulated volume control B. Volume support C. Automode D. SIMV (Press. Control) + PS

A. Pressure-regulated volume control

A patient is switched from volume-control ventilation to SIMV (Vol. Control) on the Servo 300. The SIMV frequency is set at 9 breaths/min., but only 8 mandatory breaths are being delivered. The yellow indicator next to the CMV frequency control flashes. The most likely cause of this condition is that: A. The CMV rate control is set at 8 breaths/min. B. The mode change was not activated correctly. C. The SIMV rate control is out of calibration. D. The patient has become apneic.

A. The CMV rate control is set at 8 breaths/min.

PAV+ is best described as a breath delivery method in which: A. The greater the patient effort, the higher the pressure delivered. B. The pressure is set as a percentage of inspiratory effort. C. The percent of support provided depends on the P0.1 value of the patient. D. Breaths are time or patient triggered.

A. The greater the patient effort, the higher the pressure delivered.

When "new patient" status is accepted after the Avea is turned on: A. The ventilator resets all settings to the default values. B. The ventilator begins working at the most recently stored values. C. The operator is required to enter all new parameters. D. Parameters are present based on the patient's body surface area.

A. The ventilator resets all settings to the default values.

Modes available on the PB 840

A/C, SIMV, Spontaneous, VC+, TC, Bilevel

Power source for all ventilators

All are pneumatically and electronically powered.

Which ventilators have a battery?

All of them. (PB840, Servo 300, Servo i, Avea, V60 and Drager)

Things that may cause imposed WOB

Artificial airways (upper airway accounts for 33% of the non-elastic WOB and artificial airways increase airway resistance), ventilator circuits.

AVAPS

Average volume assured pressure support. Achieves a set target volume by regulating the pressure applied following an initial pressure ramp-up. Time-cycled mandatory breaths and pressure-supported spontaneous breaths. Both are delivered at a pressure that is continually adjusted over a period of time to achieve the volume target. Breath type on the V60.

What will be the peak inspiratory pressure during bilevel ventilation when the PEEP H is set at 20 cwp and the PEEP L is set at 5 cwp? A. 25 cwp B. 20 cwp C. 15 cwp D. 5 cwp

B. 20 cwp

The Freeze control on the ventilator graphics screen of the PB 840 allows freezing of the last how many seconds of data? A. 30 B. 48 C. 60 D. 90

B. 48

An alarm occurs accompanied by three audible tones and a yellow flashing bar in the upper right area of the touch screen on the Avea. This indicates: A. A high priority alarm B. A medium priority alarm C. A low priority alarm D. A change in ventilator parameter

B. A medium priority alarm

A patient being ventilated with the volume-control mode on the Servo i is actively breathing and frequently inspires deeply during the inspiratory phase of the breath. This will result in: A. A concave dip in the inspiratory pressure curve to below baseline pressure. B. An increase in flow and volume delivery. C. No change in the constant (square) inspiratory flow waveform. D. Triggering of another breath.

B. An increase in flow and volume delivery.

Pressing the main icon in the screen selection window of the Avea: A. Checks the main circuit breaker. B. Displays the main screen. C. Lists the main ventilator parameters. D. Displays the main alarm limits.

B. Displays the main screen.

When comparing the Drager EvitaXL with the E-4, the primary difference is/are the: A. Available modes provided B. Main screen or user interface C. Internal gas delivery system D. Monitoring system

B. Main screen or user interface

Which of the following modes of ventilation is/are vailable with NIV for infants on the Servo i? I. Pressure control II. Pressure support III. Nasal CPAP IV. BiVent A. II only B. I, II, and III C. I and IV D. II and III

B. I, II, and III

A patient on PRVC has a set Vt of 450 mL. The PIP is 18 cwp. The upper pressure limit is 30 cwp. The delivered tidal volume is 400 mL. How will the Servo 300 respond to this situation? A. It will not make any changes. B. It will increase pressure by 3 cwp. C. An alarm will activate, producing the message "Pressure Limited" D. The unit will switch to VS.

B. It will increase pressure by 3 cwp

Safety ventilation on the PB 840 begins when which of the following occurs? A. When apnea is detected. B. When a procedure error is detected. C. When a patient is attached to the ventilator after the set-up is completed. D. When power is removed from the ventilator for 15 minutes or longer.

