Deck 5: Selecting the Ventilator and the Mode

Question 1

A breath that is triggered,limited,and cycled by the mechanical ventilator is which of the following?

A) Assisted breath
B) Mandatory breath
C) Spontaneous breath
D) Breath

Answer 1

B
Breaths that are triggered by the mechanical ventilator are considered mandatory breaths because the ventilator is controlling the timing of the breath and delivering either a set volume or set pressure.

Question 2

What type of breath occurs when the ventilator controls the timing,tidal volume,or inspiratory pressure?

A) Assisted
B) Mandatory
C) Spontaneous
D) Controlled

Answer 2

B
Mandatory breaths occur when the ventilator is time triggered,volume or pressure targeted.Spontaneous breaths are patient triggered,and the volume or pressure is based on the patient's demand and lung characteristiCₛAssisted breaths have characteristics of both mandatory and spontaneous,the patient triggers the breath,the ventilator delivers a set pressure or volume,and the airway pressure rises above baseline during inspiration.The term control is not used to describe the type of breath delivery.This term is used to describe the variable that is being manipulated as the target for the breaths (e.g.,pressure control or volume control).

Question 3

The ventilator mode that allows the patient to breathe spontaneously between operator-selected time-triggered volume and pressure-targeted breaths is which of the following?

A) Pressure support ventilation (PSV)
B) Continuous mandatory ventilation (CMV)
C) Intermittent mandatory ventilation (IMV)
D) Airway pressure release ventilation (APRV)

Answer 3

C
The intermittent mandatory ventilation (IMV)mode allows the patient to breathe spontaneously between operator mandatory ventilator breaths.During these spontaneous breaths the baseline pressure may be set at ambient pressure or above ambient pressure.In addition,pressure support may be used during the spontaneous breathing period.Pressure support ventilation (PSV)has no time-triggered breaths,nor does it have volume-targeted breaths.Continuous mandatory ventilation (CMV)does not allow for spontaneous breathing; it only allows the patient to trigger the mandatory ventilator breath.Airway pressure release ventilation (APRV)does not have volume-targeted breaths.It is designed to be two levels of continuous positive airway pressure (CPAP)where the patients breathe spontaneously at both levels.

Question 4

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.

Question 5

If flow or sensitivity is set incorrectly,which of the following is most likely to occur during the continuous mandatory ventilation (CMV)mode?

A) Muscle atrophy
B) Respiratory alkalosis
C) Ventilator dyssynchrony
D) Increase in mean airway pressure

Question 6

The pressure-time scalar shown in the figure represents which of the following?

A) Airway pressure release ventilation (APRV)
B) Volume-controlled intermittent ventilation (VC-IMV) with positive end-expiratory pressure (PEEP)
C) Pressure-controlled intermittent mandatory ventilation (PC-IMV) with positive end-expiratory pressure (PEEP)
D) Bilevel positive airway pressure

Question 7

Which mode of ventilation is shown in the pressure-time scalar in the figure?

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)

Question 8

A home care patient diagnosed with central sleep apnea would benefit from which of the following modes of ventilation?

A) Pressure support ventilation (PSV)
B) Noninvasive positive pressure ventilation (NIV)
C) Continuous positive airway pressure (CPAP)
D) Pressure controlled intermittent mandatory ventilation (PC-IMV)

Question 9

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)

Question 10

A 68-year-old female admitted for congestive heart failure is in respiratory distress and is being seen by the hospital's medical emergency team in her regular room.The patient is in obvious respiratory distress and is immediately placed on a nonrebreather mask.Physical assessment reveals: pulse 138 and thready; respiratory rate 30,shallow and labored; temperature 37° C; blood pressure 110/68.Breath sounds are bilaterally decreased with coarse crackles on inspiration.EKG shows normal sinus rhythm with widened cardiac output (QT)interval and an occasional irregular beat.No coughing is noted.The arterial blood gas on the nonrebreather mask is: pH 7.34; PCO₂ 46 mm Hg; partial pressure of oxygen in the arteries (PₐO₂)is 52 mm Hg; oxygen saturation is 86%; bicarbonate (HCO₃⁻)is 24 mEq/L.The patient is diaphoretic.The most appropriate ventilator mode to manage this patient initially is which of the following?

A) Noninvasive positive pressure ventilation (NIV)
B) Airway pressure release ventilation (APRV)
C) Volume-controlled intermittent mandatory ventilation (VC-IMV)
D) Pressure-controlled intermittent mandatory ventilation (PC-IMV)

Question 11

A 28-year-old male has arrived in the emergency department following a motor vehicle accident.He has a Glasgow Coma Score of 14.Chest X-ray reveals five ribs broken anteriorly in two areas each.Physical assessment reveals paradoxical movement of the chest.Breath sounds are diminished and the trachea is midline.Arterial blood gas on nonrebreather mask is: pH 7.53,partial pressure of carbon dioxide (PₐCO₂)is 25 mm Hg,partial pressure of oxygen (PₐO₂)is 59 mm Hg,arterial oxygen saturation (SₐO₂)93%,bicarbonate (HCO₃⁻)23 mEq/L.The respiratory therapist should recommend which of the following for this patient?

A) Noninvasive positive pressure ventilation (NIV) with supplemental oxygen
B) Intubation with volume-controlled continuous mandatory ventilation (VC-CMV) with positive end-expiratory pressure (PEEP)
C) Mask continuous positive airway pressure (CPAP) with supplemental oxygen
D) Intubation with CPAP and pressure support

Question 12

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

Question 13

An assisted breath in the pressure controlled continuous mandatory ventilation (PC-CMV)mode can be described by which of the following?

