RRT Kettering website Mechanical Ventilation Questions
A 57-year-old male patient requires mechanical ventilation following removal of his right upper lobe. The chest radiograph shows right-side consolidation. Ventilatory data and blood gas results are: Ventilator Settings: Mode: VC, SIMV VT: 450 mL Set rate: 20 /min Total rate: 20 /min FIO2: 1.0 PEEP: 18 cm H2O PIP: 55 cm H2O ABG Results: pH: 7.41 PaCO2: 39 torr PaO2: 43 torr HCO3: 23 mEq/L BE: 0 mEq/L The respiratory therapist should recommend A. independent lung ventilation. B. inverse ratio ventilation. C. pressure support ventilation. D. pressure control ventilation.
a Since this is an O2 problem and this pt had right lung surgery and the right lung is having trouble. The best answer will be to help that lung so independent lung therapy will help the lung that needs it.
A 22-year-old female patient with ARDS receives volume-control ventilation. The patient's airway resistance and compliance are gradually improving throughout the course of the day shift. At the start of the shift, the peak pressure was 35 cm H2O; eight hours later the peak pressure is 25 cm H2O. Based on this information, which of the following alarms should the respiratory therapist consider readjusting? A. Low oxygen B. Low pressure C. Low tidal volume D. Low-minute volume
b
A 28-week gestational age infant with severe respiratory distress syndrome receives mechanical ventilation in the PC, SIMV mode at the following settings: PIP: 28 cm H2O Set rate: 32 /min FIO2: 0.70 I-time: 0.8 seconds Flow rate: 6 L/min Umbilical arterial blood gas results: pH: 7.40 PCO2: 39 torr PO2: 42 torr HCO3-: 23 mEq/L Based on the above information, the respiratory therapist should change the A. I-time to 1.0 second. B. PEEP to 7 cm H2O. C. FIO2 to 0.75. D. PIP to 30 cm H2O.
b
A 44-year-old patient with ARDS receives mechanical ventilation in the Pulmonary ICU at the following settings: Mode: PC, A/C Peak Pressure: 36 cm H2O Plateau Pressure: 30 cm H2O Mandatory Rate: 18/min Total Rate: 20/min FIO2: 0.85 PEEP: 12 cm H2O Mean Arterial Pressure: 88 mm Hg Despite increasing the PEEP, the patient's SpO2 remains at 84%. What additional therapy should the respiratory therapist recommend to improve the patient's condition? A. Administer surfactant replacement therapy B. Place the patient in the prone position C. Initiate extracorporeal membrane oxygenation D. Switch to independent lung ventilation
b
A 52-year-old, 5' 8" male patient (70 kg, 154 lb) receives mechanical ventilation. The following data have been measured and recorded: Ventilator Settings: Mode: VC, A/C VT: 700 mL Set rate: 16/min Total rate: 16/min FIO2: 0.40 PEEP: 5 cm H2O ABG Results: pH: 7.47 PaCO2: 31 torr PaO2: 87 torr SaO2: 97% HCO3-: 23 mEq/L BE: 0 mEq/L Based upon this assessment, the respiratory therapist should A. decrease the set rate to 10/min. B. decrease the VT to 600 mL. C. increase the FIO2 to 0.45. D. increase the PEEP to 8 cm H2O.
b
A 52-year-old, 5' 9" tall male patient (85 kg, 187 lb.) is mechanically ventilated. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below: Mode: VC, A/C FIO2: 0.40 Set rate: 10/min Total rate: 10/min VT: 550 mL PEEP: 5 cm H2O Mechanical VD: 50 mL pH: 7.28 PaCO2: 74 torr PaO2: 57 torr SaO2: 86% HCO3-: 23 mEq/L BE: 0 mEq/L The respiratory therapist should increase the A. VT to 700 mL. B. set rate to 14/min. C. FIO2 to 0.65. D. PEEP to 15 cm H2O.
b
A 56-year-old male patient (90 kg, 198 lb) currently receives mechanical ventilation in the PC, SIMV mode. The following data are measured and recorded: Peak pressure: 35 cm H2O Set rate: 20 /min Total rate: 20 /min FIO2: 1.00 PEEP: 18 cm H2O Arterial blood gas results show: pH: 7.35 PaCO2: 45 torr PaO2: 43 torr HCO3-: 22 mEq/L It would be appropriate for the respiratory therapist to A. increase the set rate to 25 /min. B. switch to inverse ratio ventilation. C. increase pressure to 40 cm H2O. D. increase PEEP to 25 cm H2O.
b
A patient receives non-invasive positive pressure ventilation (NIPPV) with a Bi-level positive airway pressure ventilator at the following settings: IPAP: 25 cm H2O EPAP: 5 cm H2O Rate: 10 /min Arterial blood gas results are: pH: 7.49 PaCO2: 29 torr PaO2: 110 torr SaO2: 98% HCO3-: 25 mEq/L Which of the following should the respiratory therapist recommend? A. Increase the IPAP B. Decrease the IPAP C. Increase the EPAP D. Decrease the EPAP
b
A premature neonate with respiratory distress syndrome receives mechanical ventilation with a time-cycled, pressure-limited ventilator at the following settings: PIP: 25 cm H2O Rate: 28/min Flow: 7 L/min I-time: 0.5 sec. FIO2: 0.70 PEEP: 4 cm H2O The following blood gas results are obtained from an umbilical artery line: pH: 7.30 PaCO2: 59 torr PaO2: 66 torr HCO3-: 22 mEq/L The respiratory therapist should now recommend A. increasing PEEP. B. increasing I-time. C. decreasing rate. D. decreasing PIP.
