Deck 8: Initial Patient Assessment

Question 1

How often should the fractional inspired oxygen (FɪO₂)of an adult be measured?

A) Twice daily
B) Continuously
C) Every patient-ventilator system check
D) Every other patient-ventilator system check

Answer 1

C
The fractional inspired oxygen (FɪO₂)for a ventilated adult should be measured during each patient-ventilator system check.Most ICU ventilators have oxygen analyzers that provide continuous monitoring of FɪO₂.

Question 2

Calculate the volume delivered to the patient when the tubing compliance (Cᴛ)is 2.5 mL/cm H₂O,the tidal volume (Vᴛ)at the exhalation port is 550 mL,and the peak inspiratory pressure (PIP)is 28 cm H₂O.

A) 70 mL
B) 330 mL
C) 480 mL
D) 620 mL

Answer 2

C
Volume lost = PIP × Cᴛ and Delivered Vᴛ = Measured Vᴛ - Volume lost

Question 3

The data on the following ventilator flow sheet for a patient being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV)mode demonstrates which of the following?

A) Airway resistance is increasing.
B) Lung compliance is decreasing.
C) Dynamic compliance is increasing.
D) Water is accumulating in the patient circuit.

Answer 3

Lung compliance is decreasing.

Question 4

The operational verification procedure (OVP)involves checking the ventilator circuit for leaks.Ventilator settings that could be used to perform this procedure include which of the following?

A) Tidal volume (Vᴛ) = 500 mL, Flow rate = 60 L/min, High pressure limit = 50 cm H₂O
B) Vᴛ = 1000 mL, Flow rate = 20 L/min, High pressure limit = maximum
C) Vᴛ = 500 mL, Flow rate = 20 L/min, High pressure limit = maximum, Inspiratory pause = 2 seconds
D) Vᴛ = 200 mL, Flow rate = Maximum, High pressure limit = 50 cm H₂O, Inspiratory pause = 1 second

Question 5

An increasing PIP may indicate which of the following?

A) Decreasing lung compliance
B) Decreasing airway resistance
C) Leak in the ventilator circuit
D) Increasing dynamic compliance

Question 6

The respiratory therapist is performing a physical assessment of a patient receiving pressure support ventilation.The patient is short of breath,has a respiratory rate of 28 breaths/min,a dull percussion note over the right base that becomes resonant over the right upper lobe,and resonance over the left lung.Chest movement on the right side is decreased.The STAT chest X-ray reveals a blunting of the right costophrenic angle.The pulmonary disorder that is causing this clinical presentation is which of the following?

A) Acute respiratory distress syndrome (ARDS)
B) Emphysema
C) Pneumothorax
D) Pleural effusion

Question 7

The respiratory therapist is evaluating the following ventilator flow sheet.The recommendation that is most appropriate in this situation is which of the following?

A) Increase extrinsic positive end-expiratory pressure (PEEPE).
B) Suction the airway.
C) Switch out the heat moisture exchanger (HME).
D) Administer a bronchodilator.

Question 8

How long after beginning mechanical ventilation on a patient should an arterial blood gas sample be drawn?

A) 5 minutes
B) 10 minutes
C) 15 minutes
D) 20 minutes

Question 9

A 46-year-old male patient is 2 days post-op for surgery to repair an aortic aneurysm.He is currently receiving mechanical ventilation.Auscultation of the anterior and posterior chest reveals bilateral late inspiratory crackles.Percussion is dull in both lower lobes.A STAT radiograph reveals bibasilar infiltrates.The most likely cause of this patient's clinical presentation is which of the following?

A) Asthma
B) Pneumonia
C) Pneumothorax
D) Pleural effusion

Question 10

A female patient who is 5'7" tall and weighs 68 kg is being mechanically ventilated with volume-controlled continuous mandatory ventilation (VC-CMV),set rate 12,patient trigger rate 25 breaths/min,tidal volume (Vᴛ)500 mL,set flow rate 60 L/min,fractional inspired oxygen (FɪO₂)40%,positive end-expiratory pressure (PEEP)5 cm H₂O.The patient is currently in distress using accessory muscles of inspiration.The respiratory therapist performs a patient-ventilator system check.The flow-time waveform shows a failure of the expiratory flow to return to zero before the next breath is triggered.The most appropriate action for the respiratory therapist to take includes which of the following?

A) Sedate the patient.
B) Switch to pressure-controlled continuous mandatory ventilation (PC-CMV).
C) Decrease set rate to 8 breaths/min.
D) Switch to volume-controlled intermittent mandatory ventilation (VC-IMV).

Question 11

Identify the plateau pressure (Pₚₗₐₜₑₐᵤ)for the pressure-controlled continuous mandatory ventilation (PC-CMV)breaths in the figure.

