Deck 6: Initial Ventilator Settings

Question 1

A 39-year-old,5'4",138 lb female patient requires intubation and mechanical ventilation.Her body temperature is 39° C.She has no history of lung disease.The appropriate initial minute ventilation for this patient is which of the following?

A) 5.7 L/min
B) 6.8 L/min
C) 7.6 L/min
D) 13.8 L/min

Answer 1

B
First calculate ideal body weight (IBW)for a female,using the formula 105 + 5(ht - 60).This patient's IBW is 57 kg.Minute ventilation is about 100 mL/kg IBW,which would be 57,000 mL/min or 5.7 L/min.VE would have to be increased by 10% for each degree above 37° C: a total increase of 20% of 5.7 = 1.14; therefore,the new minute ventilation (Vᴇ)would be 5.7 + 1.14 = 6.8 L/min.

Question 2

What is the flow rate necessary to deliver a tidal volume (Vᴛ)of 600 mL,with a constant waveform,at a respiratory rate of 15 breaths/min with an I:E of 1:4?

A) 36 L/min
B) 40 L/min
C) 45 L/min
D) 60 L/min

Answer 2

C
Total Cycle Time (TCT)= 60 sec/f; Inspiratory Time (Tɪ)= TCT/Inspired (I)+ Expired (E); Flow rate = Tidal Volume (Vᴛ)/Inspiratory Time (Tɪ).

Question 3

Calculate the inspiratory time (Tɪ)when a ventilator is set at a tidal volume (Vᴛ)of 800 mL and a constant flow rate of 40 L/min.

A) 0.02 second
B) 0.5 second
C) 1.2 second
D) 3.2 seconds

Answer 3

C
Inspiratory Time (Tɪ)= Tidal Volume (Vᴛ)/Minute Ventilation (Vᴇ)(convert L/min to L/sec first).

Question 4

Calculate the average tidal volume for a patient who has a minute ventilation of 10 L/min with a respiratory rate (RR)of 12 breaths/min.

A) 120 mL
B) 833 mL
C) 1000 mL
D) 1200 mL

Question 5

The flow waveform pattern that is created during pressure targeted ventilation is which of the following?

A) Sine
B) Constant
C) Ascending ramp
D) Descending ramp

Question 6

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

Question 7

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

Question 8

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

Question 9

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%.

Question 10

Slow flow rates will cause which of the following to occur?

A) Poor gas exchange
B) Increase peak pressures
C) Shorten expiratory time
D) Decrease mean airway pressure

Question 11

A 5'2" female patient with normal lungs has been intubated and requires mechanical ventilation with volume-controlled continuous mandatory ventilation (VC-CMV).The tidal volume (Vᴛ)and ventilator rate settings that should be recommended for this patient are which of the following?

A) Vᴛ = 315 mL, rate = 20 breaths/min
B) Vᴛ = 364 mL, rate = 14 breaths/min
C) Vᴛ = 468 mL, rate = 12 breaths/min
D) Vᴛ = 563 mL, rate = 10 breaths/min

Question 12

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

Question 13

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

Question 14

Calculate the inspiratory time (Tɪ)when a ventilator is set at a tidal volume (Vᴛ)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

Question 15

Calculate the expiratory time (Tᴇ)when the ventilator frequency is set to 25 breaths/min and the inspiratory time (Tɪ)is 0.75 second.

A) 0.75 second
B) 1.16 second
C) 1.65 second
D) 2.4 seconds

Question 16

Calculate the inspiratory to expiratory (I:E)ratio when the inspiratory time is 0.5 second and the respiratory rate is 30 breaths/min.

A) 1:3
B) 1:4
C) 4:1
D) 3:1

Question 17

The flow waveform pattern that provides the shortest inspiratory time (Tɪ)of all the available flow patterns with an equivalent peak flow rate setting is which of the following?

A) Sine
B) Constant
C) Ascending ramp
D) Descending ramp

Question 18

The flow waveform pattern that will decrease peak pressure but at the same time may increase mean airway pressure is which of the following?

A) Sine
B) Rectangular
C) Ascending ramp
D) Descending ramp

Question 19

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

Question 20

A 5'10" male patient with normal lungs has been intubated and requires mechanical ventilation with volume-controlled continuous mandatory ventilation (VC-CMV).The tidal volume and ventilator rate settings that should be recommended for this patient are which of the following?

A) Vᴛ = 525 mL, rate = 14 breaths/min
B) Vᴛ = 750 mL, rate = 12 breaths/min
C) Vᴛ = 825 mL, rate = 10 breaths/min
D) Vᴛ = 950 mL, rate = 8 breaths/min

Question 21

The mode of pressure ventilation that is patient- or time-triggered and flow-cycled is which of the following?

A) Volume support (VS)
B) Pressure support ventilation (PSV)
C) Pressure-controlled continuous mandatory ventilation (PC-CMV)
D) Bilevel positive airway pressure (bilevel PAP)

Question 22

A 65-year-old,73-inch-tall,195 lb male patient was admitted 2 days ago for renal failure.The patient has a history of chronic obstructive pulmonary disease (COPD)and has a pulse of 122 breaths/min,BP 153/88,and temperature 37° C.The patient is intubated for acute-on-chronic respiratory failure with hypoxemia.The physician requests volume-controlled continuous mandatory ventilation (VC-CMV).The initial settings for the ventilator should be which of the following?

A) Vᴛ = 700 mL, rate = 12 breaths/min, PEEP = 3 cm H₂O
B) Vᴛ = 900 mL, rate = 10 breaths/min, PEEP = 5 cm H₂O
C) Vᴛ = 450 mL, rate = 20 breaths/min, PEEP = 8 cm H₂O
D) Vᴛ = 800 mL, rate = 15 breaths/min, PEEP = 10 cm H₂O

Question 23

With which flow waveform pattern will the mean airway pressure be the highest?