b
A spontaneously breathing 76-year-old patient who weighs 60 kg (132 lb) is on an FIO2 of 0.45 via a trach collar. He has had a change in his tidal volume from 600 mL to 300 mL and his respiratory rate went from 12 /min to 24 /min. Which of the following changed due to the change in the tidal volume and rate? A. Minute ventilation B. Alveolar ventilation C. Anatomical deadspace D. Mechanical deadspace
b
An 8-year-old child is being weaned from volume-control ventilation. Each time the respiratory therapist attempts to wean by decreasing the SIMV rate by 2 breaths/min, the child develops diaphoresis and tachypnea. Which of the following should the therapist recommend? A. Attempt T-tube weaning trials B. Use pressure support with SIMV C. Increase the FIO2 by 10% during the weaning attempts D. Discontinue all weaning attempts
b
An infant on a high-frequency jet ventilator (rate of 150 b/m) has the following arterial blood gases: pH: 7.30 PaO2: 60 torr PaCO2: 50 torr HCO3-: 21 mEq/L Which of the following changes would best help to improve these results? A. Increase the inspiratory time B. Increase the drive pressure C. Increase the frequency to 190 br/min D. Increase the FIO2
b
Calculate alveolar minute ventilation for a patient who weighs 68 kg (150 lb), has a spontaneous tidal volume of 450 mL, and a respiratory rate of 12 breaths/min. A. 1.8 L/min B. 3.6 L/min C. 5.4 L/min D. 8.6 L/min
b
The peak inspiratory pressure on a time-cycled, pressure-limited ventilator was changed from 20 cm H2O to 25 cm H2O. Which of the following alarms should be readjusted? A. PEEP B. Low pressure C. Peak pressure D. I:E ratio
b
Which of the following is NOT a primary ventilation parameter measured and displayed to create airway graphics of continuous mechanical ventilation? A. Flow B. PEEP C. Tidal volume D. Airway pressure
b All four can be observed on the graphics but PEEP is not the key parameter that needs a continuing monitor
An 1800 g premature neonate is receiving 30% oxygen via an oxyhood with the following arterial blood gas results obtained: pH: 7.34 PaO2: 46 torr PaCO2: 47 torr HCO3-: 22 mEq/L Based upon this information, which of the following should the respiratory therapist recommend at this time? A. Intubate and initiate mechanical ventilation B. Increase the FIO2 C. Administer CPAP via endotracheal tube D. Deliver noninvasive positive pressure ventilation
b Co2 <50 Po2 >60 Since this baby is on an oxyhood at 30% you can raise it to 40% if you go up to 60% then it will be CPAP next.
A 30-year-old male who weighs 68 kg (150 lbs.) has a minute ventilation of 9.0 liters/minute and a respiratory rate of 20 breaths/minute. What is his alveolar minute volume? A. 4 liters/minute B. 6 liters/minute C. 8 liters/minute D. 12 liters/minute
b Formula (VT-VD) RR To get the VT since it's not given to us you will need to take the L/min and divide it by the breath/min. 9 L / 20 breaths = 450 VT (450-150)20 (300)20 6 L/min
A female patient with a sub-arachnoid hemorrhage (5' 2", 65 kg, 143 lb) receives mechanical ventilation at the following settings: Mode: VC, A/C VT: 525 mL Set rate: 12 /min Total rate: 12 /min FIO2: 0.40 PEEP: 0 cm H2O I:E Ratio: 1:2 The following information is available: pH: 7.35 PaCO2: 41 torr PaO2: 85 torr HCO3-: 23 mEq/L SaO2: 94% Intracranial Pressure: 30 mm Hg The respiratory therapist should A. increase the tidal volume. B. increase the respiratory rate. C. add 50 mL of deadspace. D. add expiratory resistance.
b Her ICP is at 30 and should be 5-10 to fix this you will need this pt to hyperventilate. By increasing the RR will help with this issue and blow off C02. Wouldn't increase the VT because it is already on the higher side.
A 12-year-old girl (40 kg, 88 lb) receives continuous mechanical ventilation following an accidental drug overdose. The respiratory therapist notes the following: Ventilator Settings: Mode: VC, SIMV VT: 500 mL Set rate: 15/min Total rate: 15/min FIO2: 0.30 Arterial blood gases are as follows: pH: 7.58 PCO2: 23 torr PO2: 141 torr HCO3-: 22 mEq/L The therapist should A. decrease the tidal volume. B. decrease the respiratory rate. C. decrease the FIO2. D. add mechanical deadspace.
a
A 44-year-old male patient is being mechanically ventilated with a volume-cycled ventilator. The respiratory therapist observes that there is insufficient time for the patient to exhale completely. The therapist should A. increase the flow. B. decrease the minute volume. C. add expiratory retard. D. remove mechanical deadspace.
