Question 1

What is the primary concern when using proning to improve oxygenation in the patient with ARDS?

Accepted Answer

A)  Sudden increase in PaCO2 
B)  Displacement of tubes and lines 
C)  Pneumothorax 
D)  Hemodynamic compromise 
A)  Sudden increase in PaCO2 
B)  Displacement of tubes and lines 
C)  Pneumothorax 
D)  Hemodynamic compromise

Question 2

Which of the following findings would you expect to see in a patient who has acute ventilatory failure with severe hypercapnia?

Accepted Answer

A)  Jugular vein distension 
B)  Pale, dry skin 
C)  Bradycardia 
D)  Hyperresponsiveness and dilated pupils 
A)  Jugular vein distension 
B)  Pale, dry skin 
C)  Bradycardia 
D)  Hyperresponsiveness and dilated pupils

Question 3

After setting up a patient on a ventilatory support device, which of the following supplementary equipment would you require to be available at the bedside?
1) Suction source and catheters
2) Backup artificial airway
3) Manual resuscitator with O2

Accepted Answer

A) 2 and 3 only 
B) 1 and 2 only 
C) 1, 2, and 3 
D) 1 and 3 only 
A) 2 and 3 only 
B) 1 and 2 only 
C) 1, 2, and 3 
D) 1 and 3 only

Question 4

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a VT of 550 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

Accepted Answer

A)  5500 ml/min (7.9 L/min) 
B)  6600 ml/min (8.6 L/min) 
C)  7400 ml/min (9.4 L/min) 
D)  8400 ml/min (11.4 L/min) 
A)  5500 ml/min (7.9 L/min) 
B)  6600 ml/min (8.6 L/min) 
C)  7400 ml/min (9.4 L/min) 
D)  8400 ml/min (11.4 L/min)

Question 5

A chronic obstructive pulmonary disease (COPD) patient receiving ventilatory support in the CMV assist-control mode at a rate of 14 and a VT of 750 ml exhibits clinical signs of air trapping. Which of the following would you recommend to correct this problem?
1) Decrease "E" time.
2) Increase the inspiratory flow rate.
3) Decrease the assist-control rate.

Accepted Answer

A) 1 and 2 only 
B) 1 and 3 only 
C) 2 and 3 only 
D) 1, 2, and 3 
A) 1 and 2 only 
B) 1 and 3 only 
C) 2 and 3 only 
D) 1, 2, and 3

Question 6

A patient receiving continuous mandatory ventilation in the assist-control mode develops auto-PEEP. Which of the following changes in ventilatory patterns would you consider to minimize the effects of auto-PEEP in this patient?
1) Decreasing the rate or increasing VT
2) Using low-rate synchronized intermittent mandatory ventilation
3) Decreasing the peak inspiratory flow
4) Lowering the VT and letting the PaCO2 rise

Accepted Answer

A) 2 and 4 only 
B) 3 and 4 only 
C) 1, 2, and 3 only 
D) 1, 2, and 4 only 
A) 2 and 4 only 
B) 3 and 4 only 
C) 1, 2, and 3 only 
D) 1, 2, and 4 only

Question 7

Which of the following would decrease PaCO2 when ventilating a patient using intermittent mandatory ventilation with pressure support?

Accepted Answer

A)  Increase the level of pressure support. 
B)  Decrease the tidal volume. 
C)  Decrease the mechanical rate. 
D)  Increase the FiO2. 
A)  Increase the level of pressure support. 
B)  Decrease the tidal volume. 
C)  Decrease the mechanical rate. 
D)  Increase the FiO2.

Question 8

What is the predicted change in tidal volume by adding 6 in of tubing to a ventilator circuit?

Accepted Answer

A)  Decrease of 50 to 70 ml 
B)  Decrease of 30 to 50 ml 
C)  Decrease of 20 to 30 ml 
D)  No change 
A)  Decrease of 50 to 70 ml 
B)  Decrease of 30 to 50 ml 
C)  Decrease of 20 to 30 ml 
D)  No change

Question 9

When using a heated humidifier during mechanical ventilation, the inspired gas temperature at the airway should be set to what level?

Accepted Answer

A)  29° to 31° C 
B)  31° to 35° C 
C)  35° to 37° C 
D)  38° to 40° C 
A)  29° to 31° C 
B)  31° to 35° C 
C)  35° to 37° C 
D)  38° to 40° C

Question 10

In what clinical condition has pressure-controlled ventilation with a prolonged inspiratory time been shown to be helpful?

Accepted Answer

A)  ARDS/acute lung injury 
B)  Pulmonary embolism 
C)  Bilateral pneumonia 
D)  Severe pulmonary fibrosis 
A)  ARDS/acute lung injury 
B)  Pulmonary embolism 
C)  Bilateral pneumonia 
D)  Severe pulmonary fibrosis

Question 11

Which of the following criteria should be met before considering use of a heat-moisture exchanger (HME) for a patient being placed on ventilatory support?
1) There should be no problem with retained secretions.
2) The patient should not have fever (normothermic).
3) The patient should be adequately hydrated.
4) The support should be short term (24 to 48 hr).