A) Sine
B) Square
C) Ascending ramp
D) Descending ramp

Question 24

The mode of ventilation that provides pressure-limited,time-cycled breaths that use a set tidal volume as a feedback control is which of the following?

A) Pressure support ventilation (PSV)
B) Pressure-regulated volume control (PRVC)
C) Pressure-controlled continuous mandatory ventilation (PC-CMV)
D) Bilevel positive airway pressure (Bilevel PAP)

Question 25

An intubated patient with chronic obstructive pulmonary disease (COPD)is breathing on pressure support ventilation (PSV)13 cm H₂O with positive end-expiratory pressure (PEEP)5 cm H₂O and a flow cycle setting of 25%.The pressure-time scalar shown in the figure is evaluated by the respiratory therapist.What action should the respiratory therapist take at this time?

A) The patient and ventilator are synchronized and no change should be made.
B) The inspiratory flow rate should be increased to match the patient's needs.
C) The flow cycle setting should be increased to allow more time for exhalation.
D) The pressure support setting should be increased to match the peak pressure.

Question 26

A 47-year-old,6'1" male patient is admitted to the hospital due to trauma from a motor vehicle accident.Forty-eight hours post admission,the patient is suffering from respiratory distress with severe hypoxemia and is intubated.A chest X-ray,done prior to intubation,reveals a ground glass appearance bilaterally.The physician requests the volume-controlled continuous mandatory ventilation (VC-CMV)mode for this patient.The initial settings for the ventilator should be which of the following?

A) Vᴛ = 450 mL, rate = 18 breaths/min, PEEP = 8 cm H₂O
B) Vᴛ = 600 mL, rate = 10 breaths/min, PEEP = 5 cm H₂O
C) Vᴛ = 750 mL, rate = 15 breaths/min, PEEP = 10 cm H₂O
D) Vᴛ = 900 mL, rate = 12 breaths/min, PEEP = 5 cm H₂O

Question 27

A patient receiving mechanical ventilation via pressure-regulated volume control (PRVC)has a set target volume of 500 mL with an upper pressure limit setting of 35 cm H₂O.During the respiratory therapist's first patient ventilator system check,25 cm H₂O was needed to deliver the set volume.Several hours later the pressure to deliver the set volume is 15 cm H₂O.The respiratory therapist should do which of the following?

A) Switch the patient to pressure support ventilation (PSV).
B) No action should be taken.
C) The set volume should be reduced.
D) The upper pressure limit should be reduced.

Question 28

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

Question 29

A 57-year-old,5'3",165 lb female patient arrives in the open heart unit following coronary artery bypass surgery.The patient has a history of diabetes and no history of pulmonary disease.The most appropriate initial volume-controlled continuous mandatory ventilation (VC-CMV)settings are which of the following?

A) Vᴛ = 220 mL, rate = 25 breaths/min, PEEP = 10 cm H₂O
B) Vᴛ = 360 mL, rate = 15 breaths/min, PEEP = 5 cm H₂O
C) Vᴛ = 550 mL, rate = 12 breaths/min, PEEP = 12 cm H₂O
D) Vᴛ = 750 mL, rate = 10 breaths/min, PEEP = 8 cm H₂O

Question 30

A mechanically ventilated patient is going to be placed on pressure support ventilation following an acceptable spontaneous weaning trial.The patient is a 5'9" male who weighs 185 lb.During volume-controlled continuous mandatory ventilation (VC-CMV)his average peak inspiratory pressure (PIP)was about 26 cm H₂O and the plateau pressure (Pₚₗₐₜₑₐᵤ)was 16 cm H₂O.What initial pressure support level should be set?

A) 5 cm H₂O
B) 10 cm H₂O
C) 15 cm H₂O
D) 20 cm H₂O

Question 31

When changing the control variable from volume control (VC)to pressure control (PC),the initial inspiratory pressure should be set based on which of the following methods?

A) Body surface area multiplied by 4
B) Plateau pressure measurement taken during VC ventilation
C) Maximum peak inspiratory pressure during VC ventilation
D) Maximum peak inspiratory pressure minus plateau pressure during VC ventilation

Question 32

A 63-year-old,5'11",185 lb male patient with a history of chronic obstructive pulmonary disease (COPD)is admitted to the hospital due to liver failure.Over the course of the 48 hours he has developed respiratory distress.The respiratory therapist performs a physical assessment and finds the following: heart rate 135 beats/min,respiratory rate 28 with accessory muscle use.Breath sounds are decreased bilaterally with coarse crackles in the right base.A chest X-ray from 24 hours ago shows bilateral lower lobe infiltrates.The patient has a nonproductive cough.The respiratory therapist draws an arterial blood gas that reveals: pH 7.31; partial pressure of carbon dioxide (PₐCO₂)57 mm Hg; partial pressure of oxygen (PₐO₂)58 mm Hg; arterial oxygen saturation (SₐO₂)87%; bicarbonate (HCO₃-)27 mEq/L while receiving oxygen via nasal cannula 3 L/min.The respiratory therapist should recommend which of the following for this patient?

A) Continue with current therapy and monitor the patient closely.
B) Place the patient on a nonrebreather mask with 15 L/min oxygen.
C) Intubate and place on pressure-controlled continuous mandatory ventilation (PC-CMV), peak inspiratory pressure (PIP) 40 cm H₂O, positive end-expiratory pressure (PEEP) 8 cm water (H₂O), fractional inspired oxygen (FɪO₂) 1.0.
D) Use BiPAP with IPAP 10 cm H₂O, EPAP 5 cm H₂O, and bleed in 4 L/min oxygen.