Mechanical Ventilation-Test 2

A 38-year-old female suffered a deceleration injury in an MVC. She is alter and oriented but in respiratory distress. A portion of the patient's right anterior chest wall is moving in a paradoxical motion. Breath sounds are decreased on the right and the trachea is midline and no pneumothorax was detected. ABG data reveal pH 7.48, PaCO2 31 mmHg, PaO2 63 mmHg, and HCO3 24 mEq/L. The respiratory therapist should recommend which of the following therapies for this patient at this time? A. Mask CPAP with supplemental oxygen B. Intubate and use VC-CMV with PEEP C. NIV with supplemental oxygen D. Intubate and use PCIRV

A

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? A. 5.1 L/min B. 6.1 L/min C. 11.2 L/min D. 13.5 L/min

A

A 6-foot tall male patient with pulmonary fibrosis is being ventilated in VC-CMV, rate 10 breaths/min, VT 600 mL, FiO2 0.50, and PEEP +10 cmH2O. The patient's PIP is 53 cmH2O, and the Pplateau is 47 cmH2O. It is decided to switch the patient to PC-CMV. What set PIP will deliver 6 mL/kg IBW? A. 30 cm H2O B. 35 cm H2O C. 38 cm H2O D. 43 cm H2O

A

A hemodynamically unstable patient being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode is triggering inspiration at a rate of 25 breaths/min and has the following arterial blood gas results: pH 7.50, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2) 98 mm Hg, arterial oxygen saturation (SaO2) 100%, bicarbonate (HCO3) 24 mEq/L. The respiratory therapist should perform which of the following? A. Extubate and administer noninvasive positive pressure ventilation (NIV). B. Change the mode to pressure-controlled continuous mandatory ventilation (PC-CMV). C. Change the mode to volume-controlled intermittent mandatory ventilation (VC-IMV). D. Sedate and paralyze the patient.

A

Which mode of ventilation is shown in the pressure-time scalar in the figure? (WAVES) A. Pressure-controlled continuous mandatory ventilation (PC-CMV) B. Volume-controlled continuous mandatory ventilation (VC-CMV) C. Pressure-controlled intermittent mandatory ventilation (PC-IMV) D. Volume-controlled intermittent mandatory ventilation (VC-IMV)

B

While initially ventilating a patient with acute respiratory distress syndrome (ARDS), the extrinsic positive end-expiratory pressure (PEEPE) should be maintained using which of the following methods? A. 50% of intrinsic positive end-expiratory pressure (PEEPI) B. Open lung approach C. Offset intrinsic PEEP D. Minimize mean airway pressure

B

True or False In flow triggering, the exhalation has to be closed in order for patient to trigger A. True B. False

B (exhalation valve doesn't have to be closed in order for patient to trigger)

True or False Pressures between -1 and -2 cm H2O in pressure triggering have a faster response time A. True B. False

B (slower response time, use if patient is over breathing to slow them down)

Which fo the following ventilatory parameters is appropriate when mechanically ventilation a patient with COPD? A. Use a rectangle flow waveform B. Set tidal volume between 10 and 15 mL/kg C. Use peak inspiratory flow rates greater than 60 L/min D. Institute PEEP in the range of 5 to 10 cm H2O

C

Which of the following are life-threatening alarms/events on a mechanical ventilator? 1. Disconnected circuit 2. Leak in the system 3. Kinked tubing 4. Decrease in compliance 5. Increase in compliance A. 1, 2, 3, and 5 only B. 1 and 3 only C. 1, 2, 3, and 4 only D. All of the above

C

How often should a HME be changed? A. Every 24 hours or up to 3 days B. Every 12 hours or up to 2 days C. Every week D. Every 6 hours

A

If a patient was just successfully resuscitated, what FiO2 would you start them on? A. 100% B. 90% C. 88% D. 50%

A

True or False A sigh breath is a recruitment maneuver. A. True B. False

A

True or False Flow triggering (1-10 L/min) is the preferred method and has a faster response time than pressure trigger on a ventilator A. True B. False

A

To start a patient on a ventilator, what FiO2 would you start them on? A. 21-30% B. 30-40% C. 50-100% D. 100%

C

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

D

A patient having an acute, severe asthma exacerbation is intubated and set up on volume-controlled continuous mandatory ventilation (VC-CMV). To ensure volume delivery at the lowest peak pressure while providing for better air distribution, which flow waveform should be used? A. Sine B. Constant C. Ascending ramp D. Descending ramp

