Deck 19: Basic Concepts of Noninvasive Positive-Pressure Ventilation

Question 1

One of the physiological goals of NIV in acute respiratory failure is to improve gas exchange by ______________.

A) resting the respiratory muscles
B) decreasing the effect of secretions
C) increasing right ventricular preload
D) decreasing the functional residual capacity

Answer 1

A
The physiological goal in acute respiratory failure is to improve gas exchange by resting the respiratory muscles and increasing alveolar ventilation.

Question 2

A patient has acute pulmonary edema from left-sided heart failure and acute hypoxemic respiratory failure that has not responded to conventional pharmacologic and oxygen therapy.As the next line of therapy,the respiratory therapist should recommend which of the following?

A) Noninvasive positive-pressure ventilation
B) Continuous positive airway pressure
C) Intubation and mechanical ventilation
D) Bronchial hygiene therapy

Answer 2

B
The current recommendation for ACPE is for CPAP to be used initially.NIV should be used only in patients who were hypercapnic and continue to be hypercapnic in spite of the CPAP.

Question 3

Patients with chronic hypoventilation disorders typically need a minimum of _________ hours of NIV to experience improved quality of life.

A) 2-4
B) 4-6
C) 6-8
D) 8-10

Answer 3

B
Nocturnal use of NIV (4-6 hours)can have certain clinical benefits for patients with chronic hypoventilation disorders.The most significant of these are improvement of symptoms associated with chronic hypoventilation and an improved quality of life.

Question 4

A patient in the subacute care unit is receiving NIV with a PTV system,with an IPAP of 10 cm H₂O and an EPAP of 3 cm H₂O.The patient's latest arterial blood gas values reveal an increase in the PₐCO₂.The most appropriate action to take is which of the following?

A) Increase the IPAP.
B) Decrease the IPAP.
C) Increase the EPAP and IPAP.
D) Intubate and mechanically ventilate.

Question 5

A patient with acute cardiogenic pulmonary edema is to be placed on CPAP.What should the initial setting be?

A) 3⁻⁵ cm H₂O
B) 5-7 cm H₂O
C) 10-12 cm H₂O
D) 15-20 cm H₂O

Question 6

A 62-year-old male patient with COPD is being seen in the pulmonary clinic for dyspnea at rest and daytime hypersomnolence.The patient has been hospitalized three times in the past year for COPD exacerbations and once for pneumonia.He currently uses 2 L/min oxygen from a concentrator all the time.The patient reports that he is able to sleep only about 2 hours each night and that he has a headache every morning.Which of the following should be recommended to the physician?

A) Chest cuirass
B) Nocturnal NIV
C) Nocturnal CPAP
D) Tracheostomy and ventilation

Question 7

The leading cause of patient discomfort and noncompliance with NIV is which of the following?

A) Drying of nasal mucosa
B) Mask type and fit
C) Type of PTV
D) Lack of an oxygen blender

Question 8

If oxygen is bled into each of the following portable PTVs at the same rate,which of the following combinations will provide the highest oxygen concentration?

A) Leak port at mask, oxygen bleed at mask, IPAP 8 cm H₂O, EPAP 16 cm H₂O
B) Leak port at mask, oxygen bleed at machine outlet, IPAP 6 cm H₂O, EPAP 18 cm H₂O
C) Leak port in circuit, oxygen bleed at mask, IPAP 5 cm H₂O, EPAP 10 cm H₂O
D) Leak port in circuit, oxygen bleed in circuit, IPAP 5 cm H₂O, EPAP 15 cm H₂O

Question 9

Overtightening of the headgear straps for a nasal mask may lead to which of the following?

A) Lack of an air leak
B) Facial skin irritation
C) Nasal air leak
D) Hypersalivation

Question 10

NIV is considered the standard of care for the treatment of which of the following?

A) COPD exacerbation
B) Asthma exacerbation
C) Noncardiogenic pulmonary edema
D) Community-acquired pneumonia

Question 11

The primary goal of NIV in the acute care setting is to do which of the following?

A) Improve sleep quality.
B) Decrease muscle fatigue.
C) Avoid invasive ventilation.
D) Eliminate nocturnal hypopnea.

Question 12

A patient with acute cardiogenic pulmonary edema (ACPE),as evidenced by pink,frothy secretions,arrives in the emergency department (ED)by ambulance with a nonrebreather mask (NRM)at 15 L/min.An arterial blood gas sample is drawn in the ED while the patient is on the NRM; the values are: pH = 7.50,PₐCO₂ = 28 mm Hg; PₐO₂ = 43 mm Hg; SₐO₂ = 84%; HCO₃⁻ = 24 mEq/L.After evaluating the situation,the respiratory therapist should suggest which of the following therapies?

A) IPPB with supplemental oxygen
B) Mask CPAP with supplemental oxygen
C) Postural drainage to clear the secretions
D) NIV via nasal mask with postural drainage

Question 13

A 61-year-old female was admitted last night with shortness of breath.She currently is alert and oriented but very anxious.Her latest arterial blood gas values,on a nasal cannula at 3 L/min,show: pH = 7.39; PₐCO₂ = 41 mm Hg; PₐO₂ = 40 mm Hg; SₐO₂ = 74%; HCO₃⁻ = 24 mEq/L.Breath sounds are decreased throughout with fine late crackles on inspiration.The current chest X-ray shows an enlarged heart with bilateral vascular congestion.The most appropriate therapy for this patient is _________.