a
A 46-year-old female patient (65 kg,143 lb) receives mechanical ventilation following a motor vehicle accident. Current ventilator settings: Mode: VC, SIMV VT: 500 mL Set rate: 10/min Total rate: 16min FIO2: 0.40 Pressure support: 25 cm H2O Arterial blood gas results: pH: 7.51 PCO2: 29 torr PO2: 140 torr HCO3-: 22 mEq/L Based upon this information, the respiratory therapist should A. decrease pressure support to 20 cm H2O. B. decrease FIO2 to 0.30. C. place the patient on a T-piece at 50% oxygen. D. decrease set rate to 8/min.
a
A 48-year-old female patient is intubated and mechanically ventilated with a volume-cycled ventilator. The following parameters were obtained from the ventilator flow sheet: Time SpO2 PIP Pplat PEEP 2:00p 93% 30 25 5 3:00p 88% 42 30 10 Based on this information, the respiratory therapist should conclude that A. airway resistance is increasing. B. compliance is decreasing. C. SpO2 measurement is inaccurate. D. a decrease in percent shunt occurred.
a
A 60-year-old male patient (80 kg, 176 lb) receives volume-control ventilation at the following settings: Set VT: 800 mL Exhaled VT: 760 mL Inspiratory flowrate: 60 L/min PIP: 65 cm H2O PPL: 58 cm H2O PEEP: 5 cm H2O Which of the following statements best describes the patient's current situation? A. Dynamic compliance is decreasing. B. Static compliance is increasing. C. Airway resistance is increasing. D. Thoracic compliance is increasing.
a
A 80 kg (176 lb) patient with pulmonary fibrosis is being mechanically ventilated with a volume-controlled ventilator at the following settings: Mode: SIMV VT: 700 mL Mandatory rate: 15 Total rate: 15 FIO2: 0.45 PEEP: +10 I:E Ratio: 1:2 PIP: 50 cmH2O Arterial Blood Gas analysis reveals the following: pH: 7.34 PaCO2: 42 torr PaO2: 55 torr HCO3-: 22 mEq/L SaO2: 88% The respiratory therapist should recommend A. increasing the FIO2 to 60%. B. decreasing the respiratory rate. C. increase the PEEP level to 20 cm H2O. D. changing to pressure control mode.
a
A patient with COPD is being weaned from the ventilator using SIMV and pressure support of 6 cm H2O. The patient's spontaneous respiratory rate is 28/minute. Arterial blood gas results show: pH: 7.35 PaO2: 68 torr PaCO2: 56 torr SpO2: 92% Based upon these results, the respiratory therapist should recommend which of the following? A. Increase the pressure support B. Return to full ventilator support C. Increase the SIMV rate D. Increase the FIO2
a
In order to reduce the mean airway pressure value for a patient receiving continuous volume-cycled ventilation, the respiratory therapist should recommend decreasing the A. inspiratory time. B. peak flow rate. C. expiratory time. D. triggering effort.
a
Which of the following is NOT an indication for continuous mechanical ventilation? A. MIP -20 cmH2O B. acute ventilatory failure C. VT < 5 mL/kg D. VC < 10 mL/kg
a
Which of the following would be most helpful in determining if a patient is developing ventilatory failure? A. Arterial blood gas B. Blood pressure C. Vital capacity D. Hematocrit
a
Which of the following statements are TRUE concerning mechanical deadspace? 1. It will change the VD/VT ratio. 2. It is contraindicated for a patient with a closed head injury. 3. It increases the work of breathing. 4. It should be used in the SIMV mode. A. 1, 2 and 3 only B. 1, 2 and 4 only C. 1, 3 and 4 only D. 2, 3, and 4 only
a For this question, mechanical VD is tubing between the pt endotracheal tube and the wye adaptor. Its ventilation is rebreathe, the pt exhales in there and inhales in there. it will adjust the C02. It should not be used in the SIMV mode because it adds stress to the pt.
All of the following could be causing the peak pressure alarm to sound on a volume-cycled ventilator EXCEPT: A. airway resistance has decreased B. the patient needs to be suctioned C. compliance has decreased D. an insufficient amount of time for exhalation
a If airway resistance is decreasing instead of increasing, then you don't have secretions or bronchospasm they have a wide-open airway which means the pressure should drop
A 1600 g neonate is on a pressure-limited, time-cycled ventilator at a pressure of 30 cm H2O, IMV rate of 26 /min, FIO2 0.60 and a PEEP of 5 cm H2O. Arterial blood gas results reveal: pH: 7.33 PaO2: 58 torr PaCO2: 45 torr SaO2: 89% Based upon these results, which of the following should the respiratory therapist recommend? A. Increase the PEEP to 8 cm H2O B. Increase the rate to 28/min C. Increase the FIO2 to 0.65 D. Increase the pressure to 32 cm H2O
a Looking at the ABG the C02 is good but the O2 is low, we will need to fix the O2 level. Their Fi02 is at 60% and they have a PEEP of 5, with this you can increase the PEEP.
A 6-year-old child who weighs 20 kg (44 lb) is intubated and requires mechanical ventilation at the following settings following an accidental drug overdose: Mode: VC, A/C Tidal volume: 175 mL Set rate: 12 /min Total rate: 15 /min FIO2: 0.80 Arterial blood gas results: pH: 7.48 PaCO2: 31 torr PaO2: 54 torr HCO3-: 22 mEq/L The respiratory therapist should A. initiate 4 cm H2O PEEP. B. decrease the rate to 10 /min. C. increase the tidal volume to 300 mL. D. increase the FIO2 to 0.85.
a Looking at the Fi02 80% is high for a kid. Now with the ABG this child is ventilating but they are not getting enough oxygenation. Since they have an high Fi02 you wouldn't increase it but you will add PEEP to help with the hypoxia.