D

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 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? A. 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, fractional inspired oxygen (FIO2) 1.0 B. 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 C. 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 D. 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

A

A patient arrives in the emergency department following a motor vehicle accident in which the patient sustained a deceleration chest injury. The patient was intubated in the field for airway protection. Physical assessment reveals that the patient is spontaneously breathing at a rate of 16 breaths/min, and breath sounds reveal bibasilar fine crackles at end inspiration. A second arterial blood gas was drawn while the patient was receiving 100% oxygen from an air entrainment large volume nebulizer. Parameter 9:35 PM 10:10 PM pH 7.53 7.50 PaCO2 (mm Hg) 27 30 PaO2 (mm Hg) 48 56 SaO2 (%) 90 91 HCO3 (mEq/L) 24 24 Supplemental oxygen Room air 100% Bland aerosol The most appropriate recommendation for this patient is which of the following? A. Continuous positive airway pressure (CPAP) with supplemental oxygen B. Pressure-controlled inverse ratio ventilation (PCIRV) with positive end-expiratory pressure (PEEP) and sedation C. Volume-controlled continuous mandatory ventilation (VC-CMV) D. Airway pressure release ventilation (APRV)

A

Appropriate ventilatory parameters for an otherwise healthy 185-pound, 6'1", 26-year-old male patient who was brought to the ED because of a drug OD include which of the following? A. VC-CMV, tidal volume 600 mL, set rate 12 breaths/min B. VC-IMV, tidal volume 600 mL, set rate 6 breath/min C. PC-CMV, set pressure 25 cm H2O, inspiratory time 1.5 seconds D. Pressure support ventilation of 15 cm H2O with CPAP 5 cm H2O

A

Before intubation, a patient's PaO2 was 78 mmHg while receiving an FiO2 of 0.60. What FiO2 setting on the ventilator will bring the PaO2 up to 90 mmHg? (Assume that this patient's cardiopulmonary status and respiratory quotient are constant) A. 0.70 B. 0.75 C. 0.80 D. 0.85

A

During a pressure-triggered breath in VC-CMV the pressure-time curve on the graphic display does not rise smoothly and appears to be somewhat concave in appearance. This indicates which of the following? A. Flow rate is inadequate B. Rise time is set too slow C. Overshoot on the pressure D. Inspiratory time is too short

A

HMEs may not be appropriate for use with infants, children, and small adults due to which of the following? A. Presence of mechanical dead space in the HMEs B. Increased rate of endotracheal occlusion with these patients C. Patients' inability to overcome resistance across the HME D. HMEs inability to provide adequate humidity for these patients

A

How is pressure support ventilation cycled? A. Flow B. Pressure C. Volume D. Time

A

True or False In pressure triggering, pressure between -1 to -2 cm H2O, the exhalation valve must be closed in order for patient to generate negative pressure A. True B. False

A

Ventilator controls timing of breaths, tidal volume or peak pressure is which type of breath? A. Mandatory B. Assisted C. Spontaneous D. Normal breathing

A

Volume is constant and pressure is variable describes which kind of ventilator support? A. Volume control B. Pressure control C. Assist control D. Total control

A

What flow rate is necessary to deliver a Vt 500 mL at a rate of 15 breaths/min with an I:E ratio of 1:3? A. 30 L/min B. 35 L/min C. 40 L/min D. 45 L/min

A

What is the alarm parameter for low PEEP/CPAP? A. 2-5 cm H2O below set PEEP B. 1-3 cm H2O below set PEEP C. 3-5 cm H2O below set PEEP D. 5-10 cm H2O below set PEEP

A

Which are true about HMEs? 1. Create deadspace 2. treatments can clog them 3. Use with excess secretions 4. May lead to auto-PEEP A. 1, 2, and 4 only B. 1 and 2 only C. 1, 3, and 4 only D. 1, 2, 3, and 4

A

Which of the following is (are) true concerning the use of permissive hypercapnia in the management of ARDS? 1. Keep Pplateau below 30 cm H2O by lowering Vt to 4-6 mL/kg 2. PaCO2 should go no higher than 60 mm Hg. 3. High PEEPe levels greater than 15 cm H2O may be required 4. The PaCO2 is permitted to rise rapidly to the acceptable level A. 1 and 3 only B. 2 and 4 only C. 1 and 4 only D. 2 and 3 only

