Deck 7: Final Considerations in Ventilator Setup

Question 1

A patient's baseline arterial blood gas (ABG)reveals a partial pressure of oxygen (PₐO₂)of 78 mm Hg while receiving 35% supplemental oxygen.What should the ventilator fractional inspired oxygen (FɪO₂)be set at to obtain a target PₐO₂ of 95 mm Hg?

A) 0.34
B) 0.43
C) 0.55
D) 0.67

Answer 1

B

Question 2

How much pressure and time is necessary during a lung recruitment maneuver?

A) 20-35 cm H₂O for 30-40 seconds
B) 30-40 cm H₂O for 15-25 seconds
C) 35-45 cm H₂O for 40-60 seconds
D) 40⁻⁵0 cm H₂O for 35-45 seconds

Answer 2

C
The recruitment maneuver used to expand collapsed areas of the lung involves using a sustained high pressure of 35-45 cm H₂O for 40-60 seconds.

Question 3

In which situation should the heat moisture exchanger (HME)be replaced with a heated humidification system?

A) With all tracheostomy tubes
B) After 3 days of ventilation
C) After 24 hours of ventilation
D) Thick secretions not cleared by suctioning

Answer 3

D
If secretions appear thick after two consecutive suctioning procedures,the heat moisture exchanger (HME)should be removed and the patient switched to a heated humidification system.

Question 4

Identify the patient who could benefit from sigh breaths.

A) Patient on pressure-controlled continuous mandatory ventilation (PC-CMV) with peak inspiratory pressure (PIP) = 38 cm H₂O
B) Patient on volume-controlled continuous mandatory ventilation (VC-CMV) with a plateau pressure (Pₚₗₐₜₑₐᵤ) = 36 cm H₂O
C) Spontaneously breathing patient receiving continuous positive airway pressure (CPAP)
D) 70 kg ideal body weight (IBW) patient on 400 mL with Pₚₗₐₜₑₐᵤ = 25 cm H₂O

Question 5

What is the range for setting flow triggering?

A) 1-10 L/min
B) 10-15 L/min
C) 12-16 L/min
D) 20-30 L/min

Question 6

What fractional inspired oxygen (FɪO₂)setting should be set on the ventilator when the patient currently has a partial pressure of oxygen (PₐO₂)of 53 mm Hg while receiving 50% oxygen and the desired PₐO₂ is 90 mm Hg?

A) 0.64
B) 0.74
C) 0.85
D) 0.95

Question 7

A patient is being ventilated with pressure-controlled intermittent mandatory ventilation (PC-IMV)of 12 breaths/min.The apnea alarm time setting should be which of the following?

A) 4 seconds
B) 10 seconds
C) 15 seconds
D) 20 seconds

Question 8

A patient receiving 60% oxygen from an air entrainment mask has a partial pressure of oxygen (PₐO₂)of 45 mm Hg.The patient is being intubated and the ventilator set up.What is the appropriate fractional inspired oxygen (FɪO₂)to achieve a PₐO₂ of 60 mm Hg?

A) 0.65
B) 0.75
C) 0.8
D) 0.95

Question 9

The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which of the following ranges?

A) 40⁻⁵5 mm Hg
B) 50-60 mm Hg
C) 60-100 mm Hg
D) 100-120 mm Hg

Question 10

Calculate the humidity deficit when a heat moisture exchanger (HME)provided 14 mg/L of water to the set tidal volume.

A) 14 mg/L of water
B) 23 mg/L of water
C) 30 mg/L of water
D) 37 mg/L of water

Question 11

Following successful cardiac resuscitation,a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (FɪO₂)settings?

A) 0.5
B) 0.6
C) 0.8
D) 1.0

Question 12

How much patient effort is needed to trigger a ventilator breath when there is 8 cm H₂O of unintended positive end-expiratory pressure (auto-PEEP)and a pressure trigger setting of 2 cm H₂O?

A) 2 cm H₂O
B) 6 cm H₂O
C) 8 cm H₂O
D) 10 cm H₂O

Question 13

All of the following are appropriate situations for the use of sigh or deep breaths except which?

A) During chest physiotherapy
B) During an extubation procedure
C) During continuous positive airway pressure (CPAP) with spontaneous breathing
D) Before and after endotracheal tube suctioning

Question 14

A patient set up on pressure support ventilation (PSV)has an average minute volume of 5.8 L.What should the low exhaled minute volume alarm be set at?

A) 5 L
B) 4 L
C) 3 L
D) 2 L

Question 15

The respiratory therapist in the intensive care unit (ICU)responds to a patient's room because the ventilator is alarming.The most appropriate immediate action is which of the following?

A) Replace the ventilator immediately.
B) Silence the alarms and call for help.
C) Ensure the patient is being ventilated.
D) Troubleshoot the alarm settings.