A) Point A
B) Point B
C) Point C
D) Point D

Question 12

A 6'2" male patient is being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV)mode with a set tidal volume (Vᴛ)of 650 mL.There is 40 mL of mechanical dead space.Calculate the final alveolar ventilation.

A) 432 mL
B) 445 mL
C) 510 mL
D) 535 mL

Question 13

During the course of several patient-ventilator system checks a respiratory therapist notices that the patient's peak inspiratory pressure (PIP)is rising,while the plateau pressure (Pₚₗₐₜₑₐᵤ)has remained the same.This most likely indicates which of the following?

A) Decrease in dynamic compliance
B) Increase in airway resistance
C) Decrease in static compliance
D) Increase in elastic recoil of alveolar walls

Question 14

A patient's transairway pressure (Pᴛᴀ)is rising while the plateau pressure (Pₚₗₐₜₑₐᵤ)remains unchanged.The treatment plan that could correct this problem includes which of the following?
1)Administer a bronchodilator.
2)Insert a chest tube.
3)Increase extrinsic positive end-expiratory pressure (PEEPᴇ).
4)Suction airway secretions.

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

Question 15

A 31-year-old woman is admitted to the emergency department following a motor vehicle accident.The paramedics brought her into the ER in respiratory distress.She was intubated in the field and started on mechanical ventilation as soon as she arrived.Breath sounds were clear on the left and absent on the right.Percussion revealed resonance on the left and hyperresonance on the right.The patient's trachea was shifted to the left.The most likely cause of this patient's clinical presentation is which of the following?

A) Acute respiratory distress syndrome (ARDS)
B) Flail chest
C) Pneumothorax
D) Pleural effusion

Question 16

The volume-time curve is demonstrating which of the following?

A) Auto-PEEP
B) System leak
C) Plateau pressure
D) Volume triggering

Question 17

The respiratory therapist observes the volume-time curve shown in the figure.What action should the respiratory therapist take at this time?

A) Add extrinsic positive -end-expiratory pressure (PEEPᴇ).
B) Look for a system leak.
C) Switch to flow triggering.
D) Detach the ventilator and manually resuscitate.

Question 18

A pathophysiologic condition that causes an increase in peak inspiratory pressure (PIP)while transairway pressure (PPᴛᴀ)remains the same is which of the following?

A) Acute respiratory distress syndrome (ARDS)
B) Asthma
C) Emphysema
D) Chronic bronchitis

Question 19

Following initiation of volume-controlled continuous mandatory ventilation (VC-CMV)ventilation,the patient's average peak inspiratory pressure (PIP)is 23 cm H₂O.The high pressure limit alarm should be set at which of the following?

A) 28 cm H₂O
B) 33 cm H₂O
C) 38 cm H₂O
D) 43 cm H₂O

Question 20

The first step in the assessment and documentation of patient-ventilator interaction following placement of a patient on a mechanical ventilator is which of the following?

A) Verifying physician's orders.
B) Verifying a passing operational verification procedure.
C) Checking the integrity of the ventilator circuit and the humidifier system.
D) Assessment of the patient's vital signs, breath sounds, and level of consciousness.

Question 21

The respiratory therapist is monitoring the cuff pressure of a tracheostomy tube inserted in a patient who is receiving mechanical ventilation.The cuff pressure is measured at 41 cm H₂O.The respiratory therapist should immediately do which of the following?

A) Inject more air through the pilot balloon.
B) Release some of the air from the cuff.
C) Insert a new tracheostomy tube.
D) Do nothing; everything is acceptable.

Question 22

A patient's transairway pressure (Pᴛᴀ)is rising while the plateau pressure (Pₚₗₐₜₑₐᵤ)remains unchanged.The treatment plan that could correct this problem includes which of the following?
1)Administer a bronchodilator.
2)Insert a chest tube.
3)Measure unintended positive end-expiratory pressure (auto-PEEP).
4)Suction airway secretions.

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

Question 23

A physical examination of the chest is performed on a patient who is being mechanically ventilated.Breath sounds and percussion are normal except over the right middle lobe,where late inspiratory crackles are heard.This area is dull to percussion.An evaluative chest radiograph image reveals infiltrates in the right middle lobe.Based on these findings alone,which of the following is the most likely problem?

A) Pneumothorax in the right hemithorax
B) Congestive heart failure
C) Right middle lobe pneumonia
D) Asthma affecting the right side only

Question 24

Which of the following indicates an increase in airway resistance in a patient receiving mechanical ventilation with a constant tidal volume?

A) Increased peak inspiratory pressure (PIP) and transairway pressure (Pᴛᴀ)
B) Increased static compliance
C) Increased plateau pressure (Pₚₗₐₜₑₐᵤ) and stable PIP
D) Decreased dynamic compliance

Question 25

The normal airway resistance range is which of the following?