A

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? A. 8.9 L/min B. 9.7 L/min C. 11.4 L/min D. 13.6 L/min

B

A 5' 7" tall female multiple trauma patient was being managed on VC-CMV, f 12 breaths/min, Vt 640 mL, PEEP +5 cm H2O, FiO2 60%, and a constant waveform for the past 24 hours. Currently, PIP is 45 cm H2O, Pplateau is 38 cm H2O, and the patient has been diagnosed with acute respiratory distress syndrome. The respiratory therapist wants to switch the patient to PC-CMV. The initial pressure setting to target the appropriate Vt for this patient is which of the following? A. 10 cm H2O B. 20 cm H20 C. 38 cm H20 D. 45 cm H20

B

A 5'4" tall, 125 lbs female patient who has just been intubated because of severe asthma episode would be ventilated most appropriately with which of the following ventilator parameters? A. PSV 20 cm H2O with CPAP +10 cm H2O B. PC-CMV, 12 breaths/min, PIP 25 cm H2O, Ti 0.75 second C. VC-IMV, 12 breaths/min, Vt 800 mL, flow 50 L/min, rectangle waveform D. VC-CMV, 10 breaths/min, Vt 570 mL, flow 35 L/min, descending waveform

B

Which are ways to correct auto-PEEP? A. 0 PEEP B. Longer exhalation time C. Longer inspiration time D. Higher tidal volume

B

When do you use sigh breaths? 1. Before and/or after suctioning 2. before and after brunch 3. During extubation 4. To correct auto-PEEP A. 1 only B. 1 and 2 only C. 1, 2, and 3 only D. 1, 3, and 4 only

C

A chronic obstructive pulmonary disease (COPD) patient with an ideal body weight of 65 kg is brought to the emergency department. The patient is short of breath and using accessory muscles. Aerosolized bronchodilators are administered. The arterial blood gas reveals the following: pH 7.31, partial pressure of carbon dioxide (PaCO2) 72 mm Hg, partial pressure of oxygen (PaO2) 88 mm Hg, oxygen saturation (SaO2) 90%, bicarbonate (HCO3) 32 mEq/L on nasal cannula 2 L/min. The respiratory therapist should recommend which of the following at this time? A. Intubate, volume-controlled continuous mandatory ventilation (VC-CMV) rate 15 breaths/min, tidal volume (VT) 650 mL, fractional inspired oxygen (FIO2) 0.50, positive end-expiratory pressure (PEEP) 6 cm H2O. B. Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP) rate 8 breaths/min, inspiratory positive airway pressure (IPAP) 10 cm H2O, expiratory positive airway pressure (EPAP) 4 cm H2O. C. Intubate, pressure-controlled intermittent mandatory ventilation (PC-IMV) rate 10 breaths/min, peak inspiratory pressure (PIP) 30 cm H2O, FIO2 0.60, PEEP 3 cm H2O. D. Administer 30% oxygen via air entrainment mask and continuous bronchodilator therapy.

B

A leak around a patient's ET tube cuff during pressure support ventilation (PSV) will cause which of the following to occur? A. Volume cycle B. Time cycle C. Pressure cycle D. Flow cycle

B

A patient has just been intubated in the ED. The patient is a 64-year-old obese male patient with a suspected drug OD. The patient is 6' tall and weighs 435 pounds. The most appropriate tidal volume to ventilate this patient is which of the following? A. 380 mL B. 640 mL C. 810 mL D. 975 mL

B

A patient is intubated and on PSV. The respiratory therapist notices that inspiratory time has increased from 1 second to 2 seconds consistently on every breath since last ventilator rounds. What should be the first action the respiratory therapist should do to correct the problem? A. Change to the SIMV mode B. Check the endotracheal tube cuff pressure C. Increase the inspiratory flow setting D. Suction and lavage the patient's airway

B

A patient is ready to be changed from VC-IMV to PSV. The VC-IMV settings were VT 450 mL, f 4 breaths/min, and PEEP +5 cm H2O. The patient's PIP is 31 cm H2O, and Pplateau is 23 cm H2O. The initial PSV setting for this patient should be which of the following? A. 5 cm H2O B. 8 cm H2O C. 10 cm H20 D. 12 cm H2O

B

A patient with ARDS has been changed from VC-CMV to PC-CMV. When this change was made, there was an increase in mean airway pressure. Which of the following statements is true concerning elevated mean airway pressures? A. The mean airway pressure increases with longer expiratory times B. An increased mean airway pressure may result in improved oxygenation C. Elevated mean airway pressures decrease the risk of barotrauma D. High mean airway pressures increase the risk of cardiovascular side effects