A 3-year-old child with cystic fibrosis receives mechanical ventilation at the following settings: Mode: PC, SIMV PIP: 34 cm H2O Rate: 22 /min FIO2: 0.60 PEEP: 6 cm H2O I-time: 1.0 second Arterial blood gas results show: pH: 7.36 PaCO2: 44 torr PaO2: 49 torr HCO3-: 24 mEq/L The respiratory therapist should adjust the A. PEEP to 8 cm H2O. B. FIO2 to 0.65. C. set rate to 24 /min. D. PIP to 36 cm H2O.
a Since the Fi02 is already at 60% and this is an oxygenation problem plus they are on a peep of 6 so you can go higher and adjusting the peep will help with the O2
Which of the following ventilator controls should NOT be adjusted if the I:E ratio alarm is activated with each mandatory breath? A. rate B. sensitivity C. volume D. flow
b Since the alarm is sounding this means there is an inverse ratio. To fix an I:E ratio alarm problem you just increase the flow which means you are blowing the air in faster and decreasing the inspiratory time and giving you more time to exhale before the next breath starts. Next will be the rate or VT. Increasing the rate will not allow much time between breath and vice versa affecting the E-time. VT can affect the I:E ratio if increasing the volume being delivered will take more time of getting it and will add to your inspiratory time and decrease your expiratory time and vice versa. Sensitivity has no direct effect in this matter.
The respiratory therapist reviews the ventilator flow sheet for a post-op patient. The ventilator settings have not changed during the past 24 hours. The peak and plateau pressures were recorded as follows: This information would indicate that A. airway resistance is increasing. B. lung compliance is decreasing. C. the patient needs to be suctioned. D. the patient can begin weaning.
b The PIP keeps going up and you might think this pt needs to be suctioned. PIP is made up of two things airway resistance and lung stiffness. Look at the difference at 7am there is a 5 difference, 9am there is a 5 difference and 11am there is a 6 difference which means the airways resistance hasn't changed but the Pplat is showing the lungs are becoming stiffer and stiffer. While the Pplat goes up means the lung compliance is decreasing.
A 32-year-old victim of a motor vehicle accident (80 kg, 176 lb) receives mechanical ventilation at the following settings: Mode: VC, SIMV Tidal volume: 700 mL Mandatory rate: 10/min FIO2: 0.65 PEEP: 17 cm H2O As the PEEP level was adjusted from 17 cm H2O to 20 cm H2O, the respiratory therapist observed that the heart rate changed from 128/min to 106/min. Based on this information, the therapist should recommend A. inserting a balloon-tipped flow-directed catheter. B. drawing an arterial blood gas. C. reassessing the patient in 20 minutes. D. decreasing the PEEP level to 17 cm H2O.
b The decrease in HR can be a good or bad sign so for this situation, the best answer would be to get an ABG to see if they have approved oxygenation or if it is worsening.
A male patient (6' 2" tall, 80 kg, 176 lb) requires mechanical ventilation following exploratory laparotomy at the following settings: Mode: VC, A/C VT: 700 mL Set rate: 12 /min. Total rate: 18 /min. FIO2: 0.50 PEEP: 6 cm H2O Arterial blood gas results are: pH: 7.49 PaCO2: 32 torr PaO2: 90 torr HCO3-: 24 mEq/L Based on this information, the respiratory therapist should A. add mechanical deadspace. B. change to VC, SIMV. C. decrease the FIO2 to 0.45. D. initiate pressure support.
b This pt is being over ventilated a bit so changing to VC/SIMV will reduce the number of mandatory breath and the ventilation will drop a bit will help correct the over ventilation
An infant born after 26 weeks of gestation exhibits signs of respiratory distress including nasal flaring and retractions. Physical examination reveals heart rate 180/min, respiratory rate 72/min, blood pressure 60/38 mm Hg. The chest radiograph indicates a reticulonodular appearance. The respiratory therapist should recommend A. nasal CPAP at 10 cm H2O. B. assisted ventilation. C. 100% oxygen via hood. D. Q1H monitoring.
b This pt is developing IRD and 02 therapy with a decent number isn't suggested and 100% is too high for a baby just like the CPAP at 10 cmH20. Since those are high for this baby the best answer would be assisted ventilation.
While performing routine ventilator parameter checks on a patient weighing 80 kg (176 lb), the respiratory therapist notes the following: Mode: VC, SIMV Set rate: 12 /min. Total rate: 12 /min. FIO2: 0.65 VT: 700 mL The arterial blood gas results are as follows: pH: 7.47 PaCO2: 34 torr PaO2: 55 torr HCO3-: 23 mEq/L Which of the following should the therapist recommend at this time? A. Decrease rate to 10 /min. B. Add 6 cm H2O PEEP C. Increase FIO2 to 0.70 D. Decrease VT to 600 mL
b Ventilation is adequate and oxygenation is not adequate. So it will be a 02 problem. Since they have a Fi02 at 65% you can add PEEP therapy to bring up the O2 levels
A 70 kg (154 lb) patient is receiving mechanical ventilation in the VC, A/C mode following cardiopulmonary arrest. The respiratory therapist notes the following data: Set rate: 10 br/min. Total rate: 10 br/min. FIO2: 0.65 VT: 650 mL The arterial blood gas results are as follows: pH: 7.30 PCO2: 56 torr PO2: 78 torr HCO3-: 21 mEq/L The therapist should A. institute PEEP therapy at 5 cm H2O. B. increase the set rate to 12 br/min. C. increase the FIO2 to 0.70. D. increase the VT to 800 mL.