A) Time triggered, pressure limited, time cycled
B) Patient triggered, pressure limited, time cycled
C) Time triggered, pressure limited, pressure cycled
D) Patient triggered, volume limited, volume cycled

Question 14

Full ventilatory support is provided by which of the following modes?

A) Pressure support ventilation (PSV) with continuous positive airway pressure (CPAP)
B) Volume support ventilation (VSV) with continuous positive airway pressure (CPAP)
C) Volume-controlled intermittent mandatory ventilation (VC-IMV) rate 6 with pressure support (PS)
D) Pressure-controlled intermittent mandatory ventilation (PC-IMV) rate 12 with pressure support (PS)

Question 15

Which of the following is the minimum ventilator rate that is considered full ventilatory support?

A) 4 breaths/min
B) 6 breaths/min
C) 8 breaths/min
D) 10 breaths/min

Question 16

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

Question 17

Of the following breath descriptions,which one is considered spontaneous?

A) Flow triggered, pressure limited, flow cycled
B) Time triggered, volume limited, volume cycled
C) Pressure triggered, pressure limited, time cycled
D) Patient triggered, patient cycled, baseline pressure +5 cm H₂O

Question 18

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)

Question 19

In which of the following situations would NIV be tried?

A) Patient in whom blood pressure is 65/35, heart rate is 150 beats/min, and respiratory frequency is 34 breaths/min
B) Patient who nearly drowned who has copious amounts of white, frothy secretions
C) Patient with chronic obstructive pulmonary disease (COPD) and right lower-lobe pneumonia with respiratory acidosis and increased work of breathing (WOB)
D) A 5-year-old child who has aspirated a piece of chicken and is having trouble breathing

Question 20

A breath that is patient triggered,pressure targeted,and time cycled is which of the following?

A) Assisted breath
B) Mandatory breath
C) Spontaneous breath
D) Breath

Question 21

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

Question 22

The ventilator mode where every breath is patient triggered,pressure targeted,and flow cycled with a volume target is which of the following?

A) Volume support ventilation (VSV)
B) Pressure-regulated volume control (PRVC)
C) Airway pressure release ventilation (APRV)
D) Pressure augmentation (Paug)

Question 23

A dual control mode provides pressure-limited ventilation with volume delivery targeted for every breath.If the desired volume is not met the ventilator will volume cycle.This describes which of the following ventilator modes?

A) Airway pressure release ventilation (APRV)
B) Pressure augmentation (Paug)
C) MMV
D) Pressure-regulated volume control (PRVC)

Question 24

A patient,who is nasally intubated,due to facial surgery,has been successful on her spontaneous breathing trial.She currently has moderate hypoxemia,despite a fractional inspired oxygen (FɪO₂)of 40% and positive end-expiratory pressure (PEEP)of 5 cm H₂O while on volume-controlled continuous mandatory ventilation (VC-CMV).The most appropriate ventilator mode for this patient is which of the following?

A) Airway pressure release ventilation (APRV)
B) Continuous positive airway pressure (CPAP)
C) Pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP)
D) Intermittent mandatory ventilation (IMV) with pressure support ventilation (PSV) and positive end-expiratory pressure (PEEP)

Question 25

A patient with acute respiratory distress syndrome (ARDS)has developed a pneumothorax from elevating peak and plateau pressures.The patient is currently being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV)mode with a set rate of 12 breaths/min.However,the patient is triggering the ventilator at a rate of 25 breaths/min.The arterial blood gas reveals ventilator-induced hyperventilation with corrected hypoxemia.The most appropriate recommendation to manage this patient on the ventilator is which of the following?

A) Sedate the patient.
B) Decrease the set ventilator rate.
C) Switch the mode to pressure-controlled intermittent mandatory ventilation (PC-IMV).
D) Switch the mode to pressure-controlled continuous mandatory ventilation (PC-CMV).

Question 26

Which mode of ventilation is shown in the pressure-time scalar in the figure?

A) Pressure-controlled intermittent mandatory ventilation (PC-IMV) with pressure support (PS)
B) Volume-controlled intermittent mandatory ventilation (VC-IMV) with pressure support (PS)
C) Pressure-controlled continuous mandatory ventilation (PC-CMV)
D) Airway pressure release ventilation (APRV)

Question 27

When a patient is to be switched from continuous mandatory ventilation (CMV)to intermittent mandatory ventilation (IMV)to facilitate weaning from mechanical ventilation,which of the following could be used in addition to IMV to assist this process?

A) Continuous positive airway pressure (CPAP)
B) Positive end-expiratory pressure (PEEP)
C) Pressure support (PS)
D) Pressure control (PC)

Question 28

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.

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)

Question 29

A patient triggered,pressure limited,flow cycled breath describes which of the following?

A) Spontaneous breath
B) Pressure-support breath
C) Volume-control breath
D) Pressure-control breath

Question 30

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)

Question 31

If lung compliance decreases while a patient is receiving mechanical ventilation with pressure-controlled continuous mandatory ventilation (PC-CMV),which of the following would occur?

A) Peak pressure increases.
B) Peak pressure decreases.
C) Tidal volume increases.
D) Tidal volume decreases.

Question 32

The ventilator mode that delivers pressure breaths that are patient or time triggered,volume targeted,time cycled,and where the pressure is automatically adjusted to maintain delivery of the targeted volume is which of the following?

A) Volume support ventilation (VSV)
B) Pressure augmentation (Paug)
C) MMV
D) Pressure-regulated volume control (PRVC)