B. When a procedure error is detected.

Which of the following statements about the power sources for the Drager EvitaXL is true? A. When the AC power fails, the ventilator shuts down operation. B. An internal DC power source is available that provides 1.5 to 2 hours of power when AC power is lost. C. An internal DC power source provides about 10 minutes of power when AC power is lost. D. Two 50-psig gas sources are required for the EvitaXL to operate.

C. An internal DC power source provides about 10 minutes of power when AC power is lost.

The purpose for using the low-flow pressure-volume loop feature with the Drager EvitaXL is to: A. Determine the length of an apnea period in a patient with apneic episodes. B. Deliver nebulized medications at a slower breath rate. C. Evaluate for the upper and lower inflection points. D. Measure the slow vital capacity of the patient.

C. Evaluate for the upper and lower inflection points.

An indicator in the 840's Status Indicator Panel is blinking rapidly, suggesting a hazardous situation. Which indicator does this describe? A. Low priority alarm B. Medium priority alarm C. High priority alarm D. Battery low alarm

C. High priority alarm

When the tidal volume is set at 500 mL and the sigh control is enabled on the Avea, which of the following statements is/are true? I. A sigh volume of 750 mL will be delivered. II. The operator must also select the sigh frequency. III. A sigh breath occurs every 100 breaths. IV. The sigh tidal volume is set at twice the tidal volume setting. A. I only B. IV only C. I and III only D. II and IV only

C. I and III only

A quick method for increasing FiO2 delivery to a patient being ventilated with the Servo i is to use the: I. Direct access knob adjacent to the FiO2 screen parameter. II. Main rotary dial to proceed through the necessary steps. III. Touch screen controls IV. O2 breaths button on the lower right panel. A. I only B. II and III C. I and IV D. IV only

C. I and IV

In the PB 840, the function of the expiratory filter includes which of the following? I. Protect the ventilator from contamination with the patient's secretions. II. Filter exhaled air to protect clinicians from contamination. III. Protect the patient from potential contamination from the ventilator. IV. Measure expiratory gas flows for calculating flows and volumes. A. II only B. I and IV only C. I, II, and III only D. II, III, and IV only

C. I, II and III only

During volume-support ventilation, the following parameters are noted: upper pressure limit setting = 35 cwp, set Vt = 0.6 L, PEEP = 10 cwp, CMV frequency = 10 breaths/min. The pressure required to deliver the Vt rises to 31 cwp. Which of the following answers is/are appropriate in this situation? I. The ventilator will sound an alarm. II. The message "Limited Pressure" will appear in the window. III. The respiratory therapist should assess the patient. IV. The ventilator will switch to PRVC. A. I and III B. I and IV C. I, II, and III D. IV only

C. I, II, and III

Which of the following features are available for use with the Avea ventilator? I. Esophageal pressure monitoring II. Tracheal pressure monitoring III. Heliox gas delivery capability IV. Nitric oxide gas delivery capability A. I and II B. III and IV C. I, II, and III D. I, II, III, and IV

C. I, II, and III

Which of the following statements is/are true about the volume bar graph on the PB 840? I. The volume bar graph shows real-time exhaled volumes. II. For low tidal volumes (500 ml or less), the scale is 0 to 2000 ml. III. The bar graph on/off control is accessed through the User Setting menu. IV. The maximum exhaled volume is indicated by moving the LEDs for the last breath. A. I only B. II and IV only C. I, III, and IV only D. I, II, III, and IV

C. I, III, and IV only

An adult patient is being ventilated in volume support on the Servo 300 and becomes apneic. Which of the following will occur? I. The ventilator switches to VC. II. A light diode flashes next to the PRVC control. III. After 60 seconds the apnea alarm activates. IV. The ventilator will begin to ventilate the patient at the set rate. A. I only B. III only C. II and IV only D. I, II, III, and IV

C. II and IV only

As air and oxygen high-pressure gases enter the Servo 300, they pass to a: A. Large pressurized reservoir B. Pair of servo-controlled stepper motors C. Mixing chamber D. Spring-loaded bellows

C. Mixing chamber

The respiratory therapist must perform which of the following to begin an SST on the PB 840? A. Connect the patient to the ventilator. B. Turn off the ventilator. C. Press the SST on the touch screen or the test button on the side of the ventilator. D. Remove the proximal sensor.