b You wouldn't raise the VT to 800 because that's too high, so the only ventilation function left is raising the RR
A 29-year-old female patient is in the PACU following mitral valve replacement. She is being mechanically ventilated in the VC, A/C mode, and is combative. The peak pressure alarm is sounding with each breath. The nurse practitioner has a STAT call into the cardiovascular surgeon. The nurse asks the respiratory therapist for an immediate recommendation. Which of the following should the therapist recommend? A. Increase the peak pressure alarm limit B. Order a STAT chest x-ray C. Change to SIMV mode and evaluate the patient D. Order a STAT arterial blood gas
c
A 48-year-old patient is receiving mechanical ventilation following a hernia repair. He is 6' tall and weighs 75 kg (165 lb). Prior to initiating a spontaneous breathing trial, the respiratory therapist notes the following information: FIO2: 0.35 SIMV mandatory rate: 6 /min. Total rate: 14 /min. VT: 600 mL MIP: -26 cm H2O Spont. VT: 400 mL Arterial blood gas results show: pH: 7.39 PaCO2: 42 torr PaO2: 88 torr HCO3-: 23 mEq/L The patient is to be placed on CPAP with an FIO2 of 0.40. Five minutes into the SBT, his respiratory rate increases to 28 /min., heart rate changes from 110 /min. to 135 /min. and blood pressure changes from 112/70 mm Hg to 140/88 mm Hg. At this time, the therapist should A. shorten the SBT by 5 minutes. B. continue the SBT. C. discontinue the SBT. D. increase the FIO2 to 0.45.
c
A 52-year-old, 5' 9" tall male patient weighing 85 kg (187 lb) is being mechanically ventilated. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below: Mode: Assist/Control FIO2: 0.40 Mandatory rate: 10 Total rate: 10 VT: 650 mL PEEP: 5 cm H2O Mechanical VD: 100 mL pH: 7.28 PaCO2: 74 torr PaO2: 57 torr SaO2: 86% HCO3-: 23 mEq/L BE: 0 mEq/L Which of the following changes should be recommended at this time? A. Decrease the VT to 550 mL B. Decrease the mandatory rate to 8 C. Decrease the mechanical deadspace D. Decrease the FIO2 to 0.35
c
A 59-year-old patient is transferred from the post-anesthesia care unit to the ICU following coronary artery bypass surgery. The patient receives mechanical ventilation in the VC, A/C mode. He appears to be agitated and triggers the ventilator at a fast rate, causing the high-pressure alarm to sound repeatedly. The respiratory therapist should A. switch to SIMV mode. B. initiate pressure support. C. recommend morphine sulfate. D. recommend rocuronium bromide.
c
A 65 kg (150 lb) patient requires a minute alveolar ventilation of 10 L/min. Which of the following set of parameters would be most appropriate? A. VT 600 mL, RR 16 /min, VD mech 0 mL B. VT 650 mL, RR 18 /min, VD mech 50 mL C. VT 700 mL, RR 20 /min, VD mech 50 mL D. VT 900 mL, RR 12 /min, VD mech 100 mL
c
A 70 kg (154 lb) male patient receives mechanical ventilation following a triple coronary artery bypass graft. The chest radiograph shows bilateral radiolucency. Ventilatory data and blood gas results are: Ventilator Settings: Mode: VC, SIMV VT: 650 mL Spontaneous VT: 175 mL Mandatory rate: 8/min Total rate: 16/min FIO2: 0.40 PIP: 29 cm H2O Plateau Pressure: 21 cm H2O PEEP: 5 cm H2O ABG Results: pH: 7.31 PaCO2: 54 torr PaO2: 83 torr HCO3-: 23 mEq/L BE: 0 mEq/L Which of the following should the respiratory therapist recommend? A. Independent lung ventilation B. Pressure control ventilation C. Pressure support ventilation D. Inverse ratio ventilation
c
A patient rescued from a collapsed building sustained multiple chest injuries receives mechanical ventilation at the following settings: Mode: VC, SIMV VT: 750 mL Mandatory rate: 12/min Total rate: 12/min FIO2: 0.50 PEEP: 5 cm H2O Peak flow: 50 L/min. During a routine ventilator assessment, the respiratory therapist observes the following volume-pressure loop: Which of the following changes should the therapist recommend? A. Increase the PEEP B. Change to pressure support mode C. Decrease the VT D. Increase the peak flow
c
A patient with morbid obesity is being weaned from the ventilator following cholecystectomy. Arterial blood gas results reveal: pH: 7.40 PaO2: 96 torr PaCO2: 43 torr SaO2: 94% The patient's current ventilator settings are: Tidal volume 650 mL, SIMV mandatory rate 4 /min, PEEP 5 cm H2O, and FIO2 0.35 even though she is not fully conscious. What should the respiratory therapist recommend at this time? A. Extubate B. Re-evaluate in 1 hour C. Place on CPAP at an FIO2 0.45 D. Repeat arterial blood gases in 30 minutes
c
A premature neonate developed respiratory distress syndrome and is mechanically ventilated with a pressure-limited, time-cycled ventilator at the following settings: PIP: 25 cm H2O Rate: 24/min Flow: 7 L/min I-time: 0.6 sec. FIO2: 0.45 PEEP: 4 cm H2O Arterial blood gas results from an umbilical artery line are as follows: pH: 7.29 PaCO2: 62 torr PaO2: 68 torr HCO3-: 22 mEq/L The respiratory therapist should now recommend A. increasing the PEEP. (This will improve oxygenation) Increase FI02 first to 60% B. increasing the I-time. C. increasing the rate. D. decreasing the PIP. (Increasing PIP not decrease)