Question 16

A patient is intubated due to an acute exacerbation of chronic obstructive pulmonary disease (COPD).The patient is now breathing with pressure support ventilation 5 cm H₂O and continuous positive airway pressure (CPAP)5 cm H₂O.The patient is unable to flow trigger every inspiration.Unintended positive end-expiratory pressure (auto-PEEP)is measured at 10 cm H₂O.The most appropriate action to take is which of the following?

A) Decrease the CPAP to 3 cm H₂O.
B) Increase the CPAP to 8 cm H₂O.
C) Increase pressure support to 10 cm H₂O.
D) Change the flow trigger setting to 1 L/min.

Question 17

The ventilator volume is set at 575 mL.The low exhaled tidal volume (Vᴛ)alarm should be set at which of the following?

A) 150 mL
B) 350 mL
C) 400 mL
D) 500 mL

Question 18

The mechanical ventilator event that is considered potentially life-threatening or a level two event is which of the following?

A) Intrinsic positive end-expiratory pressure (PEEP)
B) High respiratory rate
C) Humidifier malfunction
D) Exhalation valve failure

Question 19

A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity?

A) 10 mg H₂O/L at 35-37° C
B) 20 mg H₂O/L at 31-35° C
C) 30 mg H₂O/L at 31-35° C
D) 47 mg H₂O/L at 35-37° C

Question 20

Following intubation and placement on volume-controlled continuous mandatory ventilation (VC-CMV),a patient's average peak inspiratory pressure (PIP)is 26 cm H₂O following suctioning.The appropriate settings for the low- and high-pressure alarms are which of the following?

A) Low pressure = 6 cm H₂O, high pressure = 46 cm H₂O
B) Low pressure = 15 cm H₂O, high pressure = 41 cm H₂O
C) Low pressure = 20 cm H₂O, high pressure = 36 cm H₂O
D) Low pressure = 24 cm H₂O, high pressure = 31 cm H₂O

Question 21

The application of positive pressure for patients with left ventricular failure is beneficial because of which of the following?

A) Increases venous return
B) Decreases preload to the heart
C) Increases afterload to the heart
D) Improves perfusion to the myocardium

Question 22

A high pressure ventilator alarm is sounding and you are unsure if ventilation is occurring.What action should you take first?

A) Hit the alarm silent button.
B) Increase the oxygen concentration to 100%.
C) Manually ventilate the patient.
D) Increase the peak pressure alarm.

Question 23

An 18-year-old,5'6",125 lb female patient was admitted to the hospital 2 days ago for spinal meningitis.She developed sepsis and suffered hypercapnic respiratory failure.The patient was intubated and placed on volume-controlled continuous mandatory ventilation (VC-CMV),respiratory frequency (f)12 breaths/min,tidal volume (Vᴛ)600 mL,positive end-expiratory pressure (PEEP)5 cm H₂O,fractional inspired oxygen (FɪO₂)0.40.Twenty-four hours later,the patient's oxygen requirements have dramatically increased and her lung compliance has dramatically dropped,while her chest X-ray showed development of bilateral fluffy infiltrates.The most appropriate actions to take include which of the following?

A) Keep Vᴛ the same, increase f to 25 breaths/min, increase PEEP to 12 cm H₂O.
B) Decrease Vᴛ to 250 mL, increase f to 15 breaths/min, increase PEEP to 15 cm H₂O.
C) Increase Vᴛ to 550 mL, decrease f to 8 breaths/min, increase PEEP to 10 cm H₂O.
D) Decrease Vᴛ to 400 mL, decrease f to 8 breaths/min, decrease PEEP to 3 cm H₂O.

Question 24

A male patient who is 5'10" and weighs 190 lb arrives at the hospital having suffered a closed head injury in a motor vehicle accident.The patient is unconscious and a computer tomogram of the head reveals an intracranial bleed.The patient receives an intracranial pressure (ICP)monitor following neurosurgery.Initial ventilator settings should include which of the following?

A) Volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequency (f) 15 breaths/min, tidal volume (Vᴛ) 750 mL, positive end-expiratory pressure (PEEP) 5 cm H₂O, fractional inspired oxygen (FɪO₂) 1.0
B) Pressure-controlled continuous mandatory ventilation (PC-CMV), f 15 breaths/min, peak inspiratory pressure (PIP) 35 cm H₂O, PEEP 10 cm H₂O, FɪO₂ 1.0
C) Volume-controlled intermittent mandatory ventilation (VC-IMV), f 6 breaths/min, Vᴛ 300 mL, pressure support (PS) 10 cm H₂O, PEEP 5 cm H₂O, FɪO₂ 0.50
D) Pressure-controlled intermittent mandatory ventilation (PC-IMV), f 12 breaths/min, PIP 20 cm H₂O, PS 10 cm H₂O, PEEP 5 cm H₂O, FɪO₂ 0.40