C. Press the SST on the touch screen or the test button on the side of the ventilator.

The upper screen of the GUI on the PB 840 contains which of the following? A. The set-up keys B. The symbol definition area C. The alarm status D. The SandBox

C. The alarm status

The rise time percent is best defined as: A. The level of support for a PAV+ breath B. The flow at which a PS breath will end C. The rate of rise to the set pressure during pressure ventilation D. The pressure above PEEP H when PS is set during Bilevel ventilation

C. The rate of rise to the set pressure during pressure ventilation

A patient in the radiology department is being ventilated with the Servo i and requires a stat aerosol treatment with bronchodilators. The respiratory therapist connects Servo i Ultra Nebulizer inline with the patient circuit but is unable to activate the nebulizer function. A possible cause of this is: A. There is no medicine in the nebulizer cup. B. The patient circuit has a leak. C. The ventilator is operating from battery power. D. The Servo i does not have a built-in nebulizer function.

C. The ventilator is operating from battery power.

To select and accept a ventilator parameter on the Drager EvitaXL, the operator does all of the following except: A. Touch the screen knob B. Turn the dial knob C. Touch the screen knob to accept the setting D. Press the dial knob to confirm the setting

C. Touch the screen knob to accept the setting

A nurse reports to the respiratory therapist that an alarm has been activating all evening on a patient being ventilated on the Servo i. However, the RT notes that there is no alarm message on the screen and no active alarm. The RT can determine what alarm occurred by doing which of the following? A. Pressing the "alarm profile" key. B. Viewing the "trends" screen. C. Touching the "menu" key and selecting "alarm history". D. Pressing and holding the "alarm silence" key for 5 seconds.

C. Touching the "menu" key and selecting "alarm history".

During PS on the PB 840, the ventilator goes into apnea ventilation. Under what circumstances will normal ventilation resume? A. When the patient takes three consecutive breaths. B. When the ventilator is switched to a mode that provides mandatory breaths. C. When the Reset button is pressed. D. When the Alarm Silence button is pressed.

C. When the Reset button is pressed.

The maximum available I:E ratio for a mandatory breath on the Avea is: A. 1:1 B. 2:1 C. 3:1 D. 4:1

D. 4:1

SmartCare on the Drager EvitaXL is best defined as: A. Training of the respiratory care staff from the Drager Web site. B. Respiratory care personnel who have passed the EvitaXL examination. C. Making appropriate ventilator adjustments while using PSV for weaning. D. A closed-loop form of ventilation designed to shorten weaning time.

D. A closed-loop form of ventilation designed to shorten weaning time.

When Automode is activated on the Servo i, a spontaneously triggered breath becomes: A. Pressure support when the active mode is pressure control. B. Volume support when the active mode is volume control. C. Volume support when the active mode is PRVC. D. All of the above

D. All of the above

When AutoFlow is activated on the Drager EvitaXL which of the following occurs? A. Sensitivity to patient effort is reduced. B. Inspiration is flow cycled. C. A short release time (T low) allows for exhalation. D. Breath delivery becomes pressure limited and volume targeted.

D. Breath delivery becomes pressure limited and volume targeted.

In the PB 840, the backup power source will do which of the following when electrical AC power is lost or drops below a minimum level? I. Illuminate the battery indicator in the status indicators area of the screen. II. Provide backup emergency power to the BDU and screen. III. Not power the computer. IV. Not power the humidifier. A. I only B. II and III only C. I and IV only D. I, II, III and IV

D. I, II, III and IV

The Servo 300 can be pressure or flow triggered in which of the following modes of ventilation? I. Pressure control II. SIMV (Vol. Control) III. Pressure support IV. PRVC A. II only B. I and IV only C. II and III only D. I, II, III and IV

D. I, II, III and IV

The Open Lung Tool on the Servo i can trend which of the following parameters? I. Peak pressure II. PEEP III. Dynamic compliance IV. Tidal volume A. III only B. I and II C. III and IV D. I, II, III, and IV