B

Calculate the I:E ratio when the set rate is 35 breaths/min and the Ti = 1 second. A. 1:1 B. 1.4:1 C. 1.7:1 D. 2:1

B

Calculate the inspiratory time (TI) when a ventilator is set at a tidal volume (VT) of 500 mL and a constant flow rate of 30 L/min. A. 0.6 second B. 1 second C. 1.5 second D. 1.7 second

B

Calculate the inspiratory to expiratory (I:E) ratio for a ventilator that is set to deliver 850 mL at a frequency of 15 breaths/min with a flow rate of 45 L/min. A. 1:1.1 B. 1:2.5 C. 1:3.5 D. 1:4

B

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

B

If a patient has an increase in Raw, what will change on volume control ventilation? A. Decrease in peak airway pressure B. Increase in peak airway pressure C. Decrease in tidal volume D. Increase in tidal volume

B

Patient controls timing and tidal volume, based on patient demand and lung characteristics describes which type of breath? A. Mandatory B. Spontansous C. Assisted D. Normal breathing

B

Pressure augmentation (Paug) may be beneficial for mechanically ventilated patients with which of the following? 1. Noncardiogenic pulmonary edema 2. Acute respiratory Distress Syndrome 3. Postoperative upper abdominal surgery 4. Receiving heavy sedation and paralyzing agents A. 1 and 2 only B. 1 and 3 only C. 2 and 4 only D. 3 and 4 only

B

The application of positive pressure for patients with left ventricular failure is beneficial because of which of the following? A. Increases venous return B. Decreases preload to the heart C. Increases afterload to the heart D. Improves perfusion to the myocardium

B

The flow waveform that is most appropriate for a patient with high Raw is which of the following? A. Rectangle B. Descending C. Ascending D. Exponential

B

The most appropriate tidal volume setting for a 6'3" male ventilator patient with normal lungs is which of the following? A. 300 mL B. 500 mL C. 700 mL D. 900 mL

B

What is the alarm parameter for low minute ventilation? A. 5-10% below set B. 10-15% below set C. 15-20% below set D. 1-3% below set

B

What is the minimum ventilator rate for full ventilatory support? A. 6 B. 8 C. 4 D. 10

B

What is used to determine the initial pressure support level? A. PIP+PEEP B. PIP-PEEP C. PEEP-PIP D. Plat+PIP

B

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

B

What ventilatory modes provide full ventilatory support? 1. VC-CMV 2. VC-IMV 3. PC-CMV 4. MMV A. 1 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, 3, and 4

B

What will occur if there is a leak around the cuff in PSV? A. Auto-trigger B. Time cycle C. High PIP D. Nothing

B

When switching from the CMV mode to the IMV mode to facilitate weaning from mechanical ventilation, which of the following could be used, in addition to IMV (IMV), to assist in this process? A. PCV B. PSV C. PAV D. APRV

B

What is the minimum ventilator rate for partial support? A. 2 B. 4 C. 6 D. 8

C

A 36-year-old female patient with a history of asthma is admitted to the ICU from the emergency department. Her respirations are 30, very labored, with accessory muscle use and bilateral inspiratory and expiratory wheezing. There is bilateral hyperresonance during chest percussion. A blood gas taken in the ICU after 1 hour of continuous aerosolized albuterol (15 mg) reveals: pH 7.38, partial pressure of carbon dioxide (PaCO2) 42 mm Hg, partial pressure of oxygen (PaO2) 53 mm Hg, oxygen saturation (SaO2) 88%, bicarbonate (HCO3) 25 mEq/L with nasal cannula 6 L/min. The patient is 5'5" and weighs 135 lb. The most appropriate action at this time is which of the following? A. Continue current therapy with 20 mg albuterol and reassess in 1 hour. B. Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP), f = 12, inspiratory positive airway pressure (IPAP) 28 cm H2O, expiratory positive airway pressure (EPAP) 3 cm H2O, fractional inspired oxygen (FIO2) 0.30 C. Intubate, use pressure-controlled continuous mandatory ventilation (PC-CMV), f = 8, peak inspiratory pressure (PIP) 28 cm H2O, TI 0.75 seconds, positive end-expiratory pressure (PEEP) 3 cm H2O, FIO2 1.0 D. Intubate, use volume-controlled continuous mandatory ventilation (VC-CMV), f = 12, tidal volume (VT) 600 mL, PF 40 L/min, PEEP 5 cm H2O, FIO2 0.60