Question 25

A 36-year-old female patient with a history of asthma is admitted to the ICU from the emergency department.Her respirations are 30,very labored,with accessory muscle use and bilateral inspiratory and expiratory wheezing.There is bilateral hyperresonance during chest percussion.A blood gas taken in the ICU after 1 hour of continuous aerosolized albuterol (15 mg)reveals: pH 7.38,partial pressure of carbon dioxide (PₐCO₂)42 mm Hg,partial pressure of oxygen (PₐO₂)53 mm Hg,oxygen saturation (SₐO₂)88%,bicarbonate (HCO₃⁻)25 mEq/L with nasal cannula 6 L/min.The patient is 5'5" and weighs 135 lb.The most appropriate action at this time is which of the following?

A) Continue current therapy with 20 mg albuterol and reassess in 1 hour.
B) Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP), f = 12, inspiratory positive airway pressure (IPAP) 28 cm H₂O, expiratory positive airway pressure (EPAP) 3 cm H₂O, fractional inspired oxygen (FɪO₂) 0.30
C) Intubate, use pressure-controlled continuous mandatory ventilation (PC-CMV), f = 8, peak inspiratory pressure (PIP) 28 cm H₂O, TI 0.75 seconds, positive end-expiratory pressure (PEEP) 3 cm H₂O, FɪO₂ 1.0
D) Intubate, use volume-controlled continuous mandatory ventilation (VC-CMV), f = 12, tidal volume (Vᴛ) 600 mL, PF 40 L/min, PEEP 5 cm H₂O, FɪO₂ 0.60

Question 26

Essential capabilities of an adult intensive care unit (ICU)ventilator include all of the following except:

A) expiratory pause.
B) pressure control modes.
C) flow rates up to 250 L/min.
D) respiratory rates up to 60 breaths/min.

Question 27

A 70-year-old,61-inch-tall female patient was admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD).After 12 hours of oxygen therapy,bronchodilator therapy,and intravenous corticosteroids,the patient began to show signs of clinical deterioration.Her chest X-ray revealed an enlarged heart and bilateral infiltrates.Her arterial blood gas shows acute on chronic respiratory failure.It is decided that this patient requires intubation and mechanical ventilation.The most appropriate ventilator settings for this patient include which of the following?

A) Volume-controlled continuous mandatory ventilation (VC-CMV) rate 15, Vᴛ 200 mL, FɪO₂ 1.0, positive end-expiratory pressure (PEEP) 5 cm H₂O
B) VC-CMV rate 12, Vᴛ 400 mL, FɪO₂ 0.4, PEEP 3 cm H₂O
C) Pressure-controlled intermittent mandatory ventilation (PC-IMV) rate 10, peak inspiratory pressure (PIP) 30 cm H₂O, FɪO₂ 0.60, PEEP 3 cm H₂O
D) PC-IMV rate 12, PIP 35 cm H₂O, FɪO₂ 0.30, PEEP 8 cm H₂O

Question 28

While initially ventilating a patient with acute respiratory distress syndrome (ARDS),the extrinsic positive end-expiratory pressure (PEEPᴇ)should be maintained using which of the following methods?

A) 50% of intrinsic positive end-expiratory pressure (PEEPI)
B) Open lung approach
C) Offset intrinsic PEEP
D) Minimize mean airway pressure

Question 29

A 72-year-old male patient (height 6'2",weight 95 kg)with a history of congestive heart failure (CHF)presents to the emergency department complaining of shortness of breath and inability to lie down to sleep.Physical assessment reveals a very anxious patient with a pulse of 140,respirations 32,and labored with diaphoresis.Breath sounds are decreased with bibasilar coarse crackles.The patient has a productive cough of pink frothy secretions.The patient is placed on a nonrebreather mask and the resulting arterial blood gases (ABG)show: pH 7.25,partial pressure of carbon dioxide (PₐCO₂)55 mm Hg,partial pressure of oxygen (PₐO₂)54 mm Hg,oxygen saturation (SₐO₂)86%,bicarbonate (HCO₃⁻)24 mEq/L.The most appropriate immediate action to take includes which of the following?