A) 0.6-2.4 cm H₂O/L/sec
B) 16-24 cm H₂O/L/sec
C) 26-34 cm H₂O/L/sec
D) 70-100 cm H₂O/L/sec

Question 26

How can the amount of cuff volume/pressure lost in the connecting tube be minimized during cuff measurement using a three-way stopcock,a manometer,and a syringe?

A) Using a four-way stopcock
B) Overinflating the cuff prior to measurement
C) Simultaneously inflating the cuff and manometer
D) Pressurizing the manometer to 25 mm Hg prior to use

Question 27

The flow sheet below,for a patient on pressure-controlled continuous mandatory ventilation (PC-CMV),demonstrates which of the following?

A) Overinflated endotracheal tube
B) Lung compliance is decreasing.
C) Airway resistance is decreasing.
D) Dynamic compliance is worsening.

Question 28

A 49-kg female patient intubated with a size 7 mm inner diameter (ID)endotracheal tube is being mechanically ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV)mode.During patient rounds,both the low-pressure and low-volume alarms are sounding persistently on the ventilator.Upon observation of the patient,the respiratory therapist hears murmuring from the patient,with audible sounds during inspiration.The cause of this condition is which of the following?

A) Circuit leak
B) Endotracheal tube (ET) cuff leak
C) Circuit disconnection
D) Incorrect ET tube size

Question 29

An 87-kg male patient,orally intubated with a size 7.5 mm inner diameter (ID)endotracheal tube,is being mechanically ventilated in the pressure-controlled continuous mandatory ventilation (PC-CMV)mode.During patient rounds,both the low-pressure and low-volume alarms are sounding persistently on the ventilator.Upon observation of the patient,the respiratory therapist hears murmuring from the patient,with audible sounds during inspiration.The respiratory therapist notes the position of the endotracheal tube is 21 cm at the gum line,measures the cuff pressure,and adds 3 mL of air to the cuff.To make an appropriate seal,it requires 44 cm H₂O.The respiratory therapist should do which of the following?

A) Change to a larger size endotracheal tube.
B) Add air to the cuff and clamp the pilot tube.
C) Check the position of the endotracheal tube.
D) Reposition the endotracheal tube in the mouth.

Question 30

The pressure at which large numbers of alveoli are recruited in a patient with acute respiratory distress syndrome (ARDS)is located on the static pressure-volume curve at which of the following points?

A) Upper inflection point
B) Lower inflection point
C) Peak inspiratory pressure
D) Between the lower and upper inflection points

Question 31

The static pressure-volume curve shown in the figure indicates the presence of which of the following?

A) Atelectasis
B) Pneumonia
C) Pneumothorax
D) Bronchospasm

Question 32

To help prevent inflated alveoli from collapsing and reexpanding with each breath,the positive end-expiratory pressure (PEEP)level should be set at which point on the deflation part of the loop?

A) Above the upper inflection point
B) Below the upper inflection point
C) Above the lower inflection point
D) Below the lower inflection point

Question 33

To reduce the risk of tracheal damage associated with overinflated tube cuffs,cuff pressures should not exceed what range of pressures?

A) 10-15 mm Hg
B) 15-20 mm Hg
C) 20-25 mm Hg
D) 25-30 mm Hg

Question 34

The pressure at which large numbers of alveoli become overinflated in a patient with acute respiratory distress syndrome (ARDS)is located on the static pressure-volume curve at which of the following?

A) Upper inflection point
B) Lower inflection point
C) Peak inspiratory pressure
D) Between the lower and upper inflection points

Question 35

The flow sheet below,for a patient on pressure-controlled continuous mandatory ventilation (PC-CMV),demonstrates which of the following?

A) Lung compliance is increasing.
B) Dynamic compliance is decreasing.
C) Airway resistance is decreasing.
D) There is a leak in the ventilator circuit.

Question 36

The low-pressure and low-tidal volume alarms are sounding on a mechanically ventilated patient.Measurement of the cuff pressure reveals 18 cm H₂O.What action should be taken?

A) Replace the endotracheal tube with a larger size.
B) Add enough air to the cuff to maintain the cuff pressure at 34 cm H₂O.
C) Increase the set pressure to increase the tidal volume and compensate for the leak.
D) Add air until a slight leak is heard while auscultating the larynx, then measure pressure.

Question 37

Before a ventilator is used,an operational verification check is performed.A simple variation of this procedure is also performed under which of the following circumstances?

A) Before a blood gas sample is obtained.
B) When the physician's order specifies a change in ventilator settings.
C) Before a patient is reconnected to a ventilator after the ventilator circuit has been changed or disassembled for any reason.
D) Before the patient's hemodynamic status is monitored.