c
A respiratory therapist reviews a ventilator parameter sheet and finds that the peak inspiratory pressure has been gradually rising for the past several hours. Which of the following could be the cause for this change? 1. Bronchospasm 2. Increasing pulmonary compliance 3. Accumulation of secretions 4. Increasing airway resistance A. 2 only B. 1 & 3 only C. 1, 3 & 4 only D. 1, 2, 3 & 4
c
An adolescent patient admitted with a drug overdose receives mechanical ventilation at the following settings: Mode: PC, A/C Set Rate: 16/min Flow: 25 L/min Pressure limit: 40 cm H2O FIO2: 0.30 Exhaled VT: 500 mL The respiratory therapist observes wide fluctuations on the pressure manometer during inspiration. The most appropriate action would be to A. sedate the patient. B. increase the pressure limit. C. increase the flow rate. D. decrease the trigger setting.
c
The respiratory therapist reviews the ventilator flow sheet for a post-op patient. The ventilator settings have not changed during the past 24 hours. The peak and plateau pressures are recorded as follows: This information would indicate that A. airway resistance is decreasing. B. lung compliance is increasing. C. the patient needs suctioning. D. the patient can begin weaning.
c
The respiratory therapist reviews the ventilator parameter sheet for a patient receiving mechanical ventilation. The peak and plateau pressure readings are as follows: Based on this information, the therapist should conclude that A. airway resistance is increasing. B. water is building up in the tubing. C. pulmonary compliance is decreasing. D. minute volume is increasing.
c
A patient is receiving BiPAP® therapy and is complaining of eye irritation. What should the therapist do to correct the problem? A. Decrease the pressure B. Reassure the patient C. Reposition the mask D. Intubate the patient
c If the pt is complaining of eye irritation then it will have to do with the mask, so repositioning the mask won't put any pressure on the eyes.
A 45-year-old female patient who weighs 60 kg (132 lb) remains intubated in the Post-Anesthesia Care Unit after exploratory laparoscopy. She appears comfortable on 6 cm H2O of CPAP with an FIO2 of 0.35. Arterial blood gases and vital signs have been stable for the past two hours and the following information is obtained: Respiratory rate: 16 /min. MIP: 36 cm H2O VT: 400 mL VC: 1.2 L Based on this information, the respiratory therapist should recommend A. maintaining the current therapy. B. decreasing the CPAP to 4 cm H2O. C. extubating and monitoring the patient. D. obtaining a portable chest x-ray.
c Knowing your Normal's will help you with this question. RR is good, MIP >20 good, VT 400 good, VC 1.2 good. She has been stable for 2 hrs and nothing indicates there is a problem so pull the tube and monitor this patient.
A 10-year-old child with muscular dystrophy receives non-invasive ventilation at an IPAP of 10 cm H2O and an EPAP of 5 cm H2O. The set rate is 15 /min with the following arterial blood gases: pH: 7.34 PaCO2: 52 torr PaO2: 58 torr HCO3-: 26 mEq/L Which of the following should the respiratory therapist recommend? A. Switch to invasive ventilation. B. Decrease the set rate to 10 br/min. C. Change the IPAP to 15 cm H2O. D. Change the EPAP to 10 cm H2O.
c Since this is a ventilation problem and their IPAP is only at 10 cmH20 which is a low number for a 10-year-old child. Adjusting the IPAP will increase ventilation.
A 27-week gestation age neonate with respiratory distress syndrome receives high-frequency oscillatory ventilation at the following settings: PIP: 20 cm H2O Frequency: 12 Hz I-time: 30% FIO2: 0.55 PEEP: 4 cm H2O The following blood gas results are obtained from an umbilical artery line: pH: 7.15 PaCO2: 62 torr PaO2: 46 torr HCO3-: 22 mEq/L Based on this information, the respiratory therapist should recommend increasing A. PEEP. B. FIO2. C. frequency. D. amplitude.
d
A 32-year-old woman who is 165 cm (5' 6" inches) tall and weighs 100 kg (220 lb) has trauma to the chest from a motorcycle accident. The patient has been intubated and is being manually ventilated with a resuscitation bag. Morphine sulfate and pancuronium bromide have been administered. The physician asks the respiratory therapist to determine the initial ventilator settings. Which of the following should the therapist recommend? A. VC, A/C, rate 10, tidal volume 700 mL B. VC, SIMV, rate 24, tidal volume 400 mL C. VC, SIMV, rate 14, tidal volume 800 mL D. VC, A/C, rate 12, tidal volume 500 mL
d
A 5' 10", 80 kg (176 lbs) male patient with multiple trauma from a motorcycle accident has developed ARDS and is being ventilated at the following settings: Mode: VC SIMV VT: 500 mL Set Rate: 14 br/min. FIO2: 0.60 PEEP: 12 cm H2O Arterial blood gas results reveal: pH: 7.35 PaO2: 72 torr PaCO2: 44 torr SpO2: 93% The patient is conscious and pulling on the IV lines and ventilator tubing. At this time, the respiratory therapist should recommend A. changing to assist/control mode. B. restraining the patient. C. increasing the set rate to 16 br/min. D. sedating the patient.