A) NIPPV
B) mask CPAP
C) invasive ventilation
D) nonrebreather mask

Question 14

A home care patient using NIV complains that when she puts on the NIV mask at night and turns on the machine,"at first the gas feels like it is punching her in the face." The patient is noncompliant with the NIV because of this.What action should the respiratory therapist take?

A) Decrease the IPAP.
B) Increase the EPAP.
C) Decrease the flow trigger.
D) Set the ramp and delay time.

Question 15

To use CPAP successfully,a patient must have which of the following?

A) Adequate PₐCO₂
B) Secure artificial airway
C) PₐCO₂ >40 mm Hg
D) Adequate spontaneous ventilation

Question 16

A patient who was diagnosed 1 year ago with amyotrophic lateral sclerosis is being seen in his primary care physician's office.The patient is complaining of fatigue and inability to concentrate at work.The patient's FVC is 45% of predicted,the PₐCO₂ is 47 mm Hg,and the MIP is 54 cm H₂O.Which of the following should be considered for this patient?

A) Continuation of current therapy
B) Supplemental home oxygen
C) Nocturnal CPAP
D) Nocturnal NIV

Question 17

The variable that ends pressure support breaths from a pressure-supported breath is ______________.

A) time
B) flow
C) pressure
D) volume

Question 18

A 75-year-old man with a long history of COPD is brought to the emergency department with shortness of breath.He has a persistent,productive cough with green purulent sputum,cyanosis of the lips and extremities,and is uncooperative.His arterial blood gas values on 2 L/min by nasal cannula are: pH = 7.25; PₐCO₂ = 90 mm Hg; PₐO₂ = 38 mm Hg; SₐO₂ = 59%; HCO₃⁻ = 38 mEq/L.The most appropriate action at this time is which of the following?

A) IPPB
B) Mask CPAP
C) NIV via full face mask
D) Invasive mechanical ventilation

Question 19

A patient with acute respiratory failure requires NIV.The patient is very dyspneic.Which of the following patient interfaces is most appropriate?

A) Nasal mask
B) Mini mask
C) Nasal pillows
D) Oronasal mask

Question 20

Negative-pressure ventilators cause air to enter the lungs by increasing ______________ pressure.

A) transairway
B) transpulmonary
C) transrespiratory
D) transthoracic

Question 21

Which of the following NIV settings produces the greatest tidal volume,with all other variables being equal (i.e.,airway resistance and lung compliance)?

A) IPAP = 20 cm H₂O; EPAP = 8 cm H₂O
B) IPAP = 15 cm H₂O; EPAP = 5 cm H₂O
C) IPAP = 12 cm H₂O; EPAP = 6 cm H₂O
D) IPAP = 18 cm H₂O; EPAP = 4 cm H₂O

Question 22

A patient with central sleep apnea uses a nasal mask with NIV at night.The patient complains of nasal congestion.What action should the respiratory therapist take?

A) Reduce the EPAP.
B) Add a heated humidifier.
C) Switch to a mouthpiece.
D) Add a heat/moisture exchanger.

Question 23

NIV has just been initiated on a patient in respiratory distress with an inspiratory positive airway pressure (IPAP)of 12 cm H₂O and an end-expiratory positive airway pressure (EPAP)of 5 cm H₂O.Which of the following would indicate clinical improvement of the patient's condition?
1)Decreased respiratory rate
2)Synchronization with the ventilator
3)Decreased inspiratory muscle activity
4)Decreased arterial oxygen saturation (SₐO₂)

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

Question 24

Which of the following is the most efficient means of delivering a medicated aerosol during NIV?

A) Nebulizer placed between the leak port, located in the circuit, and the mask
B) MDI placed between the leak port, located in the circuit, and the mask
C) Use of both high inspiratory and high expiratory pressures
D) MDI placed in the circuit with the leak port in the mask

Question 25

What determines the patient's delivered tidal volume in all modes of bilevel positive-pressure ventilation?

A) IPAP
B) EPAP
C) The gradient between the IPAP and EPAP
D) Patient's respiratory rate

Question 26

A 68-year-old,5-foot,10-inch male patient with acute-on-chronic respiratory failure due to COPD has been placed on NIV with these settings: IPAP = 8 cm H₂O,EPAP = 4 cm H₂O,FɪO₂ = 0.28.The patient's measured exhaled volume is 350 mL with a spontaneous respiratory rate of 24 breaths/min.The resulting arterial blood gas values are: pH = 7.27,PₐCO₂ = 77 mm Hg,PₐO₂ = 64 mm Hg,SₐO₂ = 88%,HCO₃⁻ = 36 mEq/L.What action should the respiratory therapist take at this time?

A) Increase the FɪO₂ to 0.4.
B) Increase the EPAP to 6 cm H₂O.
C) Increase the IPAP to 12 cm H₂O.
D) Decrease the EPAP to 2 cm H₂O.

Question 27

A 75-year-old,5-foot,7-inch female patient with an exacerbation of COPD is placed on the following NIV settings: IPAP = 8 cm H₂O,EPAP = 4 cm H₂O,rate = 12 breaths/min,FɪO₂ = 0.3.The resulting Vᴛ is 255 mL.An arterial blood gas sample is drawn 1 hour later,and the results are: pH = 7.33,PₐCO₂ = 70 mm Hg,PₐO₂ = 58 mm Hg,HCO₃⁻ = 35 mEq/L.What action should the respiratory therapist take at this time?

A) Increase the rate to 14 breaths/min.
B) Increase the IPAP to 10 cm H₂O.
C) Intubate and mechanically ventilate the patient.
D) Increase the IPAP to 10 cm H₂O and the EPAP to 6 cm H₂O.