Accepted Answer

A) 1, 2, and 3 only 
B) 2 and 4 only 
C) 1, 2, 3, and 4 
D) 3 and 4 only 
A) 1, 2, and 3 only 
B) 2 and 4 only 
C) 1, 2, 3, and 4 
D) 3 and 4 only

Question 12

Indications for delivering sigh breaths during mechanical ventilation include which of the following?
1) Before and after suctioning
2) During chest physical therapy
3) In patients with stiff lungs
4) When small VT values are used

Accepted Answer

A) 1 and 3 only 
B) 1, 2, and 4 only 
C) 2 and 4 only 
D) 2, 3, and 4 only 
A) 1 and 3 only 
B) 1, 2, and 4 only 
C) 2 and 4 only 
D) 2, 3, and 4 only

Question 13

On a ventilator that has separate rate and minute ventilation (VE) controls, the rate is set at 13/min and the VE at 11 L/min. Approximately what VT is the patient receiving?

Accepted Answer

A)  700 ml 
B)  850 ml 
C)  1000 ml 
D)  1200 ml 
A)  700 ml 
B)  850 ml 
C)  1000 ml 
D)  1200 ml

Question 14

What flow pattern is least optimal for ventilating a patient with cardiovascular instability?

Accepted Answer

A)  Accelerating flow pattern 
B)  Square flow pattern 
C)  Decelerating flow pattern 
D)  Constant flow pattern 
A)  Accelerating flow pattern 
B)  Square flow pattern 
C)  Decelerating flow pattern 
D)  Constant flow pattern

Question 15

In what scenario is pressure-controlled ventilation (PCV) most often used?

Accepted Answer

A)  When limiting plateau pressure is needed 
B)  When a pneumothorax is present 
C)  When the patient has chronic obstructive pulmonary disease 
D)  When bilateral pneumonia is present 
A)  When limiting plateau pressure is needed 
B)  When a pneumothorax is present 
C)  When the patient has chronic obstructive pulmonary disease 
D)  When bilateral pneumonia is present

Question 16

Which of the following would you initially verify in assessing the airway of a patient placed on ventilatory support?
1) Cuff pressure
2) Tube position
3) Tube patency

Accepted Answer

A) 1 and 2 only 
B) 1, 2, and 3 
C) 1 and 3 only 
D) 2 and 3 only 
A) 1 and 2 only 
B) 1, 2, and 3 
C) 1 and 3 only 
D) 2 and 3 only

Question 17

Compared to a pressure-controlled strategy, what is the primary advantage of volume-controlled ventilatory support?

Accepted Answer

A)  Provides a decelerating flow pattern. 
B)  Limits and controls peak airway pressures. 
C)  Improves patient-ventilator synchrony. 
D)  Guarantees a minimum minute ventilation. 
A)  Provides a decelerating flow pattern. 
B)  Limits and controls peak airway pressures. 
C)  Improves patient-ventilator synchrony. 
D)  Guarantees a minimum minute ventilation.

Question 18

For adolescents in the 8- to 16-year-old age range, which of the following ranges of ventilator setting would you initially recommend? Rate VT

Accepted Answer

A)  12 to 20 breaths/min 6 to 8 ml/kg 
B)  20 to 25 breaths/min 4 to 6 ml/kg 
C)  25 to 35 breaths/min 8 to 10 ml/kg 
D)  25 to 35 breaths/min 6 to 8 ml/kg 
A)  12 to 20 breaths/min 6 to 8 ml/kg 
B)  20 to 25 breaths/min 4 to 6 ml/kg 
C)  25 to 35 breaths/min 8 to 10 ml/kg 
D)  25 to 35 breaths/min 6 to 8 ml/kg

Question 19

The following data are gathered during a PEEP study (FiO2 = 0.60). Based on these data, what is the optimum PEEP level?

Accepted Answer

A)  10 cm H2O 
B)  15 cm H2O 
C)  20 cm H2O 
D)  25 cm H2O 
A)  10 cm H2O 
B)  15 cm H2O 
C)  20 cm H2O 
D)  25 cm H2O

Question 20

A heat-moisture exchanger (HME) should be avoided in which of the following circumstances?
1) Patients with excessive secretions
2) Patients with a high FiO2
3) Patients with low body temperature

Accepted Answer

A) 1 only 
B) 1 and 2 only 
C) 1 and 3 only 
D) 1, 2, and 3 
A) 1 only 
B) 1 and 2 only 
C) 1 and 3 only 
D) 1, 2, and 3

Exam 48: Initiating and Adjusting Invasive Ventilatory Support

What is the primary concern when using proning to improve oxygenation in the patient with ARDS?

Which of the following findings would you expect to see in a patient who has acute ventilatory failure with severe hypercapnia?