d
A 6' 2" tall, 80 kg (176 lb) male patient with a diagnosis of alpha-1 protease inhibitor deficiency receives mechanical ventilation at the following settings: Mode: VC, SIMV Set rate: 12 br/min Total rate: 16 br/min Tidal volume (set): 650 mL Tidal volume: 320 mL Peak flow: 55 L/min FIO2: 0.30 The patient is currently asleep, and all vital signs are stable. An arterial blood gas has been drawn with the following results: pH: 7.37 PaCO2: 51 torr PaO2: 68 torr HCO3-: 29 mEq/L Which of the following should the respiratory therapist recommend? A. Increase the set rate B. Decrease the tidal volume C. Increase the FIO2 D. Maintain current settings
d
A 70 kg (154 lb) male receives non-invasive positive pressure ventilation (NIPPV). Ventilator settings are: IPAP: 15 cm H2O EPAP: 5 cm H2O Arterial blood gases are as follows: pH: 7.33 PaCO2: 49 torr PaO2: 83 torr Which of the following IPAP / EPAP settings should the respiratory therapist recommend? A. 10 / 2 B. 15 / 10 C. 20 / 10 D. 20 / 5
d
A 75 kg (165 lb) male patient receives mechanical ventilation following coronary artery bypass surgery. The following data is recorded: Mode: VC, SIMV VT: 650 mL Set rate: 10 br/min Total rate: 14 br/min FIO2: 0.40 PEEP: 8 cmH2O Arterial blood gas results show: pH: 7.41 PCO2: 44 torr PO2: 85 torr HCO3-: 23 mEq/L Which of the following should the respiratory therapist recommend? A. Decrease the FIO2. B. Decrease the set rate to 8 br/min. C. Increase the PEEP to 10 cm H2O. D. Maintain the current settings.
d
A 78-year-old male patient is being treated for obstructive sleep apnea with bilevel-positive airway pressure at night. Arterial blood gas results reveal an elevated PaCO2 level. The respiratory therapist should recommend increasing the A. oxygen concentration. B. expiratory positive airway pressure (EPAP). C. inspiratory flow rate. D. inspiratory positive airway pressure (IPAP).
d
A post-operative patient underwent a craniotomy procedure 24 hours ago. The respiratory therapist notes that the patient is now thrashing about in the bed. The physician asks for a recommendation to stabilize his ICP and keep the patient from harming himself. The therapist should recommend administration of A. Anectine. B. Versed. C. Valium. D. Morphine.
d
An 80 kg (176 lb) male suffering from acute respiratory distress syndrome is mechanically ventilated at the following settings: Mode: VC, A/C Tidal Volume: 500 mL Set Rate: 10/min Total Rate: 10/min PIP: 68 cm H2O FIO2: 0.45 PEEP: 8 cm H2O The following patient information is available: pH: 7.37 PaCO2: 44 torr PaO2: 89 torr HCO3-: 22 mEq/L The respiratory therapist should A. decrease PEEP. B. change to SIMV. C. add pressure support. D. change to pressure control.
d
A patient receives mechanical ventilation at the following settings: Mode: VC, SIMV VT: 700 mL Mandatory rate: 12 /min Total rate: 12 /min FIO2: 0.50 PEEP: 5 cm H2O Peak flow: 40 L/min. The following scalar graphic is observed. Which of the following should the respiratory therapist recommend? A. Increase the PEEP B. Change to pressure control mode C. Decrease the tidal volumed. D. Increase the peak flow
d Since the graph is going above and below and doesn't go back to the 0 point before the next breath being, this is called air-trapping or auto-PEEP. So increasing the flow would decrease the I-time and letting them have more time to exhale.
A post-operative thoracotomy patient is receiving mechanical ventilation in the recovery room with a tidal volume of 750 mL SIMV mandatory rate 8/min FIO2 of 0.40. Arterial blood gas results show: pH: 7.36 PaO2: 89 torr PaCO2: 45 torr SaO2: 95% The patient is breathing fast and shallow. Based upon this information, the respiratory therapist should recommend A. repeating the arterial blood gas in 30 minutes. B. increase SIMV mandatory rate to 10/min. C. sedating the patient. D. paralyzing the patient with pancuronium bromide (Pavulon).
a The ABG looks fine so it means not to change any ventilator setting, also this pt just got done having surgery which means this pt might be in pain. We are not going to mess with the ventilation or oxygenation and the pt isn't fighting the ventilator, so we aren't going to sedate or paralyze this pt. This leaves the best answer is to do another ABG in 30 mins.