C

A 5-foot 1-inch tall female patient receiving PSV 6 cm H2O is showing signs of accessory muscle use and is exhaling a Vt of 220 mL at a rate of 28 breaths/min. The most appropriate action at this time is which of the following? A. Adjust the FiO2 B. Increase the set flow rate C. Increase the PSV to 10 cm H2O D. Adjust the flow cycling percent

C

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

C

A mechanically ventilated patient has been using an HME for humidification for the past 72 hours. During rounds and chart review, the respiratory therapist notices a steady increase in PIP over the past 2 days. The respiratory therapist suctions the patient to access the secretions. The secretions are very thick and tenacious. The most appropriate action at this time is which of the following? A. Suction the patient more often B. Add a passover humidifier to the system C. Switch to a heated wick-type humidifier D. Use normal saline to lavage before suctioning

C

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

C

A post-thoracic surgery patient currently receiving mechanical ventilation on VC-CMV with 60% oxygen has the following arterial blood gas: pH 7.45, PaCO2: 36 mmHg, PaO2: 68 mmHg. The patient's peak inspiratory pressures are averaging 55 cm H20. The ventilator mode that is most appropriate at this time is which of the following? A. PSV B. VC-IMV with PEEP C. PC-CMV with PEEP D. MMV

C

Both mandatory and spontaneous and all or part of the breath is generated by the ventilator describes which kind of breath? A. Mandatory B. Spontaneous C. Assisted D. Normal breathing

C

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

C

Every breath from the ventilator is time or patient triggered, pressure limited, and time cycled. This describes which of the following ventilator modes? A. Pressure support ventilation (PSV) B. Continuous positive airway pressure (CPAP) C. Pressure-controlled continuous mandatory ventilation (PC-CMV) D. Volume-controlled intermittent mandatory ventilation (VC-IMV)

C

Every breath from the ventilator is time or patient triggered, pressure targeted (limited), and time cycled. This describes which of the following ventilator modes? A. PAug B. APRV C. PCV D. VC-IMV

C

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

C

Partial ventilatory support can be provided by which of the following ventilator modes? 1. Pressure-controlled continuous mandatory ventilation (PC-CMV) set rate 8 breaths/min 2. Volume-controlled intermittent mandatory ventilation (VC-IMV) set rate 4 breaths/min 3. Pressure-controlled intermittent mandatory ventilation (PC-IMV) set rate 10 breaths/min 4. VC-MMV set Ve8 L/min A. 1 and 2 only B. 2 and 3 only C. 2 and 4 only D. 3 and 4 only

C

The most appropriate initial settings for a 5-foot 4-inch tall female postoperative patient with no lung disease would be which fo the following? A. PC-CMV, PIP 35 cm H2O, f 20 breaths/min, PEEP +10 cm H2O B. PC-SIMV, PIP 20 cm H2O, f 6 breaths/min, PEEP +8 cm H2O C. VC-CMV, 450 mL, f 10 breaths/min, PEEP +5 cm H2O D. VC-CMV, 700 mL, f 14 breaths/min, PEEP 0 cm H2O

C

The pattern that has been shown to improve the distribution of gas in the lungs for an intubated patient on volume-controlled continuous mandatory ventilation (VC-CMV) is which of the following? A. Sine waveform B. Ascending ramp C. Descending ramp D. Square waveform

C

The physician requests that the respiratory therapist make a recommendation for a patient with post polio complaints of increasing daytime weakness. Her VC is 12 mL/kg and maximal inspiratory pressure is -32 cm H2O. Her ABG on room air reveals pH 7.38, PaCO2 46 mmHg, PaO2 74 mmHg, and HCO3 24 mEq/L. The respiratory therapist should suggest which of the following? A. Tracheostomy with PSV B. Tracheostomy with VC-CMV C. BiPAP via nasal mask at night D. Full face mask CPAP with supplemental oxygen

C

The ventilator mode that would be most appropriate to iatrogenically induce hyperventilation to manage a closed head injury patient with severely elevated intracranial pressure (ICP) is which of the following? A. Volume support ventilation (VSV) B. Airway pressure release ventilation (APRV) C. Pressure-controlled continuous mandatory ventilation (PC-CMV) D. Volume-controlled intermittent mandatory ventilation (VC-IMV)