A) Face mask continuous positive airway pressure (CPAP) 10 cm H₂O
B) Intubate, volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequency (f) 20, tidal volume (Vᴛ) 810 mL, positive end-expiratory pressure (PEEP) 8 cm H₂O, fractional inspired oxygen (FɪO₂) 1.0
C) Intubate, volume-controlled intermittent mandatory ventilation (VC-IMV), f 6, Vᴛ 425 mL, PEEP 10 cm H₂O, FɪO₂ 0.80
D) Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP), inspiratory positive airway pressure (IPAP) 15 cm H₂O, expiratory positive airway pressure (EPAP) 5 cm H₂O, FɪO₂ 0.60

Question 30

A chronic obstructive pulmonary disease (COPD)patient with an ideal body weight of 65 kg is brought to the emergency department.The patient is short of breath and using accessory muscles.Aerosolized bronchodilators are administered.The arterial blood gas reveals the following: pH 7.31,partial pressure of carbon dioxide (PₐCO₂)72 mm Hg,partial pressure of oxygen (PₐO₂)88 mm Hg,oxygen saturation (SₐO₂)90%,bicarbonate (HCO₃⁻)32 mEq/L on nasal cannula 2 L/min.The respiratory therapist should recommend which of the following at this time?

A) Intubate, volume-controlled continuous mandatory ventilation (VC-CMV) rate 15 breaths/min, tidal volume (Vᴛ) 650 mL, fractional inspired oxygen (FɪO₂) 0.50, positive end-expiratory pressure (PEEP) 6 cm H₂O.
B) Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (bilevel PAP) rate 8 breaths/min, inspiratory positive airway pressure (IPAP) 10 cm H₂O, expiratory positive airway pressure (EPAP) 4 cm H₂O.
C) Intubate, pressure-controlled intermittent mandatory ventilation (PC-IMV) rate 10 breaths/min, peak inspiratory pressure (PIP) 30 cm H₂O, FɪO₂ 0.60, PEEP 3 cm H₂O.
D) Administer 30% oxygen via air entrainment mask and continuous bronchodilator therapy.

Question 31

Sigh breaths could be beneficial during which of the following situations?

A) Continuous positive airway pressure (CPAP) used for the treatment of hypoxemia.
B) Mechanical ventilation with Vᴛs = 8-10 mL/kg.
C) Ventilating acute respiratory distress syndrome (ARDS) patient with plateau pressure Pₚₗₐₜₑₐᵤ >30 cm H₂O.
D) Pressure-supported ventilation with tidal volume (Vᴛ) = 4-6 mL/kg

Question 32

A 45-year-old,73-inch-tall,200 lb male patient is admitted to the emergency department with an exacerbation of myasthenia gravis.The respiratory therapist assesses the patient and finds the patient's maximum inspiratory pressure is 15 cm H₂O and his vital capacity is 1200 mL.It is decided that the patient requires ventilatory support.The most appropriate ventilator settings for this patient are which of the following?

A) Pressure support ventilation (PSV) 5 cm H₂O, continuous positive airway pressure (CPAP) 10 cm H₂O, FɪO₂ 0.50
B) Pressure-controlled continuous mandatory ventilation (PC-CMV), f = 16 breaths/min, peak inspiratory pressure (PIP) = 35 cm H₂O, positive end-expiratory pressure (PEEP) 3 cm H₂O, fractional inspired oxygen (FɪO₂) 0.45
C) Noninvasive positive pressure ventilation-bilevel positive airway pressure (NPPV-BiPAP), f = 14 breaths/min, inspiratory positive airway pressure (IPAP) = 28 cm H₂O, expiratory positive airway pressure (EPAP) = 5 cm H₂O, FɪO₂ 0.30
D) Volume-controlled intermittent mandatory ventilation (VC-IMV), f = 12 breaths/min, tidal volume (Vᴛ) = 725 mL, PSV 5 cm H₂O, PEEP 5 cm H₂O, FɪO₂ 0.24

Question 33

Methods to minimize air trapping in mechanically ventilated patients include which of the following?

A) Using a longer inspiratory time (Tɪ)
B) Switching to pressure support ventilation (PSV)
C) Increasing inspiratory flow
D) Administering a mucolytic agent

Question 34

Patients with acute severe asthma requiring mechanical ventilation are difficult to manage because of which of the following?

A) Diaphragmatic paralysis
B) Increased lung compliance
C) Decreased airway resistance
D) Uneven alveolar hyperexpansion

Question 35

During mechanical ventilation,a patient with a closed head injury develops the Cushing response.This may be immediately managed by using which of the following?

A) Pressure-controlled continuous mandatory ventilation (PC-CMV) with positive end- expiratory pressure (PEEP)
B) Sedation and paralysis
C) Permissive hypercapnia
D) Iatrogenic hyperventilation

Question 36

The statement that is true concerning the use of permissive hypercapnia in the management of patients with acute respiratory distress syndrome (ABGs)includes which of the following?

A) The pH may be allowed to drop as low as 7.1.
B) Tromethamine (THAM) may be used to keep the pH above 7.2.
C) Partial pressure of carbon dioxide (PₐCO₂) needs to rise rapidly to achieve success.
D) PₐCO₂ should not be allowed to rise above 60 mm Hg.