After setting up a patient on a ventilatory support device, which of the following supplementary equipment would you require to be available at the bedside? 1) Suction source and catheters 2) Backup artificial airway 3) Manual resuscitator with O2

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a VT of 550 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

Which of the following would decrease PaCO2 when ventilating a patient using intermittent mandatory ventilation with pressure support?

What is the predicted change in tidal volume by adding 6 in of tubing to a ventilator circuit?

When using a heated humidifier during mechanical ventilation, the inspired gas temperature at the airway should be set to what level?

In what clinical condition has pressure-controlled ventilation with a prolonged inspiratory time been shown to be helpful?

Indications for delivering sigh breaths during mechanical ventilation include which of the following? 1) Before and after suctioning 2) During chest physical therapy 3) In patients with stiff lungs 4) When small VT values are used

On a ventilator that has separate rate and minute ventilation (VE) controls, the rate is set at 13/min and the VE at 11 L/min. Approximately what VT is the patient receiving?

What flow pattern is least optimal for ventilating a patient with cardiovascular instability?

In what scenario is pressure-controlled ventilation (PCV) most often used?

Which of the following would you initially verify in assessing the airway of a patient placed on ventilatory support? 1) Cuff pressure 2) Tube position 3) Tube patency

Compared to a pressure-controlled strategy, what is the primary advantage of volume-controlled ventilatory support?

For adolescents in the 8- to 16-year-old age range, which of the following ranges of ventilator setting would you initially recommend? Rate VT

The following data are gathered during a PEEP study (FiO2 = 0.60). Based on these data, what is the optimum PEEP level?

A heat-moisture exchanger (HME) should be avoided in which of the following circumstances? 1) Patients with excessive secretions 2) Patients with a high FiO2 3) Patients with low body temperature

History of Respiratory Care

Delivering Evidence-Based Respiratory Care

Quality, Patient Safety, and Communication, and Recordkeeping

Principles of Infection Prevention and Control

Ethical and Legal Implications of Practice

Physical Principles of Respiratory Care

E-Medicine in Respiratory Care

Fundamentals of Respiratory Care Research

The Respiratory System

The Cardiovascular System

Ventilation

Gas Exchange and Transport

Solutions, Body Fluids, and Electrolytes

Acid-Base Balance

Regulation of Breathing

Bedside Assessment of the Patient

Interpreting Clinical and Laboratory Data

Interpreting the Electrocardiogram

Analysis and Monitoring of Gas Exchange

Pulmonary Function Testing

Review of Thoracic Imaging

Flexible Bronchoscopy and the Respiratory Therapist

Nutrition Assessment

Pulmonary Infections

Obstructive Lung Disease: Chronic Obstructive Pulmonary Disease Copd, Asthma, and Related Diseases

Interstitial Lung Disease

Pleural Diseases

Pulmonary Vascular Disease

Acute Respiratory Distress Syndrome

Trauma, Burns and Near Drowning

Lung Cancer

Neuromuscular and Other Diseases of the Chest Wall

Disorders of Sleep

Neonatal and Pediatric Respiratory Disorders

Airway Pharmacology

Airway Management

Emergency Cardiovascular Life Support

Humidity and Bland Aerosol Therapy

Aerosol Drug Therapy

Storage and Delivery of Medical Gases

Medical Gas Therapy

Lung Expansion Therapy

Airway Clearance Therapy Act

Respiratory Failure and the Need for Ventilatory Support

Mechanical Ventilators

Physiology of Ventilatory Support

Patient Ventilator Interaction

Noninvasive Ventilation

Extracorporeal Life Support Ecls

Monitoring the Patient in the Intensive Care Unit

Discontinuing Ventilatory Support

Neonatal and Pediatric Respiratory Care

Patient Education and Health Promotion

Cardiopulmonary Rehabilitation

Respiratory Care in Alternative Settings

Filters

After setting up a patient on a ventilatory support device, which of the following supplementary equipment would you require to be available at the bedside? 1) Suction source and catheters 2) Backup artificial airway 3) Manual resuscitator with O₂

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a V_T of 550 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

Which of the following would decrease PaCO₂ when ventilating a patient using intermittent mandatory ventilation with pressure support?

Indications for delivering sigh breaths during mechanical ventilation include which of the following? 1) Before and after suctioning 2) During chest physical therapy 3) In patients with stiff lungs 4) When small V_T values are used

On a ventilator that has separate rate and minute ventilation (V_E) controls, the rate is set at 13/min and the V_E at 11 L/min. Approximately what V_T is the patient receiving?

For adolescents in the 8- to 16-year-old age range, which of the following ranges of ventilator setting would you initially recommend? Rate V_T

The following data are gathered during a PEEP study (FiO₂ = 0.60). Based on these data, what is the optimum PEEP level?

A heat-moisture exchanger (HME) should be avoided in which of the following circumstances? 1) Patients with excessive secretions 2) Patients with a high FiO₂ 3) Patients with low body temperature