C

What is the alarm parameter for low exhaled tidal volume? A. 5-10% below set Vt B. 5-10% above set Vt C. 10-15% below set Vt D. 10-15% above set Vt

C

A 45-year-old, 73-inch-tall, 200 lb male patient is admitted to the emergency department with an exacerbation of myasthenia gravis. 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? A. Pressure support ventilation (PSV) 5 cm H2O, continuous positive airway pressure (CPAP) 10 cm H2O, FIO2 0.50 B. 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, fractional inspired oxygen (FIO2) 0.45 C. 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 0.30 D. Volume-controlled intermittent mandatory ventilation (VC-IMV), f = 12 breaths/min, tidal volume (VT) = 725 mL, PSV 5 cm H2O, PEEP 5 cm H2O, FIO2 0.24

D

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? A. Face mask continuous positive airway pressure (CPAP) 10 cm H2O B. 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, fractional inspired oxygen (FIO2) 1.0 C. Intubate, volume-controlled intermittent mandatory ventilation (VC-IMV), f 6, VT 425 mL, PEEP 10 cm H2O, FIO2 0.80 D. 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, FIO2 0.60

D

A 75-year old female, admitted through the ED earlier today, is increasingly distressed and unable to breath comfortably except in the upright position. She has a history of coronary artery disease, and on admission, she was complaining of chest pain. She is becoming increasingly short of breath and appears cyanotic. Vital signs reveal pulse 142 bpm, blood pressure 150/92, and RR 30 breaths/min and labored. The ABG on nasal cannula 3 L/min is pH 7.18, PaCO2 81 mmHg, PaO2 35 mmHg, SaO2 79%, and HCO3 29 mEq/L. The RT should recommend which of the following? A. Nasal mask CPAP at +10 cm H2O B. Nonrebreathing mask with 15 L/min oxygen C. Bilevel PAP: Inspiratory positive airway pressure (IPAP) 15 cmH2O and expiratory positive airway pressure (EPAP) 5 cmH2O D. Intubation and mechanical ventilation with PC-CMV

D

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? A. Pressure-controlled continuous mandatory ventilation (PC-CMV) with positive end- expiratory pressure (PEEP) B. Sedation and paralysis C. Permissive hypercapnia D. Iatrogenic hyperventilation

D

If a patients ventilator is set up to 60%, what do you need to add? A. Pressure support B. Longer I-time C. Inspiratory hold D. PEEP

D

If flow sensitivity is not set appropriately, what can occur in CMV? 1. dysynchrony 2. Low pressure alarms 3. High MAP 4. Auto-trigger A. 1 only B. 2 and 3 only C. 1, 2, and 4 only D. 1 and 4 only

D

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

D

The appropriate minute ventilation for a male with a BSA of 2.3 m2 and a body temperature of 40 degrees C is which of the following? A. 8.2 L/min B. 9.6 L/min C. 10.6 L/min D. 11.7 L/min

D

The ventilator mode that allows the patient to breathe spontaneously at two levels of positive pressure is known as which of the following? A. CPAP B. PAug C. PRVC D. APRV

D

Ventilator controls the timing, the tidal volume and the inspiratory pressure is what kind of ventilator mode? A. Assist control B. Pressure support C. IMV D. CMV

D

What is the alarm parameter for high pressure? A. 5-10 below PIP B. 5-10 above PIP C. 10-15 below PIP D. 10-15 above PIP

D

What is the alarm parameter for low pressure? A. 10-15 above PIP B. 10-14 below PIP C. 5-10 above PIP D. 5-10 below PIP

D

What ventilator modes provide partial ventilatory support? 1. SIMV 2. PSV 3. VS 4. MMV 5. PAV A. 1, 2, 4, 5 B. 2 and 3 C. 1, 2, and 5 D. 1, 2, 3, 4, and 5

D

When lung compliance decreases while a patient is receiving mechanical ventilation with PCV which of the following will occur? A. Peak pressure will increase. B. Peak pressure will decrease. C. Tidal volume will increase. D. Tidal volume will decrease.

D

Which are true regarding to mechanical ventilator humidity? 1. Normal breathing: 44 mg/L 2. Water at 37 C 3. 10-14 mg/L at Vt between 500 mL and 1000 mL 4. Hygroscopic ones deliver 22-34 mg/L A. 1 only B. 1 and 2 only C. 1, 3, and 4 only D. 1, 2, 3, and 4

D