D. I, II, III, and IV

The battery package in the Servo i being used with a 68-year-old patient contains three fully charged batteries. The respiratory therapist must transport the patient still connected to the ventilator from the intensive care unit to the radiology department, which will take 20 to 30 minutes. How can the therapist determine how long the batteries will last? I. By estimating about 30 minutes of power for each battery. II. By disconnecting the ventilator from the wall AC power and observing the number of minutes in the "status" window. III. By touching the "status" key and viewing the battery status and time. IV. By reading the amount of time displayed on each battery. A. I only B. II only C. III and IV D. I, II, and III

D. I, II, and III

When volume-targeted breaths are activated on the Avea, triggering is based on which of the following? I. Time II. Flow III. Pressure IV. Volume A. I B. II and III C. I and IV D. I, II, and III

D. I, II, and III

Which of the following is/are specific area(s) of the Drager EvitaXL front control panel? I. Fixed keys to allow access to various functions. II. Rotary knob for selecting and confirming settings. III. Operating screen (touch screen), which contains information and controls for ventilation. IV. Four dial knobs below the screen to directly control the main parameters used in each mode. A. III B. I and II C. II and IV D. I, II, and III

D. I, II, and III

Which of the following statements is true regarding the measurement of respiratory mechanics with the Avea? I. Respiratory mechanics are accessed by pressing the screens touch pad. II. On the screens menu, respiratory mechanics is chosen. III. AutoPEEP is one of the available respiratory mechanics measurements. IV. The maximum inspiratory pressure (MIP) can be measured. A. I and III B. II and III C. I, II, and IV D. I, III, and IV

D. I, III, and IV

The easiest way to determine whether the Avea is connected to an AC power source is to: A. Check the on/off switch on the back panel. B. Check the "power on" indicator for a green light. C. See whether the touch screen is on. D. See whether the AC power indicator is illuminated green.

D. See whether the AC power indicator is illuminated green.

The Servo 300 uses what type of inspiratory flow valve? A. Stepper motor B. Spring loaded C. Scissor valve D. Solenoid valve

D. Solenoid valve

During PSV, the Esens in the 840 is set at 40%. The respiratory therapist notices that the inspiratory time is short and volume delivery is low. What might be the problem? A. There may be a leak in the system, and the inspiratory flow never drops to the 40% value. B. The patient is actively inhaling from the gas flow. C. The patient is making no spontaneous inspiratory effort to begin the next breath. D. The Esens may be set too high for the patient.

D. The Esens. may be set too high for the patient.

A respiratory therapist is changing the pressure for a patient on pressure-control ventilation on the Servo i. As he reduces the "PC above PEEP" control, the screen area begins to illuminate with a red color and a low expiratory minute volume alarm occurs. The most likely cause of this is: A. A low pressure alarm. B. An apnea alarm. C. The patient has triggered inspiration. D. The therapist has set the pressure too low to maintain minute ventilation above the alarm level.

D. The therapist has set the pressure too low to maintain minute ventilation above the alarm level.

Problems with the old IMV set-ups

Ex. = H-Bar/Parallel flow and continuous flow with reservoir. Connections fell apart, problems with cross contamination during set-up, improper set-up could keep patient from being ventilated, high imposed WOB.

What is the cycle on all of the ventilators in PSV?

Flow

Internal mechanism for the Servo 300 and Servo i

High performance solenoid

What is the limit on all of the ventilators in PCV?

Pressure

What is the limit on all of the ventilators in PSV?

Pressure

PRVC/VC+/Autoflow

Pressure controlled breaths with a volume target and flow that responds to patient effort and adjusts pressure based on compliance and airway resistance.

In which ventilator is the Vt determined by VE/f in VCV?

Servo 300

Which ventilator has inspiratory time as Ti% and PT% in VCV/PCV?

Servo 300

Ventilators offering square wave only in VCV

Servo 300 and Servo i

The VCV limit is IFR = VT/Ti on which ventilator?

Servo i

Which ventilators have inspiratory time set in VCV/PCV?

Servo i and Drager

Which ventilators include a nebulizer?

Servo i, Avea and Drager

Internal mechanism for the Drager

Servocontrol

Internal mechanism for the Avea

Servocontrol, solenoid

Modes available on the V60

Spontaneous, CPAP, Spontaneous with IPAP, Spontaneous/Timed, Timed

Dual control within a breath

Switches from pressure control to volume control during the breath.

What is the cycle on all of the ventilators in PCV?

Time