A 52-year-old male patient (6' 1", 80 kg, 176 lb) requires mechanical ventilation. Ventilatory data and blood gas results are below: Ventilator Settings Mode: VC, A/C VT: 750 mL Set rate: 14 /min Total rate: 14 /min FIO2: 0.40 PEEP: 10 cm H2O ABG Results: pH: 7.49 PaCO2: 28 torr PaO2: 87 torr SaO2: 96% HCO3-: 25 mEq/L BE: +1 mEq/L Which of the following changes should be recommended at this time? A. Decrease the set rate to 10 /min. B. Decrease the VT to 350 mL. C. Increase the PEEP to 15 cm H2O. D. Add 50 mL of mechanical deadspace.
a This situation is a ventilation problem, and he is hyperventilating. To help this pt you will need to decrease the RR because you wouldn't jump from a VT of 750 to 350 it's too much of a jump. Always do small adjustments.
A post-operative craniotomy patient is receiving mechanical ventilation and has an increased intracranial pressure reading. The goals of mechanical ventilation for this patient include all of the following EXCEPT A. increased PaCO2. B. keep airway pressure to a minimum. C. hyper-oxygenate. D. use minimum PEEP levels.
a When you have a pt with an increase ICP you should hyperventilate the pt which means keeping the C02 low, so this automatically cancels out A.
A patient receives mechanical ventilation at the following settings: Mode: VC, SIMV Set VT: 650 mL Mandatory rate: 12 /min Total rate: 12 /min FIO2: 0.50 PEEP: 5 cm H2O Peak flow: 50 L/min The following pressure-volume loop is observed: Which of the following should the respiratory therapist recommend? A. Increase the PEEP B. Change to pressure support mode C. Decease the VT D. Increase the peak flow
a Whenever you see, that the loop doesn't connect to 5 and had a flat line at the base this has to do with PEEP. So, by increasing the PEEP will help improve lung compliance and will help the loop connect back to 5
Which of the following parameters are acceptable for weaning a patient from continuous mechanical ventilation? 1. VD/VT: 65% 2. MIP: 18 cm H2O 3. QS/QT: 10% 4. A-aDO2: 12 torr (21% oxygen) A. 3 & 4 only B. 1 & 2 only C. 1 & 3 only D. 2 & 4 only
a You will need to know your normal for this problem VD/VT 20-40% MIP 20-80 cm H20 QS/QT <5% or no greater then 20% A-aD02 (21% 02) 5-10 torr or 10-15 torr
The respiratory therapist reviews the ventilator flow sheet for a patient who requires mechanical ventilation following surgery. The ventilator settings have not changed during the past 24 hours. The peak and plateau pressures were recorded as follows: This information would indicate that A. airway resistance is increasing. B. lung compliance is increasing. C. the patient can begin weaning. D. the PEEP should be increased.
d So for this problem, you want to look at the difference between the PIP and Pplat. At 7am the difference is 5, 9am the difference is 5, and 11am the difference is 6. This isn't a change in airway resistance but a lung compliance issue. As the Pplat is rising it is pushing the PIP up but the difference between the two are staying the same. Now the PEEP is at 5 so it is considered non-therapeutic. The pts Pplat is rising means their static compliance is falling and the treatment for that is to increase the PEEP and recruit alveoli.
A 52-year-old, 5' 9" tall male patient weighing 85 kg (187 lb) is being mechanically ventilated. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below: Mode: VC, A/C FIO2: 0.40 Mandatory rate: 16/min Total rate: 16/min VT: 800 mL PEEP: 5 cm H2O pH: 7.47 PaCO2: 31 torr PaO2: 87 torr SaO2: 96% HCO3-: 23 mEq/L BE: 0 mEq/L Which of the following changes should be recommended at this time? A. increase the rate to 20 /min B. increase the PEEP to 10 cm H2O. C. add 200 mL of mechanical deadspace. D. maintain current settings.
d The Co2 is a bit low, and the pH is high but the O2 is fine. The RR and the total rate are the same, so it shows that the pt isn't doing much on their own. From the answers they give you adding deadspace and would be a good answer but adding 200 deadspace is way too much. So in this situation, the best answer is to maintain the current settings.
A 15-year-old female patient who weighs 55 kg (121 lb) was admitted to the ICU with multiple trauma from a four-wheeler accident and developed ARDS after five days of mechanical ventilation. The respiratory therapist notes the following data: Ventilator Settings: Mode: VC, SIMV VT: 350 mL Set rate: 12 /min. Total rate: 14 /min. FIO2: 0.60 PEEP: 10 cm H2O The arterial blood gas results are as follows: pH: 7.34 PaCO2: 38 torr PaO2: 79 torr HCO3-: 21 mEq/L She appears agitated, is using her accessory muscles, and attempts to pull out her IV lines. Which of the following should the therapist recommend at this time? A. Change to VC, A/C B. Pancuronium bromide C. Succinylcholine D. Lorazepam
d This pt is pulling out her IV and is agitated so she is going nuts, we will need to sedate the pt to have her relax and this will fix the problem.
A 58-year-old woman who weighs 65 kg (143 lb) arrives in the surgical ICU following surgical repair of an abdominal aortic neurysm. She has a 60 pack year history of cigarette smoking and is currently smoking 1 pack/day. The physician has written orders to initiate mechanical ventilation. Prior to starting mechanical ventilation for this patient, the respiratory therapist should set all of the following controls EXCEPT A. FIO2. B. tidal volume C. frequency. D. PEEP.
d To set up a pt on MV you will need the Fi02, VT